Asian countries account for more than 60% of world suicides.
According to the WHO, in the year 2016, suicide was the most common cause of death in the 15-39 age bracket in India, the highest in the South-East Asian region. India’s own official statistics, which map the number and causes of suicides in the country, have not been made public for the last three years, hindering suicide prevention strategies and efforts to implement the WHO’s recommendations in this regard.
In 2014, the WHO released a report with a series of recommendations for successful suicide prevention. It proposed a public health model for suicide prevention, consisting of four steps:
Identification of risks and protective factors
Development & evaluation of interventions
India has not progressed beyond the first step. Lack of political will, social stigma and inadequate mental health awareness in the general and medical communities contribute to the continuous rise in the death rate of young people by suicide in India.
A Junior Doctors World Congress was held at my alma mater, Christian Medical College Ludhiana in April 2019. Si and I ran a Mental Health Workshop that was attended by 75 medical students from India and the wider South and South East Asia region.
Motivated by this event, some students have established community mental health support networks and mentorship programmes at their respective institutions. I am impressed with their passion to make a difference.
Here is an example:
Early March I was back in Delhi and was honoured to be invited by Shruti Verma Singh, the founder of a Youtube channel, Zen-Brain.com. She is determined to increase the emotional awareness in India and does it gently, through a series of interviews. We met one afternoon to talk about Saagar. I hope her work will help wake up the government, break social stigma and drive understanding and compassion.
Paramedics and trainee paramedics rotate through our Department of Anaesthesia to learn to manage airways safely. A few weeks ago, I had a young man in his mid-thirties, a trainee paramedic with me, learning about airway management. Out of curiosity I asked him, “What is the most annoying part of your job?” He was straight-up, “When people inflict injuries on themselves, I think it’s such a waste of time. It takes away from others with real problems, who really need our attention.” I just smiled. I wasn’t surprised. I know full well that paramedics do a great job of looking after all kinds of people in all kinds of trouble. But attitudes can only be changed through education.
A professor of Psychiatry tweeted today “Twice in the last week I’ve been told of cruel comments by health staff to people who had self-harmed. I really believe this is unusual now but it shows there is something deep-rooted that we have to eradicate.” A classic example of ignorance within medicine of attitudes within medicine.
No training of first responders is complete till someone
with lived experience of a mental illness has spoken with them, be it a police
academy, social workers, fire fighters, nursing or medical students or
ambulance crew. Lived
experience includes suicide attempt survivors, others who have experienced a
suicidal crisis and those who have lost a loved one to suicide. Sharing by
these individuals can be a powerful agent for challenging prejudice and
generating hope for people at risk. It enriches the participant’s understanding
of how people with these serious disorders cope with their symptoms, recover
and lead productive lives with hope, meaning and dignity. The program also
empowers those who are faced with mental illness and provides living proof that
recovery is an ongoing reality. Presenters gain confidence and self-esteem
while serving as role models for the community.
focus on research and clinical expertise too frequently fails to see the person
at the centre of a crisis as well as their loved ones who ride the wave of
terror of suicidal behaviour. This needs to change and with urgency.
Lived Experience is an underutilised and underappreciated resource in the UK.
Roses in the ocean, a charity in Australia is an excellent example of harnessing this invaluable resource and making a huge difference.
” A schoolgirl’s been murdered in our area. It’s a horrible, horrible thing to happen – never should have and is just another reminder of this shit world we live in. I’ve been trying not to follow the news on it but they released CCTV footage of her last known moments and it was actually somewhere my brother drives past on the school run four times a day so I did watch it all and check the timings to just make sure he wouldn’t have been there and possibly seen something. (Different time of day)
I’ve just been struck by how it’s pulled the community together. There’s been balloon releases, marches, leaflet drops – the mum is clearly being very much supported ….I couldn’t find one person willing to have a cup of tea with me; three years on I still can’t. And I know suicide is different. Murder is evil; what was done to this poor girl, there’s absolutely no doubt people should be outraged by it…and I know suicide is about making a decision – albeit a stupid and flawed one…. but there are things I don’t understand why they’re quite so different.
The Head teacher of the girl’s school implored students to come forward because answers were needed. We needed answers with Shauna and anyone at her school who knew anything got told it wasn’t an appropriate thing to discuss. We even had a girl go to her teacher with some information, get told off for it and then to choose to write independently to the Coroner’s Court (with info we found hugely relevant but was promptly disregarded.)
Today the girl’s school announced that they’ll be making a memorial garden for her with lots of nice words about there always being a place for her and her never being forgotten. Shauna’s name wasn’t even allowed to stay on the Year 11 hoodies. The gesture is nice but the words; it would have made such a difference to us if someone had said stuff like that to us.
