Pembrokeshire family confront mental health in young people
Health professionals are meeting in Pembrokeshire to discuss concerns about the mental health of young people.
It has been set up by the relatives of 15-year-old Oliver Edwards-Cavill, who took his own life in 2008 following a family argument at home in Llawhaden.
The forum, called Improving Young People’s Mental Health Services, is being held in Pembroke Dock on Friday.
Oliver’s aunt Suzannah Palmer said she hoped it would stop another family “having to bury their child”.
His cousin, London barrister Matthew Watkins, told BBC Wales that since his death, they have read about other young people taking their lives.
‘Direct our efforts’
“Over the past few years, there have been a number of children who have taken their lives and from what we have seen there has not been a huge amount of support, he said.
“We want to go about it the right way.
“We want to engage with all the services because we are not mental health specialists; we need to be informed where we can direct our efforts.”
Ms Palmer added: “We can’t help the children that are already gone, but if we can stop just one family from having to bury their child then I’m going to shout at the top of my voice ‘hold on a minute, this isn’t good enough’.”
Hywel Dda health board, local GPs, Pembrokeshire council and representatives from young people’s counselling services are among those expected to attend the forum meeting.
Pembrokeshire Council said there are “a range of universal school-based support available to secondary school pupils in Pembrokeshire, as well as targeted support provided in school by outside agencies”.
There is also “specific support for complex young people”, the council added.
Tim Rhys-Evans interview: ‘Mental illness should never be suffered in silence – there is always hope’
In 2013, renowned choir master Tim Rhys-Evans felt suicide was his only option. He speaks to the Independent about why he hopes sharing the story of his breakdown in a documentary will help others
Tim Rhys Evans’ life has always been full of music. From the age of five, piano-playing was his passion. He met his husband Alun when they were both choristers and later founded male voice choir Only Men Aloud, which made its way into the public consciousness when the 15-piece ensemble won a BBC talent show. A five-album record deal, tours and a series of high-profile performances followed, the Royal Variety Show, the 2012 Olympic Opening Ceremony among them, Rhys-Evans at the centre of it all “sprinkling the stardust”, as one close friend puts it.
Yet in 2013, the same year as being awarded a MBE for services to the industry he made a suicide attempt and was admitted to Cardiff’s Whitchurch Hospital, a psychiatric facility. While his mood was being stabilised by medication, he made another attempt on his life and he was left unable to listen to music. “It was too painful a reminder of the man that I wasn’t and it was also a reminder of a life I thought that I would never have back,” he tells me. “It was a self-defence mechanism to shut it out.” Then, a laugh: “I couldn’t even listen to my beloved The Archers.”
One of Rhys-Evans’ drawings from during his time in hospital
How had a man who seemed to have a real zest for life come to be so low? Unbeknown to his husband, friends and family, Rhys-Evans had endured months of suicidal thoughts, insomnia, and panic attacks without telling anyone, self-medicating with alcohol to help him sleep, while working 16 to 18-hour days on the choir and his Aloud charity, working with young people. He eventually came to the conclusion that suicide was his only option “I just didn’t see the point in my existence.”
He has made a frank documentary, airing on BBC One tonight, telling his story to help the one in four people in the UK who experience some kind of mental health problem. Given that suicide is the most common cause of death for men aged 20-49 in England and Wales, he wants to make sure that feeling this way is no longer anyone’s “dirty little secret”. For him, it was a secret he didn’t know he was keeping. Or at least didn’t recognise what he was suffering from.
“I thought everyone had suicidal thoughts,” he says. “I didn’t feel sad or tearful, I just didn’t want to live.” After speaking to his GP, it took for Rhys-Evans to be sitting on the tour bus mentally making a list of everyone he should write to before ending his life, to realise how far he had spiralled.
While there are now no shortage of programmes about the experiences of depression, including from famous names like Stephen Fry and Ruby Wax, Rhys-Evans’ frank retelling of the lowest months of his life is an eloquent but unflinching look at a mental breakdown. In the film, he reads from the suicide note he prepared for his loved ones and opens his notebooks filled with poetry and ramblings written in spidery letters and weird, fantastical drawings. To talk to, he’s matter-of-fact, with that certain brand of bleak humour that comes out of the darkest of times. At the beginning of his stay, he recalls a staff member suggesting that on recovery he could start a choir at the hospital. “I said, what are we going to call it ‘Only Nutters Aloud’?”
