9 days to go.

Why? How did we get here?
Why us? How can this be?
Why him? Such a sweet child!

How did it feel to be him at that point?
How did it get that bad?
Why could no one see it?
How could I be so blind to his pain?
Did he try to tell me in code?
Could I not hear his cryptic messages? Why?
Did he hide it? Was he trying to protect me?
Were there clues I missed?
How could all this be happening straight in my line of vision?

Is this a crazy practical joke? Fake news?
Could I just go back and rearrange events like my dressing table?
Did he tell anyone else? His friends? His hair-dresser?

Why did he say nothing to me?
Did he not trust me enough?
Did he think I loved him too much to bear hearing those words?
Did he think I loved him too little?
Did he think I wouldn’t understand? Would I have understood?
Would I have freaked out?

Did he think I’d be better off without him?
Did he have any idea how wrong that could be?

Was it a choice or a complete lack of choice?

How bad was his pain? How unbearable?
I want to stand where he stood.
I want to see what he saw.
I want to feel what he felt.
I want to experience what he experienced.
I want to go back there. NOW!!!

How much love does it take to keep someone alive? Why was mine not enough?

The annual festival of my beastly treacherous demons has begun.
Thank you Autumn.

Shauna’s Mum says

” A schoolgirl’s been murdered in our area. It’s a horrible, horrible thing to happen – never should have and is just another reminder of this shit world we live in. I’ve been trying not to follow the news on it but they released CCTV footage of her last known moments and it was actually somewhere my brother drives past on the school run four times a day so I did watch it all and check the timings to just make sure he wouldn’t have been there and possibly seen something. (Different time of day)

I’ve just been struck by how it’s pulled the community together. There’s been balloon releases, marches, leaflet drops – the mum is clearly being very much supported ….I couldn’t find one person willing to have a cup of tea with me; three years on I still can’t. And I know suicide is different. Murder is evil; what was done to this poor girl, there’s absolutely no doubt people should be outraged by it…and I know suicide is about making a decision – albeit a stupid and flawed one…. but there are things I don’t understand why they’re quite so different.

The Head teacher of the girl’s school implored students to come forward because answers were needed. We needed answers with Shauna and anyone at her school who knew anything got told it wasn’t an appropriate thing to discuss. We even had a girl go to her teacher with some information, get told off for it and then to choose to write independently to the Coroner’s Court (with info we found hugely relevant but was promptly disregarded.)

Today the girl’s school announced that they’ll be making a memorial garden for her with lots of nice words about there always being a place for her and her never being forgotten. Shauna’s name wasn’t even allowed to stay on the Year 11 hoodies. The gesture is nice but the words; it would have made such a difference to us if someone had said stuff like that to us.

There was just both girls of a similar age and it’s just really brought it home how differently people see these things. I’m glad this Mum has the support that she so desperately needs, I don’t begrudge her it – I just wish it wasn’t so glaringly different how people reacted – this Mum is a heroine because of what she’s had to endure, we’re just potentially neglectful parents who should be forgotten about/ignored 😦

I don’t know if I’m making any sense. Like I say I do understand it. It doesn’t stop it hurting though. 😦 “

‘S’ is for…

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S is for Saagar.
For Simon and Sangeeta.
Sudden shocking jolt
For shameful silent suffering,
Suffocating grief
Secret sobbings,
And survival.
Like one strike of lightening
Sucking up a few lives at once.

S is for surreal memorial services
Soul-searching and seeking
Sometimes screaming out-loud
Shattered dreams, salty tears,
Super-flowing goodness
Softened humanity,
And sweet memories
Strewn across the wooden floor
Like techni-coloured glass beads.

S is for simplicity
And sweet
Sensitivity
Sparkling smiling eyes
Spicy savouries
Salvation and solace
Soulful stillness
Shiny haloes and surrender
Like the curve of a weeping willow
Stooping down to kiss the ground.

S is for sharing
Speaking out loud
Small things
Saffron rice and saag-paneer
Saturdays and Sundays
Seeing Samsara
Self as everything
Like the stars, songs and strings
Of guitars, and drum skins.

S is for solitude
Silence and serendipity
Sublime sun and sea
Sunflowers and sushi
Shirts and silk ties
Socks mismatched
Subtle messages from beyond
Like smoke signals in the distance
Sent out by friends from before.

S is for stigma of suicide in society.
Stashes of hidden sadness
Shrouded in small dark spaces
So little support and understanding
Such little compassion
Screened behind sports-cars
Suntans and scotch.
Like a corpse in the room
tip-toed around.

S is for serendipity. Sweet child of mine. 

