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Steve - Interview 25

Age at interview: 37
Brief Outline: Steve's sister took her own life in 2006. She stepped in front of a train. She had had mental health problems for many years but was not receiving the care she needed at the time of her death. Steve was devastated. He has found most support from SOBS.
Background: Steve is an advanced nurse practitioner. He is co-habiting. Ethnic background/nationality: White British.

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Steve’s sister had been unwell with mental health problems for about ten years. She had been diagnosed with paranoid schizophrenia. However, in July 2006 she had discharged herself from the care of local mental health services and so had been without medication or support from mental health services for about five months.
 
One day in November 2006 she was reported missing and the police were called. Steve went with the police to her flat and found her there. She looked most unwell so Steve spoke to someone at the local Mental Health Trust, who gave him the name of his sister’s GP. At 3.00am he had a call from a member of the mental health crisis team, who offered to call on his sister in the middle of the night. Steve decided that the situation could wait until the morning because he had seen his sister a few hours previously.
 
In the morning Steve tried to contact his sister’s GP but could not get in touch. He also tried to talk to someone from the mental health crisis team but found them unhelpful because they would not discuss his sister due to issues of confidentiality. Later Steve managed to talk to his sister’s GP, who agreed to ask the mental health crisis team to take his sister into hospital under a Section order for the care she clearly needed.
 
The mental health team found that Steve’s sister was missing from her home and so they informed the police. With his parents permission the police broke into his sister’s flat and found documents indicating that his sister had planned to take her own life. She had also planned her funeral. At this stage Steve was not aware of the notes, and he was still hoping to find his sister alive.
 
Steve and his parents were informed that a body had been found on the railway line but that it had not been identified, so they waited anxiously for news.
 
Two days later Steve went to the police station hoping for information. He spoke to a police officer, the family liaison officer. She told Steve that the body that had been found on the railway had been identified as the remains of his sister.
 
This news was a tremendous shock for Steve and his family. Steve felt dreadful and said that he has never lived through anything so terrible. Other members of the family arrived, which Steve found comforting.
 
Steve was told he could not see his sister’s body because she had been hit by a train and was gravely injured. When he saw photographs of his sister’s body he realised that she had not died of a simple head injury. In spite of this Steve wishes he had been given the opportunity to see his sister’s body because he found it hard to accept that she had died. He would have liked to have made an informed choice instead of being denied the opportunity to see her.
 
Steve was so devastated by his sister’s death that he found it hard to leave his own house for at least four months after his sister died, except to visit his GP or his parents or to see other family members. He was unable to work at that time.
 
Steve felt angry and upset that the mental health team had discharged his sister into the community without follow up care. At the time of her death he was not aware that she was back in the community without mental health care and without medication. He wrote a letter of complaint to the Mental Health Trust. There was an investigation and Steve was told the consultant had “reluctantly” discharged his sister from her care.
 
Steve still feels that his sister’s death was avoidable and that the Mental Health Trust had some responsibility for his sister’s death. He has asked his MP to get involved in the case. Steve is not satisfied with the result of the inquest, and is not satisfied with the investigation and the report that was made for the Mental Health Trust. Steve believes that the consultant was wrong to allow his sister to stop taking medication. He feels that the mental health team let his sister down and should be held to account, so that other families do not suffer suicide bereavement in the way his family has suffered.
 
Steve’s sister left clear instructions about the way she wanted her funeral to be conducted. The family played the songs she chose and carried out her wishes. Her ashes were scattered in a local beauty spot on her instructions.
 
Steve still feels a deep pain and sadness and a sense of loss. He also feels angry with the mental health service about what happened. He also feels a sense of guilt and wonders if he could have done anything to prevent his sister’s death. For months Steve could not talk about his sister’s death. Now he can talk about it and his memory of what happened does not hurt quite as much as it did initially.
 
Steve has had some bereavement counselling organised by the NHS occupational health department. Although it was helpful to talk to someone outside the family he did not find it adequate. He wanted to talk to someone who had been bereaved by suicide. He was put in touch with a self-help group, called Survivors of Bereavement by Suicide, SOBS, which he has found really helpful. He still attends meetings run by SOBS and says that they are a wonderful, caring group of people. Steve was also comforted and reassured when he spoke to a member of the clergy about his sister’s death.
 
