Day 808

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

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

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

Day 780

Money alone will not solve the problems within Mental Health Care Systems. We need a radical shift in the understanding, training, outlook and organisation of our society as a whole, each individual and  every health service and professional. Paul Kirby writes about this comprehensively and optimistically. He points out failings and offers transformational solutions. Here are some excerpts:

“The medicalisation of mental health assumes that doctors can solve medical problems on their own, in the way that they do for physical illness with biomedical testing, drugs and surgery. That is rarely true in mental health where getting better relies significantly on the patient’s own therapeutic actions and their interaction with their friends, family and colleagues. Outpatient psychiatric care rarely works with the other people in the patient’s life, dealing with the patient one-to-one. Worse still, medical ethics prevent doctors discussing their adult patients, even vulnerable eighteen year olds, with their family and friends.

England, like other countries, has only ten per cent of the inpatient places, per head of population, that it had in the 1950s. The US has even less. It wasn’t just the asylums closing. England has halved the number of inpatient places it still had in 1998. Community-based crisis services have not worked well. Only fourteen per cent of English patients who’ve experienced a mental health crisis felt they had appropriate care and there are no English community services rated as good. In the absence of appropriate inpatient care, people who are severely ill are labelled, and dealt with, as non-medical problems, as criminals, as homeless, as addicts, as a public nuisance and as suicides.”

Doctors tell people that anti-depressants have a positive effect on half of the people who take them. That is true, but misleading. Even drug companies only claim that their drugs have a positive impact on one in eight people who take them. Drug companies are also clear that the beneficial effects of the drugs take two to six months to kick-in. Without medication, a third of people with depression are better after three months and two-thirds are better after six months. For the people who do benefit, these drugs are probably best compared to a band-aid, increasing the natural healing process a little.

A minority appear to be greatly harmed by taking anti-depressants, with a doubling of the suicide rate for people with depression and the triggering of psychosis in significant numbers of people. But the biggest harm of the anti-depressant accident is that their domination of psychiatric care has crowded out better and more varied solutions to common disorders and left millions unable to get well again.

Mental illness and poor health are often based on underlying feelings that one has lost autonomy and/or community-connectedness, experienced as helplessness, hopelessness, passivity, boredom, fear, isolation and dehumanisation. These are social problems that have medical consequences. The best solutions are, often, therefore social rather than medical. In terms of physical health, many of the biggest achievements have come from non-medical solutions. We live longer and better in large part due to clean air, safe water, better vehicle and workplace safety, less tobacco smoking, more and better food, fluoridated water. We need a similar public health approach for the social causes of mental health issues.”

Ref: https://paulkirby.net/

Day 762

Bone doctors can sometimes forget  there is a heart and a mind attached to the bone being fixed. Orthopaedic surgeons are the butt of many jokes for some unknown reason. They think it is because everyone is envious of the vast amounts of money they make and of course, they would like to think that.

What do you call two orthopaedic surgeons looking at a chest X-ray?
A double blind study.

What’s the difference between a carpenter and an orthopaedic surgeon?
A carpenter knows more than one antibiotic.

How do you hide a 20 pound note from an orthopaedic surgeon?
Put it in a textbook.

They are not what they are made out to be. Mostly. 😉

I am lucky to work with some funny, gentle and bright orthopods. One of them has changed from a purely professional colleague to a friend through the last 2 years. Yesterday, I shared with him my frustration over any meaningful improvement in the awareness of mental health issues within the medical community and beyond. I feel as if nothing has changed and no lessons have been learnt from Saagar’s death. Many others like him continue to suffer in silence. I feel that I go on banging my head against the walls completely in vain.

He wrote back:
“Saagar, has somehow had a profound effect on me, even though I never met him.

I have a young woman whose humerus I plated last week, and in clinic yesterday I could see her whole life starting to come unravelled: can’t exercise yet, not at work, not concentrating. All the things she used to give her self-worth are not available. Not despair, but the beginnings. So we talked about the dangers, and she agreed to see our psychologist.

You and Saagar have made that change in me, so keep doing what you do: it works.”

Day 760

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4500 men end their  lives every year in the UK, 3 times more than women. Many times more self harm and attempt suicide. The highest suicide rate in 2014 was for men aged 45-49.

