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 890

UNIVERSITIES MISS CHANCE TO IDENTIFY DEPRESSED STUDENTS
– A study from Chicago, by Marla Paul in Jan 2011.

This study surveyed 1,622 college students. One out of every four or five students who visits a university health center for a routine cold or sore throat turns out to be depressed, but most centers miss the opportunity to identify these students because they don’t screen for depression, according to new Northwestern Medicine research.

About 2 to 3 percent of these depressed students have had suicidal thoughts or are considering suicide, the study found.

“Depression screening is easy to do, we know it works, and it can save lives,” said Michael Fleming, professor of family and community medicine at Northwestern University Feinberg School of Medicine. “It should be done for every student who walks into a health center.”

The consequences of not finding and treating these students can be can be serious and even deadly. “These kids might drop out of school because they are so sad or hurt or kill themselves by drinking too much or taking drugs,” Fleming said.

“Things continually happen to students – a low grade or problems with a boyfriend or girlfriend — that can trigger depression,” Fleming said. “If you don’t take the opportunity to screen at every visit, you are going to miss these kids.”

The frequency of depression and suicidal thoughts among campus health clinic users was nearly twice as high as rates reported in general college samples.

Depressed students need treatment, which may include counseling and medication. These students are more likely to drink, smoke and be involved in intimate partner violence, the study found.

With new technology, screening students is simple. While waiting for an appointment at the health center, the student could answer seven simple questions – a depression screening tool that that could be immediately entered into his electronic health record. “They can answer those seven questions in a minute,” Fleming said. Universities typically separate mental health treatment from primary care treatment. If a student comes to a campus health center and complains about depression, he is referred to a counseling center.

“If we screen, we can try to find every student that is depressed.”

Historical perceptions and biases against preventive screenings are that kids who need treatment the most don’t go to campus health centers, and they won’t tell the truth about their depression.

That’s wrong. “Students will tell you the truth,” Fleming said. “If they are sad and depressed, they will tell you that. And, kids who are drinking too much or who are suicidal do go to the campus health centers.”

 

Day 888

Dying from Inequality – Samaritans commissioned eight leading social scientists to review and extend the existing body of knowledge on socioeconomic disadvantage, ie. being poor, addressing three key questions:

  • Why is there a connection between socioeconomic disadvantage and suicidal behaviour?
  • What is it about socioeconomic disadvantage that increases the risk of suicidal behaviour?
  • What can be done about it?

A few excerpts:

Neighbourhoods that are the most deprived have worse health than those that are less deprived and this association follows a gradient: for each increase in deprivation, there is a decrease in health. Additional support for those living in deprived areas is needed to reduce geographical inequalities in health and the risk of suicidal behaviour.

Economic uncertainty, unemployment, a decline in income relative to local wages, unmanageable debt, the threat or fear of home repossessions, job insecurity and business downsizing may all increase the risk of suicidal behaviour, especially for individuals who experience socioeconomic disadvantage.

Unmanageable debt is an important risk factor for suicidal behaviour. Financial advice and support for those at risk of having unmanageable debt can help reduce the risk of mental health problems and suicidal behaviour.

Suicidal behaviour and mental health problems, such as mild-to-moderate anxiety and depression, could be reduced through labour market policy design, such as higher spending on active labour market programmes and unemployment benefits.

People living with socioeconomic disadvantage and inequalities are more likely to experience negative events during their life, such as job loss, financial difficulties, poor housing, and relationship breakdown. This can lead to negative emotions and increase the likelihood of suicidal behaviour.

Ref:

Dying from Inequality: http://www.samaritans.org/sites/default/files/kcfinder/files/Samaritans%20Dying%20from%20inequality%20report%20-%20summary.pdf

arundhati-roy_picture-quote

Day 850

Findings of National Confidential Inquiry into suicides and homicides by people with Mental Illness – 20 year review published in 2016 :

Key elements of safer care in Mental health services

  1. Safer wards: Removal of ligature points /Reduced absconding / Skilled in-patient observation
  2. Early follow-up on discharge from hospital to community
  3. No ‘out of area’ admissions for acutely ill patients
  4. 24 hour crisis resolution/home treatment teams
  5. Community outreach teams to support patients who may lose contact with conventional services
  6. Specialised services for alcohol and drug misuse and “dual diagnosis”
  7. Multidisciplinary review of patient suicides, with input from family
  8. Implementing NICE guidance on depression and self-harm
  9. Personalised risk management, without routine checklists
  10. Low turnover of non-medical staff

Key elements of safer care in the wider health system:

  1. Psychosocial assessment of self-harm patients
  2. Safer prescribing of opiates and antidepressants
  3. Diagnosis and treatment of mental health problems especially depression in primary care
  4. Additional measures for men with mental ill-health, including services online and in non-clinical settings

There is strong evidence for all of the above.

5 items from the first list (MH Services) were missing for Saagar.
4 were not applicable. One, I am not sure of(rate of staff turnover).

All 4 items on the second list were missing for Saagar. The ‘wider’ health system did him more harm than good.

Can we turn this evidence into action before hundreds more die? Please.

Reference: http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/reports/2016-report.pdf

Day 848

calabi_yau_formatted-svg

Three centuries ago, Newton thought that reality had 3 basic components: time, particles and space. This model didn’t explain everything. Soon other forces that govern movement of particles came along like electromagnetism. Photons, gravitons and gluons emerged yet the essential ingredients of reality remain a mystery.

To explain gravity, Einstein merged space and time into a composite, space-time. Michael Faraday added the concept of a classical field that carries forces through empty space. Quantum Theory showed that all mass and energy are really excitations of underlying quantum fields. Quantum fields and space-time are incompatible, so perhaps there is a more basic component hidden beneath.

