Saturday, September 3, 2011

Our Guest Blogger Writes About Suicide

Kerry is our regular guest blogger, her posts appear here at least twice a month and this is her third post with us, she has more waiting in the wings (in our gmail inbox). Here are links to her last two posts.
(Please note, if you are interested in guest blogging for us we are always open to new guests, it's nice to help promote other people. We prefer posts to be about mental illness, but will also accept other topics.)

As always we have a little intro before we get to Kerrys entry, but we'll let her have the last words:)

Right up front we want to say we agree with Kerrys stance on suicide. As someone(s) who have experienced many many suicidal thoughts (and one major attempt), we found her entry to be amazing...and genuine. Having said that, please...always think of the never know, there might be something amazing right over the top of that jagged mountain peak you feel you are desperately trying to climb.

We've written before about overdosing in our early 20's, when we were married, and thus being labeled with a couple of mental disorders that, while a couple of us experience largely we do not feel, as a whole, that these are things that we experience. Catherine experiences social anxiety/paranoia and Cassandra can get pretty depressed, of course there was one other diagnoses that was just plain wrong...largely over the years they (The Other Girl, Cassandra and Catherine) have managed it with medication when needed for over seven years. Having been off of our medication (we were only one in the end, Welbutin) for a year we do experience some major thoughts of suicide (being on the medication did not stop that, however) far less frequently than ever before.

We will admit that at the beginning of this year we thought of them very heavily. There were nights we'd go to bed and one of us would beg that we don't wake up...and to please make it stop, and we would entertain thoughts of suicide. It still happens on occasion, but if you've read about our life, you know we don't fucking give up, we have someone for that. Someone to keep us strong (that someone is me). And Emmie helps too...without a body how could she do those disgusting things she likes to do?

As a side note, attempting suicide will make you ineligible for life insurance (in the United States), if you are young, and later in life marry, expect to have to explain to your new bride/groom why they can't get life insurance for you, if you attempt it and don't succeed. (yikes, that sounded harsh...but it's something you probably haven't thought of...hey, failure is a possibility even when trying to end you life...)

I have kept impulses at bay this year, desires to jump off of the bridge walking home, desires to walk in front of the city bus...desires to hang ourselves from the shower rod...but let's be honest, that thing would never hold our weight.

More than once in July I made calls to Fabulous People, our support person (who we miss, btw...just sayin'...*sigh*) asking her to put us on suicide watch. She watches our she used to know to pay attention to any lull in activity (in case people wonder about the <in the kitchen> or other Tweets regarding out activity). It's for us to see how long we are doing things (losing time sucks) and also to let our "handler" (hahahahahaha) know that it's a normal offline and not something to be alarmed about.

Bottom line, suicide sucks for people who love and care about you. The fate of the first boy we liked, who actually liked us back, in grade eight, had a huge impact on one of us all these years later. The rest of us choose to not think about it.

Anyway, if you have children, friends, family members who deal with suicidal thoughts, or you suspect Kerrys advice. You might save a life.

Is Suicide An Option – Discuss

Suicide and attempted suicide is SUCH an emotive issue.  This blog entry is an attempt to discuss this issue in an open and frank manner.  It is not my intention to hurt or offend anyone and the opinions expressed are my own and are not connected with Just Call Me Frank or any companies that I work for. Fhew now that’s over let’s talk.

In my line of work I frequently, often daily, come into contact with people who express a desire to die by their own hand.  This can be difficult to hear and difficult not to act and not to try and rescue that person.  So let me try and break down my training and thought process for you.

People: that is you, me and everyone, try and move away from pain.  If you are in physical pain you try and shift your body into a more comfortable position or take some pain killers.  If you are in psychological pain, such as a broken heart, you will do things to ease that pain such as drink alcohol or mainline chocolate.  This is a basic principle, and you will need to understand it for the rest of this piece of writing to make sense. 

Some people have so much pain in their lives, physical or psychological, that it may appear that there is no way they can carry on living such a painful existence.  Everyone bar none has had suicidal thoughts of some kind or another, at some time or another.   It may be standing at the top of a tall building and wondering what if; to having a full blown plan to kill yourself; and all points in between. 

