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Electroconvulsive Treatment (ECT)

Suicide and self-harm

People we spoke to had often experienced highly distressing thoughts and feelings. You can read more about this here: ‘Depression, psychosis and anxiety’ and ‘First becoming unwell’. These feelings could at times seem overwhelming and too difficult to deal with. Some had self-harmed e.g. cut themselves to cope with emotional pain, or attempted to end their lives at least once. While self-harm (intentionally hurting yourself) may lead to suicide, self-harm is wider-ranging then that and includes alcohol abuse, not eating and burning yourself and is often a way of coping or telling others that there is a problem. It was often difficult, even many years later, for people to talk about the details of trying to end their lives.

The Chair of the National Suicide Prevention Strategy Advisory Group says that talking about suicide does not encourage it and may save a life. And although asking about suicide can be uncomfortable, the person concerned might feel relieved that others are aware how bad they feel.

Thoughts of suicide ranged from disturbing, intrusive thoughts, to almost comforting -to end the trauma. At the time when they attempted suicide or self-harmed, many people describe being afraid, “scared by what was happening in [their] mind” and unable to cope. Some felt like they had lost control, or that everything was “unreal”. Other people said that trying to end their life seemed logical at the time, for example because it would be better for others if they weren’t around. Julian said the decision to end his life was “rational” and he felt he’d “reached the end of the line”. Some appeared to be coping on the surface, but had moments of deep despair. Kathleen said when she was self-harming she was able to “[hold] it together”, even though she “wasn’t doing very well really inside”. When Yvonne attempted suicide at the age of 18, her attempt failed. She woke up in the morning with “the mother of hangovers” and just went to work. She didn’t know she was mentally ill.  While suicide could seem the logical thing at the time, people could equally “snap out of it” by thinking of their responsibilities to family or others
 

Jenny had tried to kill herself and was admitted to hospital. She was distressed and confused in a way that she had never been before or since.

Jenny had tried to kill herself and was admitted to hospital. She was distressed and confused in a way that she had never been before or since.

Age at interview: 56
Sex: Female
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There wasn’t, I didn’t, I, my last working day led, I was a missing person, I tried to kill myself. I left work, I drove from work and tried to, to kill myself, and then was admitted. So my last working day ended with me, with a suicide attempt. So that was my last experience, and as far as I know my office has still got my books and paperwork in it. So, and I haven’t been back since.

And what can you remember of being admitted to hospital?

I can remember, I mostly try and be quite a clear-thinking sort of a person but I remember being almost childlike really, very pathetically, “I don’t give a toss what happens to me. Just do whatever you feel like doing.” And, and therefore because I was childlike, people did things to me, people told me what they thought was best for me, “Well, Jenny, you’re a risk to yourself and, you know, if you’ve disappeared once and tried to die.” In a rather bizarre way, indeed, but it’s, that was how it was. I didn’t want to die quickly so I, I wanted to die in the cold in the middle of [name of area] overnight. Which I didn’t do unfortunately. But it, it, so when people said, you know, “If we leave you at home, Jenny, this might happen again. Will you agree to being admitted?” I said in a rather feeble way, “Yes, I don’t care what happens to me. I’d rather be dead. But you can do what you, the hell you like really.” So it, it was in that confusion. And then I remember being very, very, very upset, and I’m not usually obviously upset. You’d have to know me quite well to know if I was upset by anything. So I don’t cry very often or get emotional about things really. I try and keep myself very, very clipped emotionally. But I remember being absolutely distraught on, on, what, since I was a teenager this was the first time I had been into a psychiatric ward, and what was upsetting was, “Have I come to this? Has it come to this? Has it unravelled so much, my life, that all that’s left is this heap of humanity crying in a shared room in some grotty hospital ward?” So I found it a very difficult place to have any even atom of self-belief or self-respect. And that was probably pretty well my lowest time. Because although I’ve been in hospital since then, always for the same reason because I say consistently, “I’d rather be dead” and then people get worried about that from time to time, I’ve not in a similar way not had my wits about me.
 

David Z felt very calm when he planned to end his life.

David Z felt very calm when he planned to end his life.

Age at interview: 44
Sex: Male
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If, do you mind if I ask you about the time when you were suicidal and how that felt?

It felt quite comforting, I guess. Because when you, you want to exit this life and you’ve made plans to do so, it feels very natural and very calm. So it’s very kind of, yes, it, it felt kind of c-, normal for me at that point in my life. It wasn’t frenzied, it wasn’t driven by sheer emotion, it was just very calm and very calculated. And I think that’s what concerned the, the consultant psychiatrist.
 

