I run a Suicide Crisis Centre and feel huge sadness that I sometimes encounter clinicians who express their view that a particular patient’s suicide is inevitable. This happened again only last week while we were discussing the findings of our research project into deaths by suicide in our region. A clinician who knew “Elsa”, one of the young women who died, said he had felt it was only a matter of time before she ended her life.
I have lived experience of suicidal crises and set up our services because I felt there was a need for a different kind of help for some people in crisis. We see clients who, like me, have had difficulty engaging with mental health services or have not responded well to the treatments offered or methods which were used. Sometimes clients express surprise to us: “You don’t seem to have given up on me”. We never will. They had experienced clinicians who had.
If a person appears not to be improving or responding well under mental health services, then I would assume that a change of approach or even a change of service may be indicated. I do not believe we should ever reach the stage where we say: “We have tried everything – there is nothing more to offer”. I have heard clinicians say of some of our clients: “The person is attempting suicide so frequently/self-harming so severely that it is becoming inevitable that they will die”.
Clinicians had little hope of my ability to survive back in 2012. A GP told me that she and her colleagues believed that I probably would kill myself. I had made two suicide attempts which required hospitalisation and could see no reason to live. They could identify few protective factors which would prevent me from ending my life. I had also not found mental health services helpful. My psychiatric records indicate that my long-term risk of suicide was recorded as “high”. The notes of a meeting of mental health clinicians showed that they felt they had nothing more to offer me.
They had not found a way to help me, and therefore I was categorised as a patient “who could not be helped”.
I changed GP surgeries and asked to be referred to an NHS Trust in a different part of the country. Psychiatrists assessed me and concluded that I had bipolar disorder. Although this came as a shock initially, it ultimately helped me to make sense of what had been happening to me. I understood why I was having periods of deep depression which sometimes led to my having thoughts of suicide. I learned how to manage the condition by identifying strategies to help me through the depressive episodes. There was also access to medication specifically for bipolar disorder.
GPs and mental health clinicians had spoken of my future suicide as inevitable. The reality was that I had not yet been able to access the right help or treatment. The clinicians had not properly understood what was at the root of my suicidality and so had been powerless to help. Rather than acknowledge that, they shifted the full responsibility to the patient. The patient becomes someone who “cannot be helped”. “We have tried everything” the clinicians may feel.
Recognise that you may not be the right person to help the patient, not that they cannot be helped. All of us working in a support or clinical role need to be aware of this.
In our research we identified fourteen learning points for the services involved in Elsa’s care prior to her death: these were areas where we felt that there may have been missed opportunities to provide help for her or where errors were made. I certainly did not feel that all possibilities and treatments had been explored.
When psychiatrists feel they can do no more for a patient, and start to view their death as inevitable, I believe they should be under an obligation to explore all other avenues outside their NHS Trust. I would like to see them routinely referring the patient out of county for an independent assessment. A psychiatrist in another part of the country can offer a fresh perspective and may draw up a completely different treatment plan. Being referred out of county was life-saving for me. Similarly, third sector organisations may be able to provide a different approach which could make a life-saving difference.
Please never believe that your patient’s death is inevitable or that they are beyond help. Acknowledge the likelihood that they have not found the right kind of help yet. Work persistently to provide or find that help for them. Support them. Believe in their ability to survive. It is important that you hold onto hope for them.
I believe that every client who comes to our Suicide Crisis Centre can survive. We work tenaciously to ensure that they do.
For information about the Suicide Crisis Centre: www.suicidecrisis.co.uk. The Suicide Crisis report “Research into Deaths by Suicide” can be obtained by emailing: firstname.lastname@example.org
“Elsa” is not the young woman’s real name.
Useful websites and helplines:
- Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
- 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.)
- Get Connected is a free advice service for people under 25. Call 0808 808 4994 or email: email@example.com