There are, to my mind, several stages of feeling suicidal. 
  1. Initially there are suicidal thoughts, these are transient, they flit in and then out of your head.  Everyone, at one time or another, has experienced these. 
  2. The next level up is thoughts that flit into your head but stay a while.  These would include when you split up from someone and you think well I’ll just end it as a complete ‘fuck you’ to the person who hurt you.  Again these are normal and everyone has them. 
  3. The next level would be where these suicidal thoughts arrive in your head and don’t go away.  Often people will think about what preferred method they would choose if they did commit suicide e.g. overdose, hanging and so on.  LOTS of people think and feel like this, however, it is very distressing.  Having these thoughts does not mean that people will act upon them.  These thoughts are on the same level as fancying a colleague [affair]; you may think about them a lot but ultimately you will not be cheating on your spouse.  If people are experiencing this level of suicidal thoughts I would suggest telling a health care professional such as a GP or a nurse as they are possible experiencing some form of depression or low mood and these thoughts should be taken seriously.
  4. Having a plan. ‘I want to die by hanging, I will go and get the rope from the shop and I will tie it to………’  The more detailed the plan the more at risk that person is of being successful in their attempt to kill themselves.  Means (stuff you can kill yourself with), motive, and a time frame and the alarm bells ring in my head.  The situation is serious and requires action.
  5. Having a plan and telling someone but then deliberately doing something else.  I’ll give you an example. On Thursday at 2pm I am going to jump of the bridge at (specific location), but whilst help by way of police or health care professionals are at that bridge on Thursday at 2pm I am at the other side of town overdosing so I will not be found in time.

So what do I do when someone comes and tells me that they want to die?  For clarification I spent 3 years at university learning about this stuff before being let loose on the public. THEN I received a LOT of supervision and further educational courses to help me work with and help people who feel like this.  I am NOT a lay person; I am a professional who knows what I am doing.  That does not mean to say that my heart isn’t in my mouth when someone tells me that they want to commit suicide.  If someone comes to you saying that they want to die, take them seriously, support them but don’t try and be a therapist or a have-a-go-hero, direct them to some professional help. This may take the form of going to the doctors, phoning the Samaritans, going to a group, going to a therapist or counsellor.  There are lots of people available to help.

This is what I do.  I take them seriously.  I do not dismiss their feelings of pain/fear/rejection/hurt. I acknowledge that they want to die without encouraging it or saying that they should not do it; a very fine balancing act – don’t try it at home!  A very normal reaction is that people try and say ‘no, no, don’t do it’ but this is dismissive of that person’s feelings and invalidates their emotions.  No one should have their emotions invalidated.  Some people say that people who talk about suicide don’t do it; this is so very not true.  A lot of people I talk to want to talk about their feelings and their fears without being judged.  I find people want to be taken seriously; this is the ultimate serious emotional state and they should be given the respect that they are due.

However, the difficulty arises when the person being told about the suicidal news cannot bear the emotional strain.  This is when the patient (this is the term I use for the people I help; service user, or client can also be used) tend to get short shrift because their emotional state is normally dismissed by the nurse because the nurse finds it too uncomfortable.  Ways in which it is dismissed by the nurse include them  saying ‘oh, you don’t want to do that’ or ‘but you have so much to live for’ or they may make a joke and giggle about it (this is called lightening the moment).  Let me be clear that this does not always make them bad people, just human.  Hearing that someone wants to die may strike a little close to home, they may feel panicked and ill prepared to deal with such information, they may not have a clear idea of what to do now that they have the information. It takes practice, skill and nerve to be able to ‘stay with’ someone in that emotional state.  To be able to accept that the psychological place that they are in now is unbearable.  It is not too dissimilar to seeing someone having chest wracking sobs: most people will try and comfort them; it takes a different outlook to just let them cry but to stay with them.

Naturally, once someone tells me that they want to die I don’t just leave it there.  If they are new to me I will try and find out where about on my rating scale of suicidal thoughts they are and if they have a plan I try and discretely find out what it is.  Risk management is paramount in situations such as this.  Since they have disclosed this to me I have a legal duty of care to help them to the best of my ability, manage the risk and try to save their life.  Mental health nursing may not be the most glamorous or sexy but we do save lives!  If they are really set on dying there are several things I can and will do. I call the Crisis Team to see if intensive home support/treatment may help or if they need admitting to hospital.  If I deem it to be more serious I can request a mental health act assessment where the patient will be assessed to see if they need to be detained in hospital against their will.  Personally I do not like taking this option but I have used it in the past to save people’s lives, who have then gone on to get better and live life how they would wish to.  I can also call the police – desperate times do call for desperate measures.

