Bereavement due to suicide: GPs and psychiatrists

When someone dies by suicide people often feel angry and may look for someone to blame. Health professionals sometimes become the focus for anger and criticisms, which may or may not be justified.
Some of the people we talked to knew that the person who had died was very good at convincing the doctors that everything was fine. However others felt strongly that improvements in care may prevent future suicides and wanted to get this message across to GPs, psychiatrists and health policy makers (see also Messages to professionals and policy makers).
A GP is often the first point of contact and some people were critical of the way the GP had looked after their relative with mental illness, regretting the lack of specialist knowledge.

Stephen believes that many GPs lack knowledge about how to deal with depression and how to deal…

Age at interview 45

Gender Male

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Did you ever go to your GP for any particular help? For help with sleeping or anything?

Given how poorly I felt, although I don’t have a very high opinion of general practice, sorry doctors, I don’t, I don’t believe that, I don’t believe you can practice as a doctor generally, it’s just way too much to know, and specifically in my wife’s case, the failings as I see them of the particular surgery, are specifically a function of not having someone who specialises in mental health care, really you know it’s sort of o level medical, o level medicine really what needed to be done, but because sort of Gps have got way too much on their plate and you know it’s, it’s just, Oh here have another drug you know.

She wasn’t under a specialist at the time?

Oh no. Well, she’d been to see a specialist, and she’d done this test and, and I only found this out after, I only found the test, the doctor didn’t tell me she’d filled in the test, probably because she had, you know, had I seen the results of the test, I would have done something. Maybe I wouldn’t have done, I don’t know. But I mean this test, I can’t remember the name of it, E, EBD or something or other, anyway I found it in her papers, Well, well what the hells this And every single answer she gave was as negative as you could possibly be, and how, you know, how the psychiatrist could use as their excuse that, they say, Well it’s just a diagnostic test, it’s just part ofrdquo; Well which part exactly, you know why are you doing this test, what does it, well surely this test must have some purpose, diagnosing what?

Mm.

You know, and what, what was the, what was your diagnosis, having read this, having, having seen what she filled in? That’s basically, I want to kill myself. And I have thought about doing it ( I had no support from Gps, I’d, I have heard that there are some, there are some good surgeries out there, but there’s a severe lack of knowledge within general practice about how to deal with potential suicide, with how to deal with depression. And it’s something I want to try and help change through this complaints process that I’m going through. Although the results on the, the initial feedback unfortunately has been, Well we followed standard procedure, and we didn’t do anything wrong, there’s nothing to learn, but you know, come and meet us if you like

Was this from the Trust?

The Trust and the surgery. The health trust and, and the actual specific surgery, following sort of two courses of action there.

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Darrell asked the GP to refer him for talking therapy and told the GP that he would not take…

Age at interview 39

Gender Female

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Why do you think that the GP didn’t refer him for counselling straight away?

I don’t know. Whether it’s, whether it’s just an easy option to write out; she gave him a print out from the Internet to say about depression and panic attacks and all that for him to read. But obviously he’d already been on the Internet and looked at stuff and that hadn’t helped him, which is why he went for outside help. He needed to talk to someone.

Hmm.

I suppose the next option would have been for him to go and pay for a professional counselling but he wasn’t a person to go to a, a doctor’s
Hmm.

If he’d gone, you know that it was something serious that was worrying him that he couldn’t cope with because he wasn’t one to go to the doctor’s.

Hmm.

But she didn’t link onto that. When he first went to the doctor’s she didn’t want me in the room. She said, This is a confidential thing between patient and docto, and he had to persuade her to let me in, to sit in on the interview.

Hmm.

Or the, the consultation.Because he was worried that he might forget something that might be of help to make him better.But she was insistent on him taking these tablets and the counselling thing, although we asked and asked, it was, Let’s try this first

Did he ask more than once for some counselling?

Yeah, he said that, I don’t want to take tablets; I do need to talk to someone. Is there someone I can go and talk to And she said, No, we’ll, it’s normal for us to try tablets first, this is what I’ll give you

Hmm.

