Messages to professionals and policy makers
To doctors and those involved in training doctors
- Mental health should be a bigger priority in training
- Listen to your patient and take action if people with mental illness or their relatives ask for urgent help
- Be careful not to discharge patients with mental health problems from hospital wards too soon or without adequate follow-up care or support
- If someone dies by suicide make sure that close relatives and friends are told where to find information, support and counselling. Help make a referral if appropriate
- Make sure young doctors feel valued and are given enough support so that if they find work difficult they do not feel they are failing
- Age at interview:
- Susan is a farmer and university student. She is married and has 2 grown-up children and 2 step-children. She also had a daughter who died. Ethnic background/nationality: White British.
Have you got any other messages for either health professionals or those that have been bereaved?
For health professionals, listen. Listen to what the patients are actually saying. And if someone is saying, “You don’t understand, you don’t understand what I’m trying to tell you, I’m desperate.” Then don’t say, “Well, we’ll see you in three weeks.” Listen. Take it seriously. And if the worst happens, check on the people who are left, see if they are all right. I mean, I’m lucky I have found the money for private counselling. But if, if I couldn’t I … where would I’ve gone? Nobody offered help on the NHS. Somebody, somebody within the local GP network should have checked, should have visited, should have, should have sent a note saying the doctor’s practice is open if you, if you need us, this is a list of counsellors who you could see with assisted finance … anything. But you know it’s only because I‘ve got the sort of family that I have that I’m in one piece. I cannot imagine what someone would do without …
… the both intellectual, moral and love, loving support I’ve had. So listen.
- Age at interview:
- Helen is a warden of a student hostel. She is divorced and has 1 grown-up daughter. She had another daughter who died. Ethnic background/nationality: White British.
Do you have any message for health professionals?
I feel that when people have psychosis due to drugs often the patient is not treated in the same way [as others are treated], as they [the doctors] do feel that in a way they [the patients] have brought it on themselves. And that if they put everybody in a hospital bed that had psychosis from that reason [drugs] they wouldn’t have enough beds. And at times when Charlotte was very ill with psychosis, they used to just release her back onto the streets, and at one point they released her from the hospital and she was wandering the streets all night not really knowing where she was. She went back to a previous flat that she hadn’t lived in for about six months, which wasn’t in a very nice area, and she was on the streets all night trying to get in this flat. And I, I think sometimes that no matter why somebody has got a psychosis they should be treated in the same way and be looked after because how can they make good decisions about where they’re going from there when they’re in that state. They need respite to get their head clear so that then they can make better decisions on what to do. And I think she was very vulnerable at that time, hugely vulnerable.
- Age at interview:
- Nina is a student. She is single. Ethnic background/nationality: White British.
And I think there needs to be recognition that it [death by suicide] is a different death and I think that once you know, in the hospital, wherever, you know, there should be some support, there should be an automatic referral or something, you know, whether or not you need it or not, just so you feel connected, even here we go, here’s a number for SOBS, or here’s something, but there was just nothing. We were literally at the hospital for three days, said our goodbyes to my brother and went back and then just were left. And as I said, where, where do you go from now, what, what do we do now? Try and maintain a normal life, but, that’s not possible you know.
- Age at interview:
- Barbara is a retired teacher. She is married and has 2 grown-up children. She also had a son who died. Ethnic background/nationality: White British.
Looking back, do you think there is anything that could’ve prevented this terrible event. Do you think there’s any message for the health professionals at the hospital involved for example?
…Yes, I would, I would, as I say I would, I would like them [my son’s hospital colleagues and teachers] to have been in contact with him, just a phone call or something. If somebody could just have been in contact with him, just as a friend, just in a friendly way, I know that doctors have so much to do, and it is difficult, but if somebody had phoned and just said, “How are you Matt?” You know, “What have you been doing at…?” Just something to make him feel that he was, you know, he still mattered, that people remembered him. As it happened, nothing, and I’m sure part of it was because a large part was because they’re all so busy, I see that from my own daughter and son-in-law, but also, perhaps they feel you mustn’t force people to stay in a profession with, but, I mean his consultant said, “I feel sure that your future lies, you know, in medicine.” They saw a lot in him, and maybe, I’m not sure, and I think maybe it [the profession of medicine] wasn’t right for him, I don’t know, but he didn’t have a proper chance, I really do think it could’ve helped.
If he’d been made to feel valued?
