suicide

Wrap-around?

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“What can we do to offer wrap-around care to our patients?”

In the live Q&A at the end of the NCISH conference yesterday, this question was asked of the panel. The Chairperson directed it towards me. I can’t remember what I said. This morning I woke up with what I would have liked to say.

For wrapping, we need two things. One, the fabric which we are going to use to wrap and the person we want to wrap. Let’s discuss them one by one.

  1. The fabric

The fabric of Suicide prevention in Health-Care is made up of two things – people and systems. Let’s look at them a bit closely.

  1. People

What are the beliefs of the people?

I know of an ENT surgeon from another country who wanted to move to the UK and the only job he could find was in Psychiatry. So, he is now training to be a Psychiatrist. Is he interested in suicide prevention? Do Health-care professionals believe that suicides are preventable? Are they content that simply by treating mental illness they are doing their job?

What are the attitudes and abilities of the people?

When the Emergency department calls to say there is a suicidal individual waiting to be seen, how do they feel? Are they excited to have an opportunity to make a difference? Or is it a drain on the limited time and energy they have? Do they know how to build a compassionate connection with someone who has lost all hope? Have they received any training in Suicide Prevention? Do they have enough self-compassion to look after someone else well?

Do they have the resources and the knowledge to do a good job?

Do they have access to their past history? Do they have beds on the ward? Can they ask a colleague for a second opinion if they have a doubt about how to involve family or friends in their care? Do they know of other resources, like charities, activities and people that may help this person? Do they have comprehensive and informative leaflet they can share with them? Do they have the means to follow them up?

b. Systems

Does the system have capacity? Are the various parts of the system effective and joint-up enough to be able to hold the person they are trying to wrap or are there big holes in this part of the fabric? Do the various parts of the system share the same mental model, a shared knowledge, pre-suppositions, and beliefs that can be used to help achieve mutual goals? Are their practices evidence- based? Do they investigate deaths with a view to learn lessons and implement change? Do they look after the well-being and emotional health of their employees? Do they hold themselves accountable when things go wrong?

2. The person

Allowing space for them to express themselves. Help maintain their sense of agency. Inform them it is safer for them to involve other people who care for them. Equip them with resources. Give them the support they need. Ask them what would help them? Listen. Sit with their despair. Acknowledge it. Keep them connected with their life as they know it. Keep hope alive for them.

Know that the person at the centre of the wrapping is of great value.

Information is useful if it becomes knowledge. Knowledge is useful when it becomes wisdom. So, let us not stop at information.

Ref:

Reaching common ground: The role of shared mental models in patient safety : https://journals.sagepub.com/doi/full/10.1177/2516043518805326

Joyland

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Islam forbids suicide. It calls it a grave sin or ‘haraam’. It is viewed as taking away the gifts of life given by God. The Qu’ran says, trust God, have faith in the mercy of God and do not destroy life.

Joyland is a bold film, the first Pakistani feature to be premiered at Cannes in 2022.

It is about being alone in a crowd of expectations, being punished for having secret desires and accidentally making them seen. It is about someone else having to pay the price for our impulsive indiscretions, about how the bucket of shame topples itself on our heads as soon as we allow our innermost wants to be visible. It talks about how others can forcibly live their dreams through us, how our roles in society hold us firmly in one place and make us invisible as individuals, how we don’t have permission to be confused and are not allowed the time and space to think and talk things through, how life can be cluttered and noisy.  It’s about knowing you want to ‘run away’ but not knowing what that means or looks like. It’s about having to figure all this out, all by yourself.

It’s about treasuring moments of joy when they arise.

They could be hidden in the kitchen, on the Ferris wheel or inside the pages of an old book.

Are you listening?

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‘I was sent away to live with my granny when my youngest sister was to be born. I was three and a half then. I stayed with my grandma till I was 6. When I moved back to my family, I wasn’t quite sure who they were. That time of my life shows up as murky grey when I think about it.’

“Well, everyone has gone through something or another.”

“Those days life was hard. There were no washing machines and dish-washers. So, I can understand how hard it must have been to look after three under-fives.”

“At least you were re-united with your family within a few years and you were safe.”

“I am sure your grand-ma cuddled you and loved you very much.”

“At least you were in the care of your grand-mother and not some random stranger. I was brought up by nannies.”

“It clearly did you no harm. Look at you.”

Wow! Not one person sitting around that table listened.

Did they have any curiosity? Any fascination?

Do we allow our listening to connect us with something fragile, deep within us?

Does it forge understanding and connection with another?

Do we allow ourselves to sit with someone else’s shadow?

Does our listening ease a burden?

Am I listening?

Are you really listening?

(Resource: In CORe community, we listen.)

Nights – 3654.

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A hundred and twenty months. Ten years. An outrageous survival.

Each night angry, uncharitable.  Sleep. No sleep. Dreams. No dreams.The death of so many. Dreams.

In my dreams, I plead with you. Please stay, Be’ta.

We’ll find a way. Don’t give up yet. Don’t go away.

Come here. Sit with me.

Tell me what I need to know. Tell me what hurts you so. Tell me how I can make it go.

I could guess when you were hungry, thirsty.

To your amused annoyance, even when you wanted to pee. I just knew. I don’t know how.

But this one I did not see coming.   I couldn’t. I don’t know how.

I am sorry. I had no map. I was lost in the fast lane.

In my dreams, our dark sides are friends.

Together they figure it out, Have a laugh, make it all okay.

In my dreams, we breathe together nice and slow,

As if singing a joyful melody. We hold hands and dance in our kitchen

Crying on each other’s shoulders, secretly.

From the fridge, I pull out a white china bowl

Filled with pomegranate seeds,

Rubies, I harvested earlier in the day. Please stay, my Jaan. I would say.

In my dreams,

through my furious longing

I can momentarily understand.

Your pain, your silence.

I can understand why you had to go.

Like a boat sailing into a new morn,

I must release you.

I must stay.

I must let you be on your way.

In my dreams.



(An ancestor of this poem is Walt Whitman, who said, “We were together. I forget the rest.” )