Day 851

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“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.

 

 

 

 

 

Day 829

Loneliness – a disturbing word, often invoking a sense of sadness and despair.

It’s not one thing. It is subjective. Imprecise.
It can be found anywhere.

When after many requests you still don’t have a sibling.
When you are born with skin colour darker or lighter than it should be.
When you are the new girl in class.
When you don’t get picked for the team.
When you sit alone at lunch time.
When you are not sure what you want and settle for what is available.
When you are stuck in a loop of cold-hearted bureaucracy.
When you are different.
When you are told ‘you should be happy’ by the one you are married to.
When you work from home and see no humans for many days.
When you feel you have to be somebody else to be successful and accepted.
When you are unable to have children.
When you have an abortion or a miscarriage.
When you have children and don’t see anyone but them all day everyday.
When your family is no longer a family.
When you have a fracture and are stuck in bed for weeks or months.
When ‘Facebook’ and ‘Instagram’  constantly offer comparisons.
When you get fired.

When you have just retired.
When a loved one suddenly disappears.
When you are blamed for a mistake you did not make.
When you get mugged.
When you are diagnosed with a serious illness.
When you are old and so easily forgotten.

Solitary confinement is one of the most severe forms of punishment because it can break your spirit. In 1951 researchers at McGill University paid a group of male graduate students to stay in small chambers equipped with only a bed for an experiment on sensory deprivation. They could leave to use the bathroom, but that’s all.  They wore goggles and earphones to limit their sense of sight and hearing, and gloves to limit their sense of touch. The plan was to observe students for six weeks, but not one lasted more than seven days. Nearly every student lost the ability “to think clearly about anything for any length of time,” while several others began to suffer hallucinations. “One man could see nothing but dogs.” A study at Harvard found that roughly a third of many solitary inmates they interviewed were “actively psychotic and/or acutely suicidal.”

In the biggest literature review into the subject of loneliness, the University of York looked at 23 studies involving 181,000 people for up to 21 years. They found that lonely people are around 30 per cent more likely to suffer a stroke or heart disease, two of the leading causes of death in Britain. More than 1 in 5 people in the UK privately admit they are ‘always or often lonely’. It is a public health problem.

I welcome the ‘Commission on Loneliness’ launched in memory of the murdered Labour MP Jo Cox, to look for practical solutions to reduce loneliness in the UK. Let’s do our bit, however small.
RIP Jo.

“Fools,” said I, “You do not know –
Silence like a cancer grows.
Hear my words that I might teach you.
Take my arms that I might reach you.
But my words like silent raindrops fell
And echoed in the wells of silence…
-Sound of Silence by ‘Simon and Garfunkel’

Ref:

http://www.telegraph.co.uk/news/2017/01/31/mps-launch-jo-coxs-commission-loneliness/
http://www.telegraph.co.uk/science/2016/04/19/loneliness-is-public-health-problem-which-raises-risk-of-stroke/

 

Day 828

Kimberley Hiatt was 50, a nurse for 24 years, she worked in the Cardiac Intensive Care Unit at Seattle Children’s Hospital. In September 2010 she accidentally overdosed an 8-month-old infant with calcium chloride as a result of a mathematical error. Ms Hiatt, immediately reported the event to colleagues. Unfortunately, the child didn’t survive the error. The hospital put Hiatt on administrative leave and soon dismissed her. It broke her heart when she was dismissed, not just because she lost her job but also because she lost a child. In the following months, she battled to keep her nursing license in the hope of continuing the work she loved. Six months after the event, Ms Hiatt died by suicide.

The suffering of caregivers in the face of a serious medical error has been termed the ‘second victim’ phenomenon.  These individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, seriously doubting their clinical skills and knowledge base. They may suffer from extreme fatigue, sleep disturbances, increased Blood Pressure, muscle tension, frustration, decreased job satisfaction, difficulty concentrating, flashbacks, loss of confidence and grief or remorse.

The risk factors for suicide among health professionals, including doctors, are similar to those found in the general population. However, there are some additional risks among doctors such as their unwillingness to seek timely help, access to potent drugs and the skills to self-medicate. Other risk factors include exclusion from work, poor support networks, ongoing investigations, complaints, court cases, inquests and multiple jeopardy from having a complaint considered by a range of bodies including employers and the GMC.

Scott’s 3-tiered interventional model of support for Second Victims is well recognised (Ref: https://www.muhealth.org/app/files/public/1405/Scotts_Three_Tier_Support.pdf)

It’s too late for Kimberly, but her story can serve as a catalyst for a much needed change in healthcare – support for second victims of errors.