Rhys-Evans filled many notebooks during his time at Whitchurch
A combination of therapies – both talking and art therapy – medication and support from friends and family helped Rhys-Evans to bounce back and now, nearly three years on, he is back singing and working as musical director of the Aloud charity. Yet he was nervous when the documentary first aired on BBC Wales in March, particularly for how it might affect his work with youngsters. “I was concerned that some parents might think ‘I don’t want my child in the care of this man who has a history of mental illness’.” He need not have worried, he was inundated with texts and messages, strangers came up to him in the street to say that after watching the film that they had finally been able to confide in someone or gone to see a doctor. “A lady thanked me for enabling her to understand why her son killed himself three years ago.”
Rhys-Evans now lives what he says is a “simpler” life. There is no more working around the clock, he takes time off, tries to do painting, walks and running and is back listening to his favourite radio soap.“I guess I’m trying to be kinder to myself,” he says, using one of those phrases beloved of therapists but harder to put into action. “And not have unrealistic expectations and wonder why I am feeling poorly? Why do I want to kill myself?” He is more careful with his diet and watches what he drinks, and tries to limit his time on social media. “The demands on every second of our time are so great. Being the wittiest person on Twitter, having the most followers…I know some people love that way of life, I realised that it takes its toll if you don’t look after you.“
Tim Rhys-Evans says he now leads a ‘simpler’ life to look after his mental health
He recognises there is no quick fix and is taking each day as it comes. He still takes medication twice a day and has regular consultations with his GP. “It’s nice to be a fully-functioning adult again,” he admits. “I really didn’t think I would ever get back to work, I just thought I’d burnt the candle way too low, there was no getting back from it, but you really can.”
His message to viewers is this: “If there is anyone reading this who is feeling suicidal or is feeling like there is no hope, there is always hope and there are amazing people out here who can help you, so tell somebody, talk to anybody.”
Anyone struggling to cope can contact The Samaritans for free on 116 123 or at samaritans.org.
Experts sound alarm over mental health toll borne by migrants and refugees
Hazardous journeys and harsh conditions in camps linked with depression, anxiety and psychosis
The grief of losing a child made more unbearable by the knowledge that you decided to take them in a boat that capsized; nightmares about torture; depression induced by the awfulness of living in a camp, unable to go forward or back.
A report last year by the German Federal Chamber of Psychotherapists said 40%-50% of people arriving in Germany suffered from post-traumatic stress disorder (PTSD), with half also suffering from depression.
“They have nightmares or flashbacks to pictures or scenes. These memories feel very intense, and it is just like they are reliving the traumatising experience,” the report said. Other symptoms include jumpiness, sleep disorders, problems with concentration, and emotional numbness.
“It is shameful that people suffering with such psychological injuries do not get the help they need,” the report said.
Post-traumatic stress is just the tip of the iceberg. “PTSD is very important, but it is also the disorder that everyone jumps to, including the media. We see much more depression and anxiety disorders, and also, surprisingly, a lot of epilepsy and psychotic disorders, including schizophrenia,” said Dr Inka Weissbecker, global mental health and psychosocial adviser at the International Medical Corpsin Washington.
“There are huge amounts of anxiety – we see children bursting into tears when helicopters or airplanes fly over the camps, and we can’t understand why, until we realise what they’re associating it with,” said Harriet Zych, a nurse who worked in Idomeni – site of Europe’s largest informal refugee camp, on Greece’s northern border with Macedonia – before Greek police moved people to other locations in May.
“We came across many people in a state of collapse, whose problems turn out to be psychological rather than physical,” she said. “One man hit himself with a rock on his head until he became unconscious when he found out he couldn’t cross the border.”
Nikos Gionakis, a psychologist with the Athens-based mental health unit Babel, tells the story of Hassan, 34, who fled Syria with his four children. “Passing from Turkey to Greece, he was forced to get into a boat by smugglers. Two of his kids drowned as the boat sank. He was referred to Babel because of depression. He blames himself for not having been able to protect his kids,” Gionakis said.
The UN refugee agency, the UNHCR, says mental health disorders can hinder integration into host populations, creating long-term problems for European countries that are accepting refugees fleeing from conflicts in Syria and elsewhere.
In a paper to the European commission last year, the European Psychiatric Association said: “Acute and long-term psychiatric care needs to be provided to all asylum seekers in order to avoid reaching chronic conditions of mental disorders.”
