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Live and learn blog

The day I found out that stigma can kill

An overheard conversation led Alys Cole-King to discover that the stigma of suicide can prevent patients from expressing their feelings and doctors from asking about them. Her blog marks World Suicide Prevention Day, which falls on September 10 every year.

‘Her carbon monoxide levels are below the treatment line so she can go home now...’ Twenty years later I still recall these words and remember the tense and sick feeling you get when you experience a ‘near miss’ with a patient.

alys cole kingIt was mid afternoon one Saturday in early 1993 and I was the duty psychiatrist on the ‘post take overdose round’ as we called it then. I had just assessed my seventh patient that day and felt it was way past lunch time. I was starving and running late for a pile of work at the local DGH which had been steadily building up since early that morning.

When I overheard the medical SHO say these words to his registrar I paused but insisted: ’I know you think there’s no need but I really want to see her — if only for my peace of mind, and it won’t take long’.

I entered the room and introduced myself to an immaculately presented middle-aged lady. She seemed a little flat in spirits, but with impeccable manners she invited me to sit down. She then tried to reassure me there was no need for me to talk to her as she was fine, it was all a big mistake and she needed to get home.

I could see how my colleagues had felt it difficult to break through the stigma of asking if she had attempted to take her life. She looked like she could have been my mother, an aunt, a senior colleague, a confident professional. Not someone who had just made an extremely serious attempt to end her life.

That day I learnt an early lesson about stigma. One dictionary defines it as a ‘mark of shame or discredit, an identifying mark or characteristic’. I could see how the stigma of suicide had prevented the patient from sharing their thoughts and to encourage the medical team to collude with the story that everything was fine.

Luckily I had overheard the conversation and I was prepared to scratch the surface of the polished veneer. Initially all my questions were met with polite, non-committal responses. But realising that I was going to be persistent, she started to open up, initially just a chink, by admitting that her sleep ‘may not be what it was’.

Then gradually with my gentle questioning it all came out. She was extremely depressed with a full house of symptoms of depression. She said that for the past six months she had felt her life was not worth living, but was terrified to tell her husband (‘a very busy businessman’) or her son, a surgeon in London. She had tried to end her life four times in the previous few weeks, each time engaging in progressively more dangerous attempts. This latest attempt was a determined effort to end her life.

I felt a chill and an overwhelming sense of relief that she had found the courage to tell me everything. She reluctantly agreed to confide in her family and I was delighted when she agreed to an informal in-patient stay. She subsequently made a complete and speedy recovery.

I still get jittery when I think how close it came to her not being seen, going home and carrying out what she said she had been intending to do when she got there. I wouldn’t have asked to see her if I hadn’t by chance overheard that conversation on the ward that day about her carbon monoxide levels, and I might not have stood up to the registrar.

Stigma kills. I’m convinced that both those medical doctors didn’t want to refer her to me because of the stigma of a suicide attempt. But anyone can experience suicidal thoughts. It’s not a ‘them and us’ issue. Tackling stigma and raising awareness is a vital step in saving lives. Suicide prevention is a patient safety issue and it is everyone’s business. There is more information on our website regarding the Connecting with People campaign, including resources for patients and professionals.

Alys Cole-King is a consultant liaison psychiatrist in north Wales, Royal College of Psychiatrists spokesperson for suicide and self-harm, and director and co-founder of Connecting with People, a not-for-profit organisation that provides free online resources and innovative bite-size training in building emotional resilience, mental health awareness and suicide awareness. Details in this blog have been changed to protect patient confidentiality.

BMA Counselling and the Doctor Advisor Service are available on 0330 123 1245.