Yesterday there was a terrible mix up with the meds i’ve handed over to the home treatment team. Suddenly they were missing. A Dr had to write a ‘script for 48 hours worth of meds. The ‘script read HTT. Wherever i had it made up they would know my my mental health status. Ashamed, i decided to take a bus today to a village nearby. I didn’t want our local pharmacy (of 13 years) seeing the ‘script. Sigh, the most important med the didn’t have. I had to take another bus to our local pharmacy. The ‘script was filled, my sense of failure awful. I had to collect my hay fever meds, Dseloratadine too. Fifty six tablets in the house. Urgh the urge to take them has been horrendous. I’ve decided to pass them over to Ray.
“On a freezing afternoon in February 2013, 21-year-old Becky decided to take her own life. She had depression and had been experiencing flashbacks to the abuse she suffered as a child. “I’d been managing, but things came to a head when I broke up with my partner, who had also been abusive,” she says. “I started to feel that I was a burden to my friends and it would be better for everybody if I wasn’t around.”
Thankfully, at the last minute, she changed her mind: “I started to feel scared, and I thought that if I felt fear, I shouldn’t be doing this. I realised that I didn’t want to die. I just wanted to stop hurting.” She called 999 and was helped.
Every year, 6,000 people kill themselves in the UK and the Republic of Ireland, and tens of thousands more attempt to. Now, inspired by a pioneering programme in Detroit that has reduced suicides by 82%, the NHS is funding a number of pilot projects of its own. The Detroit programme has been running within the mental health system there for eight years – and in some years, there have been no cases of suicide at all.
Central to the UK scheme is reducing the stigma attached to suicide, and encouraging people – not just patients and doctors, but all of us – to talk more openly about it. Aly Anderson, the director of development at Mind in Cambridgeshire, says: “Seventy-five per cent of people who kill themselves are not in touch with mental health services, so the people in the best position to intervene are often their family, friends, neighbours and colleagues. There is an idea that if someone is going to end their life, there is no way to stop it – but most suicides are preventable.”
Anderson’s team is working with local communities, as well as GPs and other primary care workers, to raise awareness of signs of suicidal thoughts – and how to ask someone directly about it. “Most people who are thinking about suicide will give out warning signs, either consciously or subconsciously,” she says. “Sometimes people have made a decision and can appear to be ‘recovered’ and in a good mood.” How people respond at this point is crucial, she says – yet too often we are afraid to raise the subject. “Part of that is down to this myth that we will put the idea in their head. But there is no evidence that talking about suicide is going to make people want to do it.”
The Detroit programme, which was developed by Henry Ford Behavioral Health Services, encourages talking openly about suicide at all stages, coordinating everyone from social workers to therapists to family members. “It is always poignant, but it leads to fruitful discussions,” says Dr Doree Ann Espiritu, a psychiatrist who jointly runs the programme. “I learn a lot about what is happening in the back of the patient’s mind, and it allows them to look at ways to cope if they feel like that again.”
Research shows that one of the most important aspects of suicide prevention is restricting the means to do it. This is illustrated by the so-called “British coal-gas story”. In the 1950s, suicide rates were climbing in the UK and putting your head in the oven was a common method. When we switched to natural gas in the 60s and 70s – less toxic because of its lower carbon monoxide content – suicides dropped by a third, and have remained close to that level ever since. In Detroit, means restriction often equates to working with at-risk patients to ensure weapons are removed from the home.
While professional support is essential for someone with a mental health problem, anyone can help during an acute episode, says Anderson. “It’s not a science. You just have to listen and keep them safe. We all have the capacity to save a life in that way.” If you have serious concerns, the next steps may be to arrange an urgent GP appointment or go to A&E.
The Samaritans reiterate that the most important thing is to talk. Joe Ferns, the Samaritans’ executive director of policy, research and development, says: “It can feel awkward to start a conversation. People are afraid they will say the wrong thing or make things worse, but silence is the greater danger. There isn’t really a right or wrong thing to say in these situations. The most important thing to remember is that the person needs to feel that you will listen to them, they are safe with you and you care about them.”
Becky had told doctors and friends she was feeling depressed, but hadn’t revealed how severe it was – partly, she says, out of fear that she would be sectioned. “I didn’t want to tell my friends how bad I felt because I was scared they would try to stop me. And the depressed part of me was scared they would try to encourage it. If you are considering ending your life, it is a very personal and intimate thing and it is really hard to talk about.”
Afterwards she was fast-tracked for psychotherapy and prescribed antidepressants. She is now back at university. “I’ve been suicidal since then, but in therapy I’ve worked on letting myself have those feelings, so I can separate them from actual intentions.” She gives talks to students about her experiences. “It’s an uncomfortable subject. I think people feel powerless to help – that if you feel your life isn’t worth living, they can’t convince you otherwise. I tell them it doesn’t have to be that way.”
Some names have been changed. For more information, visit mind.org.uk or stopsuicidepledge.org. The Samaritans helpline is open 24 hours a day: 08457 90 90 90.”
My day starts with a gnawing fear of the day ahead. At the weekend i have Ray around, so although i have the urges to runaway and die, his presence makes it easier not to respond. Since i’ve been off work i’ve found mornings so hard. I find it difficult to feel anything but isolated, utterly alone. I have a friend in a similar position to me. I’ve taken to spending the first hour of each day finding cute animal pictures and videos to post on her facebook timeline, so that when she gets up, she finds some cuteness in her life. For all the evils that can be facebook, right now i’m finding it a tool to help me cling on.