And she explained what they were and I mean I can’t even remember the name of them now, but he never cashed in the prescriptions, there was no way he was going to take them. Knowing him, knowing that he wouldn’t even take paracetamol for a headache, he’s not going to take anti-depressants.

Do you think he told the doctor he wasn’t going to take them or did he not want to?

Well he, he told her that she was wasting the paper printing out a prescription. So, but, that was what she was going to do and that was what she did.

Hmm.

But I mean, every patient’s different. I mean, it’s difficult for the doctor’s to know whether people are just saying it or how the situation is. But for Darrell, he was never going to take them.

Hmm.

Sometimes it helps them to take it and then they can work past it and
Hmm.

everyone’s different.

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Patricia’s husband, Andrew, had been seeing a psychotherapist for his depression. When they moved house the psychotherapist said that therapy should be continued but her husband’s new GP told him that psychotherapy was not available in the area. Patricia is sure that psychotherapy was available and that the GP misjudged the situation.

Some people complained about the long wait to see a psychiatrist or about the lack of follow-up appointments. Some felt that they had only got the care that was needed by paying for it. Arthur, for example, was desperate to find a specialist to see his son, Leon. Having heard about the waiting list he paid for Leon to see someone privately. This was in 1991 and Arthur said that he hoped that waiting times had gotten shorter since then.

Arthur paid for his son to see a psychiatrist because the waiting list (in 1991) was 11 months…

Age at interview 70

Gender Male

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Looking back what’s your feeling now about the healthcare that he got?

I think the healthcare that Leon got would’ve well would’ve not have been available but for me paying to see a specialist.

Hmm. You had to pay to go and see the specialist?

Well I had to because eleven months to see a clinical psychiatrist and even then I didn’t know he was suicidal.

Hmm.

But I knew he was I knew Leon was in crisis. And I was desperate for help, absolutely desperate.

And then he came back here and went into hospital, did he discharge himself from the hospital?

Yes he did. I mean in all fairness one of the conditions I made was that he went in of his own free will, accord, to the hospital.

Hmm. ave you got any feelings about the care he received in hospital or after?

The only thing I remember when Leon was in hospital he would sit all day long on his bedside. He wouldn’t obviously join in with any of the other patients, which I can well understand, because like I say in the interview, he said, What am I doing here with these nutters. It was a terrible thing to say that in this day. I mean obviously I’ve suffered from a slight bit of mental, ill health, but that was his reaction from being there; a young man who had suddenly been transported from everyday living into, into an institution like that.

And, and when he left, did he have any follow-up, psychiatric care or help? Was anyone following him up?

Well I think possibly not, simply because he was outside the area. Once he left the area I was in, and then gone to stay 30 miles away with his mother, there would be very little follow-up.

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Services may have improved greatly since 1991 but in 2005 Dolores’ husband, Steve, was told he would have to wait 8 weeks to see a psychiatrist or someone from the mental health team. She believes that this delay was due to lack of resources and that it cost Steve his life.
In 2005 another woman said that she had to “fight” to get appointments with a psychiatrist for her daughter, Rose, and that the appointments were few and far between. She feels angry that Rose’s drug regimen was badly managed and that Rose was not invited to return to the clinic if she felt worse at any time.
One woman had felt angry because her son, Barry, had asked to be admitted to hospital, but he was refused admission because he was not seen as a danger to anyone else. When he harmed himself by cutting his wrists he was taken to hospital but was discharged with prescribed medicine. Two weeks later he took his own life.

Once people managed to see a psychiatrist their experiences varied. Jenny, for example, spoke highly of her husband’s GP. She also thought that his NHS psychiatrist was excellent, although it was not until he saw a private psychiatrist that he was diagnosed with bipolar disorder. The NHS psychiatrist was sympathetic and included David in all decision-making, so much so that sometimes Jenny thought that David might benefit from a bit more direction.

