Further suicidal behaviour

Those individuals who have displayed suicidal behaviours that did not result in death are markedly more at risk of a later suicide attempt and suicide. Amongst those New Zealanders who make a serious suicide attempt, almost half will make at least one further attempt and one in 12 will die as a result of suicide within five years. – NZ Suicide Prevention Strategy,  p.17

Being suicidal is a state that one would think only had two outcomes – either death, or no longer being suicidal. It’s not that easy though. There are people who stay suicidal, but never attempt it for some reason. There are people who will stay suicidal, and just try and try and try until they make it. There are people who seem to have recovered, but go on to become suicidal again. It’s not a matter of dying or getting better,

The way we treat suicidal people directly affects their life outcomes. It’s not just in saving or losing their lives – there is also the question of the quality of life bequeathed to them by their care and treatment. Treating a failed suicide well could be the difference between recovery and continued psychiatric disability. Taking a potential suicide seriously could be the difference between a course of successful treatment and a suicide attempt.

These truths do not seem to be self-evident to many of the people involved in mental health care, both as frontline staff and as policymakers. Policymakers emphasise the need for good care for failed suicides, but frontline medical staff treat them poorly. Frontline psychiatric staff push for good treatment for potential suicides, but policymakers simply don’t allocate enough funding for the treatment needed. The strengths of each seem to be foiled by the weaknesses of the other.

The treatment of failed suicides especially distresses me. I cannot remember the number of attempts that I failed. Maybe half a dozen? Maybe more, maybe fewer. I’m not really sure. One of my failings is that I have a very poor long-term memory, so there are three or four episodes that I remember clearly, but there are more in the murk somewhere. Whatever the number is, it’s much greater than the ideal zero.

The key themes of my treatment by the hospitals and psychiatric teams that I dealt with were disrespect and poor follow-up. Emergency and medical ward staff had no time and no respect for someone like me, someone who wanted to die but seemingly didn’t try hard enough. Maybe I was seen as an attention seeker, someone who was deliberately wasting hospital time and resources in order to fulfil some psychological need for people to look at me. I can’t pretend to know what they thought, but I can know what their attitudes felt like. It felt like I was worthless, a waste of space, a failure, an attention-grabber and time-waster. It felt crushing. All I wanted was for the agony I live with to be over, and not only was it not over, but it was so much worse because people were angry at me, judging me, hurting me more. It made me want to die.

Hospital experiences left me feeling awful, and this is the point where psychiatric services step in. The should take a battered person, and help them and build them up and surround them with the things they need to become well again . . . Ha. Let’s see. The first time, when I was still very much a minor, the follow up involved my entire family being called in for an interview – not an environment conducive to opening up. Even if I didn’t have an abusive stepmother crushing my wrist in warning, I couldn’t say anything in front of my beloved little brother, and my adored father. I couldn’t hurt little bro, and I couldn’t admit to dad how bad things were. The entire venture was a failure, at a time in my life when intervention could have changed everything.

Other incidents included being sent home with no follow-up beyond a referral to the food bank because we had so little to eat (never mind that I had a serious mental illness showing up) and a vague promise to get in touch with an appointment at community mental health (An hours’ walk from my home, at a time when I had no car). Even when follow up appointments were made, they would be cancelled by one side or the other and never rescheduled.

What did I need? I needed hospitalising and treating properly the day I first presented, vomiting and crying, to an ED with a terribly worried boyfriend in tow. I needed someone to identify and deal with the fact that I was being abused, that my brother was being abused, and that I was developing a very serious mental illness and needed intervention immediately. What I did not need, and what I believe very few patients need, is to be released to the care of my family. In my case my family was part of the cause of my problems, but in almost every case, families are not equipped to deal with the aftermath of a suicide attempt. The truth is that going home is just not the best thing for many, if not most, people.

What are the bare minimums that I think need to be in place for failed suicides? Compassionate treatment. Immediate psychiatric treatment, with a strong bias toward inpatient treatment if there is any indication that it may be useful. Thorough follow-up on leaving either medical or psychiatric hospital treatment, with a real effort toward making sure people don’t slip through the cracks. Wrap-around services – WINZ assistance, social workers of whatever stripe is most helpful, referrals to charities and social services that actually happen, generally the things that make life easier to live.

Suicide costs us $1.4 billion per year. Dedicate some resources to prevention and treatment, and harvest some of that money back for the economy.

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