A report and a film.

A report published last month by National Child Mortality Database (NCMD) identifies common characteristics of children and young people who die by suicide between 1st April 2019 and 31st March 2020. It investigates factors associated with these deaths and makes recommendations for policy makers.

Every child or young person who dies by suicide is precious. These deaths are a devastating loss for families and can impact future generations and the wider community. There is a strong need to understand what happened and why, in every case. We must ensure that we learn the lessons we need to, to stop future suicides.

Key Findings:

-Services should be aware that child suicide is not limited to certain groups; rates of suicide were similar across all areas, and regions in England, including urban and rural environments, and across deprived and affluent neighbourhoods.

(No one is immune.)

-62% of children or young people reviewed had suffered a significant personal loss in their life prior to their death, this includes bereavement and “living losses” such as loss of friendships and routine due to moving home or school or other close relationship breakdown.

(Saagar was unable to return to his life at University due to a new diagnosis of a mental illness.)

-Over one third of the children and young people reviewed had never been in contact with mental health services. This suggests that mental health needs or risks were not identified prior to the child or young person’s death.

(Saagar had been in contact with Mental Health Services but they discharged him as soon as he showed signs of improvement. They did not follow him up. His GP was unable to identify his high risk of suicide despite his Depression scores being the worse they could be for at least 4 weeks.)

-16% of children or young people reviewed had a confirmed diagnosis of a neurodevelopmental condition at the time of their death. For example, autism spectrum disorder or attention deficit hyperactivity disorder. This appears higher than found in the general population.

(Saagar did not.)

-Almost a quarter of children and young people reviewed had experienced bullying either face to face or cyber bullying. The majority of reported bullying occurred in school, highlighting the need for clear anti-bullying policies in schools.

(At his Primary school in Belfast, his peers called him ‘Catholic’. He didn’t know what it meant but he knew it was not right. This went on for more than a year before I found out. When I spoke to his class teacher about it, she denied any problem.)

The film ‘1000 days’ tells us about Saagar and what we have learnt from his life and death. I am not sure what or how much the policy makers and service providers have learnt or changed but we have learnt and changed a lot and here we talk about that. The film is presently available on-line at the Waterford Film Festival (Short Programe 6), till the 15th of November at the link below. Please take 20 minutes to watch it if you can. You will learn something too. Each one of us can make a difference.

https://waterfordfilmfestivalonline.com/programs/collection-jlvwfxb8ctq

Ordinary people

Once upon a time there was an ordinary person. Making a living, being honest, spending time with the family, having a few friends and simple pleasures. Nothing special. Just ordinary.

Then they lost their child to the monster of unbearable pain. They carried on breathing and giving and receiving love. There was nothing ordinary about that. They couldn’t bear the thought of the same thing happening to anyone else. So, they went out to tell the stories of their angels to everyone. To exhibit the smithereens of their bleeding hearts. That was not easy or normal but they did it anyway. To say that there were other options that they wish their kids had been encouraged to explore. To give out the phone numbers of the good people out there who can help. To remind everyone that there was hope. There is hope.

These 3 dads were ordinary people. Now they are walking together for 300 miles over 2 weeks, making waves all over the country, connecting with people, smashing the stigma and sharing the stories of their lovely girls. Ordinary and beautiful. Just like you.

Please listen and take a look at what’s possible when love speaks and acts.

Not ‘them’ and ‘us’. Just ‘us’.

It has been a dream to be face-to-face, talking about Saagar with the Psychiatric community. In the past 7 years that has not really happened. On Wednesday, the 15th of September, I got as up close as possible with an entire department of roughly 100 psychiatrists and Therapists at differing levels of experience and practice. They were in New York and I was here, in London. The Grand Round was organised by a colleague, Prof Mike Myers, who gave it the title:

‘Losing a Son to Suicide: How One Mother is Opening Hearts and Minds Around the World’

After a cordial ‘meet and greet’, the film ‘1000 days’ was screened. It was followed by complete silence. Same as the previous time it was screened. And the time before. Each time the audience was left speechless.

After a long minute I gently stepped in with the assurance that this was a normal response. I invited questions and comments. I thanked them for the work they do and acknowledged how difficult it is for the profession to deal with such losses. I shared my hope that the film will deepen their insights into the human element of such deaths and the value of forging partnerships with bereaved families.

What followed was a fulsome, creative and holistic exchange of ideas.

“What led you to make this film and share your life in this way?” one young Resident asked me.

“I could only work with what I had and do what was in front of me. When I could write, I wrote. When I could speak, I spoke. When I could learn, I learnt. From the moment I heard the news of Saagar’s death, my only intention was that this must stop. No one should have to suffer the way Saagar did or the way I and his friends do. This film came about because it’s time we recognize that these lives are worth talking about, that the desire to end one’s suffering is a normal human desire and that we all have a role to play.”