I’m exhausted. I was still awake at 4am today and knew i’d be feeling rubbish for Dr Freud Dude (more so than usual). The alarm went off, i went to the toilet made coffee and realised i was too exhausted to shower. I went back to bed and asked Ray to wake me an hour later. He did, and for the first time ever i entered the hospital without showering (new low), my hair tied up (another first). I was amazed at just being there at all. Then the director of the ED unit comes in. She asks how i’m doing, and i know i look a fright, so there is no point lying. I feel a failure. The session went badly. We are trying not to bicker, but maybe we should. I need him to help me get angry at the bad people in my life, i need him to help me stay on this planet. He seems to think i’ve given up on therapy as i’ve given up with everything else. I pondered this on my long wait for a 13.30 appointment with the Occupational Health Advisory Service (OHAS). I haven’t given up on therapy – i’m still praying for a miracle. I dragged myself there today when all i wanted to do was die in bed.
I killed time and went back to the hospital to see the OHAS person. Whilst entering the building i bump into the psychiatrist of the ED unit. Again, i can’t lie…failure.
The session with OHAS went well, and there are several things for me to approach work with when i’m ready to return. OHAS will help me with these when the time is ready. I can’t be forced to go to my employers Occ health (been twice in the past and both times were car crashes). I feel a little more in control of a tiny slice of Sue today…but scared that this tiny slice will vanish.
I am very aware of my depression and i want a “snap out of it” cure so badly. Lord knows what some of my colleagues are thinking at work. One will be going “oh, she’s got nice weather for it”, as i’ve decided to go off sick to lie in the garden. Well, so far the weather has been amazing, but the garden has been tough to sit in. I spend my days curled up on the bed with the cats. It’s the safest feeling. Another will be bitching, “what’s she got to be depressed for? She doesn’t have four daughters like me, i get to be depressed”. With this colleague she doesn’t just single out mental health. When i told her i was having to have breast surgery her response was “at least you don’t have a teenage daughter that hates you.” Other colleagues i know will empathise, i know they will be concerned. It is hard that not everyone one understands depression. I know when i go back to work I’m going to be facing some cringe-worthy conversations with managers. I’m happy that they don’t understand the black place i’m in as it means they’ve never been there. Then the shame will come up. One person has already told me “oh, i thought you were stronger these days”.
Today i took the bus for my B12 injection at the GP surgery and to get weighed. I have a B12 jab every 10 weeks for pernicious anaemia, and they hurt, a lot. I hate getting weighed (even though i still refuse to know my weight). On the bus was a man who i see at work a lot. He has his own manifestation of mental ill health, he mutters to himself, over and over about why someone left, he then slams his foot on the floor/pavement. For me it is very sad to witness. Something went horribly wrong for this man, and it led him to presenting in this way. He was doing his presenting on the bus as he does on the streets or in my office building. As he got up to alight from the bus one person said loudly “he needs stronger medication”, another “people like that shouldn’t be allowed to be out and about”. I had to bite my tongue, i wanted to defend him, but some people are too ignorant to understand mental health issues. No words i said would make them think differently about this broken man.
We have a new-ish nurse at our practice and she and me are not getting on very well. When i went for bloods a few weeks ago she refused to listen to the wisdom of a paediatric butterfly needle, and jabbed my vein with an adult, normal needle. It wasn’t pretty. I took after photos to show her next time she attempts to get blood from me. Today i went in and explained i was there for my B12 and i needed a weight too. The B12 is prescribed by my GP. She greeted me with a “so why do you need this injection?”. I managed to seal up the sarky comments about enjoying the pain, and explain politely what pernicious anaemia is. I also explained that she would need a plaster as the injection site will bleed, “no it won’t”. It did and she had to get a plaster as blood dribbled down my arm. “Why do i need to weigh you?” was the next sharp question. What i should have said was “i hate my body, i hate knowing my weight, i feel too big, i feel i take up too much space”. Instead i have issues with my weight, and that i’m stepping on the scales backwards and i DO NOT want to know my weight. I got a peculiar look in response.
It’s depressing that a lot of medics are just as clueless about mental health as the people on my bus today. It’s depressing that people don’t listen instead of question.
Okay, so i have a masters degree, and should be considered fairly smart. However, yesterday evening i reached panic point about being weighed today and took not my “usual” three or four laxatives a day, but six. It’s three am an i’m in pain. Cursing the weighing scales i face later today. Cursing the value i put in them, and the scores on their doors over me, and all of my achievements.
The Nurse came in yesterday for a chat and sort my meds out. Rather than let me do it, he sat and did the medicines himself. Urgh, more excruciating than last week. I’m praying for the Nomad box to arrive asap. Another nurse will be out tomorrow and i’m being weighed. This is a better option than going to the GP practice, but i’d much prefer not needing it to be done at all.
Yesterday’s Stand Alone workshop was on “what we learnt about relationships from our families”. It was a particularly painful session for all of us. With the use of tiny pom-poms we had to show how we were with our family as a child. Such a simple task, but the emotion of it was very messy. The amazing facilitator contained the emotions all of us were feeling. The workshop moved on to the lessons we were taught as children about relationships. Mine were very simple, “you’re not wanted”. The facilitator hasn’t seen us for 6 weeks and she could see straight away that the last few weeks had obviously not been easy for me. I explained about the home treatment team input, and why. She recommended i do things to soothe myself – even just stroke my arms. This feels impossible, and i don’t know why. The sessions are really helpful, but the day after (today) is always painful, and it’s not helping my urges right now.