Steve still feels an intense sense of loss and at times he feels guilty for feeling happy,   especially occasions such as Christmas, which is a time his sister loved to celebrate.

Steve was interviewed on 7th November 2007.

 

Steve’s sister left detailed instructions about her funeral but she did not explain why she...

Steve’s sister left detailed instructions about her funeral but she did not explain why she...

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The police had broken, had gained entry to my sister’s flat and found references to her planning her own death. There were quite a lot of them [references] as well and they were all; everything was documented very well. She’d planned it to the, to the finest detail how; she hadn’t actually hinted at a method of how she was going to do it but everything else. She’d even planned her funeral, what the songs that she wanted played and the people that she wanted there and the people that she didn’t want there and that she didn’t want flowers. It was clear to the police obviously that this had been planned for quite a while. And the dates on the letters were dating back to as early as August and September, and it was November that she, she died.

 

Did she say in the notes why she was feeling so desperately unhappy?

 

I’ve got all her diaries as well which have proven to be very useful because she wrote in her diary everything, every day. Every thing that she did she, she wrote in her diary for years. And looking back the, the style of her writing and the things that she, she’s starting to write, it becomes clear that she was becoming unwell in September. And from, there is a, there is a big gap then. Most of October there’s not, there aren’t many entries written at all but it’s clear that she’s losing insight. So she, a lot of it is, it doesn’t make a lot of sense really. And her writing becomes tiny so some of it you can’t actually read, it is so small. But no she doesn’t, she doesn’t specifically name any cause for her wanting to take her life or explain why she’s feeling so, so desperate. Which I suppose is another huge cause of guilt for the family, me and my family because we don’t quite know why this happened.

 

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

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

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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 whether or not the death was avoidable. To me it was completely avoidable.

 

Steve often feels guilty. He thinks he could have done more to prevent his sister’s suicide. Now...

Steve often feels guilty. He thinks he could have done more to prevent his sister’s suicide. Now...

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The guilt probably is the biggest emotion out of, out of the three for me anyway because there are unanswered questions that I think that maybe I should have done more to prevent this. And I suppose it’s beating myself up. I should have done this. I should have done that.  But the guilt is much more intense at happy occasions really and it’s hard to deal with. But fortunately my family have gone through the same bereavement and I can discuss it with them and they know what I mean. And with the SOBS [Survivors of Bereavement by Suicide] group as well, they understand completely when I say, actually I laughed the other day and I felt guilty for laughing. And they know how I’m feeling and they know why. It’s difficult for, for people who aren’t members of the family or people who haven’t gone through this bereavement with us. At work when people are larking about and having a laugh and a joke and I can’t imagine them understanding me saying, ‘Actually I can’t laugh with you because I feel guilty about it because my sister’s dead’. It, it’s difficult.


Other people have said that.


Really?


Mmm.


I’m not surprised. I went on holiday. Well we’ve been on several holidays this year and I’m excited because we’re going on an aeroplane and then we get on the aeroplane and my mood just sinks. And it’s because I’m quietly thinking about my sister who had never been on an aeroplane. She never went on holiday with me and I’m going on holiday again and having a good time and I’m looking forward to it and I feel guilty because of that. And it, it’s hard, it’s hard to explain to people who haven’t gone through the experience of suicide really.

 

Steve thinks he would have found it easier to accept his sister’s death if he’d been allowed to...

Steve thinks he would have found it easier to accept his sister’s death if he’d been allowed to...

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I think just having the opportunity I may not; if the coroner had said, “Yes, you can see the body”. I may not have taken him up on that but to be denied the opportunity completely took away the choice really. It would have been nice to have been able to make an informed choice about whether or not to see the body. And although I discussed it with my siblings and they all said, apart from my older brother who was, had the same vision as myself, the same, the same understanding really. They all said, “No it’s not, it wouldn’t do you any good to see the body”.

