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Suicide
Report |
Among the two targets for the Health of the Nation Report 1992 (England) were to
The suicide rate in the Highlands stands at 19.1/100,000. The suicide rate for young men has been increasing over the last few years, but in the Highlands the largest increase is in men between the ages of 35 - 44 and 65 - 74 years. In response to these figures, to the recent action by Highland Health Board in this area, and to concerns amongst members of HUG about the subject, we had a round of meetings in October 1996 to discuss the subject of suicide. The comments on
the nature and quality of services in the report are based upon members'
experiences. About 57 users participated in the meetings and, in all
but one group, there were one or more members who had attempted suicide
or committed self-harm upon themselves. Everyone had knowledge of someone
who had either attempted suicide or committed suicide. Self-harm and suicide - what are they? Although self harm and suicidal feelings are linked and one may lead to the other, they are very different things. There was complete agreement that suicide was an attempt to die, whilst self-harm was hurting yourself. Suicide was described
as a point where the pain and distress was so much that there seemed
to be no solutions other than dying. With self-harm, the pain and distress
was so great that there were no other ways of expressing it other than
in this dramatic way. Self-harm could be some people's way of answering
their problems or a way of trying to get an inner anguish addressed
by seeking help or attention by hurting themselves. What contributes to the suicide rate in the Highlands, and why is it so much higher than in other parts of the country? Numerous reasons were given for this, such as:
A view expressed by a minority of people was that religion and sexism played a part too.
Again we had many thoughts about this:
More specific to
young men, as opposed to young people, was the awareness among young
men that they are now expected to play different roles. If someone is suicidal, what services can help them? The view expressed by the great majority of people who attempted suicide was as follows: Once someone has made a decision that they are going to commit suicide they will usually neither seek, ask for or accept, services aimed at helping them. This potentially has big implications for service delivery for people who are suicidal. However the key point to notice in this statement is the word "decision". The decision to commit suicide may be taken relatively quickly, whilst the feelings of someone who is beginning to contemplate suicide may be more long term and in that situation it is possible that a person will be prepared to seek help. The sorts of things that could help a person who is considering or feeling suicidal ranged from formal services to other factors as follows:
The service quality depends on the relationship that you have with the professional, and how approachable they are. Although it was acknowledged that in some situations services had been good, services were also widely criticised. People had had difficulty accessing services outside the hours of 9am to 5pm on weekends and also in obtaining appointments. Attitudes of some professionals were also criticised, especially those of GP's who sometimes didn't come out when people were in crisis, with the perception of users being that they had the attitude of "here we go again". Many professionals found it very hard to provide empathy or to acknowledge distress, and often would just come in for a short time until they thought things had calmed down. There seemed to be a reliance on the use of pills as a form of treatment. For those people not diagnosed as mentally ill, the Samaritans was perceived to be the only service available to them.
Most people said that they wouldn't use the Samaritans, although one person said that he received an excellent service from them in the past. Another person said that they were very useful for carers and yet another person regularly used them when she began to feel suicidal. The reasons for this were as already mentioned - having decided to commit suicide most people did not wish to talk about it. Some people said that they wouldn't contact the Samaritans because it was a phone line: being able to talk did not necessarily solve or get to the root of the problem. The Samaritans were perceived as an organisation that would not give information or advice, which was what many people wanted. The long distance that the Samaritans is from people in some areas was mentioned, as was the feeling that they did not have much expertise in dealing with people with mental health problems. (Members and the author were not aware as to whether the Samaritans provided training to their volunteers in mental health issues). Lastly, some people
said that the religious connotations of their name put them off. What are users experiences of admission to general hospitals? Members experience was that accident and emergency dealt with the physical problem well but paid little or no attention to the emotional underlying problems. They also stated that very little attention was paid to follow up after the physical problem had been dealt with. However, some people said that they were very happy to get away from the hospital as soon as possible after physical treatment had been completed. In some cases admission to a general hospital proved to be very traumatic. An example was given of someone who was admitted following a very serious suicide attempt. Due to the seriousness of her overdose she was treated by a series of nurses round the clock. They came in and did their job but with the exception of two nurses no one spoke to her directly in three days. The doctor spoke to her and said that she was very silly and that it was very likely that she would die. He then went into a detailed description of how you did die following paracetomol poisoning and concluded by saying "and then its bye bye". This type of experience was repeated by other people, especially the fact that no-one talks to you and that you are treated as a stupid and silly person. It was agreed by the groups that heard these experiences that such attitudes are examples of being judgmental and unprofessional and that nursing and medical staff are meant to demonstrate care, not just practical expertise. People spoke of the need to install in staff the attributes of care and compassion and to give the time to give it. There was also a feeling that staff in accident and emergency could benefit from training in mental health problems. Despite these very negative feelings about general hospitals there were a few positive examples, for instance: The hospital in Portree, which in the past had been thought to be a terrible place to be admitted following a suicide attempt, was said (with a few exceptions) to now provide an excellent service. Changing attitudes of staff to people being admitted following suicide attempts was seen as the reason for the improved service. Another person spoke of being calmed down and reassured and hugged on admission recently to an Accident and Emergency Department.
