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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.
It 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.
Thanks for writing this article Alys. Grassroots wholeheartedly believe, with you, that stigma kills. It can stop people asking for help that is badly needed, and it can stop friends, family, colleagues and professionals from asking about suicide.
Each of us can help to change this stigma in our own ways: not being afraid to talk openly about suicide and its prevention, being brave and asking about suicide if we're concerned about someone, taking the risk of asking for help when we need it.
Even just one conversation like this can be life-saving.
I also had horrible experiences at medical school due to depression and self harm. When I moved to clinical school by new supervisor told me 3 times (without having ever seen me on the wards or read any of my written work) that he didn't think I could do medicine. He then tried to get my GP to break confidentiality to talk about my MH to him. I was made to take a year out with no warning and felt like I had to jump through all sorts of hoops to get back - a psychiatrist saying I was fit, occ health agreeing etc etc. It felt like instead of being supportive members of staff were trying to make it harder for me.
When I made it back I felt like I was constantly on thin ice, like my year out was a big black mark against me. However, I persisted and although it was still difficult I qualified (big 'HA' to my horrible supervisor) and am now an F2. I loved my F1 year and even got a prize for 'F1 of the year'. All that despite having to take 2 weeks off sick due to an exacerbation of depression.
Sorry for the ramble but I wanted you to know that you are not alone, that it is do-able and that most people actually are nice and supportive whatever your current experiences might be. You are braver than me to want to enter psychiatry, I would find it too tough.
Wishing you all the best of luck!!!
Awww thank you everyone for being so supportive. I'm determined to do this and succeed in medicine. I'm glad I'm not alone and I'm glad there are some positive outcomes out there. Mental illness shouldn't get in the way of our dreams and aspirations! We can't help being depressed or bipolar or even having a personality disorder....so why should it stop us? And I'm sure that all this experience will make us better doctors in the end.
Much love to you all, Kate x
It actually sickens me a little that this kind of thing is still happening in this day and age.
I'm a student in mental health nursing, and while we are taught to always ask about things like this, it's distressing how often someone comes into services and you find out they've had a dozen admission to A&E or they've been living without support they've desperately needed for years.
My university is very supportive about issues like Kate's, I'm proud to say - a friend of mine attempted suicide last year, and another was diagnosed with cancer. Both were supported beautifully by our tutors and course leaders, and my friend is now taking time off the course of her own volition after many months of supporting her to remain. Unfortunately, the other girl passed away, but she stayed on the course for as long as she could physically manage.
I felt compelled to share this so other people can see that although discrimination is indeed widespread, it's not everywhere. Best of luck to everyone.
Mental health is at war with human nature, unable to acknowledge that they create the stigma. It Is human nature to shun that which is different and virtually impossible to really fix.
There is a reason some psychiatrists and psychologists join the anti psychiatry movement alongside so many whom are psychiatric survivors. Show me another medical profession that has an anti movement. There are none. Mental health denies and censors so much of what they do wrong that people become lost in it.
There is a reason psychiatry has no medical tests to verify anything. There is a reason they tend to avoid any ailment that can not be said to hide behind the blood brain barrier. There is a reason why psychiatry at large does nothing to study how testable biology influences behavior, such as the endocrine systems role in behavior.