‘Situational awareness’ (SA) is one of the major tenets of safety in high-risk situations such as aviation, policing and medicine. As the name suggests, it means having an accurate understanding of our surroundings or situation – where we are, what happened, what is happening, what is changing and what could happen. Good SA requires:

1. Gathering relevant information
2. Making sense of the collected data
3. Thinking ahead about possible outcomes

Let’s look at the areas where SA could have been better in my son’s care.

Gathering information:

1. He was under the care of his GP who saw him 2 days before Day 0. Neither did he talk to him about suicidal thoughts, nor did he get him to fill out a PHQ-9 that would tell him about his overall mental state.
2. I told the GP that he was really depressed and I would like him to be referred to Psychiatry services but he decided to increase the dose of his antidepressants instead. We know that antidepressants may worsen depression and cause suicidal ideology.
3. Nobody suggested that he maintain a ‘Mood Chart’ so that the trends in his mental state could be known better.
4. The patient is a young male with recently diagnosed Bipolar illness who is not on Lithium which is the drug of choice and has proven anti-suicidal effects in such patients.

Ref: http://www.bmj.com/content/346/bmj.f3646

 Making sense of collected data

1. Given that not much data was collected and my assessment of the situation was not given much attention, there was nothing much to work on.
2. NICE guidelines suggest that if a patient is depressed for 6-8 weeks, they should be referred to specialist services and he fell in that category but this action was not taken despite being suggested.
3. It was not picked up that this patient needed specialist care for various reasons that were known : young male patient with recently diagnosed Bipolar illness, severely depressed for 6 weeks, prematurely discharged by Psychiatric services due to extraneous factors without any expert follow-up or monitoring in place.
4. He was on medications that might increase his risk of suicide.

Thinking ahead about possible outcomes

1. Young males are at the highest risk of suicide. So, that was a very real possible outcome that was not anticipated.
2. His illness had been diagnosed only 10 weeks prior so it was very early in its course and hence unstable.
3. The depression had been preceded by a manic phase and that puts him in a high-risk bracket.
4. He had shown some signs of improvement over the previous weekend that also put him at higher risk.
5. No discussion took place with me as his sole carer about his care at home, signs of crisis and when I should think of taking him to Emergency services.

So, our Situational Awareness was poor. Not surprisingly, so was the outcome.

“Edward was a very rare animal,” said Mr Mallen, describing his son in The Times today. “Not only was he intelligent and gifted, he was also very kind, caring and humble.” This 18 year old is another tragic example of not enough attention paid to a young man with depression. Just after Christmas he fell into a deep depression and was ‘given an assessment’ by the NHS a month ago but had not heard back about possible treatment by the time of his death.

What a waste! How can this continue to happen again and again? Same themes emerging repeatedly! It is agonizing to hear this. I can completely identify with the parents who said, “a normal Monday afternoon became a horrifying nightmare where one is staring into this appalling abyss of grief.” Even the thought of it is unbearable.

A survey by YoungMinds, a youth mental health charity showed that quarter of parents waited more than 12 months to receive treatment for their child. The suicide rates in England are at risk of rising sharply as a third of local authorities do not have suicide prevention action plans.

Today is 18 weeks. In my heart it feels like Day 0 again.

Please let us all wake up and do something to stop this.

When he had just started to speak as a baby, it was complete gobbledygook to everyone. My Mum was impressed by how I could figure out exactly what he wanted to convey. I am sure this is not uncommon.

When he was 19 and we would be cooking together in the kitchen, I could make out from his body language when he was putting off going to the loo. I would point it out to him and he would be most embarrassed. He would say,” You are not supposed to know this!!!” I couldn’t help it. I could just read him.

While going over his medical notes recently, I noticed there were some important facts that were missed out in his psychiatric history. If they had asked me I would have told them these very relevant facts that they missed. But of course, he was over 18, an adult. Hence, what I had to say was of no importance even though he was mentally ill and I was not. Even though I was his prime carer and wanted him to get better more than anyone else.

Dear Psychiatrists, please speak with and listen to the Mum. She knows things no one else does and the level of ‘preciousness’ in her heart for your patient and her child is unmatchable.

Now, all I can do is bleed.

When love beckons to you follow him,
Though his ways are hard and steep.
And when his wings enfold you yield to him,
Though the sword hidden among his pinions may wound you.
And when he speaks to you believe in him,
Though his voice may shatter your dreams as the north wind lays waste the garden.
For even as love crowns you so shall he crucify you.
Even as he is for your growth so is he for your pruning.
Even as he ascends to your height and caresses your tenderest branches that quiver in the sun,
So shall he descend to your roots and shake them in their clinging to the earth……

But if you love and must needs have desires,
let these be your desires:
To melt and be like a running brook that sings its melody to the night.
To know the pain of too much tenderness.
To be wounded by your own understanding of love;
And to bleed willingly and joyfully.

– Kahlil Gibran, The Prophet

An occasion for celebration. A big birthday for my father. A surprise party filled with joy and laughter, love and gratitude, music and dance, children and grandchildren, friends and neighbours, memories and photographs, flowers and greetings, hugs and warmth, sharing and nostalgia.

Another opportunity to miss him, love him and be grateful for him.

Another step in the right direction.

More smiles. More healing. More light. More lightness. More hope. More acceptance.

More connectedness with myself through the love of everyone around me.

More belief in my ability to recover through the confidence of others in me.

More reassurance that things will get better through acknowledging embraces.

For the first time since Day 0 I feel that the Universe is in my corner.

Thank you Universe 🙂