The 'I Am Not Mental' Stigma - And Its Real Price

Why are we still so judgemental towards mental illness? Why does Sally meet me apologising for her "breakdown", in a way she presumably wouldn't apologise to a surgeon who would come to fix her broken arm? What do we have to do to get people like Sally come to seek support long before it's too late?

Saturday. 4:30am. My phone rings. And no, it's not a drunk dial.

I'm a psychiatry doctor, on call. The A&E nurse gives me a quick phone handover, asking when I could see Sally*, a lady in her sixties admitted earlier that night after overdosing on ibuprofen.

As I open the door of the interview room, Sally, dressed immaculately, and looking very much like any of my friends' mothers, bursts into an apology: "Oh Doctor, I am so sorry... It's so inappropriate for a woman of my age to be seen by a psychiatrist at this hour. I am not crazy you know... oh dear, it just sort of happened..."

This is Sally's story - and of many like her.

Sally had never had any mental health issues in her life. She worked for a firm of solicitors, has been married for 30 years, has 2 grown up children, a lovely garden and a mortgage she is still paying off. She was a social drinker all of her life, never smoked, never did drugs.

Then one day, her husband of over 30 years, whom she's always been so close to, her only partner and her best friend, "had a bit of a meltdown", as she describes it. He became severely depressed, and instead of asking for help, he started drinking heavily, lost his job and decided to flee overseas to his brother's "to move away from everything for a bit", giving Sally just 2 days' notice. Sally awoke to a very different reality - she can't pay her mortgage without her husband's salary, her house is about to be taken away, her husband isn't answering her calls - she feels so alone and very much a wreck.

After the initial shock settled, and after her worried friends stopped visiting every day, on one lonely, rainy Saturday afternoon Sally poured herself a large, soothing glass of Rioja. And then another one. And another... Several hours and bottles later, it all felt a bit blurry and quite hopeless, and the weeks of trying to put on a brave and gathered face just crumbled. She remembered she had some pills somewhere, found 2 boxes of painkillers for her back in a cupboard, and decided it would just be simpler for everyone if she wasn't here anymore. Her children didn't need her anymore, her husband certainly didn't act as if he needed her, and with no house to stay in, doing a job which she didn't particularly enjoy anymore, and with upcoming surgery for her bad back, it just all felt so much, too much, far too much.

20 minutes after she had downed every last tablet, she went through her kids' photos and panicked, frantically dialling 999.

That's how I met her.

Luckily in her case, that panic lead to her survival, but according to stats published by the NHS that is somewhat of a miracle - more than 55,000 suicidal deaths occur in the European Union each year, including more than 6,000 in the UK and Ireland.

That figure means there is one death by suicide every two hours - and at least ten times that number attempt suicide.

The scariest part? The majority of people who commit suicide, 73% of them, haven't had previous contact with healthcare providers, have no history of depression, have never mentioned anything to their GPs and have not been flagged on the mental health services radar.

Why is that so? I think Sally partially answers that question herself: she didn't want to be a burden, she didn't want other people to know she was not coping, she didn't want to reveal she was becoming depressed, the same as her husband didn't want to look "weak and mental" by seeking support for his depression. He instead resorted to a (more?) socially acceptable behaviour of hitting the bottle; instead of getting an appointment with a GP and feeling he was being labelled "mental".

Why are we still so judgemental towards mental illness? Why does Sally meet me apologising for her "breakdown", in a way she presumably wouldn't apologise to a surgeon who would come to fix her broken arm? What do we have to do to get people like Sally come to seek support long before it's too late?

As mentioned previously, three quarters of people who commit suicide have never sought help before and their suicide remains the first and the last sign something wasn't as it should had been.

We know that's not entirely true - just because us professionals are not contacted, it doesn't mean the people around them haven't noticed something wasn't quite right. We now know that there are behaviours that can mean someone might be at risk of suicide, such as feeling depressed; withdrawn and anxious; losing interest in hobbies, work, socialising or even in their appearance; expressing feelings of hopelessness or purposelessness; acting impulsively or in a reckless way and not caring what happens to them; giving away their possessions; sorting out their affairs or making a will; and talking about suicide, death or dying or wanting it all to end.

We now know that many people will express their thoughts of wanting to die or end it, to relatives, partners or peers, in the year before the act

And this is why I wanted to write this article - we all know (or may ourselves be?) a person who has been feeling or acting somewhat like this: a person who needs support.

Intervene, and you might save someone's life or spare someone the misery of going through years of unsupported, untreated depression. Talk. Don't ever get tricked into believing someone is their illness.

Stigma kills, literally. And it's about time we end it by talking out loud about it.

#nobody's fault #you wouldn't be ashamed if it was a broken arm #I am not my illness #say it out loud

*names and details have been changed to protect patient's identity

There is help and support available:

If you are feeling suicidal, please call 999 or go to A&E and ask for the contact of the nearest crisis resolution team (CRT). CRTs are teams of mental health care professionals, such as psychiatrists and psychiatric nurses, who work with people experiencing severe psychological and emotional distress.

Samaritans offer a 24 hours a day, 7 days a week support service. Call them FREE on 116 123. You can also email

Papyrus is a dedicated service for young people up to the age of 35 who are worried about how they are feeling or anyone concerned about a young person. You can call the HOPElineUK number on 0800 068 4141, you can text 07786 209697 or email

NHS Choices: 24-hour national helpline providing health advice and information. Call them free on 111.

C.A.L.M.: National helpline for men to talk about any issues they are feeling. Call 0800 58 58 58.