education

It is all a dream.

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Dream

When I stood in front of all those people, my arms were branches of an old oak flailing in a wild wind, my throat was shouting out commands like a drill sargeant at the top of his voice, my eyes were wide open and desperate to get through to everyone in the room. My chest was an erupting volcano and my feet had thrown deep roots into the ground. I invited Saagar and all my angels to help me as I felt exposed. The ‘normal’ part of me wanted to protect Saagar and me from people’s judgements. I am sure some were being made as I spoke. That is ‘normal’ too. But the mother in me stood like a warrior, absolutely disregarding any consequence, complete in the conviction that this was the right thing to do. It was difficult but it was worth doing.

Three times this week. Three times I got to show Saagar off to a bunch of doctors – 250 and 18 and 9. So, 277.  They saw the light in his eyes. They now know that many suicides are preventable. They know the stigma and silence of mental illness and suicide. They know that every mention of suicidal thoughts should be taken seriously. That if they notice a colleague, a friend or a family member behaving strangely, they can ask them ‘Are you ok?’ And whatever the answer, they can deal with it.  They know that it’s ok to go as far as asking, “Are you thinking of ending your life?” It’s difficult but worth doing. It might save a life. That no one is immune. That everybody can make a difference. That many doctors are lay people when it comes to suicide and believe in popular myths. That doctors, dentists and vets are very high risk groups and need to take good care of themselves and each other. That the medical curriculum is all about physical illnesses. That Mental Health services are broken in this country and we all need to educate ourselves and strongly advocate for our near and dear ones if, God forbid, the need arises. That charities like Papyrus do a great job of helping young people. That when it comes to suicide, there is only prevention. No cure. They now know when, where and how to find help.

Later on, a young lady chatted with me about how useful she found the content of my presentation and how it helped that it was delivered in such a calm and composed manner. Really? Was she talking about me?

Ref: Art of Conversation (NHS Scotland) :
http://www.healthscotland.com/documents/2842.aspx

Day 842

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A Psychiatrist recently expressed his point of view- “If I take everyone who tells me they want to end their lives seriously, I would have to admit almost everyone I see to hospital. What we need is for people to be able to verbalise how they feel rather than dash straight to a perceived solution.” I suppose he means it would be helpful if everyone had an emotional vocabulary, a way of describing how they feel – happy, worried, excited, frustrated, scared, wretched, rotten, hopeless, angry…  a process that ideally should start when we’re kids. Just like we learn to identify objects and name them, we should develop the ability to identify our feelings and name them.

“If you’re happy and you know it…clap your hands.”
“If you’re happy and you know it, hug a friend.”
“If you’re sad and you know it, cry a tear – “boo-hoo.”
“If you’re mad and you know it, use your words “I’m mad.”
“If you’re scared and you know it, get some help, “HEEELLLLPPP!”
“If you’re silly and you know it, make a face, “BBBBLLLUUUUHHHH!”

“A large and more complex feeling vocabulary allows children to make finer discriminations between feelings; to better communicate with others about their internal affective states; and to engage in discussions about their personal experiences with the world”
– Centre on the Social and Emotional Foundations for Early Learning (CSEFEL)

Adults can proactively teach young children to identify their feelings and those of others. Through stories, modelling and role play they can pair an emotion with a coping strategy, for example, taking a deep breath when angry; requesting a break when annoyed, talking to someone when sad. Positive emotions may need to be regulated too.

When I was young, feelings didn’t get much attention. They were often set aside, ignored or suppressed. They didn’t seem to be important. They came and went and changed all the time. So, it was easy to not hang on to them. Doing, behaving, achieving and knowing were important. They were tangible and afforded rewards. So, it was easy to focus on them. I didn’t have an emotional vocabulary. I didn’t know there was such a thing. I didn’t know many people who had it. Now I am learning.

Ref:

The feelings song: https://www.youtube.com/watch?v=UsISd1AMNYU

On Monday when it rained: https://www.youtube.com/watch?v=eOhwGmxDPl8

Click to access handout6.pdf

Day 837

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NSPA Conference: Part 2. Suicide Prevention: the changing conversation.

4. State of Mind Sports Charity (http://www.stateofmindsport.org/) made a dazzling presentation about how they promote positive mental health in sportsmen and women, fans and wider communities, thereby preventing suicides. Danny Sculthorpe gave a moving account of his dark times when his brilliant rugby career was seriously threatened by a very painful back problem.