Bedtime stories

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.

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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.

Here is some honest feedback on the App:

“The site is a breeding ground for hate.”

“I don’t recommend going on here unless you wish to be bullied.”

“Parents, don’t allow your kids to get this app,”

“This is an app breeding suicides.”

This powerful film entitled Bedtime stories by PAPYRUS emphasises the importance of keeping our children safe from online bullies.

Day 977

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Rebecca

Rose Polge. Rebecca Ovenden. Lauren Phillips.
All junior doctors. All deaths by suicide, in just over one year.
The only three publicly known. Total number not known.

Polge’s mother linked her suicide directly to conditions at work – exhaustion because of long hours, work related anxiety, despair at her future in medicine and the news of the imposition of a new contract on junior doctors.

This problem is not limited to the UK. Earlier this year, 4 deaths within 5 months in Australia propelled the launch of an urgent investigation into the problem. No such investigation in the UK. Indeed, the law here explicitly excludes suicide from the requirements to report work-related deaths. A GMC report in 2016 stated that the low morale amongst junior doctors was putting patients at risk. Signals of distress and a dangerous level of alienation are an indication that the system cannot simply go on as before.

At the 2017 BMA junior doctors’ conference, delegates gave the union a mandate to lobby for all suicides to be investigated formally by their employer, jointly with the GMC, Health Education England and the BMA.

In France, workplace suicides are a well-recognised entity.
Yes. Suicides are complex. There can be many contributory factors. But when there is clear evidence of a link to work pressures, that should be given appropriate attention.

Ref: BMJ Article: Suicides among junior doctors in the NHS followed by an interesting discussion.

Day 962

A letter of recommendations addressed to SLaM, drawn up along with another mother, who lost her son, Simba, to suicide:

“The laws that govern the relationship between professionals and patients namely:  the Data Protection Act (1998), the common law duty of confidentiality, and the Human Rights Act (1998) are all silent about the nature of the  relationship between  professionals and carers. This is because these laws regard each citizen as an autonomous agent capable of making decisions with regard to their own rights.

The Common Law Duty of Confidentiality in particular has been derived from the millennials-old Socratic oath taken by doctors, which is absolutist in its injunction stipulating that there is no condition under which doctor-patient confidentiality may be broken.  The 21st century has witnessed a significant shift in the doctor –patient relationships as well as, increasingly, in the doctor-patient-carer relationships. The increasing need to care for patients outside of hospitals and within communities or in their homes, has necessitated a requirement for greater collaboration between professionals and carers.

Given the pivotal roles of carers in the management of service users, the professional’s duty to share information with carers is covered by the 7th Caldicott principle: the duty to share information can be as important as the duty to protect patient confidentiality.

As carers who have had first-hand experience of caring for loved ones, we set out below some recommendations which we believe will help professionals and carers in working more effectively together for the well-being of service users and carers.

Carer’s Recommendations

  1. Patients should be actively encouraged to nominate someone they trust in their care, right from the beginning. This practice should be so well engrained that the nominated person becomes an integral part of the process of care and recovery. It is also recognised that a patient may nominate a trusted person who is a friend to attend meetings instead of a family member, as the presence of the relative may inhibit frank and honest disclosures with professionals. For example, in CAMHS a young person may trust a friend to advocate for them more than they trust their parents. If this is the case, the right of the carer or next of kin to be kept informed of the care plan should also be respected, so that they are not left out of planning and can continue to care effectively.

This recommendation is particularly relevant if the service user lives with the carer.

2. At the time of diagnosis, accurate information about the nature of the illness and the choice of treatments should be given to the carers, in written and verbal form or on- line if such facility exists. They should be made aware of their rights as carers and encouraged to partner with health professionals in the care of the patient. They should also be given realistic information about the natural course and mortality of the illness. This may mean spending more time with patients and carers at consultations, and the need for additional support services.

3. Carers should be provided with the following:
– Diagnosis or working diagnosis of the psychiatric condition
– List of symptoms to look out for.
– A management plan.
– Choices of treatment.
– Possible side-effects of any medication.
– Possible roles for the carer in managing symptoms.
– Sources of support for the carer, for example pamphlets or online resources.

  1. Professionals must remember the following when working with carers:

– To be more transparent in their communication with carers.
– To anticipate the carers need for information, providing necessary information about the nature of illness and available services even if the carer does not directly ask for this.
– To have empathy and willingness to engage carers and build a trusting relationship.
– To consider that carers may need practical support in order to be effective carers.

