In recent months there have also been reports, such as by Institute for Public Policy Research, which suggest an increase in the level of disclosures of mental health issues. Some may argue this as a result of better efforts to capture this data and awareness campaigns, while others will say that it’s a reflection of a deteriorating national picture in a call for better provision, ‘better’ often meaning ‘more’.
As a nurse and a Senior Lecturer in Mental Health, perhaps unsurprisingly I do come from the standpoint that it's far more complex than merely being about mental ill health. When people tragically die it's rarely due to one pressure, it's often an emerging pile of issues, such as social inequality or loss with a common thread of hopelessness. Therefore we cannot ignore the lines of tension and points of conflict in simply aligning suicidal thoughts as a symptom of illness, which focuses the gaze upon the individual being the problem, a problem to be fixed.
For some of our students and members of our community in which we operate, the construct of mental illness does not exist; the language and thresholds do not resonate. However distress and angst does. As a sector, students cannot simply be told to disclose to a mental health professional, we increase our bank of mental health professionals and believe our job is done. For every student comfortable in doing this there will possibly be so many more that won't, and instead approach their personal tutor, the estates member of staff who they see on the corridor of halls. It's this in-road we are trying to ensure the consistency and quality of through our award-winning Three Minutes to Save a Life programme, in collaboration with Connecting with People. This approach attempts to increase the level of consistency and quality of response across our community; both to others and indeed ourselves.
Our approach is very much considerate of differing gazes in the hope of creating an inclusive and compassionate culture. It is in an attempt to democratise suicide prevention and make it everyone’s concern. We need to acknowledge that we cannot lay a gauntlet of acceptance that students and colleagues will possibly reach out to our staff for support, without them receiving the appropriate level of training. That training gives a permission to discuss our fears and where we can explore and realign understandings, as well as considering our own wellbeing. We all need to take care of our mental health (MH), how we perceive and achieve that is very much personal to us, but first we need to consider it as important and I fear many prioritise others before themselves, judging themselves far more harshly than they ever would anyone else.
“We’ve got one of yours” - I have lost count of the times I heard this in practice, and I assume this came from a place of assumption that as a mental health nurse I would know exactly what to do and how to respond to someone experiencing thoughts that their life is not worth living. A stark fact remains that suicide awareness and response are not compulsory components of mental health practitioner or nurse training. We don’t hear the narrative of hope, of survivors who can tell us what helps, instead tales of blame when it has tragically gone wrong and merely how to fit someone in to the narrative of a risk assessment tool and then places the overwhelming responsibility on me to “predict” that risk coming to fruition and get it right. If MH professionals’ understanding of suicidal thoughts aligns to one of merely mental illness or not mental illness, this risks those being deemed “low risk” or not hitting or accepting diagnostic categories receiving no help at all. This blinkered view coupled with scant public resource makes it challenging for a widening of this threshold or capacity to offer everyone something. However when we explore the tragedies that have occurred, a vast number of individuals in contact with MH services were deemed to be low or absent in risk at the time of their death, furthermore considering the largest representation of those who died were not in contact with MH services at all.
This has often been attributed to stigma, a huge word encompassing many things and one that does risk being hijacked, “tackled” but possibly in the wrong direction. Stigma around mental ill health many would argue is actually discrimination, stigma that is thought to exist around suicide may well align to this earlier point; however suicides occurred well before the construct of mental illness did. Some research suggests that stigma can also be protective in those who are considering their own quietus, as fear of shame can tip them back to a point of safety. I would go further and argue that much of what I would deem to be stigmatising, and restricting our felt ability to help someone in distress, isn't deemed as stigma at all; more so as common understanding, therefore truth. It is this we need to talk about, for example there isn't anything we can do to stop someone if they really want to do it. This could not be further from the truth for many who reach out, who we may view their cries of pain as attention seeking, but they are indeed connection seeking.
Survivor testimony over the years has added so much depth to my understanding and confidence to reflect that I can be the difference in that moment, as a fellow human being not a professional. I must look up from my paperwork, in to someone’s eyes and ask them how I can help them. Before I commence to ask the questions, I need to earn a right to first. Therefore in an attempt to do our “bit” and continue to listen and learn from the voices that offer insight in to their experience, as well as scoping the latest evidence, we can hopefully operate and contribute to saving lives within a community where so many lines of tension collide, yet in the middle are people who often merely want a hand to hold, an ear to listen and a heart to understand.
Staying safe if you’re not sure life’s worth living- to share hope, compassionate advice, practical ideas & links for people in distress http://www.connectingwithpeople.org/StayingSafe
U Can Cope 22m film and online resources - for people in distress and those trying to support them to share hope, useful strategies and national organizations for support http://www.connectingwithpeople.org/ucancope
A leaflet designed for people in distress attending the Emergency Department following self-harm or with suicidal thoughts.
A leaflet for anybody struggling to cope when bad things happen in their life.
A leaflet designed to help young people develop the ability to cope with difficulties
Please feel free to pass on these links to a family member or a friend who is in distress or who experiences feelings of self-harm, suicide or struggles to cope.