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.

Mental – I – zation

He was 15 when his Hungarian parents thought it would be best for him to come to live in the UK with another family. His parents were refugees in Paris and he in London. World War 2 had ended a few years prior. The times were turbulent and many people were having to make difficult decisions.

This boy did not speak English. He landed up amongst strangers, completely inhibited, unable to do well in school. He was teased and taunted by his contemporaries and no one understood him. At 16, he became seriously suicidal. He had a plan. One day a neighbour noticed that he didn’t look great and encouraged him to speak to someone at the Anna Freud National Centre for children and families.

 “The therapist who saw me could see beyond the struggles and see another person, see they had certain competencies and capacities, and that, if you removed some of the inhibitions, the self-defeating behaviours, and got access to my more positive side then I could do quite well,” he remembers.

Prof Peter Fonagy is now a leading contemporary psychoanalyst who has propounded and researched the theory and practise of ‘Mentalization Based Therapy’ (MBT). He is also Chief Executive of the Anna Freud Centre for Children and families. In simple words, mentalization is the effort an individual makes to understand someone else’s thoughts, feelings, hopes, beliefs, desires and behaviours. It is the ability to mind other minds, to understand misunderstandings, to see the impact of our behaviour on others, to see oneself from the outside and others from the inside. MBT is said to be especially helpful in the management of Borderline Personality Disorders.

The things that block mentalization are, firstly, the strong feelings of anger, shame and fear. And secondly, defensiveness, not wanting to know what’s going on in another person’s mind.

I can see how mentalization could make each and every relationship work. Not just the ones we have with others, but also the most important one, the one we have with ourselves.

Working from the heart.

I had taken the day off work. The nurturing, peaceful, green lap of Amaravati Buddhist Monastery at Hemel Hampsted was where I wanted to be. It was a day of rest, solitude, silent contemplation and meditation. Autumn was at its prettiest best and despite everything, it was time to receive beauty. Receive time.

It was the fourth anniversary of Saagar’s passing. The most difficult day of the year, despite my belief that time means absolutely nothing. But this day always stares at me like the enemy. A wretched, horrid, cruel, ugly thing. A brown sludge that I have no choice but to drag myself through.

Slowly, slowly … most of the day drew itself behind me. I returned home, gazing at the sky from the train window, still looking for answers. Still nothing. Just the unbearable pain of longing.

Switched myself back into practical mode, as the next day I was meant to be working. Opened my inbox and found an e-mail from someone called Dan.

“I hope you don’t mind me contacting you out of the blue like this, my name is Dan, I’m a third year medic at Aberdeen University and also the Vice President of the Anaesthetics Society. 

I actually attended your talk at the AAGBI conference this summer. I hope you don’t mind me saying, but I found it incredibly moving. The very day before I attended I had been diagnosed with Bipolar Disorder and was worried about how this would indeed impact on my studies and working career as a Doctor. 

After your talk, I met with one of the Consultants who was offering a ‘mentoring’ session where I discussed the recent diagnosis. She spoke to me about what I need to do to stay well, one of the things was accepting treatment, which initially I admit I was not that open to doing. 

Anyways, I find myself rambling on, I suppose I just wanted to email and introduce myself. If you have any advice for someone with Bipolar who is wishing to pursue a career in Anaesthesia then I would love to hear it!

I just saw an email which was saying that you are giving a talk in Aberdeen next week about this particular topic, which I certainly hope to attend! If you would be about afterwards and free for a coffee I would certainly love to meet you!

Best Wishes and sorry again for emailing like this out the blue!

Kind regards,

Dan.“

Another green moment – tears mixed with joyful smiles. What a way to end the day. What perfect timing.

We met in Aberdeen a few days later. He was all smiles. Friendly, generous and sensitive. We got on instantly. Had a nice long chat. He dropped me in his little red car to the airport. I told him I was hoping to write a book at some stage. He offered to help me with the research that might be needed.

Last week, I was back there in Aberdeen at Dan’s request, to run a 2 hour-long Mental Health Workshop for a bunch of medical students, junior doctors and researchers. It was a good day. I had to smile when Dan talked about Saagar as if he was an old friend.