Winner – BEST DOCUMENTARY – Swindon Independent International Film Festival
Winner – Brighton Rocks Film Festival – Spirit Award
Winner – Compassion Film Festival Colorado – Reflections of Love People’s Choice Award
Nominee – Morehouse College Human Rights Festival Atlanta (winners yet to be announced) 
Semi Finalist – Gold Coast International Film Festival – New York 
Nominee – Long Story Shorts International Film Festival 

Upcoming festivals where the film can be watched starting 23rd September 2021. Tickets available now.

‘1000 Days’  
Morehouse College Human Rights Film Festival – fosters ongoing discussions about human rights and social and political issues.
September 23 – 25 https://morehousehumanrightsfilmfestival.com/2021-film-guide/

‘1000 Days’ at Women Over Fifty Film Festival:
WOFFF is an inclusive, international film festival celebrating women over 50 in front of, and behind the camera.
25 Sept – 2 Oct – tickets on sale
https://wofff21.eventive.org/films/61379c142c09f100b90ae7c4

Comments:

”Bringing people closer and keeping them deeply connected despite social isolation.”

“Keeping the silk threads of human bonds as strong as ever.”

I hate my shoes.

(‘A pair of leather clogs’ by Vincent Van Gogh 1853-1890)

“I am wearing a pair of shoes.

They are ugly shoes.

Uncomfortable Shoes.

I hate my shoes.

Each day I wear them, and each day I wish I had another pair.

Some days my shoes hurt so bad that I do not think I can take another step.

Yet, I continue to wear them.

I get funny looks wearing these shoes.

They are looks of sympathy.

I can tell in others eyes that they are glad they are my shoes and not theirs.

They never talk about my shoes.

To learn how awful my shoes are might make them uncomfortable.

To truly understand these shoes you must walk in them.

But, once you put them on, you can never take them off.

I now realize that I am not the only one who wears these shoes.

There are many pairs in the world.

Some women are like me and ache daily as they try and walk in them.

Some have learned how to walk in them so they don’t hurt quite as much.

Some have had to wear the shoes so long that days will go by before they think of how much they hurt.

No woman deserves to wear these shoes.

Yet, because of the shoes I am a stronger women.

These shoes have given me the strength to face anything.

They have made me who I am.

I will forever walk in the shoes of a woman who has lost a child.”

  • Author unknown.

One death by suicide is one too many. On World Suicide Prevention Day, today, let us start by

  1. believing that suicides are preventable.
  2. knowing that we all play a part, however small, by being aware, educated and resourceful.
  3. being kind and courageous enough to ask the ‘S’ question, listen and respond.

Blue Rose

She was the colour of almonds. Her smile so bright, it made the sun shine. Her hair waist-length, wavy and a very dark brown, like a heavy veil down her back. Her petite frame, shy, smelt of sandalwood. She was only 19.

Her friends had rebellious red, pink and green highlights in their hair. Some had happy multi-coloured beads and braids woven in. Others had playful ribbons platted in, like flower-girls at hippie weddings. She sat on her aquamarine blue sofa with her laptop, peering through colour-charts. She wanted her hair dip-dyed. She hadn’t picked a colour yet.

It was going to cost a bit but her mum had agreed to pay for it. She often did.

When alone in her room, unable to sleep at 2 am, Rose had looked up Helium and what it does. She didn’t know why. It was an involuntary act. It was nonsensical. Her body and mind were no longer of her.

Her hair appointment was in a couple of hours. She had to decide now. It was important she got this right. It was an expensive decision. The staid Royal blue or the scintillating Moroccan Turquoise? Silky peacock blue or the majestic sapphire? She wanted a straight horizontal line to run right across the dark sheet of her hair. The bottom one-third of the length a startling shade of blue, like a designer curtain.

She played classical music on the violin. Her ears didn’t particularly savour the Blues. They jarred her. She didn’t have a taste for blueberries. She preferred the ‘rasp’ variety with big dollops of double cream. Her wardrobe was a smattering of whites, pinks and reds. No blues there either, except the denim jeans and shorts. She was a proper girlie-girl. Blue skies made her spirits soar. But they left blue stains on her heart. She hid them like children hide pretty pebbles in corners of drawers. Her smile kept feeding the sun through the blueness.

She hand-wrote letters to the people she shared the house with, in blue ink. To her mother she said how wonderful a mum she was and she should take better care of herself. To her sister she expressed her appreciation for her companionship, friendship and laughter. Her little brother never left her side. She never turned down his invitation to play any kind of silly game with him. The dogs were all hers. They didn’t know they weighed as much as her. She had to sit down when they clambered all over her saying ‘we love you’.

The blue stains on her heart were expanding like drops of ink drip-dripping on a white blotting paper. She knew it was happening but didn’t know what it was. It’s creepiness had no name. It made her want to escape. It compelled her thoughts to convince her that her deepest desire was to implode. She had no say in the matter. It made her hands look up Helium on the internet. It kept her eyes wide open at night. It made her tummy churn, her legs restless and her head hurt. She now had 2 hearts and she moved between them. One blue. The other not. One wanting out. The other wanting blue hair.