“I just felt like I had lost everything and that nobody cared. After a couple of months, I couldn’t afford to pay the mortgage, and because Bradford were denying any responsibility for the injury, I had to try and find £3,000 for the physiotherapy I needed to give me any chance of getting back playing. At that time, all I could think about was how I was unable to support my family, that my career was over and that the only way out was suicide.”

Sculthorpe found help after opening up about his feelings to his parents and through support from the Rugby Football League. He now works for the State of Mind charity, which established a partnership with the game after it was rocked by the death of Wigan and Great Britain hooker Terry Newton in 2010.

Their resounding message is: “We are all one big team.” So true!

5. Professor Tim Kendall, National Director for Mental Health, NHS England presented the 5 year forward view. He appeared rushed, ill-prepared and unempathetic to a room half full of people whose children had died.  Considering he was the most powerful person in the room, he was most disappointing.

6. Counsellor Richard Kemp has been a member of Liverpool City Council for 30 years. He is passionate about providing good housing, community centres and parks for the well-being of people. Ironically he also seemed to think the suicide was a relatively small problem. Interestingly he got this insight from a  psychiatrist. However, I strongly agreed with this statement he made – “We need fewer guidelines and more vision.”
We can’t have a speaker from Liverpool who doesn’t mention the Beatles – All the lonely people, Eleanor  Rigby, Father McKenzie… This song was well used to speak about the widespread problem of loneliness.

7. Panel discussion at the end had representatives from – Public Health England, Champs, Grassroots and Mental Health Foundation. They discussed finding the ‘seat-belt’ of Suicide. May be there isn’t one. We should work with the information we have in addition to continually looking for stronger evidence. It is important to identify protective factors and talk about them too. Policy makers need to embed these into schools and colleges. Staff must be educated to enable them to spot the warning signs of suicide in a young person and to keep them safe.

Overall, it was clear that the conversation is changing, even though  there is plenty of dead-wood around. It is apparent that the motivational level of charities is much higher than the government. There are big questions about the funding of government plans. GP training is still something that is not being addressed as it should be. Somehow there is a level of denial around it, even when it is clear to many of us as an area that needs serious attention.

The drivers of these changing conversations and policies should be survivors of suicide and those bereaved by it. Lived experience is an invaluable source of a wealth of information on the lessons that can be learnt and the changes that are required.

Ref: http://www.itv.com/news/calendar/2015-07-24/the-only-way-out-was-suicide-former-rugby-star-speaks-out-about-case-over-sacking/

Day 828

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Kimberley Hiatt was 50, a nurse for 24 years, she worked in the Cardiac Intensive Care Unit at Seattle Children’s Hospital. In September 2010 she accidentally overdosed an 8-month-old infant with calcium chloride as a result of a mathematical error. Ms Hiatt, immediately reported the event to colleagues. Unfortunately, the child didn’t survive the error. The hospital put Hiatt on administrative leave and soon dismissed her. It broke her heart when she was dismissed, not just because she lost her job but also because she lost a child. In the following months, she battled to keep her nursing license in the hope of continuing the work she loved. Six months after the event, Ms Hiatt died by suicide.

The suffering of caregivers in the face of a serious medical error has been termed the ‘second victim’ phenomenon.  These individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, seriously doubting their clinical skills and knowledge base. They may suffer from extreme fatigue, sleep disturbances, increased Blood Pressure, muscle tension, frustration, decreased job satisfaction, difficulty concentrating, flashbacks, loss of confidence and grief or remorse.

The risk factors for suicide among health professionals, including doctors, are similar to those found in the general population. However, there are some additional risks among doctors such as their unwillingness to seek timely help, access to potent drugs and the skills to self-medicate. Other risk factors include exclusion from work, poor support networks, ongoing investigations, complaints, court cases, inquests and multiple jeopardy from having a complaint considered by a range of bodies including employers and the GMC.

Scott’s 3-tiered interventional model of support for Second Victims is well recognised (Ref: https://www.muhealth.org/app/files/public/1405/Scotts_Three_Tier_Support.pdf)

It’s too late for Kimberly, but her story can serve as a catalyst for a much needed change in healthcare – support for second victims of errors.

“People make errors, which lead to accidents. Accidents lead to deaths. The standard solution is to blame the people involved. If we find out who made the errors and punish them, we solve the problem, right? Wrong. The problem is seldom the fault of an individual; it is the fault of the system. Change the people without changing the system and the problems will continue.”

