Saagar is a handsome young man. A gifted linguist, musician and cricketer, he has a heart of gold and a great sense of humour. He is studying French and Arabic at University. He is my gorgeous son.
Last summer he presented with his first psychotic episode. We took him to A&E where he was seen by a trainee psychiatrist who made a diagnosis of Hypomania. He was put on medications and sent home under the care of the Home Treatment Team. Various members of the team visited him everyday and fortunately he responded very well to treatment.
As he was due to commence his third year at university, he requested the Home Treatment Team for an arrangement that would enable him to continue his education abroad. They discharged him to our General Physician. Soon thereafter he went into severe depression. He went to Brussels to start his third year but came back within two days as he was unable to cope. He continued to be treated by his physician who started him on Citalopram and saw him once every two weeks. Despite repeated requests, the GP did not refer him back to the psychiatrists.
However, six weeks later my son ended his life by suicide.
The time from first presentation of illness till death was a mere 10 weeks.
We live in London, about 10 minutes drive from the South London and Maudsley Hospital (SLaM) which specializes in mental illnesses, the same hospital where he was first diagnosed. It is affiliated to the world-renowned Institute of Psychiatry, Psychology and Neurosciences.
How could this happen? What went wrong?
The Coroner's inquest concluded that three major factors contributed to his death:
1. Inadequate information given by the Home Treatment team (Psychiatrists) to the GP in his discharge summary - a diagnosis of Bipolar Affective Disorder not mentioned. No clear warning given with regards to anticipating severe and sudden mood changes such as depression. No clear instruction given on triggers for a referral back to Psychiatric services.
2. The GP's inability to assess the severity of Saagar's depression and suicidality and seek appropriate specialist help and advice despite parental concerns. Possibly an inappropriate drug (Citalopram) having been given to him.
3. The lack of engagement of Saagar's parents in his care despite the fact that they were deeply concerned. They were always with him and looking after him at home.
This is not the first time it has happened but no lessons have been learnt.
An Honorary Consultant Psychiatrist saw him three weeks into his illness and made a diagnosis of Bipolar Disorder.
Did he speak to any of the family members/carers about this diagnosis and what it might mean for us as a family?
His GP was the only one who knew Saagar was severely suicidal for at least four weeks before he died as he did not mention it to anyone else.
Did the GP tell any of the family members/carers or seek specialist help?
The trainee psychiatrist who wrote the discharge letter to the GP must surely have seen my son at least once.
Am I surprised now that my son is dead?
I am surprised that he lived for as long as he did. He followed every instruction he was given and took his medications religiously. He really wanted to get better.
NICE guidelines say that carers should be given written and verbal information about the diagnosis and management of Bipolar Disorder and encourage a 'collaborative approach' respecting the interdependence between the patient and their carers.
In Saagar's case it wasn't the lack of advanced research that caused his death. It was the lack of basic skills - listening, informing, communicating effectively, collaborative care, anticipating problems and seeking help.
Mental illness often presents in the teens and early twenties. I believe that unless families and carers are empowered with information, young people will continue to die unnecessarily. Unless primary and secondary care services work in unison with each other, and with carers, people will continue to fall through the gaps.
Suicide is the biggest killer of young men in the UK. More than a 100 people die of suicide every week yet no one talks about it. As a society and community, as teachers and parents, as friends and colleagues we need to educate ourselves, ask questions, demand better care for ourselves and our loved ones, especially the young.
Carers care. He was my son. I wanted him to get better more than anyone else. I had a right to know about his diagnosis and his suicidality to be able to look after him properly.
Tragically, Saagar did not get to celebrate his twenty first birthday.
I miss him every moment of everyday and I always will.
Useful websites and helplines:
- Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill.)