Aid workers in Greece say diagnosis, never mind treatment, is almost impossible in the chaos of the camps and detention centres in southern Europe.
“You cannot say how many people are suffering from PTSD because diagnosis takes too long, and with such a stream of people, it is impossible. I am a trained psychologist with 40 years’ experience; it would take me two and a half hours to diagnose someone with PTSD,” said Renos Papadopoulos, director of the Centre for Trauma, Asylum, and Refugees at Essex University, who recently returned from Greece. “There is no evidence [on the prevalence of PTSD] because there cannot be evidence. The situation is complete chaos.”
“We don’t do diagnosis,” said Zoi Marmouri, a psychologist working for Médecins Sans Frontières in Idomeni. Even if diagnosis were possible, World Health Organisation (WHO) guidelines stipulate that clinical treatment is not appropriate for refugees on the move.
“Therapies should not be started without assurances that there can be follow-up. You have the potential to retraumatise people,” said Claire Whitney, Middle East mental health and psychosocial support adviser at the International Medical Corps.
The most effective treatments for PTSD include cognitive behaviour therapy with a trauma focus, eye movement desensitisation and reprocessing therapy, as well as narrative exposure therapy. But these take time as they involve slowly exposing people to their trauma, while building up their capacity to deal with it. “It cannot be rushed,” said Whitney. “When people actually have PTSD, it is one of the most complex problems to treat.”
The WHO says refugees and migrants needing diagnosis should be referred to existing non-governmental or state services. But even for those who make it into host communities, cost, stigma and language problems can lock them out of treatment.
“We have serious lacks in the services we can provide. If they need hospitalisation, there aren’t any specialised units for this,” said Gionakis.
Some experts warn there is a risk of overdiagnosing PTSD. “They are distressed, yes, but is this PTSD? Often it will not be. These are instead normal reactions to an abnormal situation,” said Papadopoulos.
The UNHCR and other agencies saymuch of the emotional suffering experienced by refugees and migrants is directly related to present-day stresses and concern about the future.
“People live in very difficult and inhumane conditions here in camps that are too crowded. Basic needs are not met,” says Gionakis.
The UNHCR advocates “psychological first aid”, which encourages those interacting with refugees to respond in a culturally sensitive and humane way that avoids distressing people further.
“The humanitarian principle of ‘do no harm’ is a huge part of it,” said Whitney. “What everyone was advising, for the most part, was really to focus on the most basic kinds of support, which do contribute to mental health. Often, basic needs must be provided before people are ready – and willing – to engage with therapy.”
Patients are being asked to wait several years for some specialist mental health treatment, figures obtained by BBC Wales have shown.
While many patients with acute and chronic problems get treatment within weeks, some areas have current waiting times of up to 50 months.
The British Medical Association in Wales called the delays “unacceptable”.
Welsh Labour, who have run the NHS in Wales since 1999, said mental health spending went up £3m last year.
The longest delay was within Aneurin Bevan University Health Board area, where patients can wait for up to 50 months to see a clinical psychologist.
A board spokeswoman put this down to “long-term sickness issues” and said it was “currently seeking to appoint more staff”.
In north Wales, Betsi Cadwaladr University Health Board patients can wait up to 26 months, but high-risk patients are seen “immediately” as a priority
Cardiff and Vale University Health Board said none of its patients should wait longer than nine months for GP-based counselling, while 73% of 1,000 people recently referred had waited less than half a year. The area’s traumatic stress clinic has waiting lists of over a year, but new staff have been recently appointed
Cwm Taf University Health Board has 11 patients waiting more than 26 weeks but it could not say what the longest wait was
At Hywel Dda University Health Board, current waits are between 54 weeks for cognitive behavioural psychotherapy and 119 weeks for psychodynamic therapy
Powys Teaching Health Board said its figures were not immediately available
Abertawe Bro Morgannwg University Health Board did not provide figures
British Medical Association in Wales spokeswoman Charlotte Jones said: “It’s unacceptable. It’s not right for the patients of Wales. We need to see more investment – we need to see a true commitment to resolving this once and for all.
“We continue to highlight it as a problem in general practice, but secondary services are also overwhelmed with demand.
“We are talking a lot more money, but it’s worthwhile.”
Mental health charity Gofal said it was frustrated that despite investment, waiting times were still too long in many areas.
It wants more counselling provision and better data monitoring.
In England, treatment and waiting times data is collected quarterly from mental health service providers but most Welsh health boards initially said this information was not available.
