Suicide prevention

Day 586

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“In an interconnected world characterized by profound mobility of people and goods, few threats to health are local anymore.
Air pollution is a trans-boundary hazard that affects the global atmosphere and contributes to climate change.
Drug-resistant pathogens, including the growing number of “superbugs”, travel well internationally in people, animals, and food.
The marketing of unhealthy foods and beverages, especially to children, is now a global phenomenon.
Safeguarding the quality of pharmaceutical products has become much harder, with complex manufacturing procedures and supply chains spanning multiple companies and countries.
Ensuring the quality of the food supply is also much harder when a single meal can contain ingredients from all around the world, including some potentially contaminated with exotic pathogens.
The refugee crisis in Europe taught the world that armed conflicts in faraway places will not stay remote.
The Ebola outbreak in 3 small countries paralyzed the world with fear and travel constraints.
Last year, a business traveller returning home to the Republic of Korea, infected with the MERS coronavirus, disrupted the country’s economy as well as its health system.
The rapidly evolving outbreak of Zika warns us that an old disease that slumbered for 6 decades in Africa and Asia can suddenly wake up on a new continent to cause a global health emergency.
This year’s appearance of urban yellow fever in Africa, now confirmed in the capital cities of Angola and the Democratic Republic of Congo, is yet another serious event with potential for further international spread.”
– an except from the address to the 69th World assembly by Dr Margaret Chan, Director-General of the World Health Organization. Geneva, Switzerland. 23 May 2016.

While there was much to celebrate and worry about in her speech, it mainly focussed on physical illnesses. ‘Non-communicable disease’ and ‘drug problem’ were the possible indirect references to mental illnesses. 

In 2013, the Lancet published the largest study looking at Global Burden of Disability (GBD) caused by mental illness. It used DALY as the unit of measurement. DALY stands for Disability Adjusted Life Years.  One DALY equals 1 year of healthy life lost. The highest DALYs attributable to mental illness and Substance use disorder were found between 10-29 years of age. Majority were due to depression, followed by anxiety and then Drug and alcohol disorders. As compared to 1990, the rise in disabilty from these causes in 2010 were 37.6% higher. These findings show the striking and growing challenge that these disorders pose for health systems in developed and developing regions. In view of the magnitude of their contribution, improvement in population health is only possible if countries make the prevention and treatment of mental and substance use disorders a public health priority.

 

Day 585

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photo

The Dragon Café is starting to feel like second home. Every Monday morning I look forward to going there for a cup of tea (and homemade banana bread) after work, meeting interesting people and being introduced to new dimensions of mind, body and spirit. Now I know some of the names and faces. I am turning into a regular and people are getting to know me too. It feels great.

This afternoon I attended a very simple but smart chess workshop and an art display by a Child and Adolescent psychiatrist and some of his patients. He talked about one of his patients with Selective Mutism, Megan Winton (self portrait above) who could not speak at all outside of her home but now does public talks on her artwork. He discussed their creativity process, the positivity of art and wellbeing and the crossover between service users and providers.

I also met with a passionate artist from a group called ‘Mental Spaghetti’ that brings together marginalised groups of society and the general public to help reduce stigma, enable social interaction and to encourage artistic practice in people of all abilities. They are working on an exhibition titled ‘Cross Pollination’ with the aim of blurring the lines of ‘Us vs Them’ (ie. service providers vs service users).

All those years I spent stuck inside a hospital building seem like such a waste now. We all are the same humans, yet there is a such a wide gap between the social model and the medical model of illnesses. I am intrigued to step out of my little world and see all these imaginative, inclusive and heart felt ways of dealing with people.

I wonder if Saagar would have enjoyed any of these things. I think he would have been a stunning percussionist and a very funny mimic. I think he would have had fun if he would have got this far. Oh! There I go again…

 

 

 

 

 

Day 584

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On the one hand there is mental health and on the other there is mental illness. It is possible to have no mental illness but poor mental health. For instance, one may not have a diagnosis but may be terribly unhappy, drinking excessively and taking drugs to cope with the stresses and strains of life.