If he’d been made to feel valued. Because once you have given something up…. And then I remember my, oh, my own father, who was born in 1900, long been dead, but he, he had a pretty stern upbringing I think and his own father said to him, “When you put your”, the Methodist tradition, “When you put your hand to the plough never turn back”. And my father had, against his own father’s wishes left school at 16 to join the merchant navy because he wanted, this was in the First World War, and he wanted to go and he was too young. So he thought he would go by joining the merchant navy. So he, he always bore in mind what his father had said, and he became a merchant navy captain and the first ever person to become a, an Extra Master.
Why am I saying that? Probably because, I was saying that probably because that was sort of the, that was the ethos in which I was brought up, and I never ever said that to the children and I never said that to Matthew, never, and I was supportive, but I’m sure that in one’s own heart, if one gives something up one, you know, a career for which one’s done sort of six years of hard work, he must’ve felt, well lost. He had not, he knew himself perhaps, perhaps he felt himself that he hadn’t, he couldn’t, if he just couldn’t go on at that time, that he really hadn’t given it a try and that everything else he would do, he liked writing, but I think he probably thought this is not the solution.
So I think yes, if somebody had, if somebody had just, if somebody in other instances of, for other people like Matt, if somebody just keeps in contact, has somebody somewhere in the university, the, the hospital somewhere to just phone and say, “How are you doing, would you like to come up and have a, a drink or something?”
Make you feel that you mattered. And it might, I don’t know, but it might make a difference. It might make a difference for somebody else.
To the police (see also ‘Police involvement’)
- Think carefully about the words you use before delivering bad news
- Don’t expect people to drive through the night to identify a body; relatives may be in a state of shock. Make sure a police officer does the driving
- Explain what is likely to happen next
- Treat the things that belonged to the person who died with respect
- Do not incinerate articles that belonged to the deceased without permission from the next of kin
- Treat the deceased and their family with respect – for example don’t talk about them as ‘the suicide’s widow’
- Find out what help exists for those bereaved by suicide
- Know where to refer people for counselling or other support
- Pass on relevant information and details about support organisations
- Make sure people understand that anything they tell you will be confidential
- Understand what might drive people to suicide, such as the importance of ‘honour’, or ‘izzat’, in the Asian community and how this can divide families
- Age at interview:
- Jasvinder is the director of Karma Nirvana. She is also an author. She is divorced and has 3 children (1 grown-up). Ethnic background/nationality: British/Indian.
I think there is such a lack of understanding of how powerful honour is in our lives, and how much it restricts us [people in the Asian community] and how much it prevents us from talking, it prevents us from making decisions that you may be presenting to us, as the easy option – leave [the marriage] for example. What you have to understand is that we need support around confidence issues; we need you to reassure us of confidence, of confidentiality, first and foremost. Secondly, as a professional I believe you have a responsibility to find out what is available for victims or survivors so that they can tap into that service to receive that level of support that you may not be able to give.
So it’s important for you to understand how to signpost, how to refer over and above what you have to offer, and I think because it is so difficult to apprehend that members of your family could drive you to commit suicide in that way, because of honour I think you have an obligation to raise your own awareness and understanding of these issues.
And if your practise hasn’t taught you that or your education, then maybe you could take the responsibility to find out more about that.
- Choose words carefully when discussing someone’s suicide with a relative
- Explain what may happen at the inquest
- Tell people about the time scales involved
- Explain the layout of the court
- Warn people if they might be called as a witness
- People are all different and they cope in different ways. Help for the individual should be tailored to their personal needs.
- Try to be patient with people. Don’t expect people to ‘move on’ too quickly.
- Those bereaved by suicide may not want support from the professionals who were responsible for the care of the person who died by suicide
- Some people may want support immediately after a friend or relative has died by suicide. Others may want support and counselling weeks, months or years later
- Age at interview:
- Lynne is a university lecturer and occupational therapist. She is married. Ethnic background/nationality: White British.
I actually think for health care professionals, and I think there, there is, there is an issue for me about appreciating the support that families and friends of someone who has committed suicide need, but also appreciating that the timing that they need, it may not be the time that it’s traditionally offered, which is around you know traditionally it’s around the time that someone has committed suicide that that people are there, certainly for me, I guess there, there maybe support for people needed then, which is about, you know, coping with the trauma of the event itself, but I think that people, when a member of your family has committed suicide there is quite a long journey that you go on.