The Liberal Democrats said it was time mental health was treated “as seriously as physical health”.
A spokesman added: “We would introduce a core set of mental health data, and would work with mental health experts to introduce new waiting time standards for mental health, including for access to psychological therapies.”
A UKIP spokesman said their party would increase health care spending with £100m saved “elsewhere from the Welsh budget” and would implement an 18-day referral target for cognitive behavioural therapy.
Plaid Cymru said it would increase funding by 2% – or £68m – a year until 2020/21, and the current poor standards of data meant “increased investment in our mental health won’t be as effective as patients deserve”.
A spokesman for the Conservatives said the party would create a new 28-day target for access to talking therapies, and increase spending on mental health.
But Labour maintained it had made significant improvements to mental health care in Wales, including the introduction last October of a 28 day-treatment target for 80% of mental health patients.
“The majority of treatment following emergency and urgent referrals will start immediately following assessment,” a spokesman said.
“The National Psychological Therapies Management Committee action plan includes a target time for treatment in secondary care of 26 weeks – the same as for treatment for physical conditions.”
I share these concerns, though not because I believe that mental health problems have no biological basis, nor because I think environmental factors invariably play a role in mental ill health; I simply wouldn’t know. But because I do know from listening to the stories of dozens of fellow service users, that adverse life experience such as physical and sexual abuse, racism, bullying and neglect is depressingly common on a psychiatric ward, and understood by a great many patients to have played at least a significant role in the development of their problems. Moreover, it is striking how often problems with housing, for example, or the stress of being assessed for benefits (which are, ironically enough, supposed to support the most vulnerable) are understood by patients to be the trigger for a relapse.
In this context, it seems to me that the decision of the BBC to portray mental health problems simply as brain disorders is a highly troubling one. While some people do undoubtedly interpret their mental health in this way, there are many who do not, many indeed who would resist the attachment of any diagnostic label, who see their mental health difficulties as a natural, rational response to adverse experience. In failing to represent their perspective, the BBC has not only presented an extremely one-sided picture, it has broadcast a message to such individuals, and to society generally, that their experience doesn’t matter.
Of course, it would be rather convenient if it didn’t. It would be especially convenient for David Cameron. It would mean that when he talks about our need to “focus on mental health”, at the same time as bringing in benefit changes that have been found to have led to the suicide of at least one person and beenimplicated in the deaths of dozens of others, we might almost be able to take him seriously. It would mean that we wouldn’t have to worry about creating a more equal society. Mental health problems are repeatedly shown to be most prevalent in countries with the highest levels of financial and social inequality. What a relief to realise it doesn’t matter!
This is why mental health must be seen as an urgent political and social issue, as well as a biological and psychological one. And it’s not just a question of responding to the needs of people with mental health problems, though this is of course important, but of being prepared, as a society, to consider what we might do to reduce people’s risk of developing them in the first place. I’d like to see a programme on that.
Five cases include woman with spina bifida and man sharing the care of his severely disabled 13-year-old son
The supreme court is to hear a legal challenge against the government’s bedroom tax from five people who argue it discriminates against the weak and vulnerable.
The five cases at the centre of the proceedings on Monday relate to people who have so far lost their cases at both the high court and court of appeal.
One challenge is that of Charlotte Carmichael, who has spina bifida. She lives with her husband in a two-bedroom housing association flat in Stockport, Greater Manchester. Her condition means she has to sleep in a fixed position in a hospital bed with an electronic pressure mattress. There is not enough space for a second bed so her husband sleeps in a separate bedroom.
When the new regulations were introduced the couple had their housing benefit reduced by 14%.
Another appellant is widower Richard Rourke, from Derbyshire, who uses a wheelchair. He is a council tenant and lives in a three-bedroom bungalow. His disabled stepdaughter used to live with him outside of university term times.
Rourke uses the third bedroom, which is a box room, to store his equipment, including a hoist for lifting him, his power chair and shower seat.
His lawyers say he previously inquired in the social rented sector about the availability of two-bedroom properties, but none were suitable for wheelchair use, and there were no suitably adapted properties in the private sector. He has had his housing benefit reduced by 25%.
Solicitor Ugo Hayter of law firm Leigh Day, who acts for Carmichael and Rourke, said: “My clients are looking to the supreme court to recognise and bring to an end the awful hardship they, and many other disabled people nationally, have been subjected to since the introduction of the bedroom tax.”
