I still hear the key turning in the door from the outside and you stepping in. Can you believe it? I still see your face, darkened by the sun. Dressed in your cricket whites, you drag your massive cricket-bag-on-wheels behind you by your left arm.
“Did you take the sun-screen with you?” I ask.
“Yes, it’s in the bag.”
“Did you actually put it on?’
“Mamma, I’m hungry.”
I still wait for you to join us for dinner. I cook the foods you like, especially on your birthday: spinach-paneer for mains, chocolate mousse for dessert. I wonder what you’d be doing in this realm if you were here. Job? Girl-friend? How silly! Isn’t it? I can’t help it. It’s involuntary. It’s got something to do with the heart. With longing. With missing. With love. It’s not supposed to make sense. You would have had a good old chuckle at my expense if you were here. But you are not and I am. How random is that?
I still remember the first time I felt you elbow-ing or knee-ing me from inside my tummy, as if we had an inside joke between us. I remember holding all three kilos of you in my arms for the first time. I couldn’t believe you were for real. You were all mine. Now my arms ache with emptiness. Is this real?
Do you miss me sometimes?
Happy birthday my darling.
It will be the past
And we’ll live there together.
Not as it was to live
But as it is remembered.
It will be the past.
We’ll all go back together.
Everyone we ever loved,
And lost, and must remember.
It will be the past.
And it will last forever.
– A poem by Patrick Phillips, on the New York subway.
(“Ghar aa” is a Hindi phrase that means “Come home”)
Every child or young person who dies by suicide is precious. These deaths are a devastating loss for families and can impact future generations and the wider community. There is a strong need to understand what happened and why, in every case. We must ensure that we learn the lessons we need to, to stop future suicides.
-Services should be aware that child suicide is not limited to certain groups; rates of suicide were similar across all areas, and regions in England, including urban and rural environments, and across deprived and affluent neighbourhoods.
(No one is immune.)
-62% of children or young people reviewed had suffered a significant personal loss in their life prior to their death, this includes bereavement and “living losses” such as loss of friendships and routine due to moving home or school or other close relationship breakdown.
(Saagar was unable to return to his life at University due to a new diagnosis of a mental illness.)
-Over one third of the children and young people reviewed had never been in contact with mental health services. This suggests that mental health needs or risks were not identified prior to the child or young person’s death.
(Saagar had been in contact with Mental Health Services but they discharged him as soon as he showed signs of improvement. They did not follow him up. His GP was unable to identify his high risk of suicide despite his Depression scores being the worse they could be for at least 4 weeks.)
-16% of children or young people reviewed had a confirmed diagnosis of a neurodevelopmental condition at the time of their death. For example, autism spectrum disorder or attention deficit hyperactivity disorder. This appears higher than found in the general population.
(Saagar did not.)
-Almost a quarter of children and young people reviewed had experienced bullying either face to face or cyber bullying. The majority of reported bullying occurred in school, highlighting the need for clear anti-bullying policies in schools.
(At his Primary school in Belfast, his peers called him ‘Catholic’. He didn’t know what it meant but he knew it was not right. This went on for more than a year before I found out. When I spoke to his class teacher about it, she denied any problem.)
The film ‘1000 days’ tells us about Saagar and what we have learnt from his life and death. I am not sure what or how much the policy makers and service providers have learnt or changed but we have learnt and changed a lot and here we talk about that. The film is presently available on-line at the Waterford Film Festival (Short Programe 6), till the 15th of November at the link below. Please take 20 minutes to watch it if you can. You will learn something too. Each one of us can make a difference.
A survey of 500 people revealed that a third of people didn’t feel comfortable at all talking to someone at work about mental health related issues and only 15% have had a colleague speak to them about their mental health.
The survey also uncovered an interesting trend: nearly a third of all male respondents have never had a friend, family member or colleague speak to them about their mental health. Worryingly, this statistic rises to 42% for males aged 45 and over and increases yet again to 60% for males aged 54 and over.
“I would say that the vast majority of people who die by suicide, don’t necessarily want to be dead—they want to end their suffering and don’t know what else to do. We know from our clinical treatment research that suicidal suffering can be effectively treated. There is hope; suicidal states can be effectively treated and people can and do recover from suicidal suffering.”