Jenny thinks David had a great GP and a really good NHS psychiatrist. Even though the…

Age at interview 35

Gender Female

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What about your feelings at the time of his death towards other people, health professionals? Have you got anything you would like to add about the way other people were looking after him before he died?

I was interviewed for local radio because I was trying to raise awareness about bipolar disorder and I remember that the guy who was interviewing me said, Did I think if he’d been diagnosed earlier, because of course he was diagnosed only five days before he walked out of the hospitaland died.Did I think it would have made a difference?And I had to think quite carefully about it, but I think the thing is it’s just impossible for me to know and therefore because, because again the sort of other implication of that question is the, the doctors and psychiatrists that you, you know, that you had, could they have done any more than they did?I think on balance the answer is no.I mean, we had a great GP, who, you know, gave us a lot of time, wasn’t at all dismissive, was very caring and interested in David, was really sort of talking things through and really trying to understand what was inside him, what was motivating him when he was sort of asking to try different things.She was great.And then the, the NHS psychiatrist that we had, who was attached to a local hospital, he was also really good.David and I had a lot of respect for him. He seemed to, you know, I want to say he seemed like a really nice guy, somehow that sounds irrelevant.

Hmm.

You know, somebody whos doing his job, but it wasn’t irrelevant, you know, he clearly understood his job.You know, David had dealt with other people before in the past that he felt didn’t have, didn’t have any kind of sympathy or empathy, and he really felt that this guy did.You know, he really liked him and that was really important.And David was always, I thought, a really good judge of character, whether he was depressed or not, he was a good judge of character. And I think that this psychiatrist did everything that he knew how to do and he would, he had, I think the main thing that I liked about him was he had a lot of respect for David.He didn’t try and take his autonomy away.He didn’t just say, Right I’m going to try this with you next.I’m going to try that.He would talk it all through with David, and with me, because towards the end David said, could I come in, and the psychiatrist said, Yes that was absolutely fine.I think because he just wanted, the psychiatrist was happy about it because he wanted to see somebody who knew David very well and might give a slightly different answer than David was giving at the time about how he was feeling, someone who might have more objectivity.So it was a good balance.

Hmm.

And David liked it, I think because sometimes he was a bit distressed and so on and he thought that I could maybe sort of summarise things that happened when he wasn’t able to.

Hmm.

So that was, so the three of us, towards the end would have these appointments together and that was really helpful. And, yes, he would, he would talk everything through with David, instead of saying what, you know, I’m suggesting this, but we could do this or that.And, I suppose there were times when I thought well maybe you should have, almost be a little bit less like that, because obviously David’s getting to the point where it’s very difficult for him to kind of make decisions, maybe it would be good if you just said, Right, I think we should do that. But it’s such a fine line because, and I think the psychiatrist knew this, David was the sort of person that he really had to you know, he had to take on board what was being done. And he, he had to you know, believe in it. Or, you know, that sort of horrible phrase, he had to ‘buy into it.

You know, otherwise he probably wouldn’t have done it. Because he was always, kind of changing his mind about whether a medication was right or not anyway, and I used to have to keep quite on top of it and say, Look, we’ve decided this, so, you know, you need to at least try this for a bit. You can’t keep jumping around or it’s going to have terrible effects on you. So you know, he had to absolutely buy into it from the start and I think the psychiatrist knew that and was very good about it and that’s why he helped, you know, made sure that David would partly be making the decision as well.

So yeah, that was sort a, a bit difficult. I’m sorry, I say it was a bit difficult just because, as, as I say, I wanted him to be a certain way with him but even I was chopping and changing all the time. You know, I think I’d get to the point where I was feeling a little bit kind of frustrated because I always think, Oh God, is this next medication going to work or isn’t it?

And so I suppose when you get like that although really you want to feel that you’re in control and that David’s in control, there comes a point where you just think, Oh just tell me what the right thing is to do.