James Daly, from Stoke, has a severely disabled 13-year-old son. He and his ex-partner share the boy’s care. Daly occupies a two-bedroom, ground floor flat which has level access throughout.
He is now deemed to be over-occupying his property by one bedroom – his son’s room. Lawyers say Daly is now in work, “but he knows that if he were to be unemployed again he would be refused full housing benefit again if the current scheme remains in place”.
Mervyn Drage, from Manchester, occupies a three-bedroom flat in a high-rise tower block, and has lived there for 19 years. He suffers from mental health problems, and various physical problems.
His legal team say his conditions are exacerbated by stress, anxiety and changes to routine, and he is “very anxious about the prospect of having to move if his full housing benefit entitlement is not reinstated”.
They say he has been reliant on discretionary payments from his local council to make up the shortfall, but that “these ran out at the beginning of February” and he is “waiting to hear if his application for a further award will be granted”.
“I am settled in my flat. All the support services I rely on are nearby. I feel safe living here,’ said Drage. “I am living on a knife edge. The amount of money they want from me may be small, but it is too much for me. I am being squeezed from pillar to post.”
Karen Ashton, from the Central England Law Centre, which represents Daly, Drage and an appellant “JD”, who has anonymity to protect the identity of her severely disabled daughter, commented: “This case is about fairness. It is about disabled people being entitled to be paid sufficient housing benefit for the size and type of accommodation they need because of their disabilities and not being penalised because they are disabled.”
Paul and Susan Rutherford, from Pembrokeshire, who won their case at the court of appeal – a ruling being challenged by the government at the supreme court – care for their severely disabled grandson, Warren, in a specially adapted three-bedroom bungalow.
They can only care for Warren with the help of paid carers who regularly stay overnight.
Lawyers say the current regulations allow for an additional bedroom if a disabled adult requires overnight care but not for a disabled child in the same situation.
The discretionary payments to cover their shortfall in rent run out next month, and their legal team says there is no guarantee they will continue.
Solicitor Mike Spencer of the Child Poverty Action Group, who represents the Rutherfords, said: “We hope the supreme court will uphold the judgment of the court of appeal and grant them the security they need to stay in their home.”
A Department of Work and Pensions spokesman said: “Removing the spare room subsidy has restored fairness to the system for claimants as well as the taxpayer, and the numbers subject to a reduction are falling.
“We know that there are cases where people may need extra support – but rather than put in place complex exemptions, we have given local councils the freedom to decide what is best for their communities.
“That’s why we have given councils £500m of funding to provide discretionary payments to those that need them, with a further £870m to be provided up to 2020.”
Suzy Favor Hamilton: Olympic athlete to Las Vegas escort
By Suzy Favor Hamilton
Suzy Favor Hamilton was a middle-distance runner who represented the US in three Olympic Games before becoming an escort in Las Vegas as she struggled with bipolar disorder. Listen to her story on Stephen Nolan, 12 February, 23:30 GMT on BBC Radio 5 live.
Mine is a story of misdiagnosis, but how did I get there?
There is a history of mental illness in my family. My brother lived with bipolar disorder and the household was often chaotic as a result.
Our family never discussed it. To the outside, we looked like the Brady Bunch. Looking back, there were signs something was not quite right with me either.
I did everything at a mile a minute and couldn’t focus for the life of me. Growing up, I lived with an eating disorder, had suicidal thoughts and a suicide attempt in college, then experienced severe anxiety when I raced. But I kept it all in, trying to maintain the facade of the perfect Midwestern girl, strong and powerful.
If others noticed any problems, they looked the other way. I usually won, and they liked it that way.
Running seemed to be the one thing in life that quieted my brain, and because of that, I loved to run and grew to obsess about it.
I saw my winning races have a positive effect on my family, namely my parents. I strangely grew to feel that my success could make this a happy family, and take away any silent pain we were experiencing as a result of my brother’s odd behaviour.
My running career was highly successful. I won more NCAA Championships than anybody ever had. I won seven US Championship titles between 1991 and 2004, set a couple of American records, and made the 1992, 1996 and 2000 Olympic teams.
I won a lot, but tended to “choke” at the big, big meets. I didn’t know why and it ate at me. My body would just tighten up on me unexpectedly towards the end of a race. Like I was running with a piano on my back. I even fell on purpose in the 1500m final at the Sydney Olympics when, as the favourite, I knew I would not medal with 50 metres to go.
That was easier to swallow than failure. I wanted so badly to win that one for my family, to ease the pain of losing my brother Dan to suicide the year before.