If I have known the patient for a while, I may not jump up and down.  They may just want me to hear how desperate they feel, which can make them feel better.  This may be all I have to do.  History is one of the best indicators of risk; if someone takes an overdose but makes sure that they will be found in time, whilst their distress is very real, it may not require as direct a response as someone who has taken a life threatening overdose in the past and were only found by accident.  So you see how different historical context will require different responses, it is not always appropriate to ‘rescue’ people.

What about people who are ‘attention seeking’?  In my opinion if a child is seeking attention, they want it for a reason.  If an adult is seeking attention, they are also requiring it for a reason.  For some people attempting suicide is a way of expressing their distress because their emotions are just too much to keep inside.  They cannot hold it or keep it to themselves.  To my mind, people who do this require my help just as much as people who are wanting to die and are not seeking for me to intervene in the nick of time.

Common myths.  In no particular order:
  1. People who try to kill themselves want to die and cannot be helped.WRONG! People who try and kill themselves can be helped and often just do not want to carry on living the life that they have.
  2. People who suicidal thoughts must be mentally ill.No, everyone has suicidal thoughts at some time or another.
  3. People who talk about suicide will not actually kill themselves.The majority of people who are successful in committing suicide, have already spoken to at least one person about feeling suicidal prior to killing themselves.
  4. Once someone has made a serious suicide attempt they do not try again, it is out of their system.Previous history is a good indicator of future behaviour.  If someone has taken a serious overdose, they have little regard for their life and are more likely to do it again rather than less likely.
  5. If you talk to someone about feeling suicidal, you put thoughts in their mind and make it more likely that they will try and kill themselves.The thought is already in their head, talking to them about it lets them share their distress and does not normally add to it (unless you are very insensitive).
  6. People who say they want to kill themselves are just attention seeking.People who are feeling suicidal feel distressed and may need to share their feelings of distress.  In seeking the attention that attention you give them may save their life.

The people that I meet in my professional career want help with their mental illnesses.  I am acutely aware that they feel terrible and are usually in a place where I would not like personally to go but professionally I extend my hand to them, down in their deep pit of sorrow and despair.  I know that for some of them, they believe that there is no other solution but to kill themselves.  This makes me feel humble.  Who am I to say no to someone who is living a nightmare?  I will not judge someone who’s darkest moments are so much more dark than my own.  For them, yes I believe that suicide is a valid option; just as life is an option and medication and therapy.

It would lack a certain finesse if I said that I was pro suicide or anti suicide; life is never that simple nor is mental illness.  I like to keep an open mind.  The benefit of taking this stance is that I can talk to my patients openly about wanting to die because if I don’t know how they feel, how can I change things to make things better.  I try everything in my arsenal to help someone.  People who know me, understand that I go the extra mile.  However, ultimately, the decision and the choice lies with the individual – and they must also take their share of the responsibility too.  I read many articles about the failings of mental health services to prevent deaths (suicide is classed as a preventable death) but if someone is hell bent of dying there is really not a lot I can do about it – only delay it in the hope that they will change their mind.

It is occasionally said that us nurses can be heartless and that we ‘move on’ to the next patient after one dies.  I have never found this to be true in my experience, there is always a period of mourning.  I have been fortunate and only been involved in one suicide in my whole nursing career.   I was a first year student nurse, 7 years ago.  I still remember what they look like, their hair, their eyes, the way they walked, their favourite food.  Being so new and inexperienced and quite far removed from the care of that person, no blame was attached to me, but I searched my soul to see if there was anything different I could have done.  Even now I could not have saved their life.  I still regret and I still mourn.

I hope that this post has given you some insight into why I think that being very anti suicide is not helpful whilst not being pro suicide either.  Discourse and action are the way forward.  Keeping the person at the centre of their care and as much in control as they can be is, in my mind, the best course of action.  Sometimes, it is only a smile and a look that can save someone’s life.

Kerry x

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