Project Eighty-four and more

180326102147-01-london-suicide-statues-restricted-exlarge-169

84 life-size statues of men were seen standing at the edge of tall buildings in central London in late March representing the same number of men lost to suicide every week in the UK – a hard hitting visual project aiming to bring this tragic loss out into the open from behind closed doors.

Common threads emerged from articles published in April:

“Students more likely to kill themselves” in the Times: Researchers from a Hong Kong University analysed the ONS figures and found that the number of university students in Britain increased by 5 per cent between 2012 and 2016. The total number of suicides among students increased by 32 per cent, from 139 to 183 deaths. A think tank said that a law banning universities from contacting the friends and family of students who are struggling should be revisited.

The number of first year university students reporting mental health problems in UK Universities has risen five fold in 10 years. A combination of increasing awareness of mental health issues, a lowering of the taboo previously attached to mental health services, mounting debts, homesickness, loneliness and a greater sense of anxiety about the future may be some of the reasons for it. Some vice-chancellors still think that mental well being is not the business of universities and it’s just about developing the mind. But developing minds means nothing unless students settle down well in their new environment and be ready to learn.

According to recent ONS statistics on loneliness, people between 16-24 are at the epicentre of the loneliness epidemic in the UK. More so than the elderly. Women were found to be lonelier than men. Other variables were renting a home rather than owning one, being single or widowed, having poor health and feeling disconnected from the local community.

In an article entitled “Doctors knew my son was suicidal. I should have been told before he died” in the Guardian, I raise this question yet again: Is confidentiality more important than helping someone at risk to stay alive? Is it correct for a father to be informed by doctors after the death of his son,”Now that he is dead I can tell you that this was not his first attempt”?

Is it?

 

Day 859

Suicide Prevention Interim Report 2016-17 Summary:

This report published by the House of Commons Health Committee outlines five key areas for consideration by the Government before the refreshed strategy is finalised:

(1) Implementation — a clear implementation programme underpinned by external
scrutiny is required.
“To me, it is extraordinary and very distressing that four years after the strategy was published we do not know how many local authorities have implemented anything [ … ] we cannot allow more lives to be lost because we do not have effective governance and implementation. It is such a waste of time and a waste of money.” – Hamish Elvidge, Chair of the Mathew Elvidge Trust.

(2) Services to support people who are vulnerable to suicide—this includes wider
support for public mental health and wellbeing alongside the identification of
and targeted support for at risk groups; early intervention services, access to help in non-clinical settings, and improvements in both primary and secondary care;and services for those bereaved by suicide. We recommend that all suicide prevention plans should include mandatory provision of support services for families who have been bereaved by suicide.

(3) Consensus statement on sharing information with families—professionals
need better training to ensure that opportunities to involve families or friends
in a patient’s recovery are maximised, where appropriate.

Misunderstanding about confidentiality, lack of confidence, or even simply time constraints can lead professionals to adopt a ‘tick box’ approach to seeking consent. Professionals may err on the side of not involving families, rather than taking the time to explore fully with the patient whether there would be benefit in contacting a trusted family member or friend.34 Hamish Elvidge explained it very helpfully: One way is to say “Do we have your consent to share information with a family member, friend or colleague?” The chances are that the answer will be, “No.” Or you could say, “In our experience, it is always much better to involve a family member, friend or colleague whom you trust in your treatment and recovery, and we know the triangle of care is likely to result in a greater chance of successful recovery. This will result in you recovering much quicker. Would you like us to make contact with someone and would you like us to do this with you now?”

(4) Data—timely and consistent data is needed to enable swift responses to suspected suicides and to identify possible clusters, in order to prevent further suicides.

(5) Media—media guidelines relating to the reporting of suicide are being widely
ignored and greater attention must be paid to dealing with breaches by the
media, at national and local level. Consideration should also be given to what
changes should be made to restrict access to potentially harmful internet sites
and content.

Is this document a proof of more red-tape or a source of hope for the future?

Source: https://www.publications.parliament.uk/pa/cm201617/cmselect/cmhealth/300/300.pdf

Day 725

Another story.
Another young man.
Another family.
Another mother.
Same themes. Same gaps. Same cover-ups.

“Y went to University, experiencing life away from home for the first time. Although only a 40-minute train journey away, he lived in halls of residence, sharing a flat with four other students. I saw him at least once every fortnight and although I knew he was upset at the break up of his first serious relationship, there were no signs that he was struggling to cope with his studies or not enjoying university life. He appeared to be the same quirky teenager who made friends easily and faced challenges full on.

One Sunday he failed to come home for lunch with the family. Frantic, I drove to his halls where an ambulance and police car were parked and I was given the news that our beloved son was gone. It was another 24 hours before we discovered he had completed suicide. Nothing could have prepared me or our family.

