NHS

Day 494

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Maytree  – a sanctuary for the suicidal is the only place of its kind in the UK and fills a gap in services between the medical support of the NHS and the helplines and drop-in centres of the voluntary sector. They offer a free 4-night stay and the opportunity to be befriended and heard in complete confidence, without judgement and with compassion and warmth.

It is an independent charity based in North London that provides a unique non-medical intervention for those at risk through suicidal thoughts and feelings. It can accommodate up to 4 guests at one time. They aim to create a calm and safe atmosphere in which people can find the time and space to rest, reflect and talk without pressure.

Common reasons for referral are – bereavement, relationship break down, depression, suicide of significant other, isolation, sexual abuse in childhood and enduring mental illness.

Here’s what some of the guests said:

‘Maytree changed my life in 4 days’
‘I felt more understood than at any time in my life’ ‘Maytree definitely saved my life’
‘I loved Maytree and I want to come back and be a volunteer’
‘I feel reborn, feel like a different person’
‘I am feeling surprisingly good – Maytree wouldn’t recognise me’ (at Maytree follow up call)
How does Maytree work? 

“I was touched. It was a nice thing to do – someone asking hey, how are you, I was touched by that, especially when you have said you are going to kill yourself.”

Sounds really simple. Doesn’t it?
Being listened to in a non-judgemental way, being given time and space to talk and think.
I suppose there is potential for every home to be Maytree but right now there is only one.

Day 487

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An independent task force overseen by Mr Paul Farmer, Chief executive of Mind recently reported that

“Mental health services have been underfunded for decades and too many people have received no help at all, leading to hundreds of thousands of lives put on hold or ruined, and thousands of tragic and unnecessary deaths.”

Mr Cameron has ‘promised’ putting mental and physical health care on an equal footing and committed himself to making sure that happens. This means that if anyone is struggling with a mental health condition they will get the help and support they need. The planned reform will be funded by an extra £1 billion a year from the NHS by 2020-21. Bulk of this money is to be spent on providing therapy for patients with anxiety, depression and stress, ensuring the presence of Mental Health teams in all A&E departments and support for pregnant women and new mothers.

This sounds like a very determined effort to improve things and finally acknowledge that for decades Mental ill health has been treated as a poor relation of physical illnesses . However, there is a vast gap between aspiration and reality.

As long as the strict compartmentalisation of services continues, the care of mentally ill patients in unlikely to be comprehensive. The interface between primary and psychiatric health services needs to be completely reformed and renewed. Presently it is poor and ineffective, costing many their lives. Education of GPs is essential as they are often the first port of call. Proper engagement with the patients and their carers is imperative to achieve better results.

However, the politicisation of health care may drive away the doctors and young professionals who are required to deliver on the stated aspirations.

Not only personnel but the entire culture within our society and the NHS in particular needs to undergo a fundamental change.

 

 

 

Day 475

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A family doctor said to newly bereaved parents, “Now that he is dead I can tell you that he had attempted suicide once before.”

Information sharing and Suicide prevention is a clear and concise consensus document that was published in January 2014 by the Department of Health together with the GMC, Royal Colleges of psychiatry, nursing, psychology and social workers. It clearly states:

“We strongly support working closely with families. Obtaining information from and listening to the concerns of families are key factors in determining risk. We recognise however that some people do not wish to share information about themselves or their care. Practitioners should therefore discuss with people how they wish information to be shared, and with whom. Wherever possible, this should include what should happen if there is serious concern over suicide risk.

We want to emphasise to practitioners that, in dealing with a suicidal person, if they are satisfied that the person lacks capacity to make a decision whether to share information about their suicide risk, they should use their professional judgement to determine what is in the person’s best interest. It is important that the practitioner records their decision about sharing information on each occasion they do so and also the justification for this decision.

Even where a person wishes particular information not to be shared, this does not prevent practitioners from listening to the views of family members, or prevent them from providing general information such as how to access services in a crisis.”

This must be the best kept secret.
Let it be known to all that there is no confidentiality when it comes to suicide.

Day 474

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The National Suicide Prevention Alliance (NPSA) is a coalition of public, private and voluntary organisations in England. Their mission is to get all parts of society working together to take action to reduce suicide and improve the support for those bereaved by suicide.

Today I attended their annual conference on ‘Empowering Communities through Collaboration’. There were more than 200 people in the room, all there to learn more about suicide prevention. The first speaker was Rt Hon Alistair Burt, Minister of State for Community and Social Care, Department of Health. He talked about ‘localism’- ways to handle the problem of suicide in communities using local people and resources, designed specifically for their needs. He talked about tackling stigma through ‘Time for Change’ , looking after those bereaved through Facing the Future and the booklet Help is at Hand . He invited questions at the end his talk.

I put Saagar’s abridged story to him and emphasised the dire need for mandatory Suicide Prevention training for medical students and GPs. I must have spoken for just two minutes and a huge applause followed. He noticed the support from the house for this proposal and promised to take it back to the DoH (Department of Health) for further discussion. Let’s see what comes of it.

Young Jonny Benjamin shared what it is like to have schizo-affective disorder and be suicidal, how difficult it is to ask for help and how quickly one can ‘flip’. He said he could never talk to his parents about his suicidal thoughts. They had given him everything and more. Telling them about these thoughts would be like throwing it all back in their faces. He still sometimes feels suicidal but knows that it will soon pass. He finds it easier to talk with strangers. He has hope. He thanked us all for doing the work we do. I understand now but I wish Saagar could have told me how he felt. I wish it was Saagar standing there and talking. I wish for time to rewind to 16 months ago. I wish I knew then what I know now.

All in all, it was a good day.

Day 469

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This afternoon one of my junior colleagues mentioned that his wife had just finished her 3 years of GP training. During those 3 years she has not spent any time in psychiatry.
It takes 7 years of training to specialise in any particular medical discipline. But it is expected that GPs should know a little bit about everything in 3 years. That seems rather disproportionate. Without any training, how can they be well equipped to look after 1 in 4 of their patients who will present with a mental illness?

It is not uncommon to hear GPs say that when they call specialist services, they can sometimes be left holding the phone for hours. They often don’t get the support and advice they need. Some general practices have doctors with special interests, such as gynaecology, dermatology, psychiatry etc. Others don’t. Some GPs work in isolation. Others have no interest in psychiatry.

Of late the news has been resplendent with the issue of ‘hospital deaths’ being more over the weekends. It is almost illegal to die in a hospital as it brings a bad name to the organisation. However anyone can die unnoticed in the community and it seems to be nobody’s problem.

No health without mental health : a cross-government mental health outcomes strategy for people of all ages’ sets out six shared objectives to improve the mental health and well-being of the nation, and to improve outcomes for people with mental health problems through high quality services. The strategy was produced in collaboration with many of the Department’s partner organisations. It will enable more decisions about people’s mental health to be taken locally, and stresses the interconnections between mental health, housing, employment, and the criminal justice system.

For those who only understand the language of money, Knapp et al at London School of Economics studied the economic benefit of GP training and concluded that investment in GP suicide prevention training is cost ­saving overall from year 1. The intervention appears highly cost­ effective from a health system perspective alone.

Hence there is a strong case for suicide prevention training for GPs.