A landscape of musical notes emanated from four musical instruments inspired by movement of people across the globe in search of a land of gold. When I closed my eyes, I could feel the magical textures at my fingertips and sense the turbulent river flowing and a lone vessel struggling to carry a tonne of isolation and desperation across to a place of hope. Vibrant colours could be heard and pathos felt in the core of my heart and every pore on my skin. The conversations and unison between those colours filled the space with absolute empathy for those forced to leave their homes, a cry against injustice of the refugee crisis. Crossing the Rubicon….dissolving boundaries…reunion…last chance…a boat to nowhere…
Land of Gold – an ode to those displaced.
Find the kind heart,
Rest your feet and soul.
May your kind heart
Find the land of gold.
Pay attention, say your name
Listen closely and keep warm.
Gentle hands, you are brave,
Look at me and carry on.
All is good, I love you.
You can hear me, you can call.
Sing your song with ease and pride.
I’ll be there, not far behind.
Tell them I walked
Tell them I walked your way
Tell them I walked
Tell them I walked your way
“Thank you Gas-lady” said the surgeon at the end of our working day as he picked up his bag to leave the operating theatre. I acknowledged it with a smile and a nod. That’s sweet. At that moment it didn’t register but later I realised that he does not know my name. We have worked in the same theatre complex one day per week for the past 4 years and he does not know my name. That’s interesting. I wondered how many people I see on a regular basis and don’t know the names of.
How did that make me feel? Not exactly insulted but definitely unimportant. I found myself making excuses for him – may be he finds my name difficult to remember. It is a foreign name after all. But this is London and many people here have foreign names. May be it is a reflection of a basic power imbalance – every one knows his name but he doesn’t have to know everyone’s name.
Knowing a name is a small thing, but it makes the difference between making someone feel that they matter or they don’t. When our name is known, we are more likely to have a sense of belonging to a person or a group. It also means that who we are is central to the interactions we have.
“Could someone get the defibrillator please?”
“James, could you please bring in the defibrillator?”
Which one of these two statements is likely to produce a quick and effective result? Knowing names can make it easier to get a job done.
Patients are not diabetics, schizophrenics, bed 10, ‘last on the list’, so on and so forth. They have their names and unique identities. Of course, it is not always easy to remember names. It does take some effort. It is easier to put in that effort if we know how much of a difference it can make not only to others but also to us. I find myself paying more attention to names now. Even if I get it wrong, I like to think I tried.
It is definitely worth the effort.
( Saagar was really good at remembering names. In fact, the more unusual the name, the more fun he had with it. Well, there’s a name I’ll never forget – Saagar.)
A survey of 500 people revealed that a third of people didn’t feel comfortable at all talking to someone at work about mental health related issues and only 15% have had a colleague speak to them about their mental health.
The survey also uncovered an interesting trend: nearly a third of all male respondents have never had a friend, family member or colleague speak to them about their mental health. Worryingly, this statistic rises to 42% for males aged 45 and over and increases yet again to 60% for males aged 54 and over.
“I would say that the vast majority of people who die by suicide, don’t necessarily want to be dead—they want to end their suffering and don’t know what else to do. We know from our clinical treatment research that suicidal suffering can be effectively treated. There is hope; suicidal states can be effectively treated and people can and do recover from suicidal suffering.”
David A. Jobes, Ph.D., ABPP. Professor of Psychology. Author of Managing Suicidal Risk
When our GP heard of Saagar’s death, the first phone call he made was to the Medical Defence Union and they advised him not to call us. Despite having known us for more than 7 years and seeing Saagar every 2 weeks with us for the last few months of his life, he did not call us on his death.
A qualitative study of GPs’ experiences of dealing with parents bereaved by suicide by Emily Foggin et al was published last month in the British Journal of General Practise.
It acknowledged that bereavement by suicide is a risk factor for suicide but the needs of those bereaved by suicide have not been addressed and little is known about how GPs support these patients, and how they deal with this aspect of their work. 13 GPs in the UK were interviewed in a semi-structured format. It explored experiences of dealing with suicide and bereavement.
GPs disclosed low confidence in dealing with suicide and an unpreparedness to face parents bereaved by suicide. Some GPs described guilt surrounding the suicide, and a reluctance to initiate contact with the bereaved parents. GPs talked of their duty to care for the bereaved patients, but admitted difficulties in knowing what to do, particularly in the perceived absence of other services. GPs reflected on the impact of the suicide on themselves and described a lack of support or supervision.
