Patient safety

Day 530

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Self-harm. What can we do?

Well, the most important thing is to keep one’s prejudices aside. It is also the most difficult. Ask them how they feel and listen with empathy.

Put no blame on them so they don’t feel guilty about it. Respond as calmly as you can and try not to appear shocked or angry. Don’t be dismissive. Self-harm could be an important warning sign.
Perform first aid and accompany the person to A&E or the GP as appropriate.
Ask directly about suicidal thoughts.
If they share thoughts of suicide, continue listening and ask open-ended questions.
Stay with them.
Reassure them.
Tell them about the treatments and support available such as school nurses and CAMHS for the young and clinical psychologists, psychiatrists and counsellors in general.

Introduce them to ways in which they can help themselves: relevant books and websites; keeping a mood diary to monitor thoughts and feelings; regular exercise and healthy eating; reducing caffeine; getting support from friends and family; identifying enjoyable activities and finding ways of spending time doing those; identifying local support groups and addressing underlying mental health problems.

Saagar’s discharge letter from psychiatric services said – “No history of self harm.” They were wrong. On questioning they said that it was because he had never presented to A&E having harmed himself. But that is not a criterion. I don’t know if he was ever specifically asked about it or whether he misled them. He had prominent burn marks on his left forearm that could easily be picked up by trained eyes. When I asked him about it he made up a story to assuage my worries and made nothing of it.

I didn’t pick up the seriousness of it and sadly, we never spoke about it.

Day 523

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Chris was 31 when he died by suicide.

After his death it was discovered that his depression was likely to have been an effect of a head injury he had when he was seven. Recent research shows that many people who have had a head injury have hormone deficiencies afterwards, caused by damage to the pituitary gland. Chris suffered not just depression but also impotence, both of which can be caused by hormone deficiencies.

About a million people with head injuries are seen in A&E departments every year in the UK and there is growing concern that doctors are missing a common complication that may not become apparent for months, sometimes years, after discharge.

Post-traumatic hypopituitarism (PTHP) occurs when the pituitary gland, a vulnerable walnut-sized structure at the base of the brain is damaged following a blow to the head. The gland regulates the actions of eight key hormones controlling the immune system, stress response, thyroid function, growth, puberty, sex drive and fertility. It acts like the conductor of an orchestra, ensuring that the right amount of hormones are released at the right time. Chaos ensues if it stops working properly.

The resulting symptoms vary depending on the degree of injury and the hormones affected. These may include lethargy, low mood, fatigue, weakness, loss of sex drive and impotence. Often these can be misdiagnosed as Chronic Fatigue Syndrome, Myalgic Encephalopathy(ME) or Fibromyalgia. A battery of tests need to be done to make an accurate diagnosis. Once diagnosed, the treatment comprises of replacing the deficient hormones.

Chris’s mother, Joanna Lane has been actively campaigning to raise awareness around PTHP within the medical community and the society at large. She has researched the subject in great detail on her website: http://www.headinjuryhypo.org.uk/index.html

Day 521

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It was too late by the time they found out but many of his friend’s knew. This couple was completely oblivious of their teenage son’s suicidal intent but he had spoken of it to many of his friends. They didn’t know what to do. They kept quiet. Now the parent’s campaign actively to prevent suicides and their main message for the young is – if any of your friends express suicidal thoughts, please speak to an older person you trust. That person could be you or me or a GP.

Trust is key. How many of us have a trusting relationship with our GP? Unluckily, I did but Saagar didn’t. He had only ever visited the practice twice –once to register as a patient and 6 years later to get his vaccinations before his trip to Uganda. I doubt if he saw the GP on any of those occasions. He didn’t even know the GP before he got really ill.

It is important for all of us to be aware of suicide risk because any of us could be asked for help by anyone at any time. That might be our one chance to keep someone safe.

PAPYRUS was founded in 1997 by a mother, Jean Kerr, from Lancashire following the death of her son to suicide. Gradually other parents all bereaved by suicide began to join her in the belief that something positive could come from their own tragedy.

Determined to prevent other parents suffering such pain, they began sharing their own personal experiences of loss in an effort to reduce the stigma surrounding young suicide and provide help to other parents worried about their child.

Since 1997, PAPYRUS has continued to listen to and learn from the experiences of those touched by young suicide. Today, PAPYRUS remains dedicated to offering support directly to young people at risk of suicide, their parents and any one concerned about a young person they know. Here is a link to their latest newsletter and contact details:

 https://www.papyrus-uk.org/news/item/papyrus-newsletter

Call: 0800 068 41 41

Email: pat@papyrus-uk.org

SMS: 07786 209697

Day 518

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A smartphone is a girl’s and boy’s best friend.

They are inseparable – on the train, crossing the road, eating, going to bed or just killing time. The phones tell us how to get from one place to another, where to eat, what to buy for a friend’s birthday, the name of an annoyingly familiar tune when waiting at the check-out desk. That is as ‘proper’ a relationship as can be. Siri, S Voice, Cortana and Google Now are technologies that listen and speak.

But when I say to them, “I am depressed,” they say things like:

“I’ll always be right here for you,”
“It breaks my heart to see you like that,”
“I hope I can make you feel better.”
“Keep your chin up.”
“Maybe the weather is affecting you.”

On the mention of suicidal intent, Google Now and Siri are the only ones that give out helpline numbers.
Sentences like: “I was raped” ; “I am being abused” ; “I was beaten up” are not recognised by any of these systems.

These devices are in the perfect place to be designed as first responders in a crisis situation. Some people might feel so isolated that their phones might be the only ‘person’ they can talk to. Just like we have automated vehicles, talking defibrillators and telephonic CPR instructions, we can incorporate useful and substantial information into these systems. It could make the difference between life and death.

Day 506

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Last week I attended an appointment at the new GP surgery with our (new) GP for my annual review of Rheumatoid Arthritis. It was more like the doctor had a consultation with the computer. He looked at the blood results, the prescriptions and notes. He measured my weight and blood pressure but he didn’t ask me anything about the condition I was there for. How are the joints doing? How long have I been in remission? He probably knows as do I that we might never see each other again. He is not ‘my’ GP. He works at the GP surgery where I am registered. I suppose he did what he could in the 10 minutes he was given. The achievement of the day was that I got the prescription of medications.

Last week I met a young man who has recently lost a parent to suicide. He went to his GP asking for help and was instantly offered antidepressant medication. He was dismayed as he knew that is not what he needed. He needed someone to talk to. “People in the UK are consuming more than four times as many antidepressants as they did two decades ago. Despite this, we still do not fully understand the effects of these drugs” says an expert from UCL.

The UK has the seventh highest prescribing rate for antidepressants in the Western world, with about four million Britons taking them each year — twice as many as a decade ago.

According to the analysis conducted by Nordic Cochrane Centre in Copenhagen, the clinical study reports on which decisions about market authorization of these medicines are based often underestimate the extent of drug related harms.”

Four deaths were misreported by one unnamed pharmaceutical company which claimed they had occurred after the trials had stopped. One patient strangled himself after taking venlafaxine but because he survived for five days, he was excluded from the results because it was claimed he was no longer on the trial while he was dying in hospital.

More than half of the suicide attempts and suicidal thoughts had been misrecorded as emotional instability or worsening of depression. In summary trial reports from the drugs giant Eli Lilly, suicidal attempts were missing in 90 per cent of cases. It appears that big pharmaceutical companies reap profits while carelessly tossing aside all human costs and ominously covering them up.