Incredibly, I never thought of myself as having any kind of brain disorder. All I knew was that I dreaded competing. Filled with anxiety most often, I could not wait to retire, but I marched on to please others.
Finally, in 2005, I got pregnant. Having a child would be my way out. This was my excuse, and I could not wait to be a mom. I would have a baby, maybe two, and live a life of perfect happiness. But that’s not what happened.
Months after having my beautiful daughter, I was in a dark place.
A new “real world” job in real estate, a suddenly strained marriage, a disintegrating relationship with my siblings, strain with my parents, a miscarriage, then another, feelings of inadequacy of being a mother. It was building up.
All I knew was that I had to hold my daughter all the time. I could not let go. I had no motivation to run. I rocked myself constantly. I was irritable like never before. And then I decided I wanted to run my car off the road, into a tree. I just wanted the pain to stop.
Thankfully, I thought of my daughter, resisted those thoughts, made it home, and told my husband.
Soon, I saw a doctor, was diagnosed with post-partum depression, put on anti-depressants, and things improved. Years passed. Triggers intensified. I was getting by, but had grown to detest the side-effects. I felt fat, sluggish, unmotivated. I stopped taking the drug that had been keeping me somewhat stable.
It didn’t take long, but before I knew it, I was in that dark place again. Suicidal. Triggers everywhere. My marriage was deteriorating. My family was driving me crazy. I had a modest speaking career, but they insisted I not publicly speak about my mental illness or my brother’s bipolar and suicide. I hated my real estate job. I just wanted to escape.
My doctor put me on another anti-depressant. The effects were immediate. I felt great. I felt beyond great. I felt alive. I wanted to live. Time for my fantasies to now become a reality.
Our 20th wedding anniversary was coming up. A nice dinner date out on the town with flowers perhaps? Not for me. I wanted to go to Vegas, jump out of a plane, hire an escort, have a threesome. Bucket list stuff I never thought I would actually do. Never. I wanted it now.
Skydiving was amazing, something I would never dare do, but I was doing it. Then the threesome. Now this was life changing. I was a new woman.
What is bipolar disorder?
One in every 100 adults will be diagnosed with the condition at some point in their life
People with bipolar experience significant mood swings including manic highs and depressive lows
Men and women of any age can develop the illness, although it often develops between the ages of 18 and 24
Symptoms can first occur and then reoccur when work, family or emotional pressures are at their greatest
How had I been missing out? Freedom. I wanted sex. It was all I could think about. Our marriage was on fumes.
I asked for and was granted permission to stray. An open relationship we would try. Divorce was not an option, not for my daughter or for business. To keep things steady, or at least seemingly steady.
Over the next six months, I made several trips to Las Vegas on my own. First meeting with a male escort, then hooking up with men I met at casino bars, then insisting on gifts in exchange for sex. And then the light bulb flashed. I wouldn’t hire the escort. I would be the escort.
Within months, I was the number two-ranked escort in Vegas (yes, there actually are rankings out there), and top 10 in the world. I was never happier, never higher, never more alive.
For the first time in my life, I was independent, could take care of myself. I loved the taboo, the riskiness, the slight danger to it all, and I always had to take it a step further. It was never quite enough.
The money was intoxicating, but not the driving force. It was the thrill, the risk, the taboo, the attention, the power, the sex. All the while, an infuriated Mark covered for me, protecting my reputation, raising our child, keeping the real estate business going on his own, while I was off, totally out of control.
A year into my life as an escort, I was outed by a jilted client. A tabloid told of my activities to the world. My life had been taken away.
Suicidal thoughts crept back in. The world came crashing down on me. My husband would leave, take my child, my parents would abandon me, as would my friends, or so I believed.
To save these relationships, I felt compelled for once to seek help, even if for appearance sake.
Admittedly, I was beginning to feel there was something wrong with me after months of denial. This was the first time I had ever visited a psychiatrist. I tried my best to fool him that I was fine, that I could continue with my life “as is”.
But within a couple of weeks, I was diagnosed with bipolar disorder, weaned off the anti-depressant that the doctor believed had driven me to a mostly constant manic state over the past year and a half.
The process of recovery would begin, slowly, with several bumps and relapses along the way.
My husband did not leave. He did not take my daughter from me. My parents failed to understand why, but they stuck with me, loved me the best they knew how.
