THE FOLLOWING ARE OUR RECOMMENDATIONS:
MENTAL ILLNESS/SUICIDE
BY THE WHITE WREATH ASSOCIATION LTD & PETER NEAME WHITE WREATH ASSOCIATION RESEARCH OFFICER AND BOOK AUTHOR.
1a. All patients should have a full physiological/neurological examination, not just a “mental health assessment”, “psycho-social assessment” and “risk assessment”. For example, when burn marks and frequent cut/slash marks are noticed on the patients’ skin and the patients say that they have never self-harmed/attempted suicide, it is tempting to say that they are hiding/lying – attention-seeking, have personality disorders etc., etc. The truth may well be that the patients are in fact very ambivalent about their self-harming behaviour. At one interview they will admit to self-harm and at another interview, they will deny that they will self-harm.
1b. The fact that they can burn or cut themselves without pain is a feature of both localized reduction in pain sensation and disturbance of the limbic/serotonergic system of the central nervous system (i.e. the brain).
At present, the tendency is for professionals to interpret signs of self-harm as wilful attention-seeking by manipulative, antisocial, personality disordered patients. Rejection by the Mental
Health System leads to further suicide attempts and a high completed suicide rate. The fact is that any mental illness from anorexia to schizophrenia can involve self-harm/self-destructive behaviour.
2. Self-referral and/or referral by relatives should be treated as an emergency – if the patient refuses admission, then compulsory provisions of the Mental Health Act should be used.
3. Public safety is paramount and when one talks about patients’ safety, this must automatically mean public safety.
The link between suicide and murder is almost without exception ignored by researchers and planners in relation to suicide policies and responses.
Professor Hughes in “Suicide and Violence Assessment in Psychiatry”. Gen Hospital Psychiatry, 1996, wrote “It is estimated 17% of Psychiatric Emergency Service patients are suicidal, 17% are homicidal and 5% are both suicidal and homicidal”.
“Murder is one of the strongest predictors of suicide with a 30% suicide rate found amongst murderers in England”. Source: “Serotonin, suicide and aggression. Clinical Studies”. Golden, Gilmore, Corrigan, Eketrom, Knight and Carbutt. Journal of Clinical Psychiatry, 1991.
Recent high-profile murders, murder-suicides and at least one mass killing in Queensland were all preceded by one or more suicide attempts. In the worst killing, the person was regarded as an “attention seeker”.
4. Threats of suicide and self-harm, including actual self-harm, should be treated as if they were actually attempted suicides. In simple terms, people are either suicidal or they are not suicidal. Personal judgements about highly, moderately, vaguely, or possibly, suicidal should not be used. They are dangerously misleading.
5. Prisons have best practice for suicide prevention. Key features are:
- If an individual or family member says that the individual is suicidal, he/she is treated as suicidal.
- No one grandiose professional can make an arbitrary decision that a patient who was seriously suicidal one day is no longer suicidal the next.
- High-risk assessment teams made up of five people determine the change in the observation category for the patient. Each individual on the team must personally feel safe about the patient before there is a change in the observation category. In simple terms, no senior clinician is able to heavy other disciplines/members to agree with him or her, as currently happens in the mental health system. We believe that this is a good model to follow and we would be happy to assist you and help to set up such a system. (This could put Queensland up there with best practice suicide prevention).
6. All terms must be defined. For example, risk means the risk of suicide, murder and violence. Assessment means a step-by-step process starting with a disciplined, outward physical examination/observation before any verbal questions are asked. Again, we are happy to take part in training professionals. This is a practical skill and needs to be taught on the job/ in the workplace, possibly with the assistance of a training video. If one is honest, assessment skills as they are currently taught in universities and places of training are appalling. In reality, many professionals miss obvious suicidal behaviours/clues. An accurate assessment is a rock on which the service rests. Safety, patient safety, means public safety, therefore part of this issue is asking the family/loved ones if they are happy with the plan of action. Minimum periods of observation should be a least five days in the hospital, for example, beginning with 48 hours category red or constant observation. Refer also to the high-risk assessment teams mentioned earlier. Suicide literally means “self-murder”.
7. In more than 80% of completed suicides and other mental health disasters, someone close to the patient and/or the patient themselves, has tried, in good faith, to get help from professionals, but has been turned away.
This is both an attitude and a training problem/issue.
Our concerns are reinforced by the real-life experiences of our members and supporters.
8. >History Taking: Currently, patients are asked only about their immediate family whereas patients should be asked if there is a history of “nervous breakdowns” (the term “mental illness” means “raving lunatic” to most people and they will simply deny it), early death suicide, self-harm, drug and alcohol use to the point where it destroys family life, for at least three generations – that is, grandparents and as further back as possible. Family history, anywhere, is one of the strongest indicators in suicide and murder.
