suicide bereavement

Random stuff

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After many years, things are being taken out of cup-boards and off shelves, turned inside out and properly looked at. Dusty books, clothes, folders, boxes and sachets. Some familiar fragrances are escaping and some old scenes are playing out on the screen of the mind. Bits of stuff slipping out of other stuff and falling to the ground with a clink. Some stuff that was believed to be misplaced is being placed. Some that was believed to be forgotten is being revisited.

Sample 1

A nappy pin. Special feature – A white safety cap to prevent accidental opening up while the baby has his cloth nappy on. Commonly used in India and other developing countries. Original owner: Baby Saagar.

Sample 2

A business card. Special feature – Simplicity. An invitation to music and joy. Original owner: Saagar.

Sample 3

A Crisis Plan. Special features – Not worth two pennies. Highly ineffective. Not accompanied by a conversation. No detail. Not individualised. Not created in partnership with the patient. Not an alive document. Does not mention anything more than ‘self-harm’. Doesn’t tell us what ‘Crisis’ looks like. Doesn’t identify any helpful distractions, activities, friends or family. Doesn’t appear to know the patient, for example, a key fact – does this person have a key worker? Does not express any understanding or compassion.

Commonly used in developed countries.

Oops! The name of the GP surgery is visible. It doesn’t matter. It closed down years ago. We were it’s last few unlucky patients. Owner: Saagar Naresh (1994-2014).

(Resource: Safety Planning is essential to safety: https://stayingsafe.net/home)

Home

Entrances and exits.

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The two little lads were inseparable. Saagar and Rohan. They cycled together all evening after school and kicked a ball about for hours. They had dinner at each other’s houses. They created snowmen and played with snowballs together. They even shared a bath every now and then. Luckily, they lived right next to each other and their parents were friends.

At Ulster Hospital in East Belfast, the staff accommodation is a set of six flats. Rohan‘s family lived in the one just below us. His mum, Shruti, was the best grower of indoor plants. A gentle, sweet lady. She was also a doctor but at that time, was not working. Over time our families became close friends and continued to visit each other even after we moved to London and they moved to the north of England. If you ask me to name my oldest friends in the UK, Shruti’s name would be on top.

Eventually Shruti started working in Psychiatry and seemed to enjoy it, even though the exams were a struggle as they are for many of us, when they must fit somewhere in between work, kids, husbands, homes, pets, friends, sleep and homesickness.

When Saagar was diagnosed with Bipolar disorder, I needed to speak with her. I needed her. I asked her by text what time would suit. She said she’s call me after work and she did.

“Hi Shruti. Thanks so much for calling.”

‘No problem. I am driving so we may get cut off. I’ll call you back if that happens.’

As soon as I started speaking it got cut off and she called back and the same thing happened again. And again. And then she didn’t call back.

When Saagar died, she came to see us the very next day with her husband, utterly shocked.

A month later I needed to connect with her again. She said she’d call me back after work. She called while driving. She had to pick someone up from somewhere or drop someone off somewhere. She was on the move. On – Off – On – Off : our phones connected and then rudely disconnected mid-sentence and stayed disconnected for seven years.

Two days back a message arrived from Shruti on Whatsapp saying, “Please join us and bless the couple.” Rohan gets married soon. A nice little electronic invitation to the reception was posted underneath the message. The invitation wasn’t for anyone in particular. It had no names on it. I can’t be entirely sure it was for us.

I am happy for the family and for Rohan. Wishing them all possible happiness, I RSVP’d with apologies for being unable to attend. There’s nothing here and let’s not pretend there is. I felt sad for a little while at this loss of a valued friendship, but not for long. This is an opportunity to let go. Yet again. If there is one thing I want to be skilled at, it is to keep letting go, remembering what the Bard of Avon said – ‘All the world’s a stage, and all the men and women merely players: they have their exits and their entrances …’ I get it.

“I would like to live

like a river flows

carried by the surprise

of its own unfolding.”                                    

– John O’Donahue

Meeting old friends for the first time.