“People make errors, which lead to accidents. Accidents lead to deaths. The standard solution is to blame the people involved. If we find out who made the errors and punish them, we solve the problem, right? Wrong. The problem is seldom the fault of an individual; it is the fault of the system. Change the people without changing the system and the problems will continue.”

  • Don Norman Author, the Design of Everyday Things

Dedicated training for all medical students and GPs in suicide prevention must be made mandatory in the NHS and all over the world as prevention of harm means prevention of first and second victims. However, as long as humans are a part of any system, errors will occur. To err is human.

 

 

 

Day 821

Suicides are grossly under-reported. Here are a few reasons for that:

  1. Criminal standard of proof, “beyond reasonable doubt”, is required when determining the cause of death as suicide. Many suicides are recorded as ‘undetermined deaths’ because of that. The Chief Coroner is supportive of the change which would reduce the standard of proof for suicide to the civil standard and has expressed his view to the Ministry of Justice but the MoJ has steadfastly refused to change the way that coroners reach a suicide verdict despite persistent requests from Suicide Prevention charities such as PAPYRUS. This leads those of us campaigning on this issue to conclude that they deliberately want to suppress the figures around the number of people who take their own lives each year.
  1. MoJ argues that a change to the law would offend certain faith groups. We, at PAPYRUS believe that determining a cause of death should be about establishing facts, not about appeasing any particular sector of the community.
  1. Many families who have lost loved ones to suicide, particularly when the deceased are their children, do not want to hear that they ended their own life. Coroners are understandably sensitive and hence, reluctant to reach a verdict of suicide and conclude that the death occurred because of an accident or misadventure. An open or narrative verdict is often returned even when the evidence clearly shows that the person took his or her own life.
  1. Death is taboo and suicide is a deeper layer of taboo underneath. Mental illness is taboo and suicide is a darker layer of taboo underneath. The stigma attached to it stops everyone from being open about it.

Research by Professor Colin Pritchard at Bournemouth University suggests that if coroners used the civil standard of proof – “on the balance of probabilities” – we would see a 30-50% increase in recorded suicides. His research validates the view held by Papyrus that the current arrangements mask the true number of suicides in the UK.

Unless we can face the enemy, how can we ever hope to vanquish it?

Sources:

https://www.theguardian.com/commentisfree/2017/jan/09/suicide-crisis-law-uk-cause-of-death-young-people

http://www.inquest.org.uk/help/handbook/section-4-3-verdicts

http://www.thetimes.co.uk/article/thousands-of-suicides-hidden-to-comfort-grief-stricken-families-5fhkspfbx

 

Day 813

Short stories have always intrigued me. Of late my attention span has become so short that those are the only kind of stories I can relate with and appreciate.

Here’s an abridged version of ‘Grief’ by one of the greatest writers of short fiction, Anton Chekov.

‘Grief’

It is twilight. Large flakes of snow are falling. A cab-driver, Iona, waits for a customer. He sits in his cab with his body bent as double as a living body can, immobilized by misery. ‘To whom shall I tell my grief?’

At last an officer arrives. Iona sets off in his cab with the officer at the back. He turns around to speak to him.
“My son…er…my son died this week, Sir.”
‘Hm. What did he die of?’
“It was a fever.”
Silence. Iona turns around again to find the officer nodding off.

As the evening progresses, Iona attempts to talk to someone three times. He tries to tell the story of his son’s death again and again. The second passenger, a high browed businessman interrupts Iona and says, ”We all must die one day.” Another man simply gets out of the sleigh. Later Iona tries to speak with a house porter but he brusquely tells him to drive on. Still later Iona offers one of his fellow drivers a drink but the young man promptly falls asleep. Just as the young man has been thirsty for water, Iona thirsts for speech. There is so much he needs to share.

“One must tell it slowly and carefully; how his son fell ill, how he suffered, what he said before he died, how he died. One must describe every detail of the funeral and the journey to the hospital to fetch the defunct’s clothes. His daughter Anisya remained in the village – one must talk about her too. Was it nothing he had to tell? Surely the listener would gasp and sigh and sympathise with him?”

Finally at the end of the working day, Iona returns to the stables. He starts to speak to his horse, “Now let’s say you had a foal, you were that foal’s mother and suddenly, let’s say that foal went away and left you to live after him. It would be sad. Wouldn’t it?”

The mare munches hay and breathes on her master’s hands. She doesn’t close her eyes, nor walks away, nor interrupts with her own wisdom on the matter. And it’s enough. Iona tells her everything.

At the risk of repeating myself, I tell the story I need to tell:

(Special thanks to Diane Morrow and her book: One Year of Writing and Healing)