1+50+176+?

Merchandise at the Manchester Firing Line. Manchester New Hampshire. USA.

On a board of chess, both sides stand face to face

Using wise moves, strategies and tacts.

No drones, no justified assassinations   

No sneaky cyber-attacks.

Two rooks, bishops and knights, both sides have by rights.

Those are the rules of the game. For both sides, the same.

Some things are clearly wrong and others that are right.

Whether your pieces are black, or brown or white.

The way the moves are made,

the way the game is played,

a knight is often not the first to be slayed.

A murder in plain sight

Yet, everyone kept quiet.

No criticism. No outcry?

The killers had good reason. That is why.

They always do.

But do they speak the truth?

Who knows? Do you?

Vietnam, Iraq and now this.

For what? For who?

He was someone’s dad, someone’s son,

A military leader, not holding a gun.

This was an act of cowardice, just for fun.

Guns are a sport in the land

from where the assassin came.

The killers proudly laid claim

To this, their ‘good deed’.

Knowing full well that yet again,

they are sowing a seed.

A seed of death and conflict.

Within a week, a stampede.

Multiple counter-strikes

Hitting innocent planes and passers-by.

Who are the ones that die?

People like you and I.

While the international bully

Keeps on keeping on fighting

In the name of self-defence,

‘Freedom and Liberty’?

When a gun is fired, two people die.

The one hit by the bullet

and the one who let it fly.

War is not the answer. Please.

How can we tolerate this?

Instead of wrapping the world in daisy-chains,

We are covering it in wreaths.

(Footnote: Sixty thousand war veterans, many of them young men, have died by suicide in the USA in 2008-2017. On an average 17 to 20 suicides per day and the rates are not falling despite massive efforts.

https://www.military.com/daily-news/2019/09/23/alarming-va-report-totals-decade-veteran-suicides.html)

One whole month

It wasn’t just a physical transportation but also an emotional one. For four weeks I was not an anaesthetist or a wife. I was just a traveling (Churchill) Fellow, curious to learn everything about ways of supporting vulnerable people through crises, advocacy for struggling families and attempt survivors, intentional and effective peer support, safe care-transitions and timely compassionate support for families, friends and communities affected by suicide.

Two contrasting towns with distinct landscapes. Concord in New Hampshire was a small, friendly town resplendent with autumnal beauty, a quiet serenity and a lot of ‘heart’. New York, a big blustering metropolis with clanking trains, crazy-ass driving (yes, worse than London), much honking and many high-level policy-makers. Hence, more like the ‘head’ of the suicide prevention community.

Rail-trail from Concord to Franklin

Since Saagar’s passing, I have not been on my own for that length of time. Especially as his 5th anniversary fell right in the middle of it. It was not easy living fully immersed in the world of Suicide prevention (SP) almost every day for a month. Sometimes it was overwhelming and ‘too much’. It turned out that I was not alone. I was met with much warmth, kindness and understanding. Some old friends made time to catch up with me and some new friends emerged.

One sunny autumn day I had the pleasure of riding a 3-person- tandem bike with an amazing couple who have cycled thousands of miles in tandem all over the world for the past 27 years. On the 16th Ann (an excellent SP trainer) and I went for a nice long walk in the woods in Derry with Dr Indiana Jones, her Border Collie. This was followed by a much needed brunch at a classic American ‘Red Arrow’ Diner where I had the best ever Tuna melt sandwich.

Polly’s pan-cakes was our destination one afternoon as we set off towards the north – Elaine, Pauline and I. We spoilt ourselves with a rich variety of pancakes before taking a walk along the river and visiting ‘The Basin’.

On my return to the UK, I joined the 50th anniversary celebrations weekend retreat of an amazing charity that supports bereaved parents and their families. It’s called ‘The Compassionate Friends’. The film below captures many aspects of the experiences as bereaved parents/siblings. Changed forever.

“Say their name”

I am happy to be back home and back at work. My life greatly enriched, I hope to share the learning and bring about changes for the better, working with various charities, the NHS and the Mayor’s office as effectively as I can. Right now I am assimilating it all, bit by bit by bit.