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Meeting old friends for the first time. In at least three dimensions. Sharing a physical space together, not just a bland rectangular screen. Actually holding hands.

“Gosh! You’re for real!”

The sparkling smiles of recognition mixed with disbelief. The hugs offering heart to heart resuscitation and healing. Sitting down side by side on the sofa, sharing stories, tea and cake.

A year ago, this could have been fiction but last weekend it was fact. While volunteering at a retreat for Bereaved parents hosted by The Compassionate Friends, we finally met people we’ve only ever seen on Zoom. It was held at the simple and serene Woodbrooke Centre, a Georgian manor house in Selly Oak, Birmingham with tall trees, beautiful flower beds and a family of geese perambulating the grounds, intermittently honking. It is a Quaker centre and has a poster in the main foyer which reads “Nameless helping the Nameless”.

The garden in front of the main house has a labyrinth mowed into it. Early on Saturday morning, birds were singing and the light was inviting me into the open. I decided to walk bare feet into the center of the labyrinth. I took my shoes and socks off at the edge of the circle. As soon as I started walking, it turned into an extremely mindful experience as the ground was littered with geese droppings.

The silence in that place was sweet and the views a treat. We talked about the importance of finding meaning. We shared the joys and challenges of taking the inward road. We watched a film and sang together. We wrote from our hearts and created pretty little candle holders for our kids from jam jars at the crafts table. We cried and laughed, reassured that in this company, it was completely acceptable to do both, sometimes simultaneously.

A pleasant exchange. Giving and receiving with compassion. Understanding. Belonging. Learning. Holding the utter magnificence of life in one hand and the absolute devastation in another. That’s what this game is all about, I guess.

I hate my shoes.

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(‘A pair of leather clogs’ by Vincent Van Gogh 1853-1890)

“I am wearing a pair of shoes.

They are ugly shoes.

Uncomfortable Shoes.

I hate my shoes.

Each day I wear them, and each day I wish I had another pair.

Some days my shoes hurt so bad that I do not think I can take another step.

Yet, I continue to wear them.

I get funny looks wearing these shoes.

They are looks of sympathy.

I can tell in others eyes that they are glad they are my shoes and not theirs.

They never talk about my shoes.

To learn how awful my shoes are might make them uncomfortable.

To truly understand these shoes you must walk in them.

But, once you put them on, you can never take them off.

I now realize that I am not the only one who wears these shoes.

There are many pairs in the world.

Some women are like me and ache daily as they try and walk in them.

Some have learned how to walk in them so they don’t hurt quite as much.

Some have had to wear the shoes so long that days will go by before they think of how much they hurt.

No woman deserves to wear these shoes.

Yet, because of the shoes I am a stronger women.

These shoes have given me the strength to face anything.

They have made me who I am.

I will forever walk in the shoes of a woman who has lost a child.”

  • Author unknown.

One death by suicide is one too many. On World Suicide Prevention Day, today, let us start by

  1. believing that suicides are preventable.
  2. knowing that we all play a part, however small, by being aware, educated and resourceful.
  3. being kind and courageous enough to ask the ‘S’ question, listen and respond.

Twenty-seven

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Dear Saagar,

It was your 27th birthday, last Thursday. You would have been 27 years old. You were 27. You are 27. Which one is it? None of the above? All the above?

You were a Presence eons before you were born as Saagar and you will be one for ever more. You are Awareness, beyond form and name. I am the same. There is no separation between us – both ageless, placeless and traceless. Untouchable. Unknowable.

Didn’t take that day off work this year. Woke up and thanked the blessed day for you, your life. On the beautiful bike ride to work, the heart overflowed with love and gratitude. Had a full productive day at work and another lovely bike ride home. Sat on your bench in the evening under the circle of trees bathed in the slanting rays of the setting sun. Felt the love.

Thank you for bringing me the true experience of love.

Yours,

Mamma.

“When love beckons to you, follow him,

Though his ways are hard and steep.

And when his wings enfold you yield to him,

Though the sword hidden among his pinions may wound you.

And when he speaks to you believe in him,

Though his voice may shatter your dreams

as the north wind lays waste the garden.

