The point of a blog is to share thoughts to get others thinking. For me, the process of writing also helps me to work out what I think.
When I was chief executive of a mental health trust, I wrote a weekly blog aimed at patients, staff and anyone else who was interested. I wrote each one myself, but it was important that I sought advice from members of my team on scope and tone. I also needed to differentiate my weekly messages from things I occasionally wanted to say that were more personal, such as when I spoke about my experience of depression in October 2013.
Now I am responsible just for me, and I can say whatever I like. There isn’t much point writing a blog simply to agree with everyone else. But I am going out on a bit of a limb about the announcement on a zero suicide policy.
When I first heard about the policy, I wasn’t sure what to think. It sounded a bit like zero-tolerance, which I have issues with. So I thought I’d ask around.
I have spoken to a number of people with wise views about mental health policy. Their reactions vary. Some think that getting mental health onto the agenda is the important thing, and that this proposal has done it. Others think that this project is anti-discriminatory because it sets a clear and challenging target for commissioners and providers. Professor Louis Appleby knows a thing or two about suicide. He thinks the policy is aspirational and ambitious.
But these views are not universal.
I am grateful to Stella, who is 17 and blew me away with her thoughtful blog. She concludes that the policy may be an election ploy. And I’ve heard from a few others who fear that, without new money, it will simply be a stick to beat mental health services with. I’ve commented myself on using the NHS as a political football. Saffron Cordery also points out the need for sufficient investment.
But my main concern, developed from a few private conversations I have had with others who, like me, experience suicidal thoughts from time to time, is the impact such a policy could have on people seriously struggling with thoughts of taking their own lives, and on their families.
As I learned during the Applied Suicide Intervention Skills Training (ASIST), if you want to help someone who is contemplating suicide, you must wait for an invitation, however small or quiet, that suggests they want help. You are taught to offer support in a way that is non-judgemental and sensitive to that person’s needs and circumstances. In the 3 months since doing the course, I have used what I learned several times. We cannot allow a policy that seeks to prevent suicide to undermine the importance of such training, which is based on international best evidence. Or initiatives like Suicide Safer Cities, where communities join together to become more suicide-aware and thus safer and kinder.
The death of Robin Williams last year caused some people to examine their attitudes to suicide. The initial response to his death was shock. And then people started saying that, as well as mourning his loss, we should give thanks for his life, and applaud someone who had clearly been battling his demons for many years, and yet given so much to so many. I truly hope that this policy won’t cause people to see deaths by suicide as a failure, rather than an end to a life that was hard but extremely precious.
The loss of a loved one through suicide is extremely hard to bear. The Sick Festival in Brighton and Manchester is running concurrent sessions on this in March 2015. There is an annual service in February at St Martin-in-the-Fields for those affected by suicide. It is vital that such a policy does not undermine compassionate efforts to reduce the stigma and guilt still associated with suicide.
Perhaps I have reacted strongly because of something that happened a long time ago. In my early 20s, I took a large overdose. Luckily I was found, and taken unconscious by ambulance to A&E. As I came round, I couldn’t respond to the nurse in the rubber apron and wellingtons who was washing out my stomach because I had a thick tube down my throat and was hanging over the side of a trolley vomiting copiously into a metal bucket. If I could have spoken, I would have agreed with him when he said that I was taking him away from looking after people who were really ill, and that I was a useless, selfish, shameful waste of space. Until last year, despite deep compassion for others who feel suicidal, I believed that description about me.
Today, there are still health care professionals, and others, who think like that nurse. So if this policy, which I am sure is based on best intentions, is to have the intended impact, it must be backed up with serious investment in mental health services. Not just to bring them back to where they were before the NHS savings programme affected them more negatively than any part of the NHS, but in response to real need. And there must be a supporting education programme to make sure that NHS staff, including commissioners and clinicians across the whole NHS, view mental health on a par with and intrinsically linked to physical health. Rather than somewhere to find savings no-one will make too much fuss about, or a distraction from “real” health care.
Good mental health care does not come cheap, although in the end it saves money as well as lives. And it is about a great deal more than preventing suicide. If we can agree on that, I can support this policy. Otherwise, we may be setting services and patients up to fail.