There was just both girls of a similar age and it’s just really brought it home how differently people see these things. I’m glad this Mum has the support that she so desperately needs, I don’t begrudge her it – I just wish it wasn’t so glaringly different how people reacted – this Mum is a heroine because of what she’s had to endure, we’re just potentially neglectful parents who should be forgotten about/ignored 😦
I don’t know if I’m making any sense. Like I say I do understand it. It doesn’t stop it hurting though. 😦 “
S is for Saagar.
For Simon and Sangeeta.
Sudden shocking jolt
For shameful silent suffering,
Like one strike of lightening
Sucking up a few lives at once.
S is for surreal memorial services
Soul-searching and seeking
Sometimes screaming out-loud
Shattered dreams, salty tears,
And sweet memories
Strewn across the wooden floor
Like techni-coloured glass beads.
S is for simplicity
Sparkling smiling eyes
Salvation and solace
Shiny haloes and surrender
Like the curve of a weeping willow
Stooping down to kiss the ground.
S is for sharing
Speaking out loud
Saffron rice and saag-paneer
Saturdays and Sundays
Self as everything
Like the stars, songs and strings
Of guitars, and drum skins.
S is for solitude
Silence and serendipity
Sublime sun and sea
Sunflowers and sushi
Shirts and silk ties
Subtle messages from beyond
Like smoke signals in the distance
Sent out by friends from before.
S is for stigma of suicide in society.
Stashes of hidden sadness
Shrouded in small dark spaces
So little support and understanding
Such little compassion
Screened behind sports-cars
Suntans and scotch.
Like a corpse in the room
‘Children and Young People’s Mental Health – Taking Early Action’ : title of a conference I attended today.
The hall was packed with 350-400 people, working for the well-being of kids as teachers, social workers, decision makers and others. Two speakers mentioned suicide in the passing – Rt. Hon. Norman Lamb MP, who lost his sister through this tragedy 2 years ago and Richard Andrews, who set up the charity Healios after experiencing serious difficulties in accessing support for friends and family affected by serious mental illness.
One of the professors spoke about the reasons for early deaths of people with mental ill-health. He attributed this mainly to physical problems such as hypertension, obesity and smoking related problems. Death by suicide wasn’t mentioned.
I learnt a lot, some of which I shall share in the next few days. A Green Paper is being drawn up to set out proposals for delivering better mental health support for children and young people. During one of the question times, I suggested that bearing in mind that suicide is the biggest killer of young people in this country, 2 things must be included in the Green Paper –
Suicide Prevention Training for all medical and nursing staff and students, just like CPR training, to bring parity of esteem between physical and mental ill-health.
Meaningful sharing of information about para-suicidal young people between medical teams, police, first-responders and families, in the best interest of the patient.
This remark was met with a stunned silence. The room froze. The chairperson mumbled something like ‘eloquent…’ and rapidly moved on to the next person.
Stigma lives here too. Inside the healthcare community.
A bereaved mum’s lament: Went out for dinner with friends. What could go wrong? All went well until there was talk of an acquaintance of one of the guests who is suffering from a debilitating mental illness. They had tried to take their life but survived. The guest herself is a breast cancer survivor. She said that she had visited the person and said “did they not realise how hard she had fought to live and there they were throwing away their life”. Its a shame she didn’t appreciate just how hard the other person was fighting to stay alive … my son lost that fight. When will they realise Depression is as dangerous and potentially fatal as cancer. You know when you are stuck in a situation when its just not appropriate to make a fuss but you want to scream “How ignorant are you ???”
From the individual level, right through the media, the regulatory bodies and up to the government, we are all ignorant. Mrs May speaks of parity between physical and mental illnesses, ie. both being given the same importance. Many others have talked about it before her but we are miles away from it.
The Ebola Outbreak in West Africa was a public health emergency of international concern and we heard about it everyday, non-stop on the radio and TV from 2014-2016. 1 person was infected with the virus in the UK and fortunately there were no deaths from it. 1 person dies every 2 hours by suicide but it is not mentioned in the media. Public health England are not particularly concerned. Suicide claims 4 young lives every day but it’s no big deal.
Imagine a middle aged man presenting to his doctor with severe chest pain and being sent home with pills that take 3 weeks to work. I am sure the GMC would have something to say about that. A young man presents to his doctor with debilitating depression together with a strong desire to end his life and he is sent home with pills that can potentially make suicidal ideation worse and the benefit, if any might be seen in 3 weeks. The GMC finds that acceptable practice.
1 in 4 patients present with a mental illness to the NHS and only 10-12 % of the NHS budget is spent on mental health.
Survivors of physical illnesses proudly claim bravery and wear their survival as a badge of honour whereas those surviving mental illness hide in corners feeling ashamed.
The acceptable faces of mental illness are Dementia and Alzheimer’s disease. This is apparent from the t-shirts worn at charity events, walks and runs. I hardly see anyone running in support of Bipolar Disorder research or British Schizophrenia Foundation or Borderline Personality Disorder Charity.
