mental health

Comings and goings.

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As usual, I sit here at my table by the window of my study, admiring the autumnal trees standing in the park across the road, looking for inspiration to write. They have been my encouraging companions for years. The difference is that today might be the last time I write sitting here.

Early autumn has cycled back again. The fullness of the moon has synchronized with the one eleven years ago. The comings and goings of the seasons, of the world carry on as usual. Moving away from this home to live elsewhere was unthinkable at one time. But now, the heart has settled. It knows things it did not before. It carries a treasure of love and memories. Saagar lives in this heart now. He cannot be left behind. He is with me everywhere.

This, our home is ‘under offer’ now. A young couple wants to buy it for the same reasons we did twenty years ago. A quiet street. A diverse neighborhood. A garden. Parks and good schools nearby. Last few days of packing up have been intense. Things that have surfaced from deep recesses – a handheld Nintendo Gameboy carefully wrapped in its purple case, a proper Canon camera, one black sock with TUESDAY on it in yellow bunched together with another with SATURDAY printed on it in green.

I know not to trust my memory. It often fails me. It misremembers things, puts them in the wrong order. Omits some entirely. It plays tricks, causes confusion. Forgets what I want to hold on to and remembers what I’d rather forget. Luckily, the job of the heart does not include remembering but feeling – how it feels to sit here looking out the window and then at a blank page, to fold a much-loved photo in silk and cover it in more soft clothing, to look at an empty room and see it filled with light, to know it’s okay. I can trust this thing in the center of my chest. It’s all okay.

Othering our Ownkind.

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“More than two thousand people read my post and saw my video today “ Yuval said.

‘They will see it and be moved by it. What then? What will they do?’ asked Basel.

That is the big question. What can we do? What will we do? Two young journalists from either camp came together to document the encroachment and destruction of a village called Masafer Yatta on the West Bank. They raise this question loud and clear for each of us. What can I do? The injustice of all this pushing and kicking, hurting and forcing fills me to the brim with a sense of sadness and powerlessness. My arms and legs go limp. So, thus far I’ve been running away from it. I must be a coward. What can I do? So many influential and powerful people have been quiet, watching the numbers and images get worse every day for decades.

Today, I watched No Other Land on the big screen. Live footage shot on a mobile phone over 4 years, 2019 to 2023. Running away is not possible anymore.

Harun’s mother prayed for his death. This young man was shot by a soldier while he was trying to stop his home from being demolished by the army. The bullet left him paralysed from his neck down. He was nursed in a cave as they had no house. No facilities. No transport. No freedoms. Everything around them was being bull-dozed – chicken coups, elementary schools, homes and villages. No one knew what new destruction each new day would bring. Toddlers were learning to speak, and older kids were trying to play and go to school in the middle of this madness. The respectable Mr Tony Blair graced the village with his pointless guest appearance for seven minutes.

Our world is bipolar, selectively blind. It’s okay for the politics of some nations to be tied to a faith but not for others, it’s okay for some nations to dishonour every treaty that they ever signed but not for others, it’s okay to condemn the exact same atrocities when committed by one nation and not another, it’s okay for third parties to fund and support the killing of women and children in plain sight. This is our world.

We humans have the arrogance to believe we are the smartest of all species, yet dogs don’t kill other dogs in millions every year. No other species has constructed the level of othering that humans have. We can’t see what we are doing to ourselves. We can’t see that there is no other. It’s only us in different garbs. Those of us who can see, must see. Those who can write, must write. Those who can sing, must sing. Let not our dark side win.

Arrogance, blindness and cowardice – a recipe for self-extinction.

By Abdul Raheem (https://www.instagram.com/mud._.lotus)

Two overlapping worlds.

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The Bhagavad Geeta addresses the ethical and moral dilemmas around the questions of who we are, how we should live our lives and act in this world. If this voluminous text was to be summarised in two sentences, they would be:

  1. Do what needs to be done, knowing that all actions come from God.
  2. Do not be attached to the results of your actions.