However, I don’t know. I’ll never know now because the opportunity wasn’t there and I didn’t have the choice and I may have accepted the death better or I may not have but I’ll never know now. That question will be unanswered. But I think having looked at the photographs of my sister’s body; they didn’t bear a resemblance to the post mortem report anyway so again there is doubt in my mind although I suppose they may have reconstructed the body from the remains. That’s perhaps why it doesn’t resemble the post, how it was described in the post mortem report. But I think certainly when it comes to accepting the death it would have been easier to accept it if I had seen the body. Never mind that’s not to be now.

 

Steve felt angry that the Mental Health Team had discharged his sister from hospital without...

Steve felt angry that the Mental Health Team had discharged his sister from hospital without...

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Did the press get involved at all?


Yes they did. Not really. Yes they did. They weren’t majorly involved. The local paper published a photograph. They, they had a story because there had been a tragedy on the railway lines locally and there was a picture of the train but fortunately before it was published we gave them a photograph of my sister a few days after they’d identified her and the police liaison officer, the lady, the local police lady she, she circulated the photograph so there wasn’t just a picture of a cold train in the paper, the local paper.

 

My anger at the time was with the Mental Health Team, I contacted a local radio station and said, put my, put my story to them and they did a live interview with me on air. And the Mental Health Team was asked for a response and they didn’t really give one. But apart from that, that really was the only media involvement.

 

So you had the chance to air your feelings?

 

I did yes but it was to no avail really because there was no response. It felt like a one-sided argument really.

 

Utility companies had to be informed. Steve made a copy of his sister’s interim death certificate...

Utility companies had to be informed. Steve made a copy of his sister’s interim death certificate...

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The reason that we knew she was missing; there was something odd going on was that my mum found a huge amount of cash in their carport the day that my sister went missing. And so that’s why we knew something was wrong. So financially she’d even sorted that out. There were envelopes for each of the family members containing various amounts of cash. And there were other things to sort out as well though such as the electricity, the water, the television licence. All the utilities had to be sorted out. And I just did a standard letter and copied the Interim Death Certificate and sent it with a standard letter to all of them. Came across a bit of difficulty with, with some of them because I’m not the official next of kin, my parents are but they [parents] couldn’t have done it. They were too… I don’t know, I think it kept me going having a purpose really. It felt like I was doing something for her. And in the end I gave up. Some, some of them still owe, owe us money but it doesn’t really matter. I’m not, certainly not going to pressurise my parents to write a letter to say that their daughter’s died. You know it doesn’t matter but there’s; I found bureaucracy is a bit of a pain. Having to write to the council to scatter her ashes in the local park, it may sound odd and it may sound you’d be expected to have to do it but for it to take such a long time it’s all bureaucratic stuff really that seemed to be barriers.  Some of the utility companies as well wanting, wanting letters from next of kin it’s all bureaucratic nonsense really. You don’t need it at the time because you’re feeling so dreadful anyway.


Especially as you sent a copy of the [interim] Death Certificate.


Yeah it’s almost like saying, well we don’t believe you, and it hurt.


Were there any insurance companies to try and sort out as well?


No.

 

After the funeral Steve’s sister’s ashes were scattered round a tree in a local beauty spot. He...

After the funeral Steve’s sister’s ashes were scattered round a tree in a local beauty spot. He...

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…She’d even specified where she wanted her ashes scattered and she wanted them scattered in a local beauty spot I’d suppose you’d call it. And I had to write to the council, the local council and get permission from them to do it and it took quite a long time to actually get them to say, yes you can do it. It went all the way up to the Chief Executive Officer of the, of the Borough Council to make a decision because nobody had ever asked such a question before. And we were able to scatter her ashes exactly where she wanted them to be scattered.


Who said that you had to ask permission?


It’s a public property. It’s council property rather. It’s a public area and we had to ask permission to be able to do it officially. The council said that we had to.


Do you sometimes go and visit that place?


Regularly yeah when it’s nice. It, it’s odd because there is no grave to go and visit. But I go to this tree where she’s scattered around the base of the tree and I go. And there’s a bench there already. It was always there because it is a public area. And I go and sit there and, and meditate a little bit really I suppose. But it is quite comforting to go there.


Would you have liked a particular place or plaque or gravestone?