David A. Jobes, Ph.D., ABPP. Professor of Psychology. Author of Managing Suicidal Risk
In one month it will be 2 years since Saagar’s time on this planet came to an end. I don’t want that date to arrive. I am absolutely dreading it. I remember when Saagar was coming close to finishing school, the thought of him going off to university made me feel terribly sad, almost panicked, knowing it was bound to happen. It’s the same feeling, only different. Another year! Another slot of time. A longer gap between him and me, more distance between the time when he lived and now. More fade. More erosion.
This evening we attended a unique black-tie event – a dinner/dance to honour and celebrate Ruth’s life. She was only 44 when she got tired of her Bipolar Disorder. She had suffered with it for most of her adult life. Her friends and family got together and had a great big fun party for her. It was a happy event. I have never met Ruth but her Mum and I have a unique bond. It felt special to be there with Si and my parents. I felt deep gratitude for all these lovely people in my life. All the proceeds went to the charity Mind.
The same adjectives I use to describe Saagar were used to describe Ruth. She was actively involved in amateur theatre and her gorgeous photographs from various productions were displayed for our pleasure – Kismet, Sweet Charity, South Pacific and Oliver. Her twinkling eyes and cheeky smile sparkled through every photograph.
“Mem’ries light the corners of my mind
Misty water-colour mem’ries of the way we were
Scatterred pictures of the smiles we left behind
Smiles we gave to one another for the way we were
Can it be that it was all so simple then
Or has time re-written ev’ry line?
If we had the chance to do it all again
Tell me, would we? Could we?
Mem’ries may be beautiful yet
What’s too painful to remember
We simply choose to forget
So it’s the laughter we will remember
Whenever we remember
The way we were… the way we were…”
11.51: Bullies at school are telling the next female caller to take her own life. She’s upset and agitated and feels anxious about talking to her parents or GP. After talking through the issues, she says she’s not in immediate danger and will try to talk to her parents and seek support from her GP or the charity if she feels it necessary.
13.49: A mother calls about her son who is struggling at university and has told her he may as well not be alive. She is worried he might be suicidal.
The adviser talks to her for half an hour about asking her son directly about suicide and discusses what other support he may need, including talking to his GP and giving him the HOPELineUK details. Afterwards, the mum says she is more confident about speaking to her son.
18.32: With the suicide prevention advisers on calls, a voicemail is left by a young man. He calls back eight minutes later and starts apologising for calling the helpline.
He’s made plans to take his own life today and despite calling his mental health team and telling them he’s suicidal, he’s still waiting for his case worker to call back.
After 42 minutes on the phone with the helpline suicide prevention adviser, he’s much calmer and says he won’t take his own life today.
18.53: A young transitioning transgender person calls, admitting she’s feeling suicidal today. She spends 23 minutes talking through her issues with a suicide prevention adviser who works with her on a plan to stay safe over the coming hours and signposts her to support networks she may find helpful.
19.38: A text comes in from a young father who says he’s feeling suicidal. He suffered domestic abuse as a child and, as a result of alcohol and drug addiction, has lost contact rights with his own children. He says he has his suicide method in front of him and is intending to end his life.
Let’s break the silence. Hopeline number: 0800 068 4141
About 5 months after Saagar’s passing, one of my close friends sent me a subtle message suggesting that I should be careful about what I write in my blog as a few of my work colleagues read it regularly and if I appear to be too fragile or vulnerable, it might have a negative impact on my professional life. I understood her concern. The medical profession is not known for its understanding and compassion for mental frailty in colleagues.
Dr Wendy Potts was a GP in Derbyshire who blogged about living with Bipolar Disorder on a regular basis. One of her patients read the blog and complained to her Practise. The doctor was suspended. A few weeks later she ended her own life.
Firstly, I don’t understand the basis of the complaint. Would patients complain if their GP had diabetes or cancer?
Secondly, I don’t understand the basis for suspension from work. If the doctor’s performance was not questionable, then there is no ground for that.
This is one of many examples of poor treatment of medical colleagues with mental health issues. I think we are a long way from seeing parity between physical and mental illnesses as the ones who are supposed to put that into practise are themselves caught in the stigma associated with mental illness.