For even as love crowns you so shall he crucify you. Even as he is for your growth so is he for your pruning.

… Like sheaves of corn he gathers you unto himself.

He threshes you to make you naked.

He sifts you to free you from your husks.

He grinds you to whiteness.

He kneads you until you are pliant;

And then he assigns you to his sacred fire, that you may become sacred bread for God’s sacred feast.”

  • Khalil Gibran

PS: Please like and retweet the link below if you can. That will give a media presence to this short documentary film, ‘1000 days’, which is based on this blog and has been made with the intention of bringing us all closer together in love, kindness and understanding so that no one reaches a point where they can’t find a way to live another day. You will be able to see the film in late summer, once it has done the rounds of a few film festivals across the globe. Thank you very much.

It changes. And changes again.

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Over and over I asked myself – Now what? Now what? What happens after a severance such as this? How long do one’s bones bleed? Do the tears ever finish? What does ‘recovery’ look like? Is it even possible? How does one keep placing one foot in front of the other? Where is the road? Where does it come from? Where does it go? How long and meandering is it? When does the screaming in my head stop? How long can I keep up the facade? Pretend to be sane? Is this what a new diagnosis of a terminal illness feels like? Is forgiveness possible? Self-forgiveness? Acceptance? Surrender? All these big words! Surrender what? To whom? Who am I now? What do I do?

No answers. Silence. The tilted earth keeps spinning around its imaginary axis. It keeps cradling me. The sun stays at the center of its orbit. My son stays at the center of my being. My breath keeps coming and going. I grow new eyes. My bones carry my weight even though they bleed. The road appears under my feet. It reveals itself one step at a time. Rumi and Khalil Gibran come and hold my hand. The screaming softens. The wall of bricks that was my body, loosens. I come to know the terror and the joy of being insane, catch glimpses of being free. Respect for those who went before and sadly others, who follow. I stop fighting with the big words and keep it simple. Watch. Observe. See. Open. Let the gash in my heart, allow the light in.

A recent talk for The Compassionate Friends, a charity dedicated to supporting bereaved families.

India – talking Mental Health.

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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:

  • Surveillance
  • Identification of risks and protective factors
  • Development & evaluation of interventions
  • Implementation

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.

Treatment versus Care

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It was a clean, warm and open space with well-designed floral furniture in pastel blues and greens. It had plenty of natural light and pots of healthy looking plants thoughtfully dotted around the floor. The artwork on the walls was selected by someone who knew their stuff. It would be hard to guess that this was the entrance to the New Hampshire Hospital. which provides acute inpatient psychiatric services for all age groups.

As I was guided through the facility, I was enamoured by a lush beautiful big greenhouse, two well-stocked libraries, a massive gym for staff and patients, 3 cafés, an outdoor patio and play area for kids, a vegetable patch, a healthy colourful aquarium on wheels, loads of Halloween decorations all around, an art workshop and cooking class in progress, television screens, a chapel, a small shop, a pool table, a ping-pong table, lots of board games and cheerful group therapy, treatment and visitor’s rooms.

Each kid had a room to himself or herself with nice bed-linen of their choice. 2 adults often shared a room. The age groups were appropriately separated. The youngest patient there was 6 years old and the oldest a septuagenarian. The nurse’s station was not a demarcated area. It was part of the ward layout. Social workers, occupational therapists, doctors and nurses didn’t wear any uniforms. They were dressed in everyday clothes. Everyone spoke softly and the atmosphere was relaxed and caring.

The most impressive part of the service was the presence of an Aftercare Liaison officer. It is well known that patients are at the highest risk within 30 days of discharge from inpatient services or Emergency department. (Ref: Luxton, June and Comtois 2013) They concluded that repeated follow-up contacts appear to reduce suicidal behaviour.

