Suicide prevention

Day 681

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About 5 months after Saagar’s passing, one of my close friends sent me a subtle message suggesting that I should be careful about what I write in my blog as a few of my work colleagues read it regularly and if I appear to be too fragile or vulnerable, it might have a negative impact on my professional life. I understood her concern. The medical profession is not known for its understanding and compassion for mental frailty in colleagues.

Dr Wendy Potts was a GP in Derbyshire who blogged about living with Bipolar Disorder on a regular basis. One of her patients read the blog and complained to her Practise. The doctor was suspended. A few weeks later she ended her own life.

Firstly, I don’t understand the basis of the complaint. Would patients complain if their GP had diabetes or cancer?

Secondly, I don’t understand the basis for suspension from work. If the doctor’s performance was not questionable, then there is no ground for that.

Ref : https://www.theguardian.com/uk-news/2016/aug/26/gp-found-dead-after-being-suspended-over-bipolar-disorder-blog?cmp=oth_b-aplnews_d-2

This is one of many examples of poor treatment of medical colleagues with mental health issues. I think we are a long way from seeing parity between physical and mental illnesses as the ones who are supposed to put that into practise are themselves caught in the stigma associated with mental illness.

(PS: apologies for not being able to insert the link to the article in a better way. The ‘link’ icon on my page doesn’t seem to work anymore. Any ideas? )

 

Day 673

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stress

The stress vulnerability model was proposed by Zubin and Spring (1977). It proposes that an individual has unique biological, psychological and social elements. These elements include strengths and vulnerabilities for dealing with stress.

In the diagram above person “a” has a very low vulnerability and consequently can withstand a huge amount of stress, however solitary confinement may stress the person so much that they experience psychotic symptoms. This is seen as a “normal” reaction. Person “b” in the diagram has a higher vulnerability, due to genetic predisposition for example. Person “c” also has genetic loading but also suffered the loss of mother before the age of 11 and was traumatically abused. Therefore persons “a” and “b” take more stress to become “ill”.

This model is obviously simplistic. However it does help with the understanding of psychosis. Vulnerability is not a judgmental term but a different way to approach the variables involved. We all have a different capacity to take on stress depending on how vulnerable we are. At different times in our lives we can be anywhere on the curve, depending on these variables. 
Increasing coping skills or altering environmental factors (family, work, finance, housing etc.) and specialist help can reduce vulnerability and build resilience. Attending a peer group may help to build self-efficacy, self-esteem and self-acceptance all of which may be protective against relapse and form a buffer to demoralisation. It gives hope!

Day 667

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Clarke Carlisle, a former footballer speaks openly about his experience of depression and two failed suicide attempts. His honesty comes through very clearly in this film titled:

‘The Silence of Suicide’
(https://www.youtube.com/watch?v=f86rz60Jcso&feature=youtu.be)

As he speaks, it breaks my heart to watch the tears roll down this handsome young man’s cheeks. I admire him for normalising vulnerability. He shares how depression makes one believe that everyone would be better off without them. He thinks that the stigma associated with suicide comes from the ‘mystery’ associated with the condition. Those left behind search within themselves and ask many questions but there are no answers. It is impossible to not personalise it. That makes it very hard for us to talk about it as individuals. Because it is so hard to speak about suicide for us as individuals, it is the same for us as a society. But it is essential and urgent for us all to talk about suicide. It is of paramount importance.

How can we encourage people to do this?

By ‘normalising’ it.
Statistics say that 1 in 4 people suffer from mental ill-health. However this may be a gross underestimation as many people are not very aware of how they feel. They may not really know and recognise their feelings.

His advice for anyone who might be thinking of ending their life is – Tell someone. Tell anyone. Once you do that, the power of that thought over you diminishes.

Day 658

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20 minutes into a phone conversation with a close friend, he asked, ‘Do you feel free?’

Wow! Do I feel free? Is it natural for me to feel more free than I did before? Am I supposed to? How are different levels of freedom experienced? Does it have to do with being in a particular job or living in a particular city or having a particular partner or dressing in a particular way? Or does it have to do with how I feel within myself? Do I feel free?

Saagar was my pride and joy and also my responsibility. Now I feel responsible for the well being of all the young people out there. I have learnt that it’s not easy to be young. Earlier I was focused on providing for us but now it’s just Si and me. I don’t worry about us. I know we’ll be fine. Earlier I lived very much within my own little world and now I have a much more expansive existence. I often wasn’t very attentive or sensitive to the people around me but now I am. Having lost what was most dear to me, I fear nothing. From a place of survival, I find myself in a place where I have something to offer to the world. I need to be aware to not attach myself to any particular identity – doctor, grieving mother, victim, indian, woman, etc. All I am is human.

Hey! Guess what. I am free.

Day 657

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When someone becomes depressed, many of their activities function as avoidance and escape from aversive thoughts, feelings or situations. Depression therefore occurs when a person develops a narrow range of passive behaviours. As a result, someone with depression engages less frequently in pleasant or satisfying activities and obtains less positive reinforcement than someone without depression.

40 years ago the first behavioural treatment for depression was described by Lewinsohn et al. Many successful trials were done which somehow got forgotten with the advent on CBT in the 1980s.

Behavioural Activation (BA) focuses on activity scheduling to encourage patients to approach activities that they are avoiding. It focuses on encouraging people to take part in meaningful activities that are linked to their core values. It helps people find out which activities make them feel better. Patients are also taught how to analyse the unintended consequences of their ways of responding, including inactivity and rumination.

A recent paper published in the Lancet by Richards et al at University of Exeter studied 440 people with depression. They were randomised into 2 groups – one received BA and the other received CBT. They found that BA, a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT. Hence, effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals.

Professor David Richards says:

“Effectively treating depression at low cost is a global priority.
Our finding is the most robust evidence yet that Behavioural Activation is just as effective as CBT, meaning an effective workforce could be trained much more easily and cheaply without any compromise on the high level of quality.
This is an exciting prospect for reducing waiting times and improving access to high-quality depression therapy worldwide, and offers hope for countries who are currently struggling with the impact of depression on the health of their peoples and economies.”

UK is one of those countries.