Could our fear of using the word ‘suicide’ be costing lives?
TONY Harrison was so close to his only child, Vicky, he describes her as a soul mate. ‘From when she was a little girl, we were on the same wavelength,’ he says. ‘if Vicky needed help with her homework or advice about a problem, she’d say: “i’ll talk to my dad.”
‘she was a normal, 21-year-old young lady — her relationship with her boyfriend was a bit on-off and she’d been job hunting for a while, but there had never been a problem in the past that i couldn’t help her with.
‘if only she’d come and talked to me, we’d have sorted this one out, too.’
On the evening of Monday, March 30, 2010, Tony, 61, a retired civil engineer, took Vicky to asda near their home in Darwen, Lancashire. ‘i bought her a burger and a DVD then dropped her at her mum’s, where she was going to stay over,’ says Tony.
‘i said: “Night love, i love you,” as usual. and she said: “Love you, Dad.” i’ve racked my brains to think of something different in her mood or behaviour, but there was nothing.’
The next morning, when Tony let himself into his ex-wife’s house to take Vicky shopping, he found her dead on the settee, having taken an overdose.
‘initially i presumed she must be sleeping, so i stroked her arm. Then i shook her shoulder. it must have been seconds before i screamed to her mum to call an ambulance but time seemed to slow down. i remember thinking: this can’t be real.
a week before she died, Vicky had confided to Tony that she’d been feeling low. He’d taken her to the GP, who had prescribed an antidepressant. she didn’t say she was depressed, and in no way did i imagine she might take her own life,’ he says.
The charity, samaritans, reports that there were 6,639 suicides in the UK and republic of ireland in 2015. While male suicide accounts for three- quarters of cases, the suicide rate for women is rising and is at the highest rate in a decade.
Earlier this year, Health secretary Jeremy Hunt described the suicide rate as a ‘litmus test’ for healthcare quality.
Now campaigners hope that a new initiative, called Zero suicide, could help reduce that rate.
AN APPROACH that originated in the U.s., its central premise is that suicide is wholly avoidable and preventable.
it calls for fundamental changes to the structure of mental health services — and the way we all think, talk about and share concerns about mental health.
This includes talking openly with those who are depressed about whether they have suicidal feelings — rather than avoiding the subject for fear it will plant a seed of the idea.
in Detroit, where Zero suicide was conceived, the number of people taking their lives has been dramatically reduced.
The city’s health system screens all patients for risk of suicide, not just those with known mental health problems. information is then shared between hospitals and GP surgeries via a centralised iT system.
communication with teachers, college departments, social workers, employers and family members has also been vital in identifying people at risk and getting them medical help.
The results have been staggering. in 1999, the annual suicide rate for mental health patients was 110 per 100,000. in the past two and a half years, not a single patient has been lost to suicide.
Now a grieving British father is leading efforts to introduce a similar approach here in the UK.
Three years ago, steve Mallen, a commercial property developer from cambridge, made a promise to his son, Edward, as he stood beside his coffin at his funeral. ‘i promised him there and then, on behalf of his generation, that i would use all my powers to make sure that other young lives are not lost in the same way,’ he says.
On February 9, 2015, Edward, then 18, the eldest of three, was hit by a train at the station he used to travel to sixth-form college every morning.
He was a gifted student and musician with a happy home life and a place at the University of cambridge to study geography. ‘My son had a disease — depression — which is eminently treatable and which he should have survived,’ says steve.
Last November, steve, with Joe rafferty, the chief executive of Mersey care NHs Foundation Trust, the first UK trust to adopt the Zero suicide approach, and Geraldine strathdee, the former national clinical director for mental health at NHs England, launched the Zero suicide alliance at the House of commons at an event attended by Jeremy Hunt.
The alliance aims to provide suicide prevention training for each member of every organisation signed up to it, including hospitals, schools, and workplaces.
it has pledged a reduction in waiting times and access to mental health care, and crucially, to involve families in the care and treatment of patients, abolishing patient confidentiality when lives are at risk.
it has also produced a free, 20-minute online training video that explains how to respond should people come across a relative, friend, colleague or stranger giving cause for concern. They’re encouraged to ask directly: ‘are you thinking about suicide?’
‘ We need to normalise that conversation,’ explains Ged Flynn, the cEO of Papyrus, a charity dedicated to the prevention of young suicide. ‘By saying the word, you create a safe place to discuss it.’
steve says: ‘i think the majority of people are afraid to mention the word suicide in case they plant the idea in someone’s head.
‘But there is a huge amount of clinical evidence to suggest that discussing suicide does not cause people to become suicidal. On the contrary, encouraging people to share feelings and talk openly is the first step to recovery.
‘it crossed my mind at the time that Edward might have thought of suicide, of course it did. We talked about how he felt but i didn’t want to trigger something by mentioning that word.’
There is no history of mental illness in the Mallen family and steve says Edward ‘was consummately happy and content in every area’.
But in the three months before he died, Edward wasn’t sleeping well, he’d lost interest in playing the piano, which he’d loved from the age of nine, and had become withdrawn,’ says steve. ‘You’ve no idea how that feels as a parent. i’ve laid awake hundreds of nights, staring into the darkness, trying to explain this.’
‘The only conclusion i can draw is that he developed a disease, a disease from which nobody, regardless of how strong, resilient, healthy, affluent or educated they are, is immune.
‘if i’d known 10 per cent of what i know now, Edward would still be alive. My son was dying in front of my eyes and i was too ignorant to see it.’
it’s a brutal conclusion and doesn’t take into account the creaking inadequacies in the system that allowed Edward to fall through the cracks.
EDWARD had in fact spoken of suicidal thoughts to his GP and was referred to mental health services as an emergency acute 24-hour risk, but his case was downgraded to ‘routine’ by a triage nurse who asked his GP to prescribe the antidepressant citalopram.
although he’d given consent for his parents to be informed, they were not. Edward’s mood deteriorated and he died 19 days later.
Like steve, Tony Harrison desperately wishes he’d known to ask his daughter about suicidal thoughts. ‘i have a saying now: “Don’t be scared, say the word.” We have to start bringing suicide into the open without fear or shame.’
When Mersey care, in Liverpool, launched the Zero suicide initiative, it fully integrated all the services involved in caring for someone with mental health problems — not just GPs and hospitals but emergency services, police and schools.
While it’s too early to see measurable results — the trust began to make changes in 2013 — it seems the approach has already made a difference. ‘We’ve seen far fewer people returning to a&E in crisis,’ says Mersey care’s medical director Dr David Fearnley.
Greater public awareness must also play its part: three quarters of people who take their own lives are not known to mental health services in the year before they die. But there are ‘warning’ characteristics that crop up again and again, in people of all ages, says the charity Papyrus.
They include extreme sensitivity, an inability to cope with criticism or disappointment and being poor at finding solutions to problems.
Other symptoms of depression are being tearful, irritable, withdrawn, unable to sleep at night but can’t get out of bed during the day. a key symptom is loss of interest in activities that previously gave them happiness.
already about 100 NHs Trusts and clinical commissioning groups have signed up to the Zero suicide initiative, including cambridge and Peterborough who were responsible for Edward’s care.
it’s a huge achievement, but steve still feels the most devastating loss. ‘it’s a loss most people never imagine and a lonely journey because i hold myself responsible for the death of my son,’ he says.
He doesn’t know if Zero suicide is achievable, but believes we shouldn’t settle for less.
‘i made a promise to my son that i would do everything in my power to help — and i will not let him down twice.’