Six weeks ago, I re-entered the world of Suicide Prevention due to a presentation I agreed to make. It took me back to a familiar battleground where strong currents of injustice flowed through me. I went over our story yet again, in mind and body. It burnt me up. It made me restless and irritable. It kept me staring at the ceiling at night. It brought back the shit of guilt in big droppings. It was silly of me to agree to do it, but it was too late already. I wrote it down, prepared a set of PowerPoint slides to support the story.  I repeated it for the nth time to many. I wondered, to what end, but I did it anyway.

Four and a half years ago, when my road gradually swerved from the Suicide Prevention world towards peer support with other parents, it was like a cool breeze gently blowing in my face. That conversation felt like a proper invitation. Instinctively I knew it was good for me. Despite huge self-doubt, I trusted that path. I went with it. This work was also about preventing isolation and possibly suicide amongst parents, as our risk is 60-70% higher than others. It did not feel like work at all. We formed strong bonds of friendship. We shared deeply and held each other in understanding and compassion. This felt like home.  

The organisers at National Confidential Inquiry into Suicide and Safety in Mental Health provided me the best possible support to be able to present my thoughts. The comments on the chat were that of gratitude and inspiration to change. One person said that it was better than any training course they had attended. I am glad that I did what was needed. The strength to do it came from somewhere. Now, it can do its work and I can go back home.

The recording is here (‘Bridging the gaps’ starts 6 minutes and 45 seconds in).

Wrap-around?

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“What can we do to offer wrap-around care to our patients?”

In the live Q&A at the end of the NCISH conference yesterday, this question was asked of the panel. The Chairperson directed it towards me. I can’t remember what I said. This morning I woke up with what I would have liked to say.

For wrapping, we need two things. One, the fabric which we are going to use to wrap and the person we want to wrap. Let’s discuss them one by one.

  1. The fabric

The fabric of Suicide prevention in Health-Care is made up of two things – people and systems. Let’s look at them a bit closely.

  1. People

What are the beliefs of the people?

I know of an ENT surgeon from another country who wanted to move to the UK and the only job he could find was in Psychiatry. So, he is now training to be a Psychiatrist. Is he interested in suicide prevention? Do Health-care professionals believe that suicides are preventable? Are they content that simply by treating mental illness they are doing their job?

What are the attitudes and abilities of the people?

When the Emergency department calls to say there is a suicidal individual waiting to be seen, how do they feel? Are they excited to have an opportunity to make a difference? Or is it a drain on the limited time and energy they have? Do they know how to build a compassionate connection with someone who has lost all hope? Have they received any training in Suicide Prevention? Do they have enough self-compassion to look after someone else well?

Do they have the resources and the knowledge to do a good job?

Do they have access to their past history? Do they have beds on the ward? Can they ask a colleague for a second opinion if they have a doubt about how to involve family or friends in their care? Do they know of other resources, like charities, activities and people that may help this person? Do they have comprehensive and informative leaflet they can share with them? Do they have the means to follow them up?

b. Systems

Does the system have capacity? Are the various parts of the system effective and joint-up enough to be able to hold the person they are trying to wrap or are there big holes in this part of the fabric? Do the various parts of the system share the same mental model, a shared knowledge, pre-suppositions, and beliefs that can be used to help achieve mutual goals? Are their practices evidence- based? Do they investigate deaths with a view to learn lessons and implement change? Do they look after the well-being and emotional health of their employees? Do they hold themselves accountable when things go wrong?

2. The person

Allowing space for them to express themselves. Help maintain their sense of agency. Inform them it is safer for them to involve other people who care for them. Equip them with resources. Give them the support they need. Ask them what would help them? Listen. Sit with their despair. Acknowledge it. Keep them connected with their life as they know it. Keep hope alive for them.

Know that the person at the centre of the wrapping is of great value.

Information is useful if it becomes knowledge. Knowledge is useful when it becomes wisdom. So, let us not stop at information.

Ref:

Reaching common ground: The role of shared mental models in patient safety : https://journals.sagepub.com/doi/full/10.1177/2516043518805326