Day 878

Gary’s story.
The Last Word.
Work Under Pressure.

These 3 powerful videos appear on the website of Mates in Mind (MiM). Suicide kills far more construction workers than work place accidents.  MiM is a charitable programme to improve and promote positive mental health in construction. It has been co-founded by Health in Construction and British Safety Council.

At present, one in 6 workers in the UK is experiencing depression, anxiety or stress. 6% of the UK work force is made up of construction workers, that is 2.1 million people. Hence at any given time at least 350,000 people in the industry will be dealing with mental ill health and possibly feeling alone. Raising awareness and generating champions through modular training in that community means there will always be someone close by who can help or are dealing with similar feelings.

A recent article in the BMJ states 5 facts about the conditions in anaesthetic training –

Workload – Nearly all had stayed beyond their shift. Nearly two thirds (62%) said that in the previous month they had gone through a shift without a meal, and 75% had done a shift without drinking enough water.

Health – Sixty four per cent of the anaesthetics trainees thought that their job had negatively affected their physical health, and 61% thought it had negatively affected their mental health.

Morale – Poor work-life balance, the burden of assessment, career uncertainty, frequent rotations, and terms and conditions of service sapped their morale.

Patient safety – This had worsened due to lack of available hospital beds, staff morale, and staff shortages.

Burnout risk – 85% of these young doctors were at risk of burnout.

I think Mr Hunt can take credit for some of these issues.

Mate in Mind is a fantastic example for other industries to make a concerted effort to address the well being of their employees in these difficult and uncertain times.

Ref:
https://www.matesinmind.org/employers.html

http://careers.bmj.com/careers/advice/Five_facts_about_conditions_in_anaesthetics_training

Day 873

It’s Thursday.
It’s the 16th.
It’s March 2017.
Exactly 29 months.
2 years and 5 months.

I am in the same part of the same hospital, doing the same job with the same people as I was on that day. I am taking a break in the same clutterred coffee room where Saagar visited me a few months prior to his death.

Today, I sit here reading the House of Commons Select Committee Progress Report on Suicide Prevention. It informs the Government’s strategy on the same.

In a nutshell, it clearly states – Suicide is preventable. Current rates of loss of life in this way are unacceptable and most likely under-reported. Even though 95% of Local Councils have a Suicide Prevention Strategy, its implementation is very poor. We must have a way to reach those at risk but not in contact with health services. It commends the work of the voluntary sector. It identifies stigma as a big hindrance. It emphasises better targeted training for frontline staff, medical students and GPs. It expresses disappointments at the poor follow-up of patients after discharge from psychiatric services, at poor information sharing with families and poor funding/staffing of services.

It identifies self harm as the single biggest indicator of suicide risk. Poor psychosocial assessment and safety planning of these patients possibly contributes to a high rate of suicides. Proper support for bereaved families should be an integral part of suicide prevention. Irresponsible media reporting is damaging. Coroner’s need to call a suicide, a suicide.

All the things that we have been saying for all these months!
To think that at least 15,000 more suicides have already taken place in the UK since Saagar’s death!

Report:
https://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-20151/suicide-prevention-report-published-16-171/

Day 871

“I have opened a door that can never be shut. How will I ever get her to trust me again?”

19 out of 20 people who attempt to end their lives will fail.

These survivors will be at a 37% higher risk of suicide.

Anger, shame, guilt, fear, minimization and avoidance are few of the reactions they evoke.

The taboo associated with the act might make them feel even more isolated. Their families may not know how and where to access support for themselves and their loved one. The ones closest to them may feel drained, stressed, exhausted and let down. The trust between the two might be deeply damaged.

Their relationship might reach an all time low, just when it needs to be solid.

Both need to take responsibility for their own well-being and  that of each other.

Here are a few useful resources.

Ref:

Supporting someone after a suicide attempt:
https://www.suicideline.org.au/media/1114/supporting_someone_after_a_suicide_attempt.pdf

Advice for those who survived:
http://blog.ted.com/real-advice-for-those-whove-attempted-suicide/

TED:

Day 859

Suicide Prevention Interim Report 2016-17 Summary:

This report published by the House of Commons Health Committee outlines five key areas for consideration by the Government before the refreshed strategy is finalised:

(1) Implementation — a clear implementation programme underpinned by external
scrutiny is required.
“To me, it is extraordinary and very distressing that four years after the strategy was published we do not know how many local authorities have implemented anything [ … ] we cannot allow more lives to be lost because we do not have effective governance and implementation. It is such a waste of time and a waste of money.” – Hamish Elvidge, Chair of the Mathew Elvidge Trust.

(2) Services to support people who are vulnerable to suicide—this includes wider
support for public mental health and wellbeing alongside the identification of
and targeted support for at risk groups; early intervention services, access to help in non-clinical settings, and improvements in both primary and secondary care;and services for those bereaved by suicide. We recommend that all suicide prevention plans should include mandatory provision of support services for families who have been bereaved by suicide.

(3) Consensus statement on sharing information with families—professionals
need better training to ensure that opportunities to involve families or friends
in a patient’s recovery are maximised, where appropriate.