Friends bailed on me, but many remained, though confused by it all. I had some support in the athletics world, but some considered me an embarrassment to the sport and wanted me to just go away. I also had to quit the real world job as it was not good for my bipolar.
How did the sweet, innocent Suzy wind up here?
My bipolar is manageable now. I learned to feel no shame for what I did. Regrets yes, but no shame. Shame holds you back and prevents recovery.
What hurts most though is what I put my loved ones through. My journey, as odd as it was, moulded me into a person I’m happier with.
I have more of a voice. I’m more independent. I’m a better wife, mother and friend as a result. I teach yoga and I am a public speaker on mental health matters. I’m healthier than I ever have been, I believe. I’ve found healthy coping mechanisms. I’m more compassionate than ever as I know what it’s like to be shamed and shunned on an intimate level.
I’ll never be cured, and I’ll live with bipolar for the rest of my life. I know it won’t always be smooth sailing ahead. But I’ll always know that as dark as things might get in the future, it always gets better.
“If it wasn’t for Open Dialogue I wouldn’t be here now. This time last year, I was suicidal. I had totally lost faith in the mental-health services; I felt I’d been put in the ‘too difficult’ box.”
Suzanne Chapman has been in and out of the mental-health system since attempting suicide twice in her early twenties. Now 49, she’s had every treatment for depression and bipolar disorder: medication, therapy, ECT. For long periods of her life, the drugs worked.
But three years ago, she hit her worst crisis: a bout of depression that made her unable to function. “On Christmas Day, my daughter gave me a potato to peel and I just stared at it. I had no idea what to do with it. I had no strength; I would just lie on the settee or shuffle about the house. I wasn’t coherent, I wasn’t sleeping, I’d lost three stone. I felt so dark, so alone, so worthless.” None of the drugs that had helped in the past made much difference. Suzanne had to give up her job as an administrator and her husband, Simon, a police officer, took three months off to look after her. The couple have two daughters, aged 27 and 25, and a two-year-old granddaughter.
By the time Suzanne was offered an experimental treatment called Open Dialogue last October, she was desperate. It’s a pioneering approach that enables patients and their families to develop their own route to recovery. After just three sessions, Suzanne’s husband noticed a “miraculous” improvement; he now says, “I’ve got my wife back.” Suzanne accepts that she will never be free of depression, but says it’s now firmly under control.
Open Dialogue is currently being piloted in four NHS trusts. It could revolutionise mental-health care in the UK, according to its champions, who include Suzanne’s psychiatrist, Russell Razzaque. The North East London Foundation Trust, where he works, has just given the go-ahead for an Open Dialogue-based service for patients referred from anywhere in the country, starting next May.
Open Dialogue is primarily for people who are suffering a mental-health crisis such as suicide or psychosis – 1.8 million of them in the UK last year. They badly need help: a damning report from the Care Quality Commission in June found that the current system is struggling to cope with mental-health crises, with 42 per cent of patients not getting the help they need. A campaign launched last month calls for an increase in funding for mental-health services and parity with physical health.
Half of parents ‘haven’t spoken to their children about mental health’
The Open Dialogue approach was first developed in Finland in the 1980s, which at the time had one of the worst incidences of schizophrenia in Europe. There are now well-established services in Berlin and New York, where state investment in four respite centres that practise Open Dialogue has been doubled to $100m (£66m). Services are also springing up in Italy, Poland and Scandinavia.
What’s most impressive about Open Dialogue is its success with even the most intractable mental illnesses, where current systems of care too often fail, or offer only short-term respite. Results over the past 30 years from Finland sound impressive: 74 per cent of patients experiencing psychosis are back at work within two years, compared with just 9 per cent in the UK. Crucially, relapse rates are far lower than here: after an average of two years’ treatment, most patients don’t need to come back – ever. Here, a mental-health diagnosis can feel like a life sentence.
Open Dialogue’s key principles are: people are seen within 24 hours of becoming unwell; and all meetings with the psychiatric team are held at home, or wherever the patient finds most helpful. Significant others in the patient’s life – family members, or trained peer-support workers – are engaged in meetings from the word go.
Setting targets has become commonplace as a way of measuring achievement and progress. We have seen this recently as the future ecology of our planet and the complexity of international policy on climate change has been reduced to negotiations around a series of targets.
It is as though the targets give meaning to the goal for change.
So surely we should set targets for suicide prevention, right? How better to concentrate efforts than to set targets for a reduction in the tragic loss of life to suicide? And surely setting targets is a way to communicate and engage with the wider community in results-based suicide prevention?
