Co-ordinating suicide prevention strategies
In the summer of 2014, my son Saagar, who was looking forward to his third year at university where he was reading Arabic and French, was diagnosed with bipolar disorder. In the autumn of the same year, while under the care of our GP, he tragically ended his own life.
"It is my belief that we are miles away from ‘parity of esteem’ between mental and physical health services." - Sangeeta Mahajan, Fellow
Looking back, there was a gulf between the medical and social aspects of his care. We can now identify many points in his journey where he could have received appropriate support but either it wasn’t offered or it failed to materialise. He fell through all these gaps.
Unfortunately, this is a recurring theme in many cases, and suicide stubbornly remains one of the leading causes of young deaths in the UK. The aim of my Fellowship was to gather lessons from the USA and Australia for bridging the gaps in the care of vulnerable individuals.
My recommendations for co-ordinating suicide prevention strategies between health and social care providers in the UK are:
- Cohesion: strengthening community collaborations. Individuals who have been recently discharged from specialist care, and those who self-harm or have survived a suicide attempt, are at a high risk of death by suicide and must be recognised and treated as such. Strengthening collaborations between the healthcare sector, carers and voluntary bodies, by developing a common language, vision and set of tools (e.g. Columbia-Suicide Severity Risk Scale and Safety Planning Intervention) can be instrumental in keeping these individuals safe.
- Literacy: improving mental health literacy of medical staff and first responders. There is a critical need to identify every individual at high risk of suicide and respond to their needs in an appropriate and timely manner. To this end, it is essential that all healthcare professionals and first responders (who are high-risk groups themselves) receive specific suicide prevention training, so they can take better care of themselves and those who rely on their expertise when at risk. Involving people with lived experience in their training helps to break stigma, which remains a barrier to compassionate care.
- Empowerment: carers, bereaved families and sub-communities. It is essential to recognise caregivers as an essential part of the safety net. Psycho-education of families, and creating support networks for them, can empower them to take better care of themselves and their loved ones. There is a need for the NHS and the voluntary sector to establish systems within which this education and networking can take place, as it embeds deep learning and openness within communities, which is hugely protective for vulnerable individuals. Powerful experiences, stories and insights of suicide loss can be effective agents for hope, healing and change. These should be utilised by including these voices in mental health training to break down stigma, influence policy-makers and create peer-support networks. There is a need for training clinicians, community services and faith leaders in suicide specific bereavement support. Formal, inclusive and collaborative endeavours, that recognise cultural strengths and vulnerabilities, should be prioritised by the government to reduce suicide rates in sub-communities while respecting their self-determination and human rights.
- Government funding: expansion of infrastructure and research. There remains a sizeable gap between the rhetoric and reality of ‘parity of esteem’, particularly in relation to funding. Parity will not be achieved if mental health budgets remain as low and evanescent as they are. Central and local governments need to invest in mental health training and infrastructure, by making long-term stable commitments to funding and commissioning services to close the gaps mentioned in my Fellow’s Report. This is a long overdue civil rights issue. Like the Australian government, our government should partner with not-for-profit organisations and fund a wide range of research projects to address large gaps in knowledge.
- Resources: non-clinical spaces and digital technologies. There is a huge need for healing and engaging non-clinical spaces for high-risk individuals in our country. This service gap can be filled by investing in creating spaces, like Headspace and Safe-Haven Cafés, that are easily accessible in the community. These spaces, co-designed by their users, create a sense of belonging, link up community and medical services and offer a less restrictive option for many at-risk individuals who might otherwise be admitted to an acute inpatient unit – and they do so at a much smaller cost. Finding large-scale digital solutions is an exciting prospect. They can expand the reach of best practices and potentially provide at-risk individuals with useful tools, within the context of a broad holistic approach.
During my Fellowship, I conducted a grand rounds lecture for the Department of Anaesthesia at State University New York to raise suicide awareness among residents. A few months later I received this e-mail from a colleague in the USA:
“One of our anaesthesia residents told me this week that she and her five female anaesthesia peers found your rounds last year life-changing for them. Shortly after you spoke, they all got together and after a glass or two of wine, bared their souls. All had been struggling with burnout and intermittent thoughts of suicide. She wanted me to tell you that your lecture, your humanism, your engagement, sparked this coming together of all six of them. They continue to watch out for each other and keep each other safe.”
It is my belief that we are miles away from ‘parity of esteem’ between mental and physical health services. The former remains much neglected. I hope my Fellow’s Report will inform the curricula for nursing, medical, paramedical, dental and law-enforcement students, and direct continued professional development requirements for all frontline staff. It should also create an impetus for strengthening connections between medical and voluntary sectors, as well as carers and those with lived experience, so that a strong and compassionate safety net is created for all vulnerable individuals.
I have shared the findings of my Fellowship report with the organisations where I have a leadership role. Together, we will continue to campaign with policy makers so that they take these findings seriously and increase funding for grassroots organisations, third sector bodies, mental health services and community groups, enabling them to create a protective infrastructure all over the country.
The views and opinions expressed by any Fellow are those of the Fellow and not of the Churchill Fellowship or its partners, which have no responsibility or liability for any part of them.