It concluded that GPs need to feel confident and competent to support parents bereaved by suicide. Although this may be facilitated through training initiatives, and accessible services to refer parents to, GPs also require formal support and supervision, particularly around significant events such as suicide. Results from this qualitative study have informed the development of evidence-based suicide bereavement training for health professionals.
This evening a vigil was held by SOBS (Survivors Of Bereavement by Suicide) at Hyde Park to remember those lost through suicide. Some of the people there had lost a brother 25 years ago or a sister 5 years ago or a friend 1 year ago and so on. Some of the families had not been able to speak about it for many years. Others had kept quiet as they were not sure if anyone would understand. But in that space, we sat together on the brownish-green grass with the pictures of our loved ones and lit candles in their memory and we opened our hearts. For about 2 hours we claimed that space and made it our own knowing full well that we are being listened to and perfectly well understood. What a rare gift that is!
When it comes to suicide, post-vention is pre-vention.
11.51: Bullies at school are telling the next female caller to take her own life. She’s upset and agitated and feels anxious about talking to her parents or GP. After talking through the issues, she says she’s not in immediate danger and will try to talk to her parents and seek support from her GP or the charity if she feels it necessary.
13.49: A mother calls about her son who is struggling at university and has told her he may as well not be alive. She is worried he might be suicidal.
The adviser talks to her for half an hour about asking her son directly about suicide and discusses what other support he may need, including talking to his GP and giving him the HOPELineUK details. Afterwards, the mum says she is more confident about speaking to her son.
18.32: With the suicide prevention advisers on calls, a voicemail is left by a young man. He calls back eight minutes later and starts apologising for calling the helpline.
He’s made plans to take his own life today and despite calling his mental health team and telling them he’s suicidal, he’s still waiting for his case worker to call back.
After 42 minutes on the phone with the helpline suicide prevention adviser, he’s much calmer and says he won’t take his own life today.
18.53: A young transitioning transgender person calls, admitting she’s feeling suicidal today. She spends 23 minutes talking through her issues with a suicide prevention adviser who works with her on a plan to stay safe over the coming hours and signposts her to support networks she may find helpful.
19.38: A text comes in from a young father who says he’s feeling suicidal. He suffered domestic abuse as a child and, as a result of alcohol and drug addiction, has lost contact rights with his own children. He says he has his suicide method in front of him and is intending to end his life.
Let’s break the silence. Hopeline number: 0800 068 4141
About 5 months after Saagar’s passing, one of my close friends sent me a subtle message suggesting that I should be careful about what I write in my blog as a few of my work colleagues read it regularly and if I appear to be too fragile or vulnerable, it might have a negative impact on my professional life. I understood her concern. The medical profession is not known for its understanding and compassion for mental frailty in colleagues.
Dr Wendy Potts was a GP in Derbyshire who blogged about living with Bipolar Disorder on a regular basis. One of her patients read the blog and complained to her Practise. The doctor was suspended. A few weeks later she ended her own life.
Firstly, I don’t understand the basis of the complaint. Would patients complain if their GP had diabetes or cancer?
Secondly, I don’t understand the basis for suspension from work. If the doctor’s performance was not questionable, then there is no ground for that.
This is one of many examples of poor treatment of medical colleagues with mental health issues. I think we are a long way from seeing parity between physical and mental illnesses as the ones who are supposed to put that into practise are themselves caught in the stigma associated with mental illness.
(PS: apologies for not being able to insert the link to the article in a better way. The ‘link’ icon on my page doesn’t seem to work anymore. Any ideas? )
The stress vulnerability model was proposed by Zubin and Spring (1977). It proposes that an individual has unique biological, psychological and social elements. These elements include strengths and vulnerabilities for dealing with stress.
In the diagram above person “a” has a very low vulnerability and consequently can withstand a huge amount of stress, however solitary confinement may stress the person so much that they experience psychotic symptoms. This is seen as a “normal” reaction. Person “b” in the diagram has a higher vulnerability, due to genetic predisposition for example. Person “c” also has genetic loading but also suffered the loss of mother before the age of 11 and was traumatically abused. Therefore persons “a” and “b” take more stress to become “ill”.
This model is obviously simplistic. However it does help with the understanding of psychosis. Vulnerability is not a judgmental term but a different way to approach the variables involved. We all have a different capacity to take on stress depending on how vulnerable we are. At different times in our lives we can be anywhere on the curve, depending on these variables.
Increasing coping skills or altering environmental factors (family, work, finance, housing etc.) and specialist help can reduce vulnerability and build resilience. Attending a peer group may help to build self-efficacy, self-esteem and self-acceptance all of which may be protective against relapse and form a buffer to demoralisation. It gives hope!