My laptop claims to have at least 8 films on it but for some strange reason, on a train from Birmingham to London, it agreed to play just one, called, ‘The Help’. It’s about the writing of a book compiling the stories of African American maids working in white households in Jackson, Mississippi in the early 1960s. A book about an open ugly secret. About the courage of a few to start talking about it as a mark of protest. About the collective impact of small actions in bringing about big changes.
Yesterday was World Mental Health day and the UK became the first country in the world to announce a minister for Suicide Prevention. The day before yesterday, I learnt that Health Education England are very keen to put measures in place to prevent suicides within medical practitioners. Having been a part of the Suicide Prevention Community for the last 4 years, the one profession that is most conspicuous by its absence is Psychiatrists.
At 2 different meetings, I happened to meet 2 different Consultant Psychiatrists. On hearing Saagar’s story, one of them said he was very sorry but ‘this has been happening for 30 years’. I went blank. I just looked at him. I wonder what the public’s reaction would be if a surgeon would publicly admit that his surgical team has been making the same errors, that have been costing people their lives for 30 years. Yes. These are systemic errors. They are difficult to tackle. But, even today, youngsters like Saagar are dying because of lack of leadership within the specialty of Psychiatry, like they have been for the past 30 years.
The other, extremely prominent and respected Consultant Psychiatrist completely rubbished Mindfulness, Yoga and Meditation, without having tried any of them. He said that all these interventions have side effects. He believed that a Psychiatrist is only meant to attend to the most extreme cases. Their role comes into play only after these 5 have been called upon – parents, schools, GPs, CAMHS and Talking therapies. I am sure he knows that many youngsters die while on the waiting list, without ever getting to see a proper Psychiatrist, once. I am also sure he knows the side effects of psychiatric medications that are offered generously to all and sundry by non-psychiatrists. Lastly, I am sure he also knows how unsupported the GPs feel when faced with patients who are severely mentally unwell due to slow and inefficient response from the secondary services. And, I am sure it’s all down to poor funding. The same excuse that we’ve had for decades gone by and will have for decades to come. How about some imaginative leadership?
As parents, let’s start by saying to our kids in words and actions –
‘You is kind. You is smart. You is important.’
To me, I say – ‘I is kind. I is smart. I is important.’
You could too.
The bridge rumbles, shakes and shudders
as trains thunder over it.
I sit under the bridge and everything around me
rumbles, shakes and shudders.
The verticals, horizontals and things in between
Outside and inside of me
I live under this bridge. It threatens to snap and bury me in rubble
Some trains are overloaded.
They crawl on top of my chest.
Crushing me to pulp.
Others come galloping,
Turning me to fine flying dust.
Thousands of us huddle under this bridge.
Wondering why our love wasn’t enough
Why no one said anything
Why it keeps happening at a maddening pace
Why we were blind
Why we didn’t know what to do
Why the Earth keeps spinning
Why the breath keeps oscillating
Why the heart keeps drumming.
4 years ago, it was all happening in September.
He didn’t know he was so close to the end.
I didn’t know I was so close to his end.
Now, I know.
Was I deaf or is it much too late?
Once again, I found myself in Swansea. The meeting was planned weeks in advance and I had travelled 4 hours to be there. I, a practising doctor, once again, seeking light in the realm of the unexplained. Why was I there? Because I wanted to write a book and I wanted to know what Saagar thought. Does that make sense? Like hell it does. That’s why I had trudged all the way there and would be changing trains for the rest of the day to get back home.
One whole wall in the waiting room was teaming with thank-you cards, mostly from women who believed they had had babies as a result of Acupuncture or other therapies received at the centre. It was a modest space with a tired fawn carpet and upright wooden chairs with plastic, foam maroon coverings. Like all waiting-room-chairs all over the country.
Her big smile snatched my gaze away from the wall and welcomed me into her space. She guided me up the stairs into the same consultation room where we had met more than a year ago. The familiar potted palm, the large window and the same arrangement of the 2 comfy sofas by the fire-place, facing each other with a small wooden table placed in between. Déjà vu, all over again.
I sat facing her and the window. She sat facing me and the door. We started with a brief catch-up and then she connected with Saagar. She said he’s happy. He’s growing his hair and following the cricket. She thinks she can hear him speak French. Is he saying something about Guy’s hospital? He says he enjoyed his time and friendships at Dulwich. He mentioned a particularly close ‘black’ friend. I am sure he means the one coming home to lunch tomorrow. He says he loved the large window by his bed with the great view of the London cityscape.