9. Suicide is special, and specially prepared professionals should always be called in before patients are turned away / released.
10. Professionals must be held accountable or nothing will change; many psychiatrists see suicide as a nuisance and a “red herring”.
11. Mental Health Act legislation must have provisions written in to ensure early admissions for suicidal patients as was always the case for hundreds of years, such provisions being removed only as part of the de-institutionalisation / anti-psychiatry policies of the last 20 years.
12. The hard scientific or factual evidence is that suicide, violence and murder are caused by morphological changes in the brain combined with low serotonin. The structure, function and chemistry of the brain are simply not normal.
The newer Selective Serotonin Re-Uptake Inhibitor drugs (S.S.R.I.s) are said to be safer in terms of it being harder to overdose on them. However, recent suggestions are that S.S.R.I.s such as Zoloft, Prozac, Effexor etc. etc., may cause up to three to five times the rate of suicide in young people, particularly those below 20 years of age. There are a number of lawsuits against drug companies and at least one murder in Australia was said, in Court, to have been caused by one of these drugs.
Depression is widely promoted as the major epidemic of the modern age and this in turn has led to a massive rise in the use of S.S.R.I.s, “…. In 1998, doctors wrote 8.2 million anti-depressant prescriptions compared with 5.1 million in 1990 ….” Source: “The New Abuse Excuse” by Claire Harvey and Monica Videnieks in Australian, 25 May 2001.
There is no scientific evidence that serious mental illness is increasing. It occurs at the rate of 3% of the general population everywhere regardless of drug use, child abuse, child-rearing practices, stress, modern life pressures youth of today, on and on ad nauseum. There is evidence that depression is the “in disease” and that the prescribing of all psychotropic medication is increasing.
We recommend that anyone who is to be commenced on medication that alters mood, feeling and thinking ability (psychotropic medication) should be commenced on this medication in the hospital. The reality is that it is extremely difficult to get the right medication for the right patient.
Practically all of the newer anti-depressant and anti-psychotic medication takes 4 to 6 weeks to reach therapeutic levels. All psychotropic, psychoactive substances have serotonergic effects on the brain – that is, all drugs from alcohol to street drugs, from speed to Prozac. This, combined with scientific evidence that there is a cause and effect relationship between low serotonin and suicide, murder and violence, in our view, means that these drugs should be commenced in hospital where patients are under observation and being protected in a place of safety. It is also a clinical observation that in the first few days of commencing an anti-depressant, the suicide rate dramatically increases.
13.Most of what we have said requires very little “New Money”. If you are really serious about suicide, then all of these areas must be covered.
Great article thank you
Interesting
Thank you
We have been told for many years that when a person is contemplating suicide they should seek help and talk to their family, friends etc Unfortunately, talking has not changed anything – statistics show that suicide in on the increase. The most sensible approach is to provide a place of safety for those who threaten suicide.
White Wreath considers suicide/mental illness as a life-threatening condition where people must be hospitalised in the same way as a patient with cancer, heart disease, heart attack stroke etc All other life-threatening conditions are treated medically, with dignity and respect, and are taken very seriously by all concerned.
But not so for those who attempt suicide.
I recently experienced the dedication of the medical system when I thought I was having a heart attack. My husband rang the ambulance, which arrived within a few minutes. I was experiencing terrible pain on my left hand side. The ambulance officer tried to put me at ease and told me that I wasn’t having a heart attack, but because of the severe pain they were going to take me to hospital as a precautionary measure. I was in hospital for a few days with many tests done. All the staff, from the emergency services to doctors, nurses etc, were wonderful and treated me with the utmost respect and concern with their main intention of getting me better before releasing me.
My question is: Why aren’t people who attempt suicide treated in the same manner? For some reason we are told to talk to a suicidal person and everything will be okay. Would we do this to a person suffering a heart attack, and just talk to them and tell them we love them and everything will be alright? No. We immediately call 000 and they are rushed off to hospital, receiving the best possible medical treatment for their life-threatening condition.
One third of all road deaths are,in my opinion caused by mental illness, but road traffic officials ,government and media do not mention this. On top of this we have a Zero Road Toll campaign from government down. Why don’t we have a Zero Suicide campaign? We don’t even have a suicide reduction campaign. Even a campaign to reduce suicide by one per year.
Suicide literally means self homicide and must be taken very seriously as it always was for thousands of years until the birth of deinstutionalisation,care in the community, mainstreaming, the recovery model on and on ad nauseum..anything to cover-up the massive closure of long term mental health care beds. We need to graft onto the new what worked best in the past. The current wellbeing, wellness, dogma from the Mental Hygiene movement is 140 years out.of date. Every improvement in mental health has come from hard scientific research or simply neurology.