For Tania said the idea of suicide “just came into my head” and “dominated every moment of my thinking”.

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For Tania said the idea of suicide “just came into my head” and “dominated every moment of my thinking”.

Age at interview: 41
Sex: Female
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But it just got worse, everything got worse and I pretty soon, I started to think, it just came into my head, the idea of killing myself and then it wouldn’t go, and it just, I couldn’t stop thinking about it all the time. It just dominated every moment of my thinking.

And I knew that, I didn’t even really feel like I had control over myself. And I don’t even think I knew why exactly I wanted to do it. I just felt that everything was so unreal.

The next one, I got really, I’d come off the drugs by then because the side effects, they weren’t helping, the side effects were, it was unliveable and I became, I became very I became very manic. It was once again, it was one of these mixed episodes but you know, manic in a really, really bad way. I was incredibly high out in terms of you know, being up all night and having vast amounts of energy and being mental productive but I was also at the same time mentally suicidal, and I was desperately trying to stop myself killing myself. I mean everything in my head was telling me to do it, but I knew because of the effect it would have on my family that I, you know, I was fighting so hard as I had always done against these kind of voices in my head that were telling me to do it. But I also knew it was just a matter of time because it was so intense, I really believed that I was going to die and I believed that I was going kill myself and I believed it was inevitable and that there was nothing that could stop this, you know, this kind of power from subsiding because up to them we hadn’t to the we hadn’t found anything and I did in the end, I made another attempt and once again, I was, fortunately unsuccessful and I tried throwing myself off a bridge, but I was caught again. So, and you know, I went back to hospital and we didn’t know what to do really, we were all stuck and in the end my consultant said to me, “Look, you know, will you try ECT again because nothing else is working?”
While attempting suicide was a rare event for most, for some it happened repeatedly. Tracy said “it was almost a habit” that when things got really bad she would overdose. Most of the time she said this was a “cry for help” but on one occasion she said she really did want to die. Sheila’s husband took an overdose on 6 occasions and she believes he meant to die. After recovering, he would say “well it hasn’t worked has it”. However, Beattie said although she had tried to commit suicide a few times she’d never done it “properly,” and Jenny described herself as making “quite a few trivial suicide attempts”.

Getting help
People often found it difficult to talk about what they were experiencing. They didn’t want people to worry, felt embarrassed and ashamed about their thoughts, or found that others were uncomfortable talking about it. When Catherine Y took an overdose at the age of 16 she didn’t feel able to speak to her parents about it. There was no history of mental illness in the family, and she felt they didn’t understand and were too close to the “issues and situation”. For some, even talking to a professional was difficult. However, several people mentioned talking to the Samaritans, which they found helpful. Catherine Y phoned the Samaritans from a phone box after she had run away from home. The Samaritans advised her to call the police and she was picked up and brought to hospital. You can read more about where people turned for support here: ‘Support networks' and about relationships with family members here: ‘Family relationships’.
 

Although Kathleen had a long history of self harm, she had never spoken to anyone about her depression. It was only in her 40s when she was working as a GP that she agreed to see someone.

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Although Kathleen had a long history of self harm, she had never spoken to anyone about her depression. It was only in her 40s when she was working as a GP that she agreed to see someone.

Age at interview: 51
Sex: Female
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In fact I think it makes it worse, because I thought ‘oh no, I can’t, I can’t get depressed’, you know, I just didn’t want to share how I felt with anybody, either with my GP or someone else. No I kept it to myself and it, I was yes, I wouldn’t say forced into, yes, I suppose I was forced into it really. It was kind of a peer review thing for revalidation and I had mine with a GP from another practice and she persuaded me that I ought to. She thought I was depressed and I ought to make an appointment to see my GP. Or she was going to phone him or something. It was like you’ve got to or else. So, so I did. That was the first time I ever saw anybody about depression and I’m sure I had depression, I certainly have a long history of self-harm as a teenager, as a medical student. Yes. A long, long time. That goes back a long way. And certainly other depressive episodes.
 

A year after her second daughter was born Tracy became very depressed. She had an appointment with a psychiatrist but ran home and took an overdose.

A year after her second daughter was born Tracy became very depressed. She had an appointment with a psychiatrist but ran home and took an overdose.

