‘A Year On’ – Suicide Prevention, Medication, and the NHS
World Suicide Prevention Day has me in two minds. On one hand, I think awareness days are important. If just one person sees a fact or piece of advice about a condition – any condition they previously didn’t know a lot about – that can only be a good thing. The caveat, of course, is that the “fact” is actually a fact (not the kind espoused by Donald Trump) and that the advice is helpful and clear (not the kind given by Boris Johnson during, say, a global pandemic).
Now I’ve got my political ‘left jab, right jab’ in, here’s the hayemaker: the UK is not good at dealing with mental health. So, while all of the “it’s ok not to be ok” posts we are likely to see today on social media are correct enough, they are not… well, enough.
It’s worth saying at this point that I think the NHS is incredible. I’m proud of it and happy to contribute to its continued operation. However, while it’s strong in some areas, it is lacking in others. Around this time last year – or during the same month, at least – I found myself in hospital after a mental health crisis.
Since the age of fifteen I have struggled with my mental health. I won’t go into details because I do fear being judged or pigeonholed by my diagnosis. I use self-deprecating humour all the time to “get in there first”, in an attempt to disrupt any misconceptions people might have about me if they know my history. Whether that has been working for me or not is up for debate. But I digress.
My experience of feeling suicidal came as a nasty surprise to me, at the age of 32, after more than a decade of living with mental illness. Several years ago, I lost a good friend to suicide. It was a horrible shock to a lot of people. I didn’t understand why having loved ones in your life wasn’t enough to keep you here. Until suddenly I did.
What I’m about to say next requires me to clarify something first: antidepressant medications are lifesavers for so many people, myself included. People should not be ashamed to take them. That said, more knowledge and caution must be exercised before they’re prescribed. I say this because I believe a type of medication was responsible for what happened to me last year.
Essentially, I was given a medication called Mirtazapine as a sleep aid to help me with nocturnal trichotillomania (pulling my hair out in my sleep) and bruxism (teeth grinding). My partner at the time was losing sleep because the combination of the two noises was not lullaby material. So off I went to the GP and was prescribed Mirtazapine (Remeron). I had been taking it for a week or so and had started feeling weirdly detached from life, like it wasn’t quite ‘real’. My thoughts were racing, and I felt impulsive and reckless. These aren’t unfamiliar feelings to me, but they seemed to come from nowhere. And then, one night, I woke up thinking about suicide.
I was fixated on it. That’s the best way to describe it. It was like the film Bird Box – and like an idiot, I’d taken off my blindfold and stared one of the shifty bastards in the eye. I lay there for a while, thinking about it. Then I got out of bed and walked downstairs.
I’ll omit the next hour or so because, frankly, I’m still processing it.
So, fast-forward to A&E. The nurse who cleaned me up, took me for an X-ray and glued me back together was lovely. It felt like she was genuinely taking care of me and I wanted to hug her for it. The second nurse I saw decided it was an appropriate time to tell me about how he struggled with feelings of suicide sometimes – I think he was telling me about how he had PTSD – and although I’m sure he was trying to make me feel like I wasn’t alone, it felt inappropriate. As an empath, I felt like I was taking on his feelings about it, since he was clearly still working through some stuff himself.
My friends arrived with some fresh clothes and got me a sandwich and a cup of tea. We sat together in the room and I felt grateful and relieved that they were there and that they were talking to me and bringing some ‘normality’ to the situation.
I saw someone from the crisis team in what was frankly one of the most unhelpful conversations I’ve had about my mental health. It felt patronising. I was discharged from the hospital with a ‘crisis plan’ card with suggestions that included returning to the hospital because “we do have a crisis team here” (where they’re located, I’m still not sure, despite returning a couple of days later, having self-harmed).
I felt incredibly lucky to have friends who were there to provide support but felt devastated for those who didn’t. How would they manage after being discharged from the hospital the same day with a promise of a visit from the local mental health team (which, to this day, has never happened)? Would they manage?
It was my friends who questioned whether the medication I was taking could have played a part in what happened. I took it for one more day and then stopped, after reading about how linked it is with increased thoughts of self-harm and suicide. I’m told that, for some people, it’s a lifesaver of a drug, but it scared me. I’ve taken fluoxetine and sertraline in the past and found them incredibly helpful, so it had never occurred to me that any medication could trigger the kind of effects I experienced.
When I next saw the GP, she said she was sorry that I hadn’t “gotten on” with Mirtazapine – much like how peanuts and I didn’t “hit it off” after that first anaphylactic reaction, I guess. The local mental health team visit was mentioned again. Still waiting.
Thankfully, I didn’t need the visit. After I came off the medication, I stopped feeling suicidal. I was depressed, my partner and I had broken up, and I was guilt-ridden. My family all rallied around me, which was another reminder that I am loved, and I do have support. Again, I worry deeply for those who don’t have this particular blessing and are at the mercy of the resource-starved system. Charities pick up the slack, but they’re not miracle workers.
Children and adolescents fare especially poorly, as this 2019 report highlights. Lack of beds, lack of mental health staff, lack of funding… these things are serious issues that a few cash grants from the government can’t solve. With the pandemic – and consequential psychological problems for people who may not have experienced them before – the gaps in this country’s mental health care provision are likely to become even more apparent, especially when treatment is given over the phone – not an adequate substitute for face-to-face talking therapies.
It feels strange to me that Suicide Prevention Day falls in September. It is an odd month for me this year. I feel thoughtful, sad, and lucky at the same time. But I also feel worried about people going through mental health challenges right now. We don’t have the support structure in place as a country. It’s propped up by carers, people’s family members and friends, charities and, if you’re lucky, the private healthcare sector.
So, what are we to do? I don’t have the answer. I think those of us who have had negative experiences with the NHS mental health services should feel able to speak about those experiences without being seen as criticising the service as a whole. As a society, speaking about and normalising issues around mental health is still important. We’re breaking down stigma and that kind of work will always be beneficial.
As individuals, equipping ourselves with information and planning ahead might work. Some people make themselves a little box of things to use during a crisis – books, colouring pencils, sensory items such as fidget jewellery or fluffy toys, hot water bottles, candles and pulse point roll-ons, interactive self-help books such as Milly Smith’s “The Adulting Manual” or little jars filled with notes to oneself or notes of our achievements, scribbled on pieces of paper and balled up, ready to be read during times of stress.
For businesses, bringing in experts to increase understanding of mental health issues is a good start. Added benefits, such as ‘no questions asked’ sick days (making it easier to take a mental health day off), and occupational health, to name but a few, are all good. Training some staff members in mental health first aid is also a new addition to the corporate mental health toolkit.
Suicide is preventable, but it’s a multi-faceted issue, and it requires so many different individuals, organisations, companies, and government departments to pull their weight equally. It’s the only way that, as a country, we can do better when it comes to reducing death by suicide.