CHIME

132 billion pounds = money saved for the UK by unpaid carers.

6.5 million = number of carers in the UK.

6000 = number of people who become carers every day.

1 in 8 adults are unpaid carers for a family member or friend.

Carers UK call them ‘The Second NHS’.

Yet, do we or the Health Service truly value them? Listen to them? Include them? Give them a voice? Understand their concerns? Treat them as an ally? Respect their abilities and contributions? Answer their questions? Educate them? Empower them? Support them? Partner with them as well as we could? Sadly not.

In my experience and that of many other families of individuals with a mental illness, the power imbalance between the health care providers and the service users does not allow for an equitable relationship. Hence, denying the patient the best chances of recovery. There is national and local evidence that proves that carer engagement saves lives.

Triangulation of services is essential for best outcomes for patients and professionals. Risk averse practices may help reduce risk in the short term but may increase risk in the long term. A recovery approach to risk and development of a “life worth living” may have longer lasting benefits through rebuilding relationships, increasing service-users skills and confidence in collaboration with carers.

Norfolk and Suffolk Foundation Trust (NSFT) have developed a program called “Stepping Back Safely” up-skilling staff, carers and service-users. It is based on five main drivers of Recovery: CHIME

  • Connection
  • Hope
  • Identity
  • Meaning
  • Empowerment

NSFT are offering free training in Stepping back Safely in July 2021 on-line. Having heard many stories where a life could have been saved only if there was a meaningful and effective communication between the three parts of the Triangle of Care, I think this training is most relevant and essential. I shall be taking it as I am sure it will deepen my understanding of the subject. If you or anyone you know might like a point of contact, here it is: catherine.phillips@nsft.nhs.uk

Twenty-seven

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.

To my brothers … lean on me.

This video was made after a spate of suicides by senior NFL players in the USA as they were starting to feel the effects of Chronic Traumatic Encephalopathy (CTE). Michael Irvin spoke from the heart without a script and his truth is visible.

If your isolation is getting the better of you, know that you are not alone. You are loved, silently. Reach out your hand and they will be there.

Civilized. Are we?

An anthropologist, Margaret Mead was asked by a student “What do you consider the first sign of civilization to be?” He expected her to mention things like clay pots, fish-hooks and grinding stones but she replied, “A femur that had been broken and then healed. In the animal kingdom, if you break your leg, you die. You can’t run from danger, get a drink from the river or hunt for food. You are meat for prowling beasts. No animal survives a broken leg for long enough for the bone to heal. A bone that has healed indicates that someone took the time to stay with the one who fell, bound up the wound, carried the person to safety and tended the person through to recovery. Helping someone else through difficulty is where civilization starts.”

She also said that we should never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.

Over the last weeks and months, there have been thousands of job-losses, much sadness caused by separation and bereavement and much suffering due to limited social contacts and falling away of normal support systems. Perhaps explaining this tweet by London Ambulance Service.

May be this is the time for us all to step up and be there for those who are affected. Sharpen our radars and pick up the subtlest signs of despair around us. However small, there is something we can all do – start a conversation, smile, share a hot coffee, offer a few coins or share information on useful resources. There will always be a reason to not do it but you are a member of a small group of thoughtful, committed, citizens who are going to change the world. Slowly. Slowly.

Resource: PAPYRUS: A charity dedicated to the prevention of young suicide: https://www.papyrus-uk.org/

Shushshsh…

In June 2020 Sher et al said “Social isolation, anxiety, fear of contagion, uncertainty, chronic stress and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use and other psychiatric disorders in vulnerable populations including individuals with pre-existing psychiatric disorders and people who reside in high COVID-19 prevalence areas … COVID-19 crisis may increase suicide rates during and after the pandemic.”

This possibility is slowly starting to unfold. The number of calls being made to crisis help-lines of all kinds is up by about 40%. Economic uncertainty, insomnia, stress and suicidality feed into each other. The previous financial crisis of 2008 had a tragic outfall in terms of the toll taken on human life, essentially due to job losses. Now we are heading into another one. Unless governments all over the world wake up now, lives lost by suicide over the coming months and years could be more than those lost to COVID-19. As per the ONS data from last year, the England and Wales suicide rate remains statistically significantly higher than the rates seen in recent years.