I cannot recall how many Royal Commissions and Senate inquiries have
been held into Mental Health. Millions of dollars have been wasted and
nothing has changed. Hopefully our newly elected Government does not follow suit and instead get on with the job of fixing.
“Mental ill health and suicide are costing Australia dearly and services are failing to meet “community expectations”
We need to ensure people get the right type of help when they need it. Too many people still avoid treatment because of stigma and too many people fall through the gaps in the system because the services
are not available or suitable.”
The greatest cause of suicide has always been schizophrenia and other psychosis. Anxiety and Depression , Stress, has never been more than propaganda designed to cover up the massive run down in effective mental health services, particularly long term mental health care beds.
We have been told for many years that when a person is contemplating suicide they should seek help and talk to their friends etc. Unfortunately, talking has not changed anything – statistics show that suicide in on the increase. The most sensible approach is to provide a place of safety for those who threaten suicide.
White Wreath considers suicide/mental illness as a life-threatening condition where people must be hospitalised in the same way as a patient with cancer, heart disease, heart attack stroke etc. All other life-threatening conditions are treated medically, with dignity and respect, and are taken very seriously by all concerned.
But not so for those who attempt suicide.
Through out history institutionalization followed by de-institutionalisation has been a continuing cycle. The failure of governments to be honest and acknowledge that mental illness is solely and only a neurological disorder and that 10 per cent of the mentally ill need long term beds is the reason for high suicide rates and other mental health tragedies.
During and following the Spanish flu an illness emerged which was called sleeping sickness…officially called encephalitis lethargicus. The Spanish flu is said to have killed over 50 to 100 million world wide and encephalitis lethargicus another 2o million. Millions of people ended up in long term care, mostly psychiatric hospitals because because the end result was total lack of motivation or get up and go, mood disorders sleeping long periods and inability to perform activities of daily living. This viral induced brain inflammation/damage caused psychiatric symptoms . There are in my assessment/ opinion similarities between the current pandemic and the Spanish flu. All the more reason for increased spending on the neurology of Mental illness. That is the way forward in the management of Mental illness and the prevention of suicide
When we hear the word Cancer it leaves an imprint in our mind. We know it’s an illness and we also immediately think it can be fatal. We hear even more lately of “Post Traumatic Stress Disorder”, “Depression”, “Paranoia” or “Schizophrenia” but it does not leave the same imprint on most of us. But let there be no doubt these can also, like Cancer, become a fatal illness. The pain of these and other Mental Illnesses are often too great to bear for the sufferer.
For these reasons it is important that an Education Campaign be orchestrated immediately to inform the general public of the seriousness of Suicide and Mental Illness. This Campaign must be implemented in the same hard-core manner as we continually see advertisements on Drugs, Road Accidents, Aids, Cancer, Heart Attacks, etc. Informing us that these can kill. We are told constantly and shown graphic photos that drink driving, wearing no seatbelts, driving tired etc Can Kill. We are told Melanomas, Breast Cancer, Cervical Cancer, and Prostate Cancer Can Kill. We are told not having safe sex Can Kill. We are told too much Cholesterol in our bodies Can Kill. We are told don’t smoke because smoking Can Kill. The list goes on and on and all these Campaigns have worked well in reducing the number of deaths. Why isn’t the same campaign implemented on mental illness as this also Can Kill?
It is time for us to come to terms with our high suicide rate and accept the seriousness of this illness and it’s consequences that is plaguing our country. We must accept that suicide/mental illness be treated as a serious medical emergency as we do any other life threatening condition. The myth that an attempted suicide is used as an attention-seeking device must be stopped. In most cases an attempted suicide leads to completion.
“There is sound sense in grafting onto the new what worked best in the past ” what did we do fifty years ago in mental health with people considered suicidal? They were immediately admitted and specialled for 24 to 48 hours. What did specialled mean? A nurse would be within arms length of the patient every second.. Peter Neame
Drawing on the experiences of people who have gone through the trauma of a suicide can help us cope if we are ever faced with a similar situation.
The tragic after-affects of suicide have an influence on all of us.
The death of a loved-one, family member, friend, colleague or casual acquaintance through suicide has repercussions on our future lives.
English poet, lawyer and cleric, John Donne, summed this up when he wrote: “Any man’s death diminishes me, because I am involved in Mankind.”
True-life stories are an important tool in helping dispel the misinformation surrounding suicides and mental health.
White Wreath Association receives many suicide stories written by people telling their personal experiences about loved ones who have suicide.
If you would like to share your experiences of your efforts to receive help for loved ones contemplating suicide and what you went through after they suicided, please forward brief scenarios we can share with others.
The scenarios with your permission will be published on our website under personal stories.
Your experiences may help others recognise the early signs of suicide intentions being exhibited by their loved ones, friends and colleagues.