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Overdose? No - requires too much time alone to avoid discovery.
Jumping from a high building? No - too violent, he did not want scraping off the ground.
Hanging? Perhaps - he is yet to evaluate all the evidence for and against, and the best method.
There I was, a 5th-year medical student, sitting opposite a middle-aged man, Carl, who was divulging his suicide plans.
At this point I should stress that these plans were not new, they had scarcely changed since his last appointment, but what had was the manner in which Carl was willing to discuss them openly. This gentleman had been suffering from severe major depressive disorder for a few months following the sudden breakdown of his marriage. He would have likely gone undiscovered if it weren’t for his ‘confession’ to a close friend. I am thankful that he did ‘confess’ and I am thankful for the healthcare service responding so urgently to the referral.
What strikes me now, however, is that although Carl admits he is feeling better, his plans are still under way. Had I not asked about suicidal ideation in the interview, I suspect I would never have learnt about these plans. Carl had certainly done his research, using online suicide communities as a source of advice; he stated his biggest fear was failing to kill himself. He had family who had committed suicide in previous years, yet when asked about family history of mental health problems, he denies any. I worry that Carl sees suicide as the inevitable end to his life; I hope that the fantastic team working with him are able to change this.
It was only in the days following my interview with Carl that I really begun to understand the importance of asking those difficult questions. I entered the interview knowing he had previously disclosed his plans to commit suicide, but what I had not been prepared for was the acceptance with which he spoke about his pending plans. While Carl sighted several protective factors, they were time sensitive and I had no doubt that when the time came and without further help he would see through those devastating plans.
If I hadn’t known previously about Carl’s suicidal ideations, I like to think I would still have asked about suicidal thoughts and explored this. Although it is fair to say I would have been shocked by the answer. From the moment the patient entered the consultation room, he did not look distressed or in crisis. That is probably why when he attended emergency care several weeks ago with a major laceration to his arm, he was not asked about self harm or screened to determine his suicide risk. This gentleman had been suffering in silence and even when he failed to give an explanation for how the laceration happened, it was not picked up that Carl might need another form of help.
I am not criticising, if anything I want this to serve as a reminder for the pressures on emergency department staff and the impact that this has for consultations.
As a medical student new to psychiatry, my time in this specialty has certainly opened my eyes to how to approach difficult situations and ask those difficult questions. I hope I carry this with me through all specialties and my training. I always want to treat the whole patient. However, I fear that with NHS pressures at an all time high, I simply won’t have time to do my job properly.
The specialty of psychiatry is in my eyes a tough one. It certainly takes its toll on the psychiatrists, nurses, psychologists and health visitors who work in this sector. Mental health services are central to keeping many individuals alive, not just ‘well’ and right now they are under extreme pressure. We need to be supporting our colleagues and patients, not making access to services harder. It is estimated that one in four individuals will be affected by mental health at some points in their lives. We potentially have a quarter of the population to support, many of whom will be suffering in silence and may not look like they are in crisis .
Getting the right care should not be a competition around who can shout the loudest, quite simply healthcare professionals should get more time with their patients, to enable them to detect people such as Carl at the first interaction.
For more information on mental health visit MIND [https://www.mind.org.uk/?gclid=EAIaIQobChMIuu7C-5KQ1gIVypPtCh2DgAwuEAAYASAAEgKj4fD_BwE]
Or for a safe place to talk any time, call the Samaritans on 116 123
Patients’ names and some details have been changed to protect confidentiality
The Emma gill is a competent physician in the USA and well known for annual physical exams. On this www.reviews.io/.../edubirdie.com website she presented a comprehensive dimensions that how to avoid a person committing suicide. I think its great work and I really appreciate her for this service.
Parkour includes running, freerunning, climbing, swinging, vaulting, jumping, plyometrics, rolling, quadrupedal movement (crawling) and other movements as deemed most suitable for the situation.