Active outreach is necessary. If you know friends or family who might be struggling or worried, please do reach out to them with your time and open up supportive conversations. Sending a text or WhatsApp message is not enough. Having a proper check-in by telephonic or video link, possibly meeting up for a cup of tea or a drink fosters proper connection. If you find yourself in a tight spot, please know – this too shall pass. It is a temporary problem. Life still holds promise and beauty. Do reach out to your friends and family for support. More than ever before, in the present times suicide prevention is everybody’s business. Take care of you and yours.

The man who loved yellow.

He dropped out of the security of an Engineering Course to enrol into the futility of a dance school. He carved his way through sheer hard work from a humble home in the north-east of India to the flashing lights at the heart of Bollywood. He personified simplicity. He had no god-fathers in this brutal industry known for its nepotism and ruthlessness. He stood on the sheer credibility of his talent.

Stars, moons and aliens took up a lot of space in his head. He spent hours on his beloved telescope which he called his ‘time-machine’.  He made new friends, kept old ones and his humility through the fame and the wealth of stardom. He stayed true to himself and his name which meant ‘Peaceful’.

His charm and talent won hearts all around. His youthful portrayal of his love of cricket came through in his films ‘KaiPoChe’ and “M.S Dhoni, the untold story“. But the media gave him a hard time as they saw him as an outsider. Of journalists he said, “First they’ll ignore you, then they’ll laugh at you and then they’ll fight with you. Right now, they’re laughing at me.”

Not anymore. Bollywood is in a state of shock. On the 14th of June 2020 Sushant Singh Rajput ended his life at the age of 34. It seems he had been on treatment for depression for the past 6 months. Police is frantically interviewing multiple people to establish a ‘cause’ for his death.  

Film contracts falling through? Not enough new offers of interesting roles? Disparaging remarks made by influential bitchy colleagues? Being bullied and ignored? Financial difficulties? A painful break-up? The death of his mother at the age of 16? The death of his young manager, Disha Salian 3 days prior to his? Unmet parental expectations? Inadequate treatment for Depression? Migration away from home? Loneliness? Stigma of having a mental illness? Not knowing how to ask for help? Being a man?

All of the above.  

RIP Sushant.

PS: India has the highest suicide rate in South-east Asia: 16.5 suicides per 100,000 people

Food, water, shelter and clothing.

That’s what it’s all about. Isn’t it? Our most basic needs.

For some, who were comfortable, these basics are threatened in the current climate. For some they have constantly been under threat. For the lucky ones, all is well. For now.

The fact remains that food needs to be grown by someone. Seeds need to be sown and nurtured. Given the right amount of nutrients, sun and water. Given time to mature and then harvested. Like Midas, even if everything else was made of gold, we could not eat it. Even if we put hundreds of satellites in space, we need our basic needs met.

Over the past few months I have appreciated growing a few things from seed. Sunflowers, mint, coriander and sage. Not enough to keep me alive but enough to give me a smug feel of being someone who grows stuff. I have little trays laid out by the windowsill and they fill me with pride each day they reach out for the sun, a few millimeters more than yesterday. What must it be like to be a real farmer!

In India, more than 11 thousand farmers ended their lives in the year 2016. Too much rain. Too little rain. Aberrant weather. Poor quality seeds. Exploitative middle men. Illness in the family. Monsanto. Easy access to pesticides. False promises of relief measures, incentivising a farmer suicide. The government promises money but fails to deliver again and again. It then blocks articles and videos that try to make this information public.

Kheyti is an organisation that helps small farmers design and implement low-cost farming interventions. “Greenhouse-in-a-Box” is a low-cost greenhouse bundled with end-to-end services. This greenhouse fits in 2-5% of a small farmer’s land, protects crops from environmental risks and grows 7 times more food using 90% less water.

This prolonged lockdown is going to affect many individuals and small businesses. Many are starting to worry about their very basic needs. Uncertainty, insecurity and the feeling of being stuck is rising everyday. Helplines are receiving more calls. Food banks have had to expand beyond capacity. The indirect and unintended consequences of the pandemic might be worse than the direct and predicted ones. As incomes fall away, despair in our communities will rise further.

Each of us needs to think of one person we know whose income might be affected by this and call them. We need to think of one person recently bereaved and call them. Not text. Not e-mail. Phone call. Speak. Directly. Ask questions. Connect, have a chat, come up with ideas and creative answers. Signpost to resources. Reassure. Give hope. Together, figure it out.