You know. So

And then, but I, I think he did a good job. And, and then, of course, you see, we had this new diagnosis so you might think, Well, didn’t the other psychiatrist not do his job then? How come he didn’t see that? But I think, you know, the psychiatrist in, the private psychiatrist at this hospital he diagnosed David straight away. Even he said, you know, Look, it’s very difficult to diagnose. And he said, I am specialist that’s why I’ve seen it.

And, you know, the, the NHS psychiatrist said to me after he died, he said, I did ask David on a number of occasions, you know, do you suffer from, or do you experience highs as well as lows and, and David always said ‘No, I’m just me, or I’m low.

And even I, you know, being outside of David, you know, I couldn’t see that because, you know, I suppose because I knew him well you know, the NHS psychiatrist may have been on the other side of it, he, you could say he, well sure he was more objective he should have seen it, but on the other hand he didn’t see enough of David to know that he would have had highs. He could only go on what we were both telling him, that’s all he could do.

So, in the end he was diagnosed in a private hospital.

That’s right. Yeah. That’s, that’s

By a specialist.

That’s right, where he was an in-patient.

I can’t emphasise enough, you know, I don’t blame anybody, I really don’t. But if there’s any sort of lesson to be learnt it’s that maybe there isn’t enough awareness of this whole kind of bipolar spectrum things and that, you know, maybe you can be a little bit bipolar. And where it’s difficult to diagnose you just need to be aware because what they’re saying now is, and it, it could anything up to 50% of people who are diagnosed with unipolar depression are actually somewhere on the bipolar scale.

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Some people said that the person who had died had been admitted to hospital but discharged too quickly, either without follow-up care or without an adequate care plan.

Felicity thinks it was unforgivable that her daughter, Alice, was discharged from psychiatric…

Age at interview 61

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I’m always very angry with the psychiatrist she had. When she was at [the local town] she was going to see the psychiatrist once a month and she was on pills. The Lithium had never agreed with her, which is what they usually use for people who are bipolar. So she was on something called Sodium Valproate, and that seemed to work. But she was quite over weight, because that’s a sort of bi-product of it. She felt that she wasn’t her lively self. And so she said to the psychiatrist that she would like to go off it. I don’t know what happened in that conversation cos of course I wasn’t there, I wasn’t allowed to be there. But anyway she just came home and said he’s let me go off the pills and he’s discharged me. And I was so, so, so angry with him. Because even if he’d just put it down to a very low dose, or even if she’d insisted on going off it, if he’d not discharged her, she’d have had to see a psychiatrist on a regular basis. It would’ve been, how should I put it? She was allowed to think that she’d recovered for good. And of course with manic depression that very rarely happens, or doesn’t often happen. And so when she went to Glasgow, she didn’t register with the counselling people or with a doctor, and there was no way anybody would know, to look out for her.

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Steve complained to the Chief Executive of the Community Mental Health trust. He wanted to know…

Age at interview 37

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I need to go back a little bit in time. On the Monday that the British Transport Police liaison officer contacted me and then the Cornoner’s Office had contacted me I’d already started my draft letter of complaint to the Chief Executive of the Community Mental Health Trust. And I didn’t know at this point. I didn’t know until quite a long time after I’d complained about their lack of care of my sister that she’d been discharged from their service. She didn’t ever share that information. She was quite. She was a very private person anyway and certainly when it came to her health and her mental health she did not like to share any information with anybody, even family. I think she felt quite ashamed that she’d had this, this, this judgement. I think she thought it a judgement of schizophrenia placed on her. She didn’t like it at all.

And so we still didn’t know for quite a while that she’d been discharged by the consultant and that she hadn’t been medicating for five months. And so I wanted to know why they’d allowed my sister to, to do this really. So I wrote a letter to the Chief Executive and got the usual standard response from his office saying, oh yes sorry to hear about your sister. And we will investigate this.