Five months later we attended an inquest into his death where an open verdict was recorded, and the Coroner claimed that everything possible had been done by health care professionals to support Y following a university doctor diagnosing him with depression and prescribing anti-depressants. He had been referred for counselling and his university tutor was informed.

At the inquest, the GP had legal representation. A representative of the university’s counselling service gave evidence on behalf of the counsellor; a statement was read out from a doctor who had admitted Y to hospital following two incidents of self-harm, and another statement was read from the university tutor in whom Y had confided.

As a family, we sat completely dumbfounded that all of these people knew that our child was suffering from mental health issues. Not one of them had contacted any of us, or identified us as a ‘safety contact’, yet felt the need to be legally and professionally protected in court.

Just one month after starting university and following the break-up with his girlfriend, Y made his first suicide attempt. We were not informed. The reason we were given was that he was an adult and all of the professionals involved had a duty to respect his confidentiality. The counsellor’s representative commented that it was ‘possible’ that it ‘may have been suggested’ that Y talk to me about his situation, but she could not confirm that this was the case.

Had Lawrence been involved in any sort of accident then I would have been contacted immediately, but because his admission was a mental health issue the veil of confidentiality came down and prioritised clinical staff welfare rather than that of my son.

Did we as a family – or me, specifically, as his mother – fail him? We failed to see his suffering, but when he was around us he was the usual Y we all knew and loved.

Did the university fail him? Yes, they should have informed his emergency contact/next of kin that he had expressed suicidal thoughts.

Did the clinicians fail him? Yes, by averting culpability and absolving themselves within a care system culture that protects its own and isolates the patient from their family – the people closest to them and those who would have provided the love, care and protection that could have saved a young life.

As a family we felt that the ‘professionals’ closed ranks to protect themselves. In the weeks leading up to that awful day, and the months before the inquest, their self-protective instincts mattered more than the duty of care they had towards protecting our son Y, a caring, funny, intelligent young man with a whole lifetime of adventures in front of him.”

NO CONFIDENTIALITY WHEN IT COMES TO SUICIDE.

In Jan 2014, an official document was published – “Consensus statement on information sharing” (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/271792/Consensus_statement_on_information_sharing.pdf)

“The statement applies to adults in England. Information can be shared where it is in the public interest to do so. In practice, this means that practitioners should disclose information to an appropriate person or authority if this is necessary to protect the child or young person from risk of death or serious harm. A decision can be made to share such information with the family and friends, and normally would be.”

Who’s left to deal with the loss for the rest of their lives? The people who never knew it was happening. The people who would have gone to any lengths to avert the tragedy. The people who had a right to be informed.

10th of october 2014 was a friday, the beginning of my last weekend with my darling son, the last italian meal we shared. All that is left now is a broken heart holding many beautiful memories on one hand and reliving the nightmare over and over again on the other.

 

 

Day 404

Tutors and staff at universities struggle with the issue of confidentiality with regards to their students who are suffering with mental distress. While they are not trained counselors, they have the best interest of their students in mind. Yet, they are not allowed to take the parents of these students in confidence in the name of confidentiality.

Confidentiality is a foundational ethical standard for health professionals. It is the ethical duty to fulfill the promise that client information received during therapy will not be disclosed without authorization. It becomes a legal concern if broken, whether intentionally or not.

What if not breaking confidentiality leads to harm?
There are exceptions.

Confidentiality does not apply when disclosure is required to prevent clear and imminent danger to the client.
Protecting the client from harm must supercede the harm to the relationship that may happen due to a breach of confidentiality.

BACP (British Association for Counselling & Psychotherapy) Ethical Framework says:

“Situations in which clients pose a risk of causing serious harm to themselves or others are particularly challenging for the practitioner. These are situations in which the practitioner should be alert to the possibility of conflicting responsibilities between those concerning their client, other people who may be significantly affected, and society generally. Resolving conflicting responsibilities may require due consideration of the context in which the service is being provided. Consultation with a supervisor or experienced practitioner is strongly recommended, whenever this would not cause undue delay. In all cases, the aim should be to ensure for the client a good quality of care that is as respectful of the client’s capacity for self-determination and their trust as circumstances permit.”

The GMC reiterates the importance of confidentiality in good medical practice but does not talk of suicide in particular.

Courts usually consider two fundamental issues:

  • did the professional adequately assess the likelihood that a patient was suicidal?
  •  if an identifiable risk of harm was determined, did the professional take sufficient precautions to prevent suicide?

In general, the therapist is protected from liability if they have conscientiously performed and documented a thorough evaluation, followed by carefully considered, appropriate interventions.

Early diagnosis and treatment of mental illness is key for better outcomes. Hence the staff at schools and universities should be equipped with skills and knowledge to identify such illness in students. They should be empowered to get appropriate help for them at the earliest. 

In case of disclosure of severe suicidal ideation, the safety of the ‘at risk’ person should be the only concern.