  • Don Norman Author, the Design of Everyday Things

Dedicated training for all medical students and GPs in suicide prevention must be made mandatory in the NHS and all over the world as prevention of harm means prevention of first and second victims. However, as long as humans are a part of any system, errors will occur. To err is human.

 

 

 

Day 814

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A bereaved mum’s lament: Went out for dinner with friends. What could go wrong? All went well until there was talk of an acquaintance of one of the guests who is suffering from a debilitating mental illness. They had tried to take their life but survived. The guest herself is a breast cancer survivor. She said that she had visited the person and said “did they not realise how hard she had fought to live and there they were throwing away their life”. Its a shame she didn’t appreciate just how hard the other person was fighting to stay alive … my son lost that fight. When will they realise Depression is as dangerous and potentially fatal as cancer. You know when you are stuck in a situation when its just not appropriate to make a fuss but you want to scream “How ignorant are you ???”

From the individual level, right through the media, the regulatory bodies and up to the government, we are all ignorant. Mrs May speaks of parity between physical and mental illnesses, ie. both being given the same importance. Many others have talked about it before her but we are miles away from it.

The Ebola Outbreak in West Africa was a public health emergency of international concern and we heard about it everyday, non-stop on the radio and TV from 2014-2016. 1 person was infected with the virus in the UK and fortunately there were no deaths from it. 1 person dies every 2 hours by suicide but it is not mentioned in the media. Public health England are not particularly concerned. Suicide claims 4 young lives every day but it’s no big deal.

Imagine a middle aged man presenting to his doctor with severe chest pain and being sent home with pills that take 3 weeks to work. I am sure the GMC would have something to say about that. A young man presents to his doctor with debilitating depression together with a strong desire to end his life and he is sent home with pills that can potentially make suicidal ideation worse and the benefit, if any might be seen in 3 weeks. The GMC finds that acceptable practice.

1 in 4 patients present with a mental illness to the NHS and only 10-12 % of the NHS budget is spent on mental health.

Survivors of physical illnesses proudly claim bravery and wear their survival as a badge of honour whereas those surviving mental illness hide in corners feeling ashamed.

The acceptable faces of mental illness are Dementia and Alzheimer’s disease. This is apparent from the t-shirts worn at charity events, walks and runs. I hardly see anyone running in support of Bipolar Disorder research or British Schizophrenia Foundation or Borderline Personality Disorder Charity. 

Things most resistant to change are cultures and mindsets.
Parity of esteem?
We have aeons to go!!!

Day 813

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Short stories have always intrigued me. Of late my attention span has become so short that those are the only kind of stories I can relate with and appreciate.

Here’s an abridged version of ‘Grief’ by one of the greatest writers of short fiction, Anton Chekov.

‘Grief’

It is twilight. Large flakes of snow are falling. A cab-driver, Iona, waits for a customer. He sits in his cab with his body bent as double as a living body can, immobilized by misery. ‘To whom shall I tell my grief?’

At last an officer arrives. Iona sets off in his cab with the officer at the back. He turns around to speak to him.
“My son…er…my son died this week, Sir.”
‘Hm. What did he die of?’
“It was a fever.”
Silence. Iona turns around again to find the officer nodding off.

As the evening progresses, Iona attempts to talk to someone three times. He tries to tell the story of his son’s death again and again. The second passenger, a high browed businessman interrupts Iona and says, ”We all must die one day.” Another man simply gets out of the sleigh. Later Iona tries to speak with a house porter but he brusquely tells him to drive on. Still later Iona offers one of his fellow drivers a drink but the young man promptly falls asleep. Just as the young man has been thirsty for water, Iona thirsts for speech. There is so much he needs to share.

“One must tell it slowly and carefully; how his son fell ill, how he suffered, what he said before he died, how he died. One must describe every detail of the funeral and the journey to the hospital to fetch the defunct’s clothes. His daughter Anisya remained in the village – one must talk about her too. Was it nothing he had to tell? Surely the listener would gasp and sigh and sympathise with him?”

Finally at the end of the working day, Iona returns to the stables. He starts to speak to his horse, “Now let’s say you had a foal, you were that foal’s mother and suddenly, let’s say that foal went away and left you to live after him. It would be sad. Wouldn’t it?”

The mare munches hay and breathes on her master’s hands. She doesn’t close her eyes, nor walks away, nor interrupts with her own wisdom on the matter. And it’s enough. Iona tells her everything.