In the late 1990s, String Theory was proposed. I don’t understand it fully but basically it says that elementary particles emerge from the vibrations of one-dimensional strings. Therefore, an electron is not really a point, but a tiny loop of string. If it oscillates one way, we see an electron. If it oscillates in another way, then we call it a photon, a quark, or a …

Julian Barbour, a British physicist believes that space and time, united by Einstein must be uncoupled. The only way to define space is to consider it as the geometric relationship between observable particles. He argues that the universe is a set of possible configurations of the 3D geometry of space. He believes that these configurations or ‘snapshots’ exist in a space of possibilities. Time is not real but merely something we perceive – an illusion that comes about because the universe is constantly changing from one snapshot to another.

Spiritual masters have been teaching the concept of everything being an illusion for thousands of years. Physics seems to be catching up.

“Reality is merely an illusion, albeit a very persistent one.”
– Albert Einstein

Ref:

Day 829

Loneliness – a disturbing word, often invoking a sense of sadness and despair.

It’s not one thing. It is subjective. Imprecise.
It can be found anywhere.

When after many requests you still don’t have a sibling.
When you are born with skin colour darker or lighter than it should be.
When you are the new girl in class.
When you don’t get picked for the team.
When you sit alone at lunch time.
When you are not sure what you want and settle for what is available.
When you are stuck in a loop of cold-hearted bureaucracy.
When you are different.
When you are told ‘you should be happy’ by the one you are married to.
When you work from home and see no humans for many days.
When you feel you have to be somebody else to be successful and accepted.
When you are unable to have children.
When you have an abortion or a miscarriage.
When you have children and don’t see anyone but them all day everyday.
When your family is no longer a family.
When you have a fracture and are stuck in bed for weeks or months.
When ‘Facebook’ and ‘Instagram’  constantly offer comparisons.
When you get fired.

When you have just retired.
When a loved one suddenly disappears.
When you are blamed for a mistake you did not make.
When you get mugged.
When you are diagnosed with a serious illness.
When you are old and so easily forgotten.

Solitary confinement is one of the most severe forms of punishment because it can break your spirit. In 1951 researchers at McGill University paid a group of male graduate students to stay in small chambers equipped with only a bed for an experiment on sensory deprivation. They could leave to use the bathroom, but that’s all.  They wore goggles and earphones to limit their sense of sight and hearing, and gloves to limit their sense of touch. The plan was to observe students for six weeks, but not one lasted more than seven days. Nearly every student lost the ability “to think clearly about anything for any length of time,” while several others began to suffer hallucinations. “One man could see nothing but dogs.” A study at Harvard found that roughly a third of many solitary inmates they interviewed were “actively psychotic and/or acutely suicidal.”

In the biggest literature review into the subject of loneliness, the University of York looked at 23 studies involving 181,000 people for up to 21 years. They found that lonely people are around 30 per cent more likely to suffer a stroke or heart disease, two of the leading causes of death in Britain. More than 1 in 5 people in the UK privately admit they are ‘always or often lonely’. It is a public health problem.

I welcome the ‘Commission on Loneliness’ launched in memory of the murdered Labour MP Jo Cox, to look for practical solutions to reduce loneliness in the UK. Let’s do our bit, however small.
RIP Jo.

“Fools,” said I, “You do not know –
Silence like a cancer grows.
Hear my words that I might teach you.
Take my arms that I might reach you.
But my words like silent raindrops fell
And echoed in the wells of silence…
-Sound of Silence by ‘Simon and Garfunkel’

Ref:

http://www.telegraph.co.uk/news/2017/01/31/mps-launch-jo-coxs-commission-loneliness/
http://www.telegraph.co.uk/science/2016/04/19/loneliness-is-public-health-problem-which-raises-risk-of-stroke/

 

Day 821

Suicides are grossly under-reported. Here are a few reasons for that:

  1. Criminal standard of proof, “beyond reasonable doubt”, is required when determining the cause of death as suicide. Many suicides are recorded as ‘undetermined deaths’ because of that. The Chief Coroner is supportive of the change which would reduce the standard of proof for suicide to the civil standard and has expressed his view to the Ministry of Justice but the MoJ has steadfastly refused to change the way that coroners reach a suicide verdict despite persistent requests from Suicide Prevention charities such as PAPYRUS. This leads those of us campaigning on this issue to conclude that they deliberately want to suppress the figures around the number of people who take their own lives each year.
  1. MoJ argues that a change to the law would offend certain faith groups. We, at PAPYRUS believe that determining a cause of death should be about establishing facts, not about appeasing any particular sector of the community.
  1. Many families who have lost loved ones to suicide, particularly when the deceased are their children, do not want to hear that they ended their own life. Coroners are understandably sensitive and hence, reluctant to reach a verdict of suicide and conclude that the death occurred because of an accident or misadventure. An open or narrative verdict is often returned even when the evidence clearly shows that the person took his or her own life.
  1. Death is taboo and suicide is a deeper layer of taboo underneath. Mental illness is taboo and suicide is a darker layer of taboo underneath. The stigma attached to it stops everyone from being open about it.

Research by Professor Colin Pritchard at Bournemouth University suggests that if coroners used the civil standard of proof – “on the balance of probabilities” – we would see a 30-50% increase in recorded suicides. His research validates the view held by Papyrus that the current arrangements mask the true number of suicides in the UK.

Unless we can face the enemy, how can we ever hope to vanquish it?

Sources:

https://www.theguardian.com/commentisfree/2017/jan/09/suicide-crisis-law-uk-cause-of-death-young-people

http://www.inquest.org.uk/help/handbook/section-4-3-verdicts

http://www.thetimes.co.uk/article/thousands-of-suicides-hidden-to-comfort-grief-stricken-families-5fhkspfbx