Day 925

Vulnerability. Not weakness.

Stories are data with a soul. Researcher and storyteller Brene’ Brown has taken the time to take a deep hard look at shame and vulnerability.

She believes that ‘connection’ is neurobiologically why we are here.

Shame is fear of disconnection or not feeling like you are worthy of connection. For example, not good enough, not pretty enough, not strong enough, not rich enough and so on. All experiences of excruciating vulnerability.

After 6 years of researching ‘Shame’ she took a closer at a sub-group of individuals with ‘Worthiness’, people with a strong sense of love and belonging who believe they are worthy of love and belonging. She called them  ‘Wholehearted’. This group had a few remarkable  traits:

  1. Courage – to be imperfect
  2. Compassion – ability to be kind to themselves and others
  3. Connection – ability to give up the idea of perfection

They fully embraced their vulnerability. They believed that vulnerability makes them beautiful. They were willing to reach out their hand first, to invest in a relationship that may or may not work out. It was not comfortable but they did it anyway.
Vulnerability is also the birthplace of tenderness, belonging, love and joy.

What makes us vulnerable?
The simplest things like asking for help, waiting for the doc to call back, initiating sex, loosing a job, asking someone out on a date and many more.

Why do we struggle with vulnerability?
The uncertainty is too uncomfortable. So we numb it.

At present, we are most highly addicted, medicated and obese populace ever.
We can’t selectively numb feelings.
When we numb vulnerability we also numb joy and connection.

The ways in which we deal with our discomfort with vulnerability are:

  1. We make everything uncertain, certain, eg- religion.
  2. We Blame- a way to discharge pain and discomfort.
  3. We Perfect – most dangerously our children.
  4. We pretend – like what we are doing doesn’t have an effect on people.

We need to let ourselves be seen.
To love with our whole hearts even if we are unsure.
To practice Gratitude despite the uncertainty because our vulnerability means we are alive.
Lean into joy and believe – I am enough.
That enables us to be kinder and gentler to the people around us and to ourselves.

Ref:

Book :
Daring Greatly by Dr Brene Browm
TED talk by Dr Brene Brown on Power of Vulnerability:

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