He felt there was a place for him at the wedding. It was fun, especially the bit by the river in the early morning hours. He must have meant the photo-shoot of Si and I in our normal clothes. It shows us in our ‘natural habitat’. The camera loved the early morning sun. So, we complied. ‘Natural’ and ‘photos’ don’t belong in the same sentence. We tried our damnedest best, seeking inspiration from Hollywood and Bollywood combined, getting confused and dramatic and giving rise to some cracking moments. He was there.
He offers me a Green Tara through her. A Buddhist manifestation of active compassion, Tara is the saviouress, the one who reaches out and responds freely to all who suffer. She is fearless and boundless. He wants me to have a jade statue of Tara. He knows my heart and mind. We walk in the same light.
She says the book will happen. A book of beauty and joy that was him. Of his continued presence. Of hope.
( A 20 minute video of an awareness raising presentation for trainee anaesthetists at a national conference in Glasgow from earlier this month: Being Human)
[E-mail address for Moya O’Dwyer, the medium: email@example.com]
84 life-size statues of men were seen standing at the edge of tall buildings in central London in late March representing the same number of men lost to suicide every week in the UK – a hard hitting visual project aiming to bring this tragic loss out into the open from behind closed doors.
Common threads emerged from articles published in April:
“Students more likely to kill themselves” in the Times: Researchers from a Hong Kong University analysed the ONS figures and found that the number of university students in Britain increased by 5 per cent between 2012 and 2016. The total number of suicides among students increased by 32 per cent, from 139 to 183 deaths. A think tank said that a law banning universities from contacting the friends and family of students who are struggling should be revisited.
The number of first year university students reporting mental health problems in UK Universities has risen five fold in 10 years. A combination of increasing awareness of mental health issues, a lowering of the taboo previously attached to mental health services, mounting debts, homesickness, loneliness and a greater sense of anxiety about the future may be some of the reasons for it. Some vice-chancellors still think that mental well being is not the business of universities and it’s just about developing the mind. But developing minds means nothing unless students settle down well in their new environment and be ready to learn.
According to recent ONS statistics on loneliness, people between 16-24 are at the epicentre of the loneliness epidemic in the UK. More so than the elderly. Women were found to be lonelier than men. Other variables were renting a home rather than owning one, being single or widowed, having poor health and feeling disconnected from the local community.
In an article entitled “Doctors knew my son was suicidal. I should have been told before he died” in the Guardian, I raise this question yet again: Is confidentiality more important than helping someone at risk to stay alive? Is it correct for a father to be informed by doctors after the death of his son,”Now that he is dead I can tell you that this was not his first attempt”?
When Saagar was ill, he filled out an online form and referred himself to IAPTs – Improving Access to Psychological Therapies. This programme began in 2008 and has transformed treatment of adult anxiety disorders and depression in England. Over 900,000 people now access IAPT services each year. I have used this service in the past and found it useful. I suggested to him to fill out the form a second time and he did. They usually call back within a day or two. He didn’t hear back from them.
I recently found out that IAPTs does not look after suicidal people. I would like to know what they do when they read a self-referral form of this nature.
There is a vacuum in the NHS. There is little face to face support for those who feel life is no longer worth living. Why do most people with physical illnesses ask for help? Possibly because they trust they will receive appropriate help from the system. Why is it that many people with mental anguish don’t approach the medical services for help? Probably due to lack of trust.
The Listening Place works towards filling that vacuum. A few days ago I visited their premises, a short walk from Pimlico station, in the heart of London. This airy, green, warm and welcoming place felt ideal for anyone in need of care, support and understanding. Here, individuals can speak openly about their feelings without being judged. They receive on-going support from trained volunteers over a number of weeks as deemed appropriate. The volunteers help relieve emotional pain and stress and offer opportunities to consider alternatives to suicide. Anyone over 18 can be referred to them by themselves, other charities, NHS as well as health and social care organisations. They try to give continuity by facilitating you to speak with someone who knows you from before. They charge nothing and keep your information confidential. It is remarkable that they are open 9 am to 9 pm, 7 days a week.
Sarah Anderson, who was once director at the largest call centre for the Samaritans, set up The Listening Place in 2016 and the service has since helped hundreds of individuals with its unique approach to care. During our chat, Sarah’s passion and dedication to the cause comes through, loud and clear.