There were two main themes to this:
All the groups called for an education programme to help people come to the realisation that:
Some people also thought that it should be harder to commit suicide, especially through making access to paracetomal more difficult. There were mixed views on this - some people believed that making suicide harder was just a temporary solution as, in due course, other methods would become available leading to another increase in suicide rates. However there was agreement that, if possible, an antidote should be put into paracetomal as it is a common form of overdose of which many people are ignorant of how dangerous it is. One group suggested that paracetomal should become a prescription only drug.
Better detection
and earlier treatment of depression was also called for. However many
people also said that, in common with suicide, people were reluctant
to seek help at first for depression. Better detection would follow
from the education programme suggested in this report. Lastly, there was a call for more awareness that people beginning to recover from depression may only then have the energy to take action on suicidal feelings, and that care is taken in treatment at this stage.
For people at risk, or beginning to become suicidal, it was thought very important to have immediate access to services on a seven day a week 24-hour basis. People did not consider the present situation of being able to access a GP to be the answer to this problem.
Many people with mental health problems commit or attempt suicide. Although this can be partly put down to the condition itself, there was also a widespread belief that suicide occurred because of the guilt and lack of hope that accompanies a diagnosis of mental illness. This has little to do with the illness and a lot to do with discrimination and prejudice from society. With regard to users attitudes to mental illness, it was said that it was important to accept the illness and to come to terms with it.
In addition to the previously mentioned points, it was thought very important to have trained liaison psychiatric staff attached to general hospitals and Accident and Emergency in particular.
There was a lack of confidence in hospitals adhering to their discharge policies and a feeling that shorter stays in hospital reflected a climate of financial insecurity rather than a concern for the needs of the individual. There was also a feeling that, however good the discharge policy, this would be worthless if the person did not have immediate access to community services straight after discharge from hospital. One group spoke
about how the practice of giving people in psychiatric hospital passes
to go back to their own homes over the weekend had been changed to mid-week.
This was highly praised - in mid-week there are services and people
available for the person on pass whereas at the weekend there are virtually
no services and therefore no help if the person starts feeling suicidal. We had a great deal of difficulty in dealing with this complex issue. We agreed that hospital treatment should always be a possibility, as should the use of the Mental Health Act. Treatment should not rest solely on the criteria of whether someone is mentally ill or not, but also on the degree of distress and the likelihood that they will commit suicide. Whilst a very small number of people may have very good reasons for committing suicide, the vast majority of people are in a huge amount of distress and have a right to care that reduces that distress. There was however agreement that, whilst we would want to intervene if we believed someone to be suicidal, we cannot take the final responsibility for that person's act which is their decision alone to take. This however gives rise to the discussion of when is someone's decision rational and justified and when is it not. The most obvious thing to do when assessing the risk someone can be allowed to take is to discuss it with them and their relatives in the first place and act from that point.
The effect of someone committing suicide, or attempting it, can be devastating on the people that they are close to. It is important that they have help.
It was suggested that there should be a measure of the degree of risk of someone of committing suicide, and that services should be activated after a person crosses a threshold point. It was also suggested that people who repeatedly attempt suicide are in great need of services and help, and that this help should replace the judgmental attitude which persists, that they are just attention seeking. Some people found
that having access to services that allowed them to express understand
and come to terms with their feelings following suicide attempts, such
as art therapy and counselling were very helpful.
Many thanks to all the users of mental health services who participated in this. For more information about HUG call Graham Morgan on 01463 718817. |
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