When a GP is aware that a patient is having suicidal thoughts or intent, they will usually consider a number of actions, one of which may be to contact the local mental health team, in particular the Crisis Resolution and Home Treatment Team (CRHT). But what happens when a person doesn't want the involvement of CRHT because they find them unhelpful? Does the duty of the GP end at this point?
On occasions, a GP will then respond by saying "There isn't really anything I can do to help." They explain that they are not a trained mental health professional. They may end the consultation or phone call moments later. This happens, particularly with the out of hours GP service, and it's extremely concerning that it does. The person may hear this as "There is no help" or "There is nothing anyone can do for me". The risks of giving such a message to a person who is having suicidal thoughts are clear.
GPs can indeed help at this point - and most do.
Consider this very different phrase: "I want to do whatever I can to help." It's a powerful phrase and for most patients it's hugely reassuring to hear. For some, it is extremely surprising - and disarming - to hear it from a doctor. When low and depressed, you may place little value upon yourself. You may see yourself and your own life as inconsequential. It may be difficult to imagine that anyone else would see it as important that you survive or that anyone would spend time on you or help you. That's one of the reasons why it is powerful when a doctor says it.
The doctor may then spend time with the patient, seeking to understand what has led to their crisis. They will ask questions not just to assess risk but also to really try to understand the reasons why they are at risk now. You show that they are important enough that you would allocate your time to them. This demonstrates that they matter, and their life matters to you.
I spoke to a GP about this initial response to the person in crisis and their view was that their role was to prescribe medication and refer on rather than to provide therapy or counselling. However, the immediate response to a person in crisis that I have described is not counselling. Consider it as part of a crisis intervention, because in effect it is. Your actions of staying with that person at this time of acute crisis are helping them to stay alive. Your focused attention on helping to preserve their life is absolutely part of the role of a doctor - even if you only have a short time with them. Please see this as the potentially life-threatening situation that it is.
You have a person before you who may be very close to the point of death. If they had a physical condition which had led them to such a point, you would not hesitate to act and give help. As a doctor, surely you should have the same intent to help someone with a mental health condition which has led them to reach a similar proximity to death.
The fact that you recognise their risk is important - and it's vital that you let them know that you do. It is distressing to a patient to feel that they are not being heard or fully believed when they speak of having suicidal intent. Does the fact that the doctor didn't offer help mean they didn't recognise the risk, a person might feel.
I often refer to the power of empathic listening and validating what a person is saying - recognising the impact on them of what's happened (the events which have led them to feel suicidal). The fact that you understand the impact is helpful. In the moments that a doctor has with a person at risk of suicide, their kindness, concern and care will also be hugely powerful. Some medics tell me they find all this quite intangible and so perhaps the powerful message they can give to the patient instead is "We do not want the consequence of this to be your death." That phrase alone tells the patient that their life matters to you.
In the best responses, the GP discusses with the patient how the surgery will provide ongoing support over the next few weeks (or, in the case of the out of hours GP, how their service can support over the coming hours or weekend). They will also talk through alternative support services to CRHT.
The person who is told "There is nothing I can do to help" may never seek help again. It may reinforce the lack of hope they already felt. It may reinforce the feeling that they have that they cannot be helped or are not worthy of being helped. It may seem that everyone has given up. It may feel that no one cares. None of this is true, but it can become the truth of a profoundly depressed person. Please seize the opportunity to help. Even if you doubt your capabilities to do so, you have more skills at hand that you realise. You simply need to respond as a concerned professional, who has the desire and the will to help, and who cares about the life of every individual.
Joy runs a Suicide Crisis Centre in Gloucestershire and has lived experience of mental health crisis herself.
For information about the Suicide Crisis Centre: http://www.suicidecrisis.co.uk