The world needs more people who give a damn about other people.
(PS: Through the grapevine I hear the future funding of IAPTs is in jeopardy. The vacuum grows.)
During his holidays, Saagar and his friends would be subjected to Woman’s hour on BBC Radio 4 second hand, as their mothers listened. They would later have amusing/interesting discussions about breast feeding, female education and employment challenges. This station was pre-set on the car-radio and at home. It was designated as the ‘old people’s’ radio-station by him. Invariably, ‘Gardener’s question time’ would come on while we were in the car together, travelling over the weekend. It was quaint by its sheer irrelevance to us as we could barely keep our 4 nameless indoor plants alive. Our urban pre-occupations meant we didn’t have a gardening vocabulary.
‘Just a minute’ was our all-time favourite – a panel of funny people asked to speak for one whole minute on a given topic without repetition, hesitation or deviation. The seemingly innocent topics often held great potential for hilarity, for example, billiards, the best thing about cats, how I spread a little happiness, keeping a straight face, my love of the absurd, garages and such. The correct and incorrect challenges posed by the panellists generated tremendous amount of laughter. Our attempts at giving each other topics resulted in great amusement.
On Thursday evening I was asked if I’d like to be a guest on Woman’s hour to talk about Saagar. It was unbelievable. It made me smile and cry at the same time. What a paradox! Of course I’d love to be on Woman’s hour. Under these circumstances? Meeting Jenni Murray was an honour. She was down to earth and professional, looking just as I imagined, in her trademark glasses sitting just above the tip of her nose.I told her she had my dream job. She said Joan Baez had been in the studio the day before, sitting at the same chair as me. How cool! Oops! Saagar prohibited me from saying ‘cool’ as he thought it sounded all wrong coming from me. I wonder how he would feel about this interview if he knew. Maybe he does.
Despite making notes and preparing as well as I could, I was a bit flummoxed by some of the questions. I didn’t say everything I wanted to. I hope there will be other opportunities. This conversation must grow until everyone is a part of it in a meaningful and constructive way. In a way that saves lives.
A recording of the interview with brilliant and committed Mr Ged Flynn, the CEO of PAPYRUS and I:
All those decades ago when I was at school, bullies were visible. Their names were known. They were often big built and their demeanour, unpleasant. Girls could be bitchy, forming little clubs ousting this one or that one depending on how jealous they were of them. The playground was the scene for most unplayful activities. Lunch time was about much more than just lunch.
The only respite was that I knew when I left school I could leave it all behind and come home feeling safe. I wouldn’t have to deal with all that unpleasantness that went on at school.
Now, bullying happens over the electromagnetic waves all times of day and night, incessantly with no breaks. It can reach toilets and bedrooms. The instigators don’t have to have names or forms. They can be cowardly as hell and yet have the mean pleasure of bullying vulnerable people. The abusive messages are often un-erasable, making it possible for the victim to visit them repeatedly and being humiliated and traumatised over and over again. It is inescapable.
In Arabic, ‘Sarahah’ means ‘honesty’. It is also a highly trending app for anonymous messaging, invented by Mr Towfiq (above) from Egypt. He says it was designed so people could have honest feedback on their strengths and weaknesses from their colleagues at work. But in the west it is the perfect platform for anonymous nastiness.
Suicide by mental health in-patients continues to fall, most clearly in England where the decrease has been around 60% during 2004-14. This fall began with the removal of ligature points to prevent deaths by hanging but has been seen in suicides on and off the ward and by all methods. Despite this success, there were 76 suicides by in-patients in the UK in 2014, including 62 in England.
Suicides after discharge:
The first three months after hospital discharge continue to be a period of high suicide risk. In England the number of deaths rose to 200 in 2014 after a fall in the previous year. Risk is highest in the first two weeks post-discharge: in a previous study we have shown that these deaths are associated with preceding admissions lasting less than 7 days and lack of care planning. There has been a fall in post-discharge deaths occurring before first service contact, suggesting recognition of the need for early follow-up. In all there were around 460 patient suicides in acute care settings – in-patient and post-discharge care and crisis teams – in the UK in 2014.
First of all I want to say that every suicide is a huge tragedy and must be prevented at all costs. Behind each of these numbers are precious lives and beautiful people. I don’t allow myself to forget that even when I am angry. This blog is a mere observation on how I have seen politics being played in front of my eyes in the last week. In light of the above findings, in consultation with his expert advisors and in all his wisdom, Mr Jeremy Hunt has decided to focus his attention on in-patient deaths – a group that is manned by the most highly trained professionals in a very controlled environment, a group that is on the list of ‘never-events’, a group that has already shown a decrease by 60%, a group where even a small reduction in numbers will amount to a big percentage and will make him look good.