On the other hand, it is possible to have a mental illness and be in a state of good mental health. For example, someone with a diagnosis of a mental illness who is able to feel good and function well with the help of friends and family, talking therapies and medications.

And then there is everything in between. At all times we are all on a spectrum. Our vulnerabilities are different at different times. They determine our ability to handle stuff thrown at us. Sometimes it feels like we have ‘too much on our plate’ even if there is very little on it. At other times, our plate might be truly full but we can cope.

I wish I had heard of ‘Happiness hour’ before. It is one hour spent on ourselves, doing something we enjoy doing, if possible everyday – taking a soak in a warm bath, watching TV, going for a walk, doing yoga and meditation, listening to music and so on. It keeps us feeling good and increases our capacity to manage our lives better. I have been consciously grabbing that hour for myself at least three times a week and it does make me feel better and stronger.

 

Day 582

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A lovely lady came up to me at the end of the Mental Health First Aid for Youth training today and asked, ”This may sound silly but could I have seen you on a morning TV show last summer?” I said yes, quiet possibly. I had put one of Saagar’s black and white pictures up before talking about him at the end of the training. She had seen that picture on TV 10 months ago and seeing it again had reminded her of him and me. Interestingly she had registered Saagar’s image much more strongly than mine. Well, he is unforgettable and not just for me.

She went on to share how she had been inspired that day to look into Mental Health issues closely and make the wellbeing of her students her top priority. She is an English teacher and is passionate about creative writing and now, Mental Health.

On the afternoon of 22nd July last year, at 3 pm I received a call to ask if I would be prepared to show up at BBC studios at 8 am the next day to appear on TV on a live current events show to talk about some issues around suicide. It was very short notice but with the help of my work colleagues I was able to arrange the morning off work. It was a short but meaningful conversation. The responses on Twitter, I am told were many, from people who were deeply touched by it. That one step was taken in a state of being lost and dazed, very unsure of myself having never done anything like that ever before, speaking about the most painful event of my life on national television.

After meeting this lady today, I can see the impact of real stories and conversations.
My faith in the Universe gets stronger everyday. We shall overcome.

“Take the first step in faith. You don’t have to see the whole staircase. Just take the first step.”
–Dr Martin Luther King Jr.

Day 581

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After more than a year of Saagar’s death I could see that nothing at all had changed. Nothing was going to change. There is no power behind a Coroner’s inquest report, no legal, professional or financial implications for anyone concerned. Hence no lessons learnt.

I approached the GMC for help with the view that may be they will see things as they are and have more power to influence change but this is the letter I received from them today:

“In January 2016 documents regarding Saagar’s care were referred to a GMC Medical Case Examiner for review. I can confirm that the Case Examiner was specifically dealing with Dr GP and any issues surrounding his fitness to practise when they reviewed the documents. A decision was made by the Case Examiner that there was nothing contained within the documents which would call into question Dr GP’s fitness to practise and that as such the case should be closed with no further action.”

  1. Really? Is this protectionism or is it a reflection of a deeper level of ignorance within the medical community than I thought?
  2. Am I the one who’s crazy? Imagining things? Over-reacting? Making false judgements just because I am grieving?
  3. The job at hand is clearly much harder than I thought it might be. I can teach children to ask for help. I can teach parents and teachers to identify signs of crisis and get professional help for them. They can take them to the GP. And then what?

The GP may ask them to fill out a PHQ-9 questionnaire. They may score 27/27. The GP might not discuss that with the parents. Not get anyone’s advise on the phone. Not refer them to a mental health specialist. They may send them home with a medicine that might worsen their suicidal ideation. They may also reassure them that they will get better.

That is like sending someone with terminal cancer home with the assurance that they will get better. That however would be unacceptable because cancer is a physical illness.

Severe depression can be invisible to the untrained eye. So, it’s ok for GPs to send young men with the greatest degree of depression home. Unquestionably.

‘Parity of esteem’ is a joke.