Misunderstanding about confidentiality, lack of confidence, or even simply time constraints can lead professionals to adopt a ‘tick box’ approach to seeking consent. Professionals may err on the side of not involving families, rather than taking the time to explore fully with the patient whether there would be benefit in contacting a trusted family member or friend.34 Hamish Elvidge explained it very helpfully: One way is to say “Do we have your consent to share information with a family member, friend or colleague?” The chances are that the answer will be, “No.” Or you could say, “In our experience, it is always much better to involve a family member, friend or colleague whom you trust in your treatment and recovery, and we know the triangle of care is likely to result in a greater chance of successful recovery. This will result in you recovering much quicker. Would you like us to make contact with someone and would you like us to do this with you now?”

(4) Data—timely and consistent data is needed to enable swift responses to suspected suicides and to identify possible clusters, in order to prevent further suicides.

(5) Media—media guidelines relating to the reporting of suicide are being widely
ignored and greater attention must be paid to dealing with breaches by the
media, at national and local level. Consideration should also be given to what
changes should be made to restrict access to potentially harmful internet sites
and content.

Is this document a proof of more red-tape or a source of hope for the future?

Source: https://www.publications.parliament.uk/pa/cm201617/cmselect/cmhealth/300/300.pdf

Day 851

article-2335030-19f33d94000005dc-704_634x422

“The university did not ring and tell us that she had been admitted to hospital critically ill. We were in the dark for hours as to what had happened. We found out off Facebook” says Nikki, mother of Miranda.

Miranda Williams 19. Student of Philosophy.
Daniel Green 18. Student of Law.
Kim Long 18. Student of Law.
-Deaths by suicide, first term of first year at the same University.

Lara Nosiru 23. Student of Neurosciences.
-Died by suicide, Final year at the same University.

All these lovely young people died within a few months of each other. On the surface of it the deaths do not seem to be related to each other.

At least 1600 families face this nightmare every year and at least 1600 beautiful young lives are wasted year on year with no sign of a drop in numbers, only a rise.In 2007, there were 75 university students died of suicide in England and Wales. In the ghastly year of Saagar’s death, 2014, the number went up to 130, nearly 75% higher.

Why?

Underdiagnosed anxiety and depression at school.
Problems identified but not dealt with.
Stigma stopping young people from asking for help.
Unfamiliar surroundings.
Being away from home/family/friends for the first time.
Excessive drinking culture.
Trying their best to start off Uni on the right foot.
Debt / financial pressures.
Academic pressures.
Suddenly being treated like ‘adults’.
Trying to cope with pressures all alone.
Too proud, worried or ashamed to ask for help.
Not enough help available at Uni.
(“During Kim Long’s inquest this week, it was revealed that more than 600 Bristol University students were referred to support services by their tutors last year because they were deemed at “high risk”.)
Improper use of ‘Confidentiality’.
New students not being identified as high-risk.
Poor understanding and management of depression in the community

1600!!!

Ref: https://www.thesun.co.uk/news/2838174/is-a-cocktail-of-ballooning-costs-stigmatisation-of-mental-health-problems-and-academic-pressure-killing-our-kids/

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 836

The National Suicide Prevention Alliance (NSPA) is an alliance of public, private and voluntary organisations in England who care about suicide prevention and are willing to take individual and collective action to reduce suicide and support those bereaved or affected by suicide. (http://www.nspa.org.uk/)

Today I attended a conference organised by them. The room was filled with people who care. Here are some of the highlights as seen from my eyes:

  1. Jeremy Hunt, Secretary of State for Health sent his apologies and a recorded message that said all the right things, unconvincingly. (Yes. I am a cynic.)
  2. Professor Louis Appleby (Professor of Psychiatry, University of Manchester. Chair, National Suicide Prevention Advisory Group. Department of Health) talked about National Strategy and emphasised that every component of the strategy has to line up in order to impact everyday lives of people. The 5 main points on the strategy were: Local Suicide Prevention plans a must for all Local councils; a sound policy on self-harm; special attention to middle aged men, mental health patients and prisoners, better data collection and bereavement support.

He proposed that if the data was looked at differently, it could mean that the suicide rates were on a decline. Hence, the rising rate of suicide argument may not work. However, we know that suicides are grossly under-reported. So, this statement reminded me that at the end of the day he is an academic and while he does brilliant work, part of his job is playing with numbers.

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(Statistics are used by some as something to lean on rather than to illuminate.)

  1. Rt. Honorable Norman Lamb MP for North Norfolk was the speaker with most conviction and the biggest vision. I am so proud that he is the Patron of the charity I work with, PAPYRUS. He spoke of leadership, immediate investigation of deaths so valuable lessons can be learnt before the facts get fudged and forgotten, GP training and same day referrals of patients with depression to specialist services, stop sending patients out of the area for in-patient care and provide meaningful patient support in the community. He set out a clear ambition of – Zero Suicide. He was the only one in the room who stated:  “Death toll from suicide is intolerably high.”  There is hope.

To be continued tomorrow.