“I am finding this difficult Mum.”

‘We need to leave in about 20 minutes for the hair-dressers my darling.’

“Yes. I am thinking about it … looking up the options on the internet.”

‘Good idea. We can take your laptop with us. I am sure the hair-dressers will have some ideas for you. Don’t worry.’

“I have some ideas but haven’t decided yet.”

‘Take your time. No rush.’

Midnight blue was the final choice. She was happy.

Over the next year that wretched blue embedded deeper into her heart and from there, leached into every cell of her body. Then it burst out, released itself and merged back into the midnight, the sky, the ocean.

That was 5 years ago. Till this day, her mother’s mind twists into painful knots when she remembers that day. How could her lovely Rose have wanted to live with blue hair and at the same time, to not live at all? At nineteen! How?

No one knows. Sometimes it’s like that.

———————————–

A video for every parent: https://www.youtube.com/watch?v=3BByqa7bhto

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

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)

Patients first.

Credit: Mario Sanchez Nevado (www.aegis-strife.net)

When I speak with gatherings of doctors, I often start with asking them to shout out whether they think the statements below are True or False. What do you think?

  • Sick doctors know when they are sick.
  • Doctors are good at asking for help and following advice.
  • Doctors take good care of themselves.
  • Doctors have strong support networks.
  • Doctors are kind to each other.   

Irrespective of which country I am in, without fail the auditoria flood up with a big resounding ‘FALSE’ for each of the above, accompanied with some sniggering. Isn’t it shocking? One would expect that people who work in ‘healthcare’ would know a thing or two about their own health as individuals and as a community.

These are the highlights of a survey conducted by the Royal College of Anaesthetists in 2016-17:

The NHS Sickness statistics consistently show that NHS hospital doctors have the lowest rate of sick leave as compared to any other staff group.  Here is a list of personality traits of doctors (a broad generalization, of course) that might explain this:

  • Perfectionism (I must do this right!)
  • Narcissism (I am good at what I do.)
  • Compulsiveness (I can’t give up till I finish.)
  • Denigration of vulnerabilities (If I need help, I am weak.)
  • Martyrdom (I care for my patients more than myself. Their needs come before mine.)

The very traits that make us good doctors are the ones that may not be very good for us. But our seniors have not been aware of this and hence they have not been able to help us understand ourselves. This tradition has been going on for generations of doctors. There is a nobility associated with such self-sacrifice, which we all have bought into. The fact is that if your own cup is empty, you cannot serve others well.

Things add up – a dysfunctional department, work pressures, lack of support outside work, ill-health, emotional burden of the job, a traumatic adverse incident, lack of sleep, fatigue, a complaint made against you, poor diet and no time to exercise or pursue hobbies, impaired judgement of one’s own symptoms, fear of letting others down, difficulty in admitting that they have a problem.

Burnout among medics is not unusual. It looks much like depression and sometimes ends in devastating tragedies. But help is available. Sadly, unlike other illnesses, for mental health issues, the onus of getting help lies with the sufferer. It takes courage to acknowledge one needs help and seek it out in good time. It might be the best thing a doctor can do for themselves and their patients.

Sources of support:

  1. https://www.bma.org.uk/advice/work-life-support/your-wellbeing/sources-of-support
  2. Doctors in Distress, a charity set up by Amandip Sidhu in memory of his brother Dr Jagdip Sidhu who was an eminent cardiologist and tragically died by suicide on 27th November 2018.

Me and Thee

Ron and Jeanette

The first time I saw Jeanette, she was acting in a play called ‘Hearing Things’ being staged at South London and Maudsley (SLaM) Hospital, where Saagar received (inadequate) treatment. The play was inspired by events and conversations from real ward rounds of patients with serious mental illnesses. It was written by the playwright often described by critics as the ‘English Chekhov’- Philip Osment, well known for giving a voice to those at the margins of society.

The play highlighted harsh facts through a story sensitively told. Just three actors  illuminated the wide swathes of blurred lines between sanity and insanity, between the healer and the ill, between strength and fragility. I learnt a lot from it. It was a powerful blast that left me thinking about my roles as an ordinary member of society, a doctor, a mother, a patient. It gave me an insight into how and why the system does and does not work. I thought it gave me a little peek into Saagar’s mind.  It certainly made me feel utterly close to him in an unearthly compassionate way.

A few weeks later I arranged to meet with Jeanette. I trusted her even before I knew her. She listened. We talked for a long time. She read the blog. I suggested a documentary. I spoke with some of Saagar’s friends and they wanted to participate. So was Si. We all had something to say. Ron and Jeanette filmed it last year.  

This year we aim to complete it and release it. We have a name – ‘1000 days’. We have found a suitable and brilliant editor. We need to find some platforms to showcase it and we will. We are working on a crowd-funding campaign which will be launched within the next 10 days. The intention is to make this world a kinder and more understanding place. Watch this space.

Many thanks in advance.