Aside from following up on these patients, the Aftercare Liaison Officer has the following roles before the patient is discharged:

  1. Speaks, listens and connects to each child and adolescent patient. Educates them and their support system about warning signs of suicide, triggers, risk factors, protective factors and restriction of means of self-injury.
  2. Draws up a detailed Safety Plan with them and their carers.
  3. Helps them identify sources of social support (trusted adults) and develop personal resources through open conversations.
  4. Interface with other professional agencies (eg. for DBT) and community services that will help dilute their identity as a person diagnosed with a Mental Illness. For example, they match their interests to activities such as therapeutic horsemanship, a running group or a Mountain Teen Project.
  5. Engage their parents, families and friends and anyone they would like to involve.
  6. Use technology if possible – MY3App.

I don’t think we have this service in the UK. I know we don’t.

The one thing that is most important to me and worth living for is … to continually express my love for Saagar and help other parents do the same for their kids.

Little things

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Croydon, Berlin, Lebanon, Antrim and Troy, all within a few miles of each other. Yes. This is the New Hampshire (NH) part of New England. But the capital city of NH is not New London. It is Concord.

1.35 million inhabitants of NH live in 9,300 square miles.

9 million inhabitants of London live in 600 square miles.

It’s a different world. Time and space assume a different dimension here. They are both expansive. I have a sense of abundance and connection.

I have met nothing but kindness since I’ve been here. On the very first day, I was offered two lifts, one from Manchester airport (yes, they have a Manchester too) to Concord and then from my AirBnB house to the grocery shop and back. I have no car as I can’t trust myself to drive on the right (wrong) side of the road. I can literally hear the wires clanging and short-circuiting in my head as I watch the cars move on the roads.

Apples, maple syrup, random conversations with the locals on the street, excellent assistance in shops, witty Halloween decorations and the fall colours. Within the last week, a festival of colours has unravelled in all their glory. I don’t think any camera can do full justice to the drama of Orange, Yellow, Red, Terracotta and Green.

I have really noticed the small things. I spent yesterday morning cutting out small squares of felt in preparation for a community meeting at a small village school where they have recently lost a student to suicide. These pieces are for everyone who attends. They serve as tiny ‘blankies’, something for people to hold on to and fiddle with, to help them cope with the difficult conversations taking place in the room. I would have never thought of that.

When we got there, each table was decorated with twines, hydrangeas, little pumpkins and squashes to make the atmosphere a little bit festive. Warm and welcoming. Not too sad and drab. These little things made such a huge difference for everyone present.

On World Mental Health Day and every other day, let’s remember the little things. They are the big things.

Come October

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3/10/2019. 6 am: I am excited. At the airport, waiting to board my flight to Washington Dulles. Change to another flight to Manchester and then a taxi ride to Concord, New Hampshire. This is the first leg of my travels as a Churchill Fellow. I have checked in and am having a cup of tea. I have just come across this post from a young woman on Facebook:

“According to my local crisis team, I was ‘too articulate’ to be feeling suicidal.
As a writer, and someone who works in languages, I am a naturally very articulate person. Because I could speak so clearly about my thoughts and feelings, I was discharged from the crisis team as I didn’t fit the bill of someone suicidal, or indeed, of being mentally unwell enough to need their support despite evidence to the contrary.

The Papyrus text line allowed me to articulate how I felt (you don’t have any choice really when you’re using the text service, you have to ‘say’ it how it is!!), and that was delved into so much deeper with thoughtful questions, suggestions and recommendations that allowed me to get through a real low point and see that there was hope. At no stage did they reply with ‘sorry, you’re too articulate to be feeling the way you claim’.

Non-judgemental, kind, compassionate, a REAL life saver, especially in the current climate of NHS mental health cuts.”

Judgement. The ultimate wall. Even a positive judgement can be harmful. A missed opportunity. A lost life. Who fills the gaping holes created by ‘unfit for purpose’ services, NHS cuts and ignored carers?

Charities. Families. Friends.

The needs of young people are different. They need an active, positive and creative interaction to make sense of how they feel. They need to be heard and understood. They need to know in their hearts that they are deeply loved and cared for just the way they are. They need to know that things get better. Educating families is crucial.

4/10/2019

Today’s gem: Mayo Clinic video for parents. All parents of adolescents should see this.