This has already started. In 2013, the World Health Organisation (WHO) promoted a target of 10% reduction in suicides by 2020 for member countries, of which Australia is one. Then, in 2014, the WHO released its first ever report on suicide documenting the key elements of any national strategy for suicide prevention, drawing on research evidence and expert opinion.
Some countries were ahead of this, such as Scotland which in 2002 set a target for a 20% reduction in suicide deaths by 2013. In fact, Scotland achieved an 18% reduction in this time period. Perhaps setting bold targets matched to an effective national suicide prevention strategy actually works.
Here Suicide Prevention Australia has recommended a target of 50% reduction in suicide deaths in 10 years, as an aspirational statement to galvanise support and action.
‘Let’s reach out to men to halt shocking suicide rate’
So far, the governments of Australia have declined to accept this recommendation, and it lies as an unresolved matter after more than 12 months of national review of suicide prevention and mental health programs.
The disappointing background to this discussion is that in Australia the number of deaths by suicide each year has not dropped for some time – in fact it has increased by 20% over the past 10 years. Our national suicide rate has stayed stubbornly around the same level of 10 or 11 deaths per 100,000 in population – on par with the annual global age standardised suicide rate. Surely Australia can do better than this.
But target-setting is not without problems on something as complicated and apparently intransigent as suicide. It’s easy to agree that targets should be set; less easy to agree on what the targets should be and on where the accountability for achievement against targets should rest.
One point to consider is the rationale for any target in reduced suicide deaths. If international expertise and evidence through WHO suggests 10% is achievable, is it folly for Australia to adopt a 50% reduction?
Or, does the Scottish experience suggest setting “stretch targets” matched with sound strategy will deliver results? Given there is no calculated rationale for a 50% reduction in Australia, it becomes murky water indeed trying to set the “right’” suicide prevention target.
And there is this inconvenient question – does a target of 50% imply community acceptance that still in Australia 1,300 people will die by suicide each year? Does it suggest an inevitability around some deaths by suicide that is beyond the capability of national strategies, effective services and community action to prevent? Is the prevention of suicide really so difficult as to warrant “easy” targets or is this letting our collective minds, hearts and spirits off the hook a little too easily?
Ethical issues also start to emerge when targets for suicide prevention are raised. Does a focus entirely on reducing deaths diminish our understanding and empathy with the profound despair and pain felt by suicidal persons – whether or not they actually attempt suicide or die?
Perhaps there is a case for setting goals to reduce human suffering with equal attention to the more recognisable and measurable goal of saving lives?
When it comes to poverty reduction, the trend in international aid and development has been to recognise quality of life and wellbeing factors for vulnerable populations instead of simply calculating the prevention of deaths. Indexes on health, wellbeing and opportunity have been established as measures for success in poverty reduction. Programs seek to achieve outcomes that uphold dignity, self-determination and culture for those exposed to poverty, not just abrupt outcomes indicators of life-span and disease based death rates.
Indigenous suicide: ‘prevention should focus on cultural reconnection’
This is not to suggest that the preservation of human life should not be clearly associated with suicide prevention. A death by suicide is, after all, a preventable and tragic loss of life. In Australia, the median age of a person who has died by suicide Is 44.5 years of age. According to the latest Australian Bureau of Statistics results, in the year 2013 suicide accounted for over 85,000 years of life lost, making it the leading cause of premature death in Australia.
We should never discount the value of these lives – real people now sadly missed.
However, the debate about target setting for suicide prevention has some way to go. There are other questions. Should targets be set to reduce suicide attempts – and re-attempts, as indicators of suicidal behavior which is equally worthy of attention as the behaviors that result in actual death? This point has particular relevance along gender lines as more Australian women attempt suicide than die.
Possibly the best target to set is one of zero tolerance – the target should be “zero” deaths and attempts of suicide.
We should not admit to tolerating any loss of life to suicide, nor should we neglect to provide the very best compassion, support and recovery care for those who come to the dark place which suggests death is better than living. All our effort, our programs, our government suicide prevention strategies, our community action should then be measured up against the contribution made towards this target. Our measurement systems then could be associated with celebrating each and every step towards the end result.
Such a stance would reflect the comment from Dr Margaret Chan, director-general of the WHO, when introducing the international report on suicide: “Every single life lost to suicide is one too many.”
Conwy and Denbighshire Mental Health Advocacy Service