(PS: apologies for not being able to insert the link to the article in a better way. The ‘link’ icon on my page doesn’t seem to work anymore. Any ideas? )
It was on the 21st of August two years ago that Saagar was officially diagnosed with Bipolar Disorder by an Honorary Consultant Psychiatrist. He was the only one in the family who was informed of it. I wonder how it made him feel. I wonder if he felt weird, confused, traumatised or all of the above. I wonder if it made him question who he was and what this means in terms of his future. I wonder what it did to his self-esteem and confidence. I bet it was scary. I am sure he looked it up on the net. He handled it very well. He made no big deal of it. He took his medicines, did not drink or go out too much, he waited patiently for the medicines to work and they did. He got better for a bit but then…
In 8 weeks time he will be dead. I didn’t know it then. I know it now and it kills me.
I bring myself back to this moment over and over again. Right now, I am chopping tomatoes. Right now, I am walking up the stairs. At this moment I am writing this blog. Right now I am folding towels. Right this moment I am watching the flickering flame of the candle in front of his picture. At present I am sitting here loving him with all my heart. At this present moment I am feeling sad for all the suffering he endured and I am admiring his dignity, strength and courage.
Right now I can see that this present moment is inevitable. It is here in front of me and all I can do is honour it.
The stress vulnerability model was proposed by Zubin and Spring (1977). It proposes that an individual has unique biological, psychological and social elements. These elements include strengths and vulnerabilities for dealing with stress.
In the diagram above person “a” has a very low vulnerability and consequently can withstand a huge amount of stress, however solitary confinement may stress the person so much that they experience psychotic symptoms. This is seen as a “normal” reaction. Person “b” in the diagram has a higher vulnerability, due to genetic predisposition for example. Person “c” also has genetic loading but also suffered the loss of mother before the age of 11 and was traumatically abused. Therefore persons “a” and “b” take more stress to become “ill”.
This model is obviously simplistic. However it does help with the understanding of psychosis. Vulnerability is not a judgmental term but a different way to approach the variables involved. We all have a different capacity to take on stress depending on how vulnerable we are. At different times in our lives we can be anywhere on the curve, depending on these variables.
Increasing coping skills or altering environmental factors (family, work, finance, housing etc.) and specialist help can reduce vulnerability and build resilience. Attending a peer group may help to build self-efficacy, self-esteem and self-acceptance all of which may be protective against relapse and form a buffer to demoralisation. It gives hope!
A brain surgeon, Paul Kalanithi got diagnosed with terminal lung cancer at the age of 36. Suddenly he found himself on the other side of the table. He wrote a ‘rattling, heartbreaking, beautiful’ book about his life as a doctor and then as a patient before he died. It is called “When breath becomes air’. In it he tactfully dissects the walls that exist between doctors and patients. Having found myself on either side of the table – first as a physician and then as the mother of a severely ill child, I can completely relate with this excerpt below.
“The reason doctors don’t give patients specific prognoses is not merely because they cannot. Certainly, if a patient’s expectations are way out of the bounds of probability – someone expecting to live to 130, say, or someone thinking his benign skin spots are signs of imminent death – doctors are entrusted to bring that person’s expectations into the realm of reasonable possibility. What patients seek is not scientific knowledge that doctors hide but existential authenticity each person must find his or her own. Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.”
“I had to face my mortality and try to understand what made my life worth living and I needed Emma’s (my doctor’s) help to do so. Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, I struggled, while facing my own death to rebuild my own life – or perhaps find a new one.”
I cannot imagine what one’s options would be when diagnosed with a severe/ terminal mental illness. Saagar was unable to access his own life as he knew it and perhaps chose to find a new one.
”No history of self harm” said the discharge summary from the Home treatment team to the GP. This sentence was one amongst many on the four page long letter.
Saagar was seen by at least 3 psychiatrists – 2 senior trainees and one Consultant and they all missed it. Did they ask him and he didn’t tell them the truth or was it an omission? The scars could easily be seen on his left forearm. They were clearly visible. Did they find the scars and questioned him about them? Did he make up a convincing story for them as he did for me? Or were they missed altogether? No one asked me about his history of self harm. He was mentally ill at the time and I don’t think I was.
At the Coroner’s inquest when this question came up, the psychiatric team said that the remark was made because Saagar never presented to the Emergency department with self-inflicted injuries. Is that a valid criterion?
Self harm is a personal and often a very private act. Given it is an important clue to the extent of a person’s emotional suffering, we as carers and professionals cannot afford to miss it.
“The only antidote to mental suffering is physical pain.”
– Karl Marx