Day 906

Last September I started writing a case study on patient safety for an academic paper. For every sentence, it required evidence. Unfortunately, the level of evidence for some of the material is not high because of the nature of the subject. Secondly, research in mental illness is poorly funded in the UK.

I am reminded of a young friend who is looking for a job but she can’t find one as they require her to have experience which she cannot gain unless she has a job. A classic chicken and egg situation.

So, the deadline has been extended time and again and finally we are going to have another attempt at submitting it before the end of this month. The lowest level of evidence to be found is Level 5 – ‘Case series or studies with no control’.

Here is one that I am going to use to support my statement: “Almost everyone who is suicidal is ambivalent. They don’t necessarily want to die. They just want the pain to end.” Hopefully it will be accepted. 

Kevin Hines is one of less than 1% of people to survive a jump from the Golden Gate bridge in a suicidal attempt. He is now a mental health advocate and works actively towards suicide prevention.

“The millisecond my hands left that rail, I thought, ‘what have I just done? I don’t want to die, God please save me’, and then I hit the water,” he said.
“You fall four seconds, you hit the water and get vacuum sucked down 70 or 80 ft – when I opened my eyes I was alive. “All I desperately wanted to do was survive – suicide experts call this being ‘shocked into reality’.”

Ref:

Kevin Hines:
http://www.bbc.co.uk/news/uk-northern-ireland-29995470

Youtube clip:
https://www.youtube.com/watch?v=WcSUs9iZv-g

Website: http://www.kevinhinesstory.com/bio/

Day 816

Health and social care, care of the elderly, care homes, care in the community, child care, nursing care, residential care, respite care … The word ‘care’ is used everywhere but what does it mean?

The Cambridge Dictionary defines it as ‘the process of protecting someone or something and providing what that person or thing needs’ and ‘serious attention, especially to the details of a situation or thing’.

Synonyms: caution, attentiveness, alertness, vigilance, observance, responsibility, forethought, mindfulness, regard.

Medicine and nursing are caring vocations. Yet, they are jobs like any other. They pay a salary for a service rendered. The care element can potentially become optional as long as all the boxes are ticked.

‘Continuity of care’ is particularly tricky in mental health as relationships are based on trust and every time a new person takes over a caring role, all the facts need to be repeated and trust re-established, starting from scratch.

Now that I belong to a network of mothers and fathers who have lost their children to suicide, one common theme emerges: “It seems that our sons and daughters didn’t need more resources, more GP’s or more psychiatrists or more nurses. They just needed more care…”

Let’s not use the word carelessly. 

Day 813

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 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 782

For a long time I didn’t understand why Saagar couldn’t speak to me about his suicidal thoughts. I felt terrible about myself – untrustworthy. In short, Bad Mum. I thought we were close. When he took his own life, I felt betrayed and shunned like an outsider. He must have known that I cared for him deeply even if I didn’t always know how to show it. I am sure he felt the vastness of our love as much as I did. It glued us together and carried us as one through thick and thin. It was the most solid part of my life, unwavering, undying and unfaltering.

What stopped him? Why couldn’t he? In the early months it nearly killed me, the utter and complete sense of failure as a parent. How alone must he have felt! Was he embarrassed? Ashamed? Confused? Did he feel trapped? Why couldn’t I see it? Was it out of concern for me that he didn’t share? Did he know that I would probably freak out if he did? Could he feel my pain as I watched him suffer? Could he see how lost and powerless I felt? Was his silence his way of being kind to me? Did he really believe that I would be better off without him? Did he even know the meaning of what he was doing?

All these unanswerable haunting questions coming back uninvited! But now, I can understand. 

ps: If you are concerned about anyone close to you, please call PAPYRUS for help and advice. I wish I knew of them when Saagar was ill. (https://www.papyrus-uk.org/)

Ref: http://www.speakingofsuicide.com/2013/05/29/parents-and-teens/

 

 

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/