Apparently my sister had been asking the consultant for quite a number of months if she could stop taking medications. And she said that she wanted to be discharged from the Mental Health Service and just carry on with her normal life. And they reluctantly agreed to both of my sister’s requests in July of 2006. So my sister was without medication from then and without support from the Mental Health Team. I say without support, their, their plan as they call it was to assess my sister by a fortnightly telephone call, but obviously she didn’t want to speak to them. She didn’t answer the phone. There was no contact with any mental health professional from July up until after she’d died.

Before that had they been visiting her regularly?

Weekly. And she’d had regular, they called them reviews where there’s a consultant and the, the mental health nurse and the social worker I think and the patient, my sister, as well. And it just stopped. There was nothing, nothing at all. I mean I think that they tried to phone her but she didn’t want to know. She didn’t answer the phone. She wanted to not be part of the mental health service anymore.

And from my general nursing background that is completely nonsensical and is asking for something to go wrong really because comparing this mental health condition, this chronic lifelong mental health condition that my sister was suffering from with a medical condition, such a lifelong medical condition, we would not be allowed to stop medicating somebody say with diabetes who is on insulin injections every day. They would not be discharged from, from care. So this is a huge issue which is still ongoing which my MP is now taking up, on my behalf because I’ve just hit brick walls everywhere I’ve turned really.

The mental health team are suggesting that they are not responsible for this because her case was not open at the time of her death. The case wasn’t open to her consultant so the consultant has no, hasn’t got to account for their actions which I don’t agree with.

However I had my opportunity to speak at the inquest. I mean this lady that prepared the mental health report sent me a copy of the report prior to the inquest and it was as I expected really. They’ve covered their own backs quite well, the mental health team. They’ve admitted a number of, of mistakes that were made but their conclusion is that they don’t know whetheror not the death was avoidable. To me it was completely avoidable.

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After Dave’s son died in 2003 he and his wife wished they had been more involved in his care…

Age at interview 56

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Looking back, how do you thing the mental health services should have dealt with everything?
They should have involved us more. They didn’t involve us enough. They dealt with Ben as a, they almost took him out of our family and dealt with him, and told us to back off and they were dealing with him.
How old was he at the time?
Ben?
Mm.
Ben was twenty two, so.
So, were they excluding you because they saw him as an adult?
Afterwards they said that. Yeah, they said it was confidential, confidentiality. But they were, they just hide behind that.Since he died, we put in a complaint to try and find out what had happened. Why there such difference between what his medical notes said and what we were thinking at the time, and the treatment that someone in his position should have got.
Mm.
Under the mental health terms like, there’s the national service framework that describes what people with mental health problems should get.And all of the trust work under a system called, Care Programme Approach, which says what should be delivered.
Mm.
And it’s all based on what’s happened, in the past, to people slipping through the system and struggling and killing themselves, and not getting good treatment.And they’ve got this framework but it, they don’t implement it, and they didn’t implement it for Ben.So we looked at what should, he should have got and what he’d got, and we said, This is no good. And we put in a complaint to the trust, and said he didn’t have a care plan, for instance. He was released on an enhanced care programme approach and he didn’t even after three months, or after six months, have a care plan. He didn’t when he killed himself, he didn’t have a care plan.

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Parents sometimes wished that the doctors had told them more about their child’s mental health problems, but understood that issues of confidentiality were involved because their child was over 18. Susan was also upset and angry that her son, Stephen, had had access to illegal drugs when he was in hospital. She argued that if he had money he would buy drugs but the hospital staff said that he could not be prevented from having his own money.

Susan had not been told about changes that might predict that Stephen would take his own life…

Age at interview 58

Gender Female

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And I’ve got to be honest, I asked one of his carers, because when he, he had two main carers in the community as well as us, and I actually asked one of those carers, when Stephen was going through a really bad time, Is Stephen suicidal? And I was told, No. And it wasn’t until after Stephen died that we were told by his doctor on a meeting that we had, that they felt that if Stephen ever lost his brother’s voice, then he would be more likely to commit suicide. And again, I felt really angry, we were part of his care team for ten years, my husband especially, and yet we were never ever told, and I do understand that things do have to be kept confidential when people are a certain age, I quite understand that, but there’s lots of things that Stephen told the hospital that they couldn’t confide to us. Stephen talked to his Dad quite a lot, at different times.

