Friday, 24 January 2014

Draft prose for APPG parlimentary group


I used to work at Mind HQ in their information department. I've volunteered time to Mind and Rethink. I've written to my  MPs on various issues related to mental health. I am also the England affiliate of Mind Freedom International and am  an active member of the European Network of Users and Survivors of Psychiatry.




The only thing I would like to convey to the APPG and the mental health charities involved is on the thorny subject of suicide. "Reducing premature mortality for people with mental health problems" is the subject and I assume mortality relates to all-cause mortality including suicide. I consider myself a suicide expert by experience and I have an opinion which I feel must be understood by mental health decision makers. I will try to talk a little about factors other than suicide  and I will endeavour to be concise but there is a lot of information and novel concepts I need to communicate and my personal experience.


My first point is that there are related factors between suicide and other causes of premature mortality but I feel it is important to differentiate the two because they are different types of death, especially when measuring and acting to prevent them from happening.


The tragedy

It is a tragedy that people with severe mental health problems die earlier and are significantly over represented in the attempted and successful suicide  rate. This tragedy is well understood and I welcome the issue is being taken seriously by the government.


My opinion is it isn't the greatest tragedy. A human being - a conscious,  sentient mind - driven to want to die, to end their personal and unique suffering using the last resort of suicide. That's the tragedy and the lack of appreciation of this truth adds insult to injury.


 Suicide data commonly quoted is the number of successful suicides every year but I think the number of attempted suicides gives a clearer presentation of the problem. Counting how many people want to die, though difficult, is the best measure of the problem.


I live day after day, year after miserable year wanting to die. I rarely make attempts and much to my sadness I've not yet succeeded. Private and NHS services have not succeeded in abating my desire to die in over a decade. They have no evidence base because the syndrome approach in research doesn't prioritise the single symptom of suicidal ideation alone, or not that I've been able to find anyway. Some mental health measures do include suicidal ideation along with a lot of other measures which have no or little bearing to suicide. Suicidology is a severely underfunded research field.


Not being able to die and living is a unique hell, one which mental health services have always seemed apathetic to resolving. They're more concerned with labelling (and it feels like no two professionals can agree on my label) than dealing with suicide. I've tried various drugs and therapist to little avail.


Living with this state of mind changes how I live. I live with little care for my health. In  fact I make decisions to reduce my life expectancy to die quicker and I pray for death. It is, I hope, obvious to the reader, that this state of giving  up on life itself would contribute to a reduced life expectancy. The pervading sense of despair alone is a large factor in my desire to die and my (I hope) reduced life expectancy and I don't think I'm the only one who feels this rotten.


I'll admit drugs and alcohol are also a conscious choice to reduce my life expectancy but also to provide limited escape from a reality I no longer want to live in. I don' think anyone feels the pain of being a self-medicating junkie in the mental health system. There's so much prejudice. They can cause illness and contribute to reduced life expectancy but so do treatments like clozapine, ECT or neurosurgery for mental health. I'm an informed junkie and my personal experience is highs can, for a short while, heal or at least abate the psyche pain in a way psychiatric pharmaceuticals have never been able to.


It's this root pain and suffering which mediates the various mental states which mediate reduced life expectancy and suicide. Isolation, exclusion, poverty, victimisation, plain old misery and despair are all experiences felt by people who end up giving up on…I suppose it depends on the person…on life/reality/society/humanity/people/living.


It is a litany of errors and circumstances which have driven me to the broken mental state I'm trying to describe. It is not a mental illness in my opinion because it is a reasonable reaction to an awful life and this awful life is a severe disability.


Can you imagine what not wanting to live might feel like or guess what it might do to a person over the days and months and years of a living hell. I'm trying to convey it to you but my key point is not for you to pity my pathetic existence. My life experience exposes a problem which you may not be aware of.


My key point is perhaps even more alien than my life experience. Simply, people should be prevented from ever getting to the mental state where they want to die. The events and circumstances leading to a person wanting to die are the cause of so many people in this country feeling the god awful misery of a mind emotionally harmed and tortured beyond its limits.


If the APPG hopes to tackle the great tragedy of the lifetime prevalence of suicidal ideation then I believe the aim should be to eliminate the harms which make citizens want to die. The current paradigm of suicide prevention has failed me: they can't change the way I feel (but can make it worse) and they won't give me the methods to end my life when and how I want it ended (to naturally drift off to a last sleep with no pain and a feeling of bliss).


The goal of reducing all-cause mortality isn't the purview of physical health services alone. Society and culture play a large part in causing awful psychological states as does (for some) mental health treatment. Preventing people from getting to those awful states - especially the one where a person wants to die - is what I would recommend as a goal for the APPG if they truly want to tackle all-cause mortality and morbidity.


It may sound difficult or even insane as a realistic objective and I'm wary of this opinion. It would be difficult but not impossible. More importantly though: it's necessary. Completed suicide like suicidal ideation are tragedies and the product of circumstances which can be changed but unlike actual suicide suicidal ideation requires commitment to a better society where individuals are driven to choose self-death as a recourse. Without it people with psychosocial disabilities will continue to die earlier and that's not a good thing….in fact, it's a bad thing.

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We It comes in part from an appreciation that no one can truly sign their own work. Everything is many influences coming together to the one moment where a work exists. The other is a begrudging acceptance that my work was never my own. There is another consciousness or non-corporeal entity that helps and harms me in everything I do. I am not I because of this force or entity. I am "we"