  1. The carers must be educated and empowered with knowledge about the psychiatric condition. They should be made to feel involved in the process of care, especially if the patients are being cared for in the community. Crisis teams and early intervention teams should engage members of the family in the care package.
  1. It needs to be understood that carers are a valuable resource, and must be listened to, as they spend more time with the patient than professionals do, and therefore will know them well. Even when service users instruct teams not to see their families, professionals should always meet with the families for collateral history, and especially if the family requests to be seen by a professional. Carers and friends know their relatives well enough to see early warning signs, and should be encouraged to share such information if necessary, in confidence with professionals especially if the service user is too ill to give consent because they are lacking in insight.
  1. Carers’ perspectives should be part of the training curriculum for junior doctors and medical students wherever possible.
  1. Patients should not be discharged from one team to another or from specialist care to primary care without arranging an early follow-up date. Given the risk of patients falling through cracks in the service following discharge, carers should be given adequate information about service structures and not merely told to go to the GP or the local AE in crisis situations.
  1. Decision making around the timing of discharge should be properly scrutinised, as premature discharge could have disastrous consequences.
  1. Discharge plans should include information for carers about the following:

-What are the warning signs to watch out for?
-What service number to call?
-How quickly one can expect help to arrive.
-Where to go in day/night time in a crisis.

  1. GPs must also understand the importance of engaging with carers, listening to them, and sharing important information.
  1. Community teams should engage patients and families in discharge planning. Where necessary, designing a crisis plan should be a joint enterprise between teams and patient and family. Carers should be involved in the design of the plan, and be given a copy of the finished document. Professionals must anticipate any problems with the patient and share them with carers at the time of discharge.
  1. Organisational structures should be redesigned to address the problems brought on by the strict compartmentalisation of services. This can be a hindrance to the provision of safe and efficient patient care.
  1. Mishaps and suicides should be investigated within a week, with the intention of learning lessons and preventing future serious incidences due to the same causes. Carers should be involved in this process, in order to hear the story from their point of view and arrive at real answers. Defensive investigations do not add to learning or patient safety. Contact with families must be at the earliest possible time following death or serious incidents. This is the time when families are most vulnerable and require information about their loved ones from those who were present. Legal considerations of blameworthiness should not prevent staff from empathetic consideration and communication with the bereaved families. Likewise, protracted legal processes should not be allowed to stop the trust from reaching out to bereaved families. Carers understand that staff may feel vulnerable following serious incidents but it should be understood that carers feel equally vulnerable and unlike professionals, may have no access to support networks at such times.
  1. At Coroner’s inquests, the trust should send representatives who have a deep knowledge of the case and who will not hide behind jargon.

 

Day 919

Prozacation

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In 2004 the U.S. Food and Drug Administration issued a black-box warning against the use of all antidepressants in individuals up to 24 years old due to concerns about the increased risk of suicidal thoughts and behavior.

Depression often presents differently in children and adults. The very condition that the antidepressants are supposed to treat is made worse by their use in the young because their brains are still developing.

A meta-analysis of 34 RCTs published by Oxford University in the Lancet in August 2016 says that only one drug among all antidepressants is statistically better than placebo and that is Fluoxetine or Prozac. The lead author, Dr Andrea Cipriani claims no influence of the pharmaceutical industry on these findings.

Prozac has made hundreds of court appearances and billions of dollars have been paid out in compensation lawsuits.

‘The idea that it’s been a major step forward for Prozac to select serotonin only is just hypothesis,’ says Malcolm Lader, professor of clinical psychopharmacology at the Institute of Psychiatry. ‘There’s no science behind it.’ Some SSRI users have reported agitation and an inability to keep still, a preoccupation with violent, self-destructive fantasies and a feeling that ‘death would be welcome’. In Germany, Prozac was initially refused a licence after trials resulted in 16 attempted suicides, two of which were successful.

For mild depression, talking therapies are recommended. Young people with moderate to severe depression are often believed to need medication. They need frequent and close monitoring. However, there are huge variations in practice. It is easier to write out a prescription at a brief consultation rather than delve deep into details. As for the usefulness and safety of antidepressants, the jury is still out.

Saagar was on Citalopram for a few weeks before he died. The GP investigator said he should have been on Prozac but she didn’t write it down in her report. The representative of the Psychiatric hospital was a Clinical Psychologist. She said she could not comment on medications. The mud is watery. 

Ref:

Lancet August 2016: http://thelancet.com/journals/lancet/article/PIIS0140-6736(16)30385-3/fulltext

Prozac and lawsuits:
http://thesandersfirm.com/dangerous-drugs/ssri-antidepressant-lawsuits/

History of Prozac:
https://www.theguardian.com/society/2007/may/13/socialcare.medicineandhealth