What hadn’t you been told? You hadn’t been told that he might commit suicide if he lost the voices?

No. Not until?

That’s what you’re cross about.

Yep, Not until actually after he died.

Mm. And you were aware that he had lost the voices.

Yeah, I was also very angry that Stephen would be able to get access to drugs, illicit drugs, and I actually put in a letter of complaint, stating what I felt, and why was he able to get drugs. Stephen’s biggest fear when he became ill and we knew that he was heading back into hospital, he would actually say to his Dad, Please don’t send, let them take me back Dad. Because he knew that the one place that he should’ve felt safe, he wasn’t, because he knew he’d have access to drugs.

He could get drugs in hospital?

Exactly, people coming onto the premises selling, and they know this goes on. They know it happens.

And this was only last year?

Yeah. And I was very very angry. I mean I know my husband visited Stephen one Sunday morning with his brother-in-law and Stephen was coming back from, they’ve got like a bit like a sort of nature reserve up there, and Stephen was coming back with a coloured guy that wasn’t a patient and my husband knew then and there that Stephen had had something off of him.

And you say it’s his money, that’s money that’s given to him by the state?

No, it was money, Stephen was on income support, because he couldn’t work.

Yes, so that’s his money.

Because of his illness, it was his money which he gave to his Dad to keep for him and he would have bits and bobs here and there. When Stephen was at home, he never touched drugs, he was fine. But as soon as he got back into the hospital he was back on the drug scene.

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People also criticised the healthcare system, the lack of options and resources, poor communication with families or the lack of continuity of care. Helen, for example, was upset because for a while the psychiatric team refused her daughter care because she was taking illegal drugs and had been transferred to the Drugs Team. Her daughter was told that she would only be seen by the psychiatric team when her drug problem had been resolved.

Helen points out that many people with drug problems end up with psychiatric problems. She…

Age at interview 53

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She was under a psychiatric team, not the team that she was with for the last two years, a different one, and when I wrote to them explaining that I thought that actually now she was taking harder drugs, class A drugs, they immediately put her over to the drugs team, and they said that they couldn’t see her at the same time. That when she got her drug problem sorted out, they would see her again in the psychiatric team. But when we got to the drugs team and we spoke to them there, they were really quite annoyed at that, because they said, actually they said, it’s time they came up to the twenty first century, that most people with psychiatric problems, not most but a lot nowadays have drugs problems as well. And a lot of people with drugs problems end up with psychiatric problems. And it needs to be dealt with as a whole thing, not as a separate thing.

So there’s a lack of communication as well between the two teams?

Yes, Yes. But it, this team at the end they actually did deal with all of it, but not very many, they have so many people on their books, that there’s a lot of people that need their help that don’t get it because they’re just, they’re just over worked.

The drug team?

Yeah. On the, on the, on the, it’s a psychiatric team.

But who are looking after people who have both.

They have multiple, they people they take care of have to have multiple problems.

But you felt that the original psychiatric team should’ve gone on caring for her.

I think they let her down. Yes definitely.

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Rose’s mother considered admitting her to the local psychiatric hospital but felt that it was so depressing there that her daughter would just discharge herself.

Kavita wishes her brother had been forced to stay in hospital under the Mental Health Act for hospital treatment. To some extent she blames the health professionals for his death by suicide because even though at times he appeared perfectly well, at other times he told them that he was feeling suicidal. Melanie also wishes that her husband had been sectioned but she understands that he could not be kept in hospital because he did not reveal enough of his “torment”.

After the bereavement some people said that their GP had not given adequate help and support, but others spoke highly of their GP and the excellent care they received (see Help and support from professionals and see Messages to professionals and policy makers).
Amanda was grateful that her son’s counsellor expressed her grief and sorrow that her son had died by suicide while he was in her care. Knowing that she was genuinely sad really helped Amanda.