I don’t know. I think perhaps not because I think we had to abide by what she wanted and that was more important than me, us having to decide a place for her ashes to go to. I think it would be quite selfish of us to say, no we’re not going to do what you wanted to do. I think we had to do what she wanted to do. And although it feels; it perhaps would be nice to have a focal point to go to but we’ve got, we’ve got the tree where she’s scattered so it doesn’t really matter. And I think for me personally I believe in spirit life anyway so to me it doesn’t matter where her bodily remains are, her spirit is probably around me anyway.

 

The coroner’s officer made insensitive comments when he spoke to Steve on the phone about his...

The coroner’s officer made insensitive comments when he spoke to Steve on the phone about his...

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And also on the Monday we had a phone call from the Coroner’s Officer. Obviously they want, gathering evidence as well. I have to say that my experience of this particular Coroner’s Officer wasn’t that great because his initial, the way that he opened the conversation was, “I’ve been doing this job X amount of years and this is the third worst I’ve seen.” And I said, “Well that’s very nice of you to share that with me. Please do not say that to my parents.” But he did. So quite an insensitive person really.


What did he mean?


It was the, the worst. He said he’d seen my sister’s remains and, and the state of her remains were the third worst. There were two others that had been worse that he’d seen. Which is a terrible way to, to introduce yourself to a bereaved family under such tragic circumstances. And immediately I had no respect for this man at all. And then he went on to say it to my parents as his way of introducing himself to them as well. Consequently, I mean I’d never met this man up until the date of my sister’s inquest and he; I’d already built up a mental picture of how I expected this man to appear and how I expected him to behave and I was right.


Did he ask you for a statement at all?


I actually did write a statement but I don’t know if it was him that asked me for it or the Coroner himself because I had a letter from the Coroner and I think it was the Coroner himself who asked me to write a statement of what, about my sister’s life and any health problems or, or any other. He wanted a whole picture of her really. So I did that. It took me quite a while to do it because I didn’t feel like it initially. It’s as simple as that. I was, I was deeply hurt and grieving and shocked and I just left it for a little while. But it, it took me a while to do it when I did get around to writing it.


And the Coroner’s Officer, what role did he play with your parents? Did he again ask them for statements?


No. We never met him at all. It was just a phone call to say I am, this is my name and I will be the Coroner’s Officer. And that was all, all the involvement he had really. There was, there was nothing. We never met him. I mean I spoke to him perhaps on a handful of occasions on the phone but it was usually only when I wanted answers to questions that I would contact him. He didn’t really contact us. I don’t quite understand the role of this Coroner’s Officer. There was, he was certainly no help to us as a bereaved family.


Did he tell you what was going to happen at the inquest?


No.


So no preparation for the inquest?


No not really. The inquest was quite a while after the death anyway. And fortunately I’d been in contact with the Coroner by E-mail and any questions that I had I put to the Coroner directly himself. Because I didn’t want to deal with this, this cold person really, he had, I’d got no respect for.

 

Steve had bereavement counselling through his NHS occupational health department, but he felt...

Steve had bereavement counselling through his NHS occupational health department, but he felt...

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Did you ever get any help with your feelings? Did you have any counselling?

 

I did. I did have counselling. I had to go on a waiting list for it at my GP surgery that is. I had counselling through my NHS Trust occupational health department. And initially I suppose it was, it was good to talk to people who were not directly involved but it wasn’t helpful. It wasn’t helpful at all. It wasn’t. It didn’t meet my needs. It, it wasn’t just a death. This, a suicide death is so different from a natural death. It’s, you need to be able to share your experiences with people who know what you’re actually feeling and bereavement counsellors, unless they’ve experienced it themselves, don’t actually know how you are feeling. So although the bereavement advice they give you I suppose is pretty, pretty standard and generalised and it may be helpful I suppose but it didn’t help me at all.

 

It took Steve months to find out about Survivors of Bereavement by Suicide. He now goes to meetings about once a month. Survivors of Bereavement by Suicide has helped Steve tremendously because he knows that he is not alone.

It took Steve months to find out about Survivors of Bereavement by Suicide. He now goes to meetings about once a month. Survivors of Bereavement by Suicide has helped Steve tremendously because he knows that he is not alone.

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I needed to speak to people who knew how I felt in my heart really. And so the one thing that the bereavement service were able to do for me was to put me in touch with a, like a self-help group that meets locally every month and it’s specifically for people who have been bereaved by suicide. And that’s helped tremendously.