Things most resistant to change are cultures and mindsets.
Parity of esteem?
We have aeons to go!!!
I love Lucy.
Mad about you
Will and Grace
Sex and the City
All very popular. All featuring happy, funny, quirky characters. All based in New York City.
It seems NYC is not such a happy place after all.
– At least one in five adult New Yorkers is likely to experience a mental health disorder in any given year.
– 8% of NYC public high school students report attempting suicide.
– Consequences of substance misuse are among the leading causes of premature death in every neighbourhood in New York City
– Each year, 1,800 deaths and upwards of 70,000 emergency room visits among adults aged 18 to 64 can be attributed to alcohol use.
– 73,000 New York City public high school students report feeling sad or hopeless each month
– Approximately 8% of adult New Yorkers experience symptoms of depression each year
– Major depressive disorder is the single greatest source of disability in NYC
– At any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40% report receiving care for it.
– There are $14 billion in estimated annual productivity losses in New York City tied to depression and substance misuse.
– Unintentional drug overdose deaths outnumber both homicide and motor vehicle fatalities.
– The stigma of mental illness has been found to have serious negative effects on hope and an individual’s sense of self-esteem. Stigma also increases the severity of psychiatric symptoms and decreases treatment adherence.
The First lady of NYC, Ms Chirlane McCray recognised this as matter of public health in crisis and launched a bold initiative last year in order to tackle it. It cost nearly a billion dollars. It is called Thrive NYC (http://www1.nyc.gov/assets/home/downloads/pdf/press-releases/2015/thriveNYC_white_paper.pdf). It relies heavily on peer counsellors, who are not mental health professionals but are already entrenched in underserved communities. One of its main objectives is to address the stigma associated with mental illness. The plan is aggressively ambitious, attempting to make life easier for New Yorkers in every community and of every age.
I hear the Mayoral office in London is making plans of a similar nature. Can’t wait to hear more. It’s about time!
“Random thoughts”, he said, looking perplexed. “I keep getting these random thoughts.”
“Thoughts of what exactly?” I would ask.
I didn’t know how to explore any further.
He confided in at least 3 men he trusted about his suicidal thoughts and none of them knew what to do.
He specifically told them not to tell me about it. He even shared his plan with one of them. But he did not know what to do.
Not his fault.
No one is taught what to do in a situation like that.
How would you feel if some one came up to you and said they were seriously considering ending it all?
Calm and confident knowing exactly what to do as if you were being asked to do CPR?
What would you do?
Break into a sweat?
Think they are kidding?
‘Fix it’ for them?
Take them to A&E?
Ask them to see their GP?
Connect them to the Samaritans?
Tell them to get over it because life is beautiful?
Yesterday I watched a video of a skilful conversation between a suicidal person and a person in a position to help. It was a caring and respectful exchange designed to model an evidence based framework which has been developed over 30 years by LivingWorks whose mission is to create a life-affirming suicide-safer world (https://www.livingworks.net/programs/asist/). It made me cry floods of tears as I was reminded why the poor bugger didn’t have a hope in hell. Even his doctor didn’t know CPR or what would be CPR for him. The video was a part of the ASIST Course (Applied Suicide Intervention Skills Training). Regardless of prior experience LivingWorks enable ordinary people to provide suicide first aid. They have training programmes lasting from 90 minutes to 2 days. Shown by major studies to significantly reduce suicidality, LivingWorks courses teach effective intervention skills while helping to reduce stigma and raise awareness.
While speaking with the trainers of ASIST it emerged that the most difficult group to train is GPs as they can never make time. The last General Practice who contacted them wanted them to come at lunch time for half an hour and provide training and lunch for all staff members in that time.
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.
“Take care of your feet” has been the resounding advice and part of best wishes from all my friends and colleagues over the past few days, on hearing of the upcoming long walk. Guess what. All that distance and not a single blister. Regular trainers. Nothing fancy. Regular hiking socks and lots of ‘compede’ in the bag but none on the feet. My feet just don’t blister. Must be my thick skin!
Before the walk, I didn’t think I could do it.
Before Saagar passed away, I didn’t know I could survive it.
After the walk, I know I can even though at times it seemed impossible to go on.
Nearly 2 years after Saagar, I know I can, even though at times it seems impossible to go on.
Both of these experiences, while not comparable, took me right outside my comfort zone and put me in a very vulnerable and painful place. And I am still here, learning new things about myself and the world around me everyday.
A young man from Scotland survived a serious suicide attempt in May 2015. He suffers with depression. He is now cycling around the world to raise awareness of mental health and suicide prevention. His journey will take him to 80 countries on 6 continents. He calls himself ‘The Tartan Explorer’ (http://tartanexplorer.com/) and his name is Josh Quigley. Good luck young man!