The doctor who spoke prior to me was a Consultant Psychiatrist. She spoke about depression. Her take-home message was ‘Depression is treatable.’ There was no mention of suicide. The fact that when depression gets too severe it may result in suicide was not presented to the audience. I wonder why! Are para-suicide and suicide not essential parts of the extreme end of the spectrum of depressive illness? Do they not deserve a mention given the appalling statistics?

If depression is treatable, suicide must be preventable. Maybe it is too simplistic a corollary but it makes sense. Doesn’t it?

In this age of ‘community based’ care of as many patients as possible, proper education of carers and the general public must be top priority. The government does not have the financial, motivational or organizational ability to meet the needs of patients and families. The government also has nothing at stake. We do. It is down to us to educate ourselves. Education is key. Nearly 6000 of us here in the UK die every year as a result of suicide – mostly young people. It’s a huge tragedy. 15-16 individuals everyday!

Today I spoke to a gathering of about 250-300 people about suicide prevention – my first attempt at generating awareness of this epidemic. As I read out the numbers indicating the enormity of the problem the gasps in the room were highly audible. My take home message was – “Let’s talk about it. It is our problem.”

It’s been 6 months and 9 days since he’s been gone. Was it too early to make this presentation? I don’t know. It took everything I had to stand up there and speak about it but it made perfect sense to do it. It’s already too late for me and those like me. But there is still time for many others.

Suicide prevention is a global issue.

The World Health Organisation has outlined 6 basic steps for the prevention of suicide, 4 of which centre on reducing the availability of methods.

1. More effective treatment of mental disorders
2. Gun possession control
3. Detoxification of domestic gas
4. Detoxification of car emissions
5. Control of toxic substance availability
6. Toning down suicide reports in the media.

If deprived of one method of suicide, won’t a suicidal person simply seek out a different one?

Preventative efforts will not go far without support from the public and without adequate funding from governments. Major success at suicide prevention is an unrealistic goal if the treatment of mental illness remains poor and/or unaffordable, if hospital stays for the ill are limited to days rather than weeks, if carers are expected to look after patients at home without any guidance and if society continues to be unaware of the suffering of so many people in its midst.

“Suicide is the number one killer among young black people,” said John Wilson, D.C. Council Chairman, “but we call it gunfire.” shortly before he killed himself. “We don’t even like to talk about it. We’ve got to change the way [America] feels about depression. We can’t put it all in God’s hands. God’s busy.”

In Chicago there is a patient-run advocacy and support group called National Depressive and Manic-Depressive Association.
Here is a list of recommendations they make to family members and friends who believe that someone they know is in danger of committing suicide.

• Take them seriously.
• Stay calm but don’t underreact. (?)
• Involve other people. Don’t jeopardize your own health or safety. Call Emergency services if necessary.
• Contact the person’s psychiatrist, therapist, crisis intervention team or others who are trained to help.
• Express concern. Give concrete examples of what leads you to believe your friend/family member is close to suicide.
• Listen attentively. Maintain eye contact. Use body language such as moving close to the person or holding his hand if it is appropriate.
• Ask direct questions. Find out if they have a specific plan for suicide. If possible determine the method they have in mind.
• Acknowledge the person’s feelings. Be empathetic, not judgmental. Do not relieve the person of responsibility for his/her actions.
• Stress that suicide is a permanent solution to temporary problems. Remind them that there is help and things will get better.
• Don’t promise confidentiality. You may need to speak to their doctor.

• If possible don’t leave the person alone until you are sure they are in the hands of competent professionals.

I was a lay-person when it came to psychiatric illnesses. I wish I would have been treated as one by the psychiatrists and the GP. I was afraid. I was sad as a result of my empathy for him. I could not think straight. I was recovering from the manic phase of his illness. I was in pieces.

I wish I had had a chance to say good bye and tell him how much I loved him. I wish I could know in my heart and say that I did everything I could to help him.

I love you my darling. xxx

“How can you look after me like this?” he asked me as I drove him to the gym one day. He was probably referring to his recent rude behavior due to the hypomanic phase of his illness. I responded by saying that it could very easily have been me who fell ill in which case I was sure he would have taken good care of me. That’s what we do for people we love.

The rapid rate of change in his mental state was baffling! Initially I thought he was just acting up. Then we found out it was hypomania. He responded well to treatment and was near normal, then mildly depressed, severely depressed and then he was gone. All within 10-12 weeks!

Before I could come to some understanding of what was going on, it had already changed. Those weeks were very confusing. I felt so alone. There were no proper conversations about his condition. I looked up stuff on the internet which did not give me any practical help. I felt really lost. In addition I felt his pain. He would say heartbreaking things like – ‘I wonder what it feels like to be homeless’  or ‘I can see myself stacking shelves in Sainsbury’s’. I did not share these things with anyone except my closest friends. May be…..

It was a terrible place to be in.

Today I heard this piece of indian (Rajasthani) folk music which I love. The sound of the saarangi ( a violin like instrument) is deeply soulful. I was surprised at how the first few notes of it brought tears to my eyes as though I had just seen a dear old friend again. I would like to share it with you. Here it is:

Good decision-making involves proper awareness of a situation and then choosing a course of action. If the awareness is inaccurate the decisions taken will most likely be incorrect. In high-risk fields of work, such as medicine, this can mean the difference between life and death.

Thinking about how we think is one kind of ‘Critical thinking’. More often than not we are unaware that we have biases, which greatly affect our ability to make decisions.

1. Action-Oriented Bias

This makes us take an action believing in a positive outcome and completely dismissing the possibility of a negative result or a chance occurrence. We are overconfident in our ability to influence events positively.

Example: “This is not the first time I am treating this condition. The last time I did this it worked so it is bound to do the same this time (and of course “I know best”)”.

2. Self-Interest Bias

When the wrong behaviour is incentivised due to conflict of interests, it is easy to get it wrong.

Example: “my surgery saves money if I don’t refer patients to specialist services”. Or, “If I ask for help I might look silly” – very common amongst some senior doctors.

Silo thinking is not considering the bigger picture or other stakeholders. In this case educating the carers and paying attention to their inputs was not considered important.

3. Pattern-Recognition Bias

We look for and see patterns where they don’t exist and give more weight to recent or to highly memorable events. Once we have formulated a theory, we pay more attention to items that support it and ignore evidence that disproves it.

Example: A belief in the myth that directly questioning a depressed patient about suicidal ideation makes them actually think about it.

4. Social Harmony Bias

Maintaining the status quo, not rocking the boat and not alerting the relatives about warning signs and possible outcomes.

In the absence of proper training or significant self-awareness it is easy to fall into these biases with tragic results.  It would seem that the necessary training is not widely available with respect to mental health in the UK National Health Service.