I have been reading Death by Choice: Living with the Impact of the Suicide of a Loved One by Vicki Hutchinson, published in 2014. It has raised some timely issues given the theme of this year’s World Suicide Prevention Day, “Preventing Suicide: Reaching Out and Saving Lives.”
Vicki Hutchinson lost her brother Philip, to suicide after a battle with mental illness. He was 48.
Much has been written about suicide prevention but an effective universal strategy has proven elusive. I would like to highlight several initiatives that are addressed in this book that might allow us to achieve better outcomes.
We need to be smarter at identifying suicide risk and more alert to warning signs.
When Philip arrived home from Thailand his sister Vicki, made the following observation. “He had no concentration, he had lost interest in everything, including his personal care, his mood was very flat, with conversations focused on hopelessness and suicide as the only option. He stopped answering his phone and became more socially isolated.”
On the suicide continuum Philip was ‘high risk’ – restless, agitated, poor concentration, self neglect, social isolation, feelings of hopelessness, and thoughts of suicide.
But where is the consensus as to what constitutes ‘high risk’?
When our son Adam was discharged from the Acute Mental Health Unit he was considered ‘low risk’. But how is this possible? What assessment criteria were used to arrive at this conclusion? Who was making the call and what was the intent?
Researchers are united in their view that the first month after discharge from hospital is particularly difficult. The person is often returned to the same environment that contributed to the crisis, they forgo the supervision necessary to monitor their wellbeing, their commitment to the prescribed treatment will be severely tested, and they often feel alone, isolated and without meaningful and/or informed support.
We need to understand the intense striving and the dark recesses of the suicidal mind.
As Vicki Hutchinson noted, “Philip would try so hard to change his mood and he would get constant moments of hopefulness, but he could not break the power and weight of the negative thoughts, gut-wrenching anxiety and distorted sensory perceptions.”
Philip was able to put into words the depths of his anguish. He says, “…then the ugly ‘demon’ known to humans as anxiety forces you to deal with what to do next. Well the force and power of this revolting illness known as depression seems to automatically, almost in a robotic way push the victim so down and out that a word, replaces everything that just previously took a pounding then it is there ‘suicide’. Why on earth do we the sufferers or victims think about this? Well I know because when depression gets bad, I mean really bad and you feel like you have gone completely mad or crazy … then I suppose not being here and ‘lights out’ seems to be the only nice or comforting thought there is.”
We need a collaborative approach in determining what support people who are at risk of suicide require and how it will be delivered.
Vicki Hutchinson captures the frustration experienced by family members who have lost a loved one to suicide. She argues persuasively that those who are called upon to provide the ongoing support are often denied the opportunity to influence the treatment plan or know their role in its delivery. Even worse, they often feel that they are not being heard and/or believed.
She says, “I have learnt for personal experience how important the holistic picture is. The family and carers are extremely important in the process and the recovery. They know the patient much better than the mental health staff. It is essential to work together collaboratively. Of course, there are situations where the family dynamics can be destructive and require a different approach. In general healthy families working together are an essential ingredient for a good recovery.”
We need more evidence based research to highlight the lasting impact of suicide bereavement.
Losing someone to suicide can be an isolating, painful, and life-altering experience. Research has firmly established that family members of individuals who die by suicide – including parents, children, and siblings – are at increased risk of suicide.
Vicki Hutchinson comments on her own journey since the death of her brother Philip. “Philip’s suicide … has left me a changed person. I am not sure if I am repairable. I have felt like a strong and powerful person for most of my life. Currently I am not feeling so resilient. I have not been able to return to work since Philip’s suicide. I have been traumatised by the event. Not only because of the ten months of intensive support and management of Philip living in my home, but the struggle to accept the tragic outcome. Then there is the reality of the suicide in my home and its impact.”
The suffering of the one who decides to take their own life then becomes suffering for those left behind.