Is that SOBS?

 

Yes it is. I didn’t know if I could mention the name, yes SOBS. I go to SOBS every month if I can. It’s difficult now I work so far away but I try and go as often as I can.. Straight away, my first meeting at SOBS I realised that actually no I’m not alone. There were quite a number of people who had been bereaved by suicide. There was somebody else there whose relative had stepped in front of a train so she knew very specifically how I felt. And they were all so, so caring. They understood. Things that I felt quite difficult to share with other people, it was easy to share with them because they knew. They knew how I felt. They knew how I was feeling. They were able to help me prepare myself for the inquest. They are a tremendous help. They are a wonderful group of people.

 

Do they meet every week?

 

Every month.

 

Every month?

 

Yeah.

 

You try and go every month?

 

I try yeah. And unfortunately there, there are new, new people regularly who, who’ve got a relative or a friend, somebody they know who have taken their own life. And the last meeting we went to there were a couple of new, new people there and it took me back to how I was feeling at the time which is upsetting, very emotionally draining but then on reflection it’s a very healthy thing to do, to share experiences and to feel the way I did because it makes me realise that my sister is still here almost. It makes me feel close to her and it’s good that I can, I can share my experiences with these people who are recently bereaved by suicide.


By talking about her you feel you are closer to her?

 

Yes.

 

And I can’t, I can’t elaborate on that. I can’t explain that to you but it makes me feel good. It makes me feel that I’m keeping her spirit alive. And the way I, I talk to her now. I mean I imagine conversations with her. You know I imagine she’s there in the car with me some days when I’m missing her more than other times. And I speak, you know I speak normally as if she were there. And that helps me and it may, it may seem quite an odd, I suppose it’s a coping mechanism, a coping strategy but it helps me because I do still really miss her and I still feel so much pain.

 

And SOBS help tremendously. But I had to wait quite a few months until they; I didn’t have to wait, it took months for anybody to actually suggest them to me and it was, it wasn’t actually the bereavement service who knew of SOBS. It was through a friend who works at another hospital whose bereavement officer had suggested them to her and she told me, otherwise I wouldn’t have known about them. And I may still have been in a state of turmoil but they’ve really helped.

 

Steve explains what happens at a typical Survivors of Bereavement by Suicide meeting in his area. After he lost his sister by suicide he found the group very helpful.

Steve explains what happens at a typical Survivors of Bereavement by Suicide meeting in his area. After he lost his sister by suicide he found the group very helpful.

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What happens at a typical meeting? Do people just talk about whatever they feel like?


Yeah. Yeah there’s no, there’s no pressure at all. There’s a group leader or there are two group leaders really, and most of us know each other now because it’s regular people that go. But if there is somebody new then we generally, the leader will introduce themselves and say that it isn’t a counselling group. It is a self-help type group and they will tell them about their bereavement. And then you go round and speak about yourself and your bereavement if you want to. You don’t have to. And then we talk about experiences and how we are feeling at the moment. If there’s a, an anniversary, a birthday or Christmas, a special occasion then we generally share experiences. And although it’s not a counselling group it feels supportive. We help each other through really and we have a cup of tea and, and we just talk. And you talk about however you’re feeling at the time if you want to. And it’s, although it doesn’t sound quite as dynamic I suppose but it is really, really helpful.

 

Steve found the support group, “Survivors of Bereavement by Suicide” very helpful.

Steve found the support group, “Survivors of Bereavement by Suicide” very helpful.

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Have you got any other messages?


It’s really difficult to have, to have a message really because you hope, I certainly hope that people don’t find themselves in the similar situation to me. The biggest message really is to the mental health people to sort themselves out and to not allow people to be put in the situation that we’ve been put really. For people who have suffered a bereavement by suicide I would highly recommend that they join some kind of group specifically run for bereavement of suicide because the bereavement counselling although it’s good to talk and perhaps get some things off your chest it probably won’t fulfil your needs completely. So I suppose the biggest message is, you’re not alone. There are other people out there who are feeling the way you feel and who are experiencing the same things as you. And if you can, join a group like SOBS because they are so helpful.

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