‘Building Modern Men’ is a series of articles published by Huffington post to mark the International Men’s Day (19th Nov). It covers a wide range of topics from male role models to inability to swim. (http://projects.huffingtonpost.co.uk/building-modern-men/) A Masculinity Audit carried out by Huff Post and CALM,looking into the causes of male suicide  found that :

  • Four out of ten males feel they lack the qualities and abilities that partners look for in a man

  • 61% of all respondents agree that men are stereotyped in the media

  • Four in ten male respondents strongly agreed that ‘women have unrealistic expectations of men’

(Ref: http://www.huffingtonpost.co.uk/entry/mens-mental-health-building-modern-men_uk_58206805e4b0c2e24ab022fb?utm_hp_ref=uk)

‘For many, masculinity is a fatal burden’ says Grayson Perry on why old-school masculinity is man’s greatest enemy. The 56 years old transvestite artist has always seen masculinity as a choice. He has questioned his gender identity since the age of 12. He believes that his transvestism permits him a greater distance and sharper insight into the layers of manhood that he talks about in his new book ‘The Descent of Man’.
He believes that the traditional approach of ‘stiff upper lip’ is completely out dated. It renders men emotionally illiterate and unable to form healthy relationships. It leaves them very fragile yet unwilling to express their vulnerability, a lethal combination when it comes to mental health. The inflexibility of traditional masculinity doesn’t fit in the present times of change and diversity. That masculinity comes from an age of heavy industry and farming and it doesn’t work anymore.

‘We need to think of masculinity like a piece of equipment. Some men, like soldiers, need to use it all the time, others might need it at the weekend and others not at all.’

Day 759

“My daughter, Frances, developed severe clinical depression when she was in her second year at university, aged 20. She started to self harm, cutting her arms and 3 months later attempted to take her own life by taking an overdose of paracetamol. She was taken to the general hospital in Derby and was released to us 3 days later with no follow up treatment of any kind. The depression continued and we were constantly terrified that she would attempt to take her own life again. She moved backwards and forwards between Derby and home for several months, still clearly very unwell, and was eventually admitted to a psychiatric ward in Addenbrookes hospital in Cambridge (fortunately now closed down) where she only stayed 5 days as she was badly bullied by a psychiatric nurse and forbidden to access either food or drink unless she went to the dining area, which her catatonic depression and severe distress prevented her from doing.

After leaving the hospital, she was offered no further treatment and was not even assigned a CPN. We continued struggling for 3 more years, desperately trying to get the appropriate help for my daughter to survive and cope with the debilitating depression. In 2006 Frances became very severely depressed again and came home after splitting up with her boyfriend, leaving her extremely fragile and deeply depressed. My husband checked the memory on our computer and found out that Frances was actively researching suicide sites. I called our G.P practice and begged for an appointment for her with our G.P, who had been very understanding when we were able to access her. I had complained numerous times that it was often impossible to get an appointment with our G.P as one of the women on reception always insisted that Frances should see whoever was available and she repeatedly refused to give her access to our G.P. On that fateful day, 6 June, 2007, access was once again denied and Frances was given an appointment with another doctor. I went with Frances, as she was catatonic at this stage, and begged the G.P to refer her to hospital. I stressed, repeatedly, that Frances had already made a serious attempt to take her own life and was currently researching suicide sites on our computer. Despite my entreaties, the G.P insisted that Frances should have a prescription for a halved dose of anti depressant, prior to changing it to another one, and sent her away with a leaflet on counselling. Only 5 days later on 12 June 2007, Frances attempted to hang herself. She survived after 6 months in hospital and was left with a severe brain injury, unable to do anything for herself and requiring 24/7 care at a huge cost to Social Care and the NHS.

Frances lived a life with very little quality for a further 9 years and died this year of breast cancer.

I have actively campaigned for many years to improve mental health provision, especially for young people, who are most at risk. I have helped Papyrus and the Samaritans with media work and research and also campaigned for Headway. Over the past 9 years, I have listened to countless parents telling me their story and I have learned that my daughters experience with a G.P, just before attempting or completing suicide is sadly very common. All doctors, and particularly G.P’s, should have a mandatory day’s training on suicide awareness. The training for doctors is long and rigorous, but currently has nothing with regard to suicide prevention. As G.Ps are the gatekeepers of the nation’s health, and are usually the first point of health care access, it is particularly essential that this training becomes mandatory.”

Just one days training in suicide awareness for all doctors could potentially save thousands of lives every year. Teachers, too, would benefit from this training and young people in secondary schools should be taught about mental health, how to protect themselves and to feel able to confide in a trusted adult if they self harm and or have suicidal thoughts. As a teacher, myself, I am well aware of the considerable emphasis on physical health, taught as part of the PSHE curriculum, at primary and secondary schools, but there is nothing in the current national curriculum regarding safe- guarding mental health and so the stigma still remains. Many young men, in particular, suffer from severe and devastating depression, yet tell no-one except,their G.P that they have thoughts of self-harm and suicide. Their parents and families often say that they had no idea that their son or daughter was suicidal until it was too late.” – RW

Another lone voice in the dark joining up. Watch out for the big clang. It’s coming. It’s long overdue. We will be heard. I promise you Saagar. Things will have to change.