Age at interview: 49
Sex: Female
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And then a year or so later I had my second daughter. And it was probably about a year after that I started to become really depressed. And I can remember having to go to the Department of Psychiatrist and the psychiatrist interviewed me, and he went off to get some paper work and I just ran. I had a little moped at the time and I drove that home and took a massive overdose and I went to the general hospital and I have vague memory of it. 

I think what happened was I panicked at the last moment and phoned a colleague of mine and she came and took me to the hospital.

So you went in to see the psychiatrist but, sort of, ran away half way?

Yes, half way…

… through. Can you remember anything else about that appointment or…?

I don’t know why I was there by myself, why nobody came with me? My ex-husband must have been at work, or whether I just wanted to go by myself. I can’t even remember if it was an emergency appointment. I think probably it was an emergency appointment. I tried to hide my depression and I think that’s quite normal for a lot of people. You know, people were shocked that I was that bad really, because I’m quite a jovial person most of the time and I think a lot of people with depression hide it, mask their symptoms with mucking about.

No I can just remember the long corridor that I had to run and hope that I wouldn’t get caught. And I, oh I got on my moped and went to my friend’s house, but she wasn’t in, and that was the final straw. You know, how dare she not be in when I need her so desperately? [small laugh]. And I just went home and took all the tablets that I could find. How I haven’t got, how I haven’t mucked up my liver I don’t know.
Some people were in hospital when they tried to end their life or were harming themselves. Enid says that she was trying to hurt herself “with everything [she] could lay [her] hands on” and staff tried to stop her. She said staff were very good. Others had negative experiences and felt staff were not so supportive.
 

When Helen was in an “asylum” many years ago, she found the hospital staff were not sympathetic towards her after she had taken an overdose.

When Helen was in an “asylum” many years ago, she found the hospital staff were not sympathetic towards her after she had taken an overdose.

Age at interview: 60
Sex: Female
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And also from that point on I was acutely suicidal which I hadn’t been until I actually had the shock treatment. It’s a bit like hospital, you’re not on tablets when you go in but when you come out of hospital you sure as hell are on tablets. And it was the blackness that you were really in outer space and just I can remember walking along the motorway in the dark and phoning the Samaritans who have also been very good over the last years because they’re an impartial body. I overdosed quite badly and that left me blind and they weren’t very kind either the doctors, they’d shove tubes down your throat and in post war Britain it was cowardice and they made it clear that I was wasting their time and they needed to be spending their time on people who were ill. 
 

Sue tried to leave the unit she was staying in so she could kill herself. She was stopped by her psychotherapist. Other members of staff were “frosty” with her after that.

Sue tried to leave the unit she was staying in so she could kill herself. She was stopped by her psychotherapist. Other members of staff were “frosty” with her after that.

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Plus I’ve got to be honest at the time, I was using the excuse of going there to try… put myself in a position where I could commit suicide and he felt I was using that as an excuse, which was perfectly true, perfectly true. I certainly tried two attempts to try and get away from the unit. And he blocked my exit on one occasion. He was very intuitive. And the two members of staff, excuse me, like she took me there, I disappeared somewhere and of course they were chastised about that because they’re supposed to be available at all times. But because I’m not violent in any way of course, I didn’t try pushing them out the way or anything. And he just blocked by his physical presence really and he asked someone to go and find the two members of staff. Then they complained about the two members of staff not being there, and I think it was quite a frosty sort of reaction from staff towards me then, and they became quite, what am I looking for, their attitude towards me? It sort of degenerated didn’t it?
Caring for someone who was mentally ill and at risk of harming themselves could be very upsetting and stressful for carers. People usually felt very responsible for the person they cared for whilst they were at home, and some felt healthcare services were unhelpful when it came to self-harm and suicide issues. When a loved one repeatedly attempted suicide, family members often had to reduce working hours so they could be with them or find other ways to check on them regularly. Some carers expressed feelings of anxiety, anger and resentment, even though they knew the mental illness was the cause of the problem (for more see ‘Caring for someone with a mental illness’).
 

When his wife had post natal depression Tristan said that she had tried several times to kill herself when she was living at home. ECT was brought forward because of the need for a quick treatment.

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When his wife had post natal depression Tristan said that she had tried several times to kill herself when she was living at home. ECT was brought forward because of the need for a quick treatment.

