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Dublin: 6 °C Thursday 13 December, 2018

'I’m tired of all the feel-good campaigns when there's no real debate around entry into mental health services'

A sibling writes about their brother’s experience of being suicidal and needing access to treatment.


LAST WEEK I kept hearing about the Darkness into Light events, which were organised for suicide awareness.

I see people wearing ‘Cycle against Suicide’ T-shirts. I read about balloon releases. Radio advertisements ask us to wear a green ribbon to end mental health stigma. This is all very nice, but is it useful? Is it what’s needed?

This is my experience of bringing my brother James to an A&E department three weeks ago.

It was a Sunday evening at 8pm and it was a last resort. James had admitted to our family that he was going to kill himself that evening; he could no longer cope. James was going to walk into a water and not turn around. After having a breakdown last December, followed by six months living at home with my parents, he was suffering from severe, chronic anxiety.

He hadn’t slept past 4am for five months. My brother is brave and wonderful and funny, and a truly beautiful human being. He is dearly loved by his partner, his friends and family. James has struggled for much of his adult life with depression, but has always managed to stay on top of it, to stay in work, to pay his taxes.

He’s never been unemployed or claimed benefits. James had tried everything: he went to a counsellor every week and to his GP. He tried exercise, meditation. He read the self-help books. We brought him to Pieta House for a few sessions. He went to a psychiatrist privately.

‘It took a lot to admit’

I thank God that James told us how bad he was feeling that Sunday. It took an awful lot for him to admit that to us, because unfortunately we had lost another sibling to suicide eight years ago.

So how bad must James have felt to have to admit that he almost plunged the family into the same suffering we all experienced before?

At 9pm, we were seen by a triage nurse. She told us that luckily there were only six people ahead of us in A&E and no one for the psychiatry NCHD (non-consultant hospital doctor), so we shouldn’t have to wait too long.

James was ready to be hospitalised. He was looking for help. He was doing what all the awareness campaigns told him to do. He didn’t want to feel this way any longer.

The best analogy I ever heard for how someone is thinking when they take their own life is that it’s like jumping from the tenth floor of a burning building, but in this case the burning building is your mind. It’s not a rational decision. It’s not that you think you’ll survive the jump, but you just want the pain to stop. James’s thoughts and anxiety made living too unbearable.

It was 2am when the Psychiatric NCHD (non-consultant hospital doctor) arrived. The first thing anyone could notice about this woman was that she was chewing gum. Loudly, unsubtly, like a teenager.

I explained how worried we were because of the family history. To my astonishment, after hearing us for half an hour, this NCHD informed us that James should go home straight away, and a community nurse would come out and visit him in a week.

James looked like he was going to crumble.

I explained again that he’d already missed three months in work and had been living with my parents for six months, and nothing was working. The doctor said “hospital isn’t always the answer”. I explained again that we had been through all this before, eight years ago. She chewed her gum.

‘Do you want to go to hospital?’

She looked into my eyes and said hospitalisation wasn’t the answer. I asked James ‘Do you want to go into hospital James?’ He said ‘Yes’. He had tears in his eyes.

We were asking for help and she was trying to send us home. What message does that send to someone on the very night they have chosen to end their life? We can’t help you. You’re on your own.

I told her that if there were no free beds, I would bring him to another hospital, she just had to arrange it. I would drive him there that night. I told her I wasn’t going to lose another sibling.

She was silent except for chewing her gum. I told her I wasn’t leaving the hospital until my brother was admitted. I told her my brother doesn’t drink, doesn’t do drugs. No one has tried as hard as James to feel well.

For him to be here means he is desperate for help, and my family desperately needed him to be admitted.

She just chewed her gum.

It was 3am.

I had been trying to convince her for an hour. There was no empathy, no compassion. She wanted us gone. I looked her in the eyes and told her I was refusing to take James home. And it seems these were the magic words, the code words. “Okay,” she said, “So you’re saying you are refusing to take him home?”

She said she would call the psychiatric consultant, and that we would have to wait. It was 3.10am. Two hours later, the NCHD finally returned and said there was a bed for James in a hospital in the next county. I drove James and he was admitted at 6.30am.

He said he finally felt safe. It should not have taken a verbal battle of wills for over an hour. Weeks on and James is still there, still very sick, still with suicidal thoughts. His psychiatrist there says it will take time. He says he needs to be in hospital. I wonder what would have happened if James had turned up to A&E alone that night? I’m afraid our brother would be dead now.

There were no beds in that psychiatric ward. That’s why that doctor was turning him away, not because a hospital wasn’t the right place for him as she claimed. That’s what is sickening. That was her role that night: to convince us he was better off at home when the truth was there were no beds.

I think about all of these kind people getting up at dawn to walk in solidarity with those who have lost loved ones to suicide. They want to help, but at the coalface, in the emergency departments where people go when they are at the very end of all hope, there is no change. Patients are not wanted.

Can you imagine what it’s like to want to end your life, and in one last desperate attempt to survive, you seek help, only to be turned away?

I’m so tired of hearing all the feel-good communication campaigns when there is no real debate around entry into mental health services. There’s something really wrong with the whole system when so much money is being spent on telling us to ask for help when there is so little there when you do.

In business, you’d never promote a product or service if it was flawed and useless to the consumer. Are the HSE’s attempts to be part of ‘awareness campaigns’ a fig leaf for a grossly underfunded system which fails people on a weekly basis and results in the needless deaths of our citizens?

You can keep your stigma ribbons and your balloons, and let’s fight instead for our taxes to be used to properly train staff and properly fund our mental health services.

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