At the risk of repeating myself, I tell the story I need to tell:

(Special thanks to Diane Morrow and her book: One Year of Writing and Healing)

Day 811

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Her Voice – a short story

‘I hear her. Her voice is in my head’ says Joe.
“How long has the voice been there?” asks the trainee psychiatrist.
‘Since I was 12.’
“And you are now 18.”
‘Yes.’
“Is it really upsetting for you?”
‘Yes. Distressing. I feel terrible.’
“What does the voice say?”
‘Different things. Often cries desperately.’
“How often does this happen?”
‘At least 3-4 times every day. It’s painful.’
“Hmmm. Let me speak to my senior and come back to you in a few minutes.”

A few minutes later.

“We think you might have Schizophrenia. Let’s start you on Quetiapine and see how it goes.”
‘Okay.’

Joe waits at the pharmacy to collect his medication. A trainee nurse is also waiting there to collect some meds for a patient on the ward. They talk. He tells her why he’s there. She asks him who is ‘she’? Whose voice does he hear?

‘She is my little sister. When we were kids we shared a bedroom. At night, my mum’s boy friend would come into our room and trouble my little sister behind a curtain. She cried. I could hear her but I was powerless. I could hear her then. I can hear her now.’

‘Do you think these pills will work?’

Day 808

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Yesterday our Prime Minister put Mental health at the top of the national agenda. Great to have these focussed conversations in prominent places with special emphasis on schools and work places being equipped to intervene early for children and young people with difficulties. These announcements are welcome but are also met with a slow applause as this government does not have a great track record with the NHS.

Relevant tweets:

“Schools will be linked to local NHS #mentalhealth services to support early intervention for Children and Young People” in PM speech.

“You can make the promises, but you need the workforce to deliver them.”

“Biggest challenge PM faces -getting funding to the front line. Services over-pressed, under-staffed + facing even more demands.” – President of the Royal College of Psychiatrists.

In my opinion, as long as we stick strictly to the medical model of mental illness we will never get it right as it does not put enough emphasis on prevention. We need to start with educating young parents about the family, environmental, individual and social factors that contribute to the mental well being of a child.

Thereafter the schools need to be aware that if a child is happy, he or she is more likely to perform well. Hence putting them under academic pressure can be counterproductive. Bullying policies must be strictly implemented. Kids must be allowed to fail sometimes. There is grace and learning in defeat.

By no means do I claim to have all the answers but this would be a good start. Prevention is better than cure.

Day 801

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There are many doctors who still believe that if a person is serious about killing themselves then there is nothing they can do. That is a myth

Feeling actively suicidal is temporary, even if someone has been feeling low, anxious or struggling to cope. The majority of people who feel suicidal do not actually want to die, they just want to stop the pain. This is why getting the right kind of support at the right time is so important.

The purely medical model of symptoms = diagnosis = medication does not work for mental illness as there are many social factors that can serve as important contributors and resources. Paying attention to the concerns of carers and empowering them with relevant information and points of professional contact is crucial.

“A large percentage of individuals who end their life by suicide have had contact with primary care around the time of their death.” Luoma et al 2002.
(https://www.ncbi.nlm.nih.gov/pubmed/12042175)

Suicide is the single biggest killer of young people in the UK. Unless Human factors training and Suicide Prevention Training is made mandatory for all frontline medical staff, just like CPR training is, we will continue to silently loose thousands of beautiful people through suicide year after year.

I dedicate this plea to the memory of my darling son Saagar Naresh who would have been 23 this year. RIP my love.

Ref: http://www.samaritans.org/how-we-can-help-you/myths-about-suicide

Day 790

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Home is so sad

Home is so sad. It stays as it was left,
Shaped to the comfort of the last to go
As if to win them back. Instead, bereft
Of anyone to please, it withers so,
Having no heart to put aside the theft

And turn again to what it started as,
A joyous shot at how things ought to be,
Long fallen wide. You can see how it was:
Look at the pictures and the cutlery.
The music in the piano stool. That vase.

  • by Philip Larkin

Here is a link to the video recordings of presentations made at a Suicide Prevention conference in Belfast, Northern Ireland on 17th November 2016. Stories of triumphs, visions, ideas and tragedies. All worth watching. The 10th one tells the story of Saagar and my sad home.

https://contactni.com/Contact-Conference-2016-Suicide-Prevention-What-Works.php