This too will pass but before that it will test us. All of us.

Kooth Infographics – suicidal thoughts rising. Highest in the Midlands.

Kooth Week 10 COVID infographics

India – talking Mental Health.

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.

A phone call.

Last week we got a call to assess a patient for a possible transfer to ITU. Our team of three anaesthetists went along with all our kit and PPE. From a distance, he didn’t look too unwell. And he looked young. I hoped he wouldn’t need too much intervention. We donned out protective equipment and looking like aliens, entered his cubicle. I checked his name and date of birth. He was born in the same year as Saagar. After making a quick assessment, we decided that his breathing needed support. We spoke to him about getting him off to sleep so that we could place a tube in his wind-pipe and assist his breathing. We explained to him that we would transfer him to ITU for further care.

By this stage he was shaking, his eyes swollen with fear. He asked to make a call to his mum. We stood back while he called her. He held the phone to his left ear while oxygen hissed through his face mask. We waited, watching his face slowly relax, his fear melting into tears that dripped down his cheeks. After what seemed like a long time, he said bye to her, told her he loved her, composed himself and said he was ready to go to sleep.

It was like watching the dance of life and death. Love and separation. Help and helplessness. I was grateful and pleased that this mum and this son could connect at this crucial time.

Saagar didn’t have this luxury. He didn’t get to call his mother. No words of comfort fell into his ears. No tears of relief spilt from his eyes. Nobody offered him their understanding. I felt sorry for his mother too. She didn’t have a chance to say good-bye, to tell him that she loved him, that she would pray for him and that she wished him the very best.

When there is political will, governments can bring countries to a shrieking halt, the world can come to a stand-still.

When it is a physical illness, millions of pounds can be spent in seconds. New hospitals can be erected within weeks. Multiple trainings can be put in place for the front-line staff. Awareness campaigns are everywhere. What to do, what not to do, repeated endlessly. Retired doctors can be redeployed. National economies can be allowed to crash. Everything else can be put on hold.

When it is a mental illness, there isn’t enough money. There isn’t enough time. Not enough people. Very little expertise. No effective awareness-raising campaigns. No appropriate spaces. Not enough beds. Not enough research. The bottom-line is that there just isn’t enough respect for the fact that people with mental angst suffer the same, if not worse than those with physical ailments. That on many occasions they too, die alone.

 Its about Respect and Political Will.

Nowhere to go.

On the 9th of March, I reached Melbourne for the second leg of the Churchill Fellowship. I had been looking forward to it for ages and just couldn’t wait to get started. I had the taken the whole month off. Despite the long journey I didn’t feel any fatigue. My AirBnB was homely and comfortable. After a good night’s sleep, I was ready for work.

The Beyond Blue Office was easy to find. After a brief introduction to the team, we all went out to get coffee together. I was already one of them and the coffee was great. The following days flew past with meetings, interviews, presentations and briefings. A trip to Headspace. Despite some background murmurings of a virus, I was having the best time, learning and exchanging thoughts and ideas. Then Australia closed its borders. Meetings and conferences started getting cancelled.

On the 16th, I took a return flight to London.  My trip shrank from 3 weeks down to one. I had to miss Sydney altogether. Now, I am back here with a blank diary for 2 weeks and I am loving it. I have volunteered myself to work and I am on standby.

I can now research and look up things I’ve been meaning to for a long time. I can clear out one cupboard every day and get rid of stuff I don’t need or use or get joy from. Unclutter and create space in my house and my head. I can go to bed without setting an alarm. That pile of unread books that’s been sitting atop my table, feeling ignored and giving me dirty looks, can now be tackled.

Part of me is rushing in to fill the time with a list of a hundred things to do but I am consciously slowing down. Having an easy routine. Fitting in things I love doing, like arranging flowers. Making time for friends. Cooking. Walking. Not getting hooked to the media but keeping an eye. Writing hand-written letters to loved ones. Sitting still. Enjoying our home. Truly appreciating the weirdness of our cat, Milkshake. Cherishing having breakfast, lunch and dinner with Si as he works from home.

Simplify. Make easy. Make plain.

The Way Back – supporting attempt survivors – an idea worth adopting.