That starts with dealing with the actual suicide itself, and kind of almost progresses through to trying to understand and make sense of it, and understand and make sense of your role in it.
And the other thing that I just wanted to say, is also to think about that the person who offers the support as well, because although support and help was offered to us by Mum’s psychiatrist, that actually, probably at the time that she died, wasn’t the person that certainly I would’ve chosen to have gone to for support, because there was quite a strong sense that he was a person who had let Mum down. So although that person had offered support, I wouldn’t have gone there, so I think it is that, that that thinking about whether it is the same team who care for the person with the mental health problem, whether they are the appropriate people to be supporting the family if the family do have a feeling that maybe things didn’t go so well with the team or that the team hadn’t picked up on stuff. Maybe the family needs their own support independent of the team looking after their relative.
- More money should be spent on mental health issues
- Information for people who have been bereaved should be more easily available
- Half-way houses’ should be created for people with mental health problems to go to when they leave hospital, where they can feel safe and get help when they need it without having to pay
- Age at interview:
- Melanie is a barrister. She is a widow with 3 children. Ethnic background/nationality: White British.
And have you got any message for health professionals or other professionals?
Just spend more money on mental health issues. It’s a huge problem. I understand that more people in the UK take their lives each year than are killed in road traffic accidents.
Just provide more help. I mean the ward where Simon was treated has been closed down now.
For lack of funds?
Well the idea that people can be treated better in the community I think. I’m sure, all for very admirable reasons, [but] there also needs to be some half-way house between this sort of confinement where you’re with people who are overtly unwell and perhaps a place like the clinic where Simon was where people are not overtly unwell but who are highly intelligent who are capable of saying whatever needs to be said. There needs to be somewhere that doesn’t need to be funded at thousands of pounds a week by the families, where people can go to where they can feel safe or where they can get the help, where they can get the right help (…). We wanted him out of there [the hospital]. It felt like confinement. I think the clinic was the right place for him, but at £4000 a week.
Oh I see. So you would like something similar and available free?
- The issue of assisted suicide needs wider debate, so that people can be offered dignified choices when it comes to dying (also see the Healthtalk site called ‘Living with Dying’ where we talked to others about this)
- Age at interview:
- Susan is a part time teacher. She is married and has 2 grown-up children. Ethnic background/nationality: White British.
I think the only sadness I have about his death is that I think that there should’ve been an easier way for him to go, and you, you just hope that if you are, you know, we, or I ever reach that stage in life where you’ve got a terminal illness and you don’t want to suffer long painful undignified death that, that I really pray that things change in the future, and that we do have, this country become more civilised about people having a choice.
Of assisted dying?
Yes, have assisted suicide. I really do strongly feel that. Because how much easier it would it have been. He made a very rational, reasonable, decision which we completely understood and appreciated, and how much better would it have been for him to be able to do that at that stage? Having lived his life so fully, so well, to have made a, an easier decision, yeah, it’d have been much better.
And how do you feel about it all now, looking back?
Comfortable. I found somewhere; you know my behaviour on that morning, not trying to stop him, strange. But I can, I can reason that out really as to what I, cos I, I think that that, it would’ve just been, he would’ve done it sometime anyway, and it would’ve been, the repercussions for trying to stop him wouldn’t have been very pleasant.
I mean much more unpleasant for all of us.
Was there anything that could’ve prevented his death do you think?
No, I don’t think so. No.
Is there anything else that you want to add that we haven’t covered, do you think?
No, just a, a plea for further work into assisted suicide really, giving people dignified choices when, when it comes to dying.
- Age at interview:
- Gillian, a consultant, lives with her partner. Ethnic background/nationality: White English
Is there, is there something that you would want GPs, nurses, policy makers in the UK to, to know, to understand from your experience?
Well, yes, I’d like them to understand that some people want to end their lives, you know, there is, for whatever reason, you know, and, and it’s their reason. And that I don’t see that other people should be so judgmental, and that they shouldn’t assist them to do it. And that they make them do it in many horrible ways. My father was very lucky. He did it in a very nice way. But some people have to throw themselves off cliffs or under trains or on the tube or all sorts of dreadful, dreadful; drink, you know, drink poisons rather than some medication. I think it’s appalling. And, you know, if, and I don’t understand anyone’s moral or religious objection to it. Because to me it’s a person’s right. And, and I think people should respect that and help enable it.
Last reviewed January 2015.
Last updated October 2010.