Age at interview: 38
Sex: Male
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And it was talked about the possibility of having ECT as potentially a quick fix and that perhaps it, that it should be brought forward in comparison to the normal routine because I think it is seen as quite a last resort treatment. It was thought that it could be reasonable to bring it forward compared to normal because of this added impetus of wanting her to be better quickly in order for her to form a bond with the baby. And the during all this period [name of wife] had several attempts to kill herself, or to harm herself, including trying to take overdoses. She did take more than one overdose - pouring water all over an electric socket and sticking her fingers in the socket, drinking bleach, I can’t remember all of it but various things that every time it happened we had great big debates over the best thing for her, whether she ought to be admitted into a psychiatric unit, or whether we could manage her at home and for a long time we decided that we would manage at home. She was, she had someone with or near her all the time so we were usually able to limit the effects of any attempt she had to harm herself pretty quickly. But yes we were terribly worried obviously about the potential for her to harm herself that was another reason to want to act as quickly as possible. 
 

Dafydd described his wife’s attempts to harm herself and how he tried to get help. When she took an overdose he didn’t know what to do. NHS Direct was a useful service, but he found it difficult to care for her.

Dafydd described his wife’s attempts to harm herself and how he tried to get help. When she took an overdose he didn’t know what to do. NHS Direct was a useful service, but he found it difficult to care for her.

Age at interview: 79
Sex: Male
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And did self- harm when she was feeling really dreadful, she’d come down during the night and hurt herself with a knife one time she did it so bad I had to call the ambulance out and take her into the hospital to get stitched up. And the way I managed to first aid that was to put a pad of tissue over the wound and bind it with post office tape, post office tape is waterproof and seals very well if you bind it tight and so that enabled us to get into the hospital and get it stitched up. But the health service had sort of deteriorated and they didn’t have a bed to put her in under observation for the rest of the night they’ve closed the beds in the mental hospital that she’d gone into before. 

They had two mental health hospitals with beds for taking in people with mental health problems one is a 100 miles away and the other one is about 30 miles away from the original hospital where we took her in, where I had her taken in with her arms. And worse than that on another occasion she was feeling so very low that she took an excess of tablets and wanted to end it all, I very fortunately keeping an eye on her and discovered her passed out on the couch here and so I tried to wake her up and I realised that she was a bit gaga and she’d taken a number of tablets. So I didn’t know what to do so I phoned NHS Direct because I knew it was useless trying to phone the local health centre and pretty well useless to phone the hospital where she’d been in as an inpatient. 

I spoke to a psychiatrist on the NHS Direct which was more useful. Who asked me to describe what condition she was in and so on and agreed with me that what was needed was an urgent visit to the hospital which we did. But on that occasion as well they didn’t have a bed to take her in so on both occasions she was released in my care and it’s impossible for me to stay awake without a wink of sleep all night and all day so that is the situation with our local health service which makes it difficult for somebody caring for someone who is severely clinically depressed.
 

Sheila talked about the effect her husband’s mental distress and overdoses had had on their family. She gave up full time work in order to support him.

Sheila talked about the effect her husband’s mental distress and overdoses had had on their family. She gave up full time work in order to support him.

Age at interview: 64
Sex: Female
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Well I’ve, I finished work full time, so that I could be with him. I used to do two days a week. But, so that I could maybe be with him. He hasn’t, he’s lost his confidence about driving. He’s changed, he says he’s lost his emotions. He, although he knows he’s got a home, he’s got me, he’s got our daughters, he’s got a good support network. He can’t see it like that, and he knows, and he’s had the Crisis Team involved with him. He’s… totally changed with everything and I’ve found it quite difficult. So much so that its happened every, well only once it’s happened while I’ve been here, no twice actually, that he’s taken overdoses, and he’s taken six overdoses. The first ones were when I was actually at work and once he took, eighteen months ago, he took a massive overdose, he took anything and everything he could find in the cupboards. And I spoke to my daughter. I went to work and I was really worried about him, and I spoke to my daughter who was taking my grandson to playgroup and she was due to come in and see my husband at quarter past twelve when she picked up my grandson up. But I said to her, “I’m really worried about Dad.” I said, “Do you mind popping in?” She said, “Well I’m going out into town, but I’ll pop in Mum after I’ve dropped my son off at play group.” And she did come in and she actually saved my husband’s life, because he hadn’t even made it to the bed, he was unconscious at the top of the stairs. Now if she had come in at the time that she said she would, if I hadn’t have rung her, she would have found him and he would have definitely gone, because he ended up on life support and in Intensive Care because of what, you know, what had happened. 
Last reviewed January 2018.

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