With all good intentions, he has converted a healthy aspiration of Zero-suicide in the community to an unhealthy target for in-patients creating huge anxieties. Last week at the NSPA conference I heard Mr Hunt speak in the most self-congratulatory of tones about how wonderful it is that UK is the first country to legislate for ‘Parity of Esteem’. I am sorry Sir, that means nothing on the ground. The workforce coming in contact with the majority of suicidal people in the UK is largely untrained. They don’t even know how to talk with them, let alone ‘look-after’ them. The massive funding cuts focus on mental health which in turn results in poor training of junior doctors. When questioned directly about ‘parity of training’, he masterfully slips and slides away.
It’s a dry winter morning. I am in my favourite red jumper and floral denims, on my way to the therapist. I have seen him for 3 years and I remain completely unfinished. My train will arrive at this platform, Platform number 1, West Norwood Station in 4 minutes. There are only 2 tracks and only 2 platforms here. The sun is in hiding and all trains are delayed, allegedly due to bad weather. Despite 2 people ahead of me in the queue there is enough time for me to get a cappuccino with one and a half sugars from the newly-opened kiosk, the Blackbird Bakery. The pair of sweet, smiley girls behind the counter have a way of making things work while maintaining an environment of relaxed, chatty friendliness.
A toddler in a pram doesn’t want her half-eaten kitkat anymore. She wants to feed it to the birds. Her mum takes it from her and lovingly puts it in her own mouth. She gets a quizzical look from her daughter. She beams a gentle smile back on to her baby.
Just as the train pulls up behind me, my order is ready. In the here and now, the yellowness of the foliage on the ground and on trees is bright as stippled sunshine. My drink smells like the warmth of Brazil. Grateful for no rain, I turn around and step onto the train holding my hand-warming and heart-warming treat.
I look for a forward-facing window seat with a table. The one I find seats an unclaimed blue knitted scarf, coiled up like a snake. An overweight elderly lady sits with a smile opposite me.
‘Is this your’s?’ I ask.
The train starts to move.
‘No.’ says she.
‘How are you?’
‘I am ok’, she says in a strong Spanish accent.
‘Doing anything nice today?’
‘Going to see a friend in Victoria. We don’t talk much. We meet once a week. We go for hot-chocolate.’
She looks down at a picture of 3 pretty young women in her magazine.
‘I always wanted daughters but I got 2 sons and1 grandson. No girls.’
‘Boys are lovely too.’
‘Yes. But I would have liked a girl.’
West Norwood station is well behind us by now.
Saagar, my son comes alive in my mind.
Platform 1 was where he spent his last couple of hours. That was 3 years ago. He was more than I could have dreamt of. All I wanted was him, his happiness. Nothing else.
He was there for at least two whole hours. No one spoke with him. Small talk saves lives. For every life lost on the railway, 6 are saved by those around them. Only if someone had interrupted his train of thoughts. Only if someone had trusted their instincts enough, to act. Only if someone had cared enough to ask if he was ok. Only if everyone had the basic tools of suicide prevention, just like they do for choking and drowning. Who knows?
Now, all I want is for him to come back to me.
Free on-line training for all, in Suicide prevention, launched by the Zero Suicide Alliance. 20 minutes of life-saving skills : https://www.relias.co.uk/zero-suicide-alliance/form.
231 school kids died of suicide in 2015.
Please support PAPYRUS in tackling this impossible reality.
‘Take a minute, change a life.’
Taking time to look out for someone who may be struggling, encouraging them to talk, offering a word of support and listening could help change the course of their life. Making someone a cup of tea, inviting them for a walk or a run, asking them,”Are you OK?’ could make a world of a difference to them. It would surely enrich your life too.
This series of short films is about real people and real stories. It’s about life and death. It’s about what we can do as individuals and as communities to help each other through dark times. It’s about you and me. Please scroll all the way down to watch all the snippets.
A vigil will be held on Thursday, the 14th of September at Hyde Park, Speaker’s corner at 6.30 pm. We will get together to honour the lives of those lost by suicide. Please bring pictures, candles, stories, poems, memories and songs. It will be an occasion for us to celebrate our love.