A mother’s anguish
The number of mental health patients dying by suspected suicide is on the rise. A Christchurch family tell Cecile Meier about their long battle with the mental health services ending in their son’s death.
Margaret* says her son took a huge part of her heart with him when he died by suspected suicide in June.
‘‘If feels just as if it had been ripped from you physically and you cry so hard you feel that you could die from the sorrow that swells up from so deep inside,’’ she says.
Jonny’s death ended a twodecade fight for his family to get him the mental health he needed.
SCARY VOICES
Growing up, Jonny had been a ‘‘wonderful son’’, enjoying music and sports.
But when he turned 13, he became angry and started selfharming.
Youth mental health services struggled to diagnose him and eventually discharged him.
At age 16, he started hearing voices.
‘‘He would talk of the voices as being evil at times and they scared him,’’ Margaret says.
After a suicide attempt a couple of years later, Jonny’s GP referred him to Totara House, a specialist provider for young people experiencing psychosis.
But specialists did not believe he was hearing voices and said he was making it up to get attention, Margaret says.
‘‘I couldn’t get him to continue with appointments – he felt embarrassed and let down.’’
TURNING TO DRUGS
Jonny went flatting and turned to drugs to block the voices, Margaret says.
In 2008, at age 21, he became a father with his then partner, who was also a drug addict.
‘‘The plan had been to have a baby for the benefit to help fund the drugs, but Jonny fell deeply in love with his daughter and she became his whole world,’’ Margaret says.
An ‘‘endless battle’’ ensued over their daughter’s care, with Jonny and his partner living with their parents at times.
Jonny became clean for a period in 2010-11.
But without the drugs, return to reality ‘‘would bring on depression’’, Margaret says.
His GP prescribed him a high dose of anti-depressants.
PSYCHOTIC BREAK
Jonny started using drugs again and, mixed with the antidepressants, he became psychotic.
In one frightening episode in January 2012, Margaret called psychiatric emergency and was told to bring him to hospital and to ring police if she had any issue.
While Margaret tried to organise care for her granddaughter, Jonny lost control.
He believed his parents were possessed by aliens and he became violent, leaving his daughter traumatised and his mother with bruises.
Police took him to Hillmorton Hospital.
Jonny was placed on compulsory treatment order and released after three weeks as an inpatient.
He could not stay in his family home anymore for safety reasons and was placed in a community flat.
He received monthly antipsychotic injections but did not have access to talking therapy, Margaret says.
He told his mother he felt devastated not to be with his daughter and wanted to die.
He hated his accommodation and had no money but was not well enough to find a job that would allow him to get a flat of his own, Margaret says.
After a few months, Jonny complained about the injections’ side effects and his doctor agreed to take him off the medication. His parents felt it was a mistake.
‘‘If Jonny had been properly supported, counselled, remained medicated and kept as an inpatient until his mood was stabilised, he would have been able to reestablish his relationships with his family and daughter.
‘‘Over time [doctors] would just repeat to us that Jonny was an adult and we had no authority to speak for him – he could make his own decisions no matter how unwell he was.’’
STUCK IN A CYCLE
Off medication, Jonny slipped back into his ‘‘angry and frustrated psychotic state’’.
It was not until 2013 that was he diagnosed with schizophrenia.
‘‘It was so obvious to us – the voices, saying he could hear what people were thinking, but you would always just get those condescending looks from specialists who knew better,’’ Margaret says.
In the years that followed, his parents called emergency services countless times to have Jonny readmitted at Hillmorton but he would always walk out after a night there.
‘‘We were stuck in a cycle.’’ He became ‘‘extremely unwell’’ in 2015 and 2016 and lost a lot of weight.
‘‘I knew he had no way to look after himself and we couldn’t have him with us in our house as we care for his daughter full time and he was too unwell,’’ Margaret says.
Earlier this year, Jonny was taken into crisis respite care but left shortly afterwards.
‘‘He said there was only one old lady there cooking and he didn’t get any comfort from being there,’’ Margaret says.
‘‘If you’re in crisis and you go to an empty house, stand there and look around. All that is there is another person in crisis cooking themselves some food. Why on earth would you stay there? No welcoming atmosphere, no support people to sit and listen and counsel you, just a bed for the night . . . To me this is not a response to a person in crisis.’’
In June, Margaret told Jonny’s care manager how worried and frustrated she was with his care.
‘‘He was very depressed and had been popping in and out of Hillmorton whenever he got really low. They did nothing however other than let him sleep the night. Then he would just take himself off in the morning . . . They seemed to think nothing of his repeated cries for help.’’
Jonny stayed at Hillmorton overnight on June 12. He died alone the night of June 14.
EVERY SUICIDE A FAILURE
Canterbury District Health Board (CDHB) chief of psychiatry Peri Renison says mental health patients’ suicides are on the rise.
‘‘We see every suicide as a failure of our system and examine it as such and review it and try to learn from it.’’
The serious event review team does an initial scrutiny within a few days of a patient’s suspected suicide, followed by an internal review, which is usually complete before the coroner’s inquest.
DHBs have to review any suspected suicide happening within 28 days of contact with the services, but the CDHB reviews cases outside of that timeframe if there are any concerns about the care, she says.
She concedes there are two few psychologists available to provide talking therapies. Corrections and the private sector offered better remuneration, leading to recruiting difficulties.
Solutions included investing in case managers so they could offer talk therapy.
Renison agrees with critics of the region’s run-down mental health facilities.
‘‘All of our buildings are end of life, are needing replacement . . . We would like better facilities.’’
Buildings designed in the 1970s when the use of seclusion was more common were not fit for purpose anymore, she said.
A suicide mortality review committee report from 2016 includes analysis of people who accessed mental health services in the year before their suicide.
It looked at 829 mental health service users’ suicide between 2007 and 2011, which accounted for 46 per cent of all suicides during that period.
Almost half of them had been in contact with mental health services in the seven days before they died.
The report highlighted failures in care similar to the ones experienced by Jonny’s family, including a lack of long-term plans for patients, and families often excluded from care decisions.
The report was a pilot and the committee has been funded to continue this work, but how it will collect and analyse data is still being determined.
LITTLE DATA AND ANALYSIS
More recent data on mental health patients suicide is hard to come by.
The coroner releases provisional suicide statistics each year but does not say whether people who died had been in contact with mental health services.
The Ministry of Health could only provide data on mental health patients’ suicides for up to 2013 because of the time lag between a death and the coroner’s confirmation the death was a suicide.
About 37 per cent of people who died by suicide in 2013 were mental health service users.
The ministry does not collect data on suspected suicides.
DHBs around the country report mental health patients’ suspected suicides to the Health, Quality & Safety Commission.
The commission provided data showing a significant increase in suspected suicides over the past six years but says year-on-year comparisons would not be accurate as reporting rules and culture have changed over the past few years.
Initially, DHBs only reported suspected suicides of patients who had been in contact with mental health services within seven days of their death. In 2011-12, the criteria changed to include cases within 28 days of contact with the service.
Doctors said we had no authority to speak for Jonny and ‘‘he could make his own decisions no matter how unwell he was’’.
Margaret, Jonny’s mother
‘‘We see every suicide as a failure of our system and examine it as such and review it and try to learn from it.’’
Canterbury District Health Board (CDHB) chief of psychiatry Peri Renison