Many thanks to Mind for disseminating this opportunity and the restraint consultation.
Lizzie. I saw the survey questions. Thanks. I was going to ignore them and put what I had to say in the Other box (sorry). What I have to say may not have direct significance to the goal of the APPG. I know it's looking at parity and what I have to say is a longwinded route to propose..well...a mad idea which is like the public health initiative to ban smoking (which is what those evil healthcare professionals want to do to us smokers!).
I appreciate you taking the time to read my views as they are rather than having to squeeze them into boxes. Without further ado, here's what I have to say!
In solidarity
Arj
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Rubric
I used to work at Mind HQ in their information department. I've volunteered time to Mind and Rethink. I've written to 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.
I would like to convey something to the APPG and the mental health charities involved on the thorny subject of suicide. "Reducing premature mortality for people with mental health problems" is the subject of the APPG session 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 as well as 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.
My experience
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 also 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 addressing. They're more concerned with labelling (and it feels like no two professionals can agree on my label) than dealing with suicidal ideation. 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 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. Drugs 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 (if I can get high enough).
It's this root extreme of mental pain and suffering which is involved in 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 living, and those with severe psychosocial disabilities are massively over-represented in this group.
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 to be suicidal in my opinion because it is a reasonable reaction to an awful life and this awful life is a severe disability as well as causing profound, inextinguishable misery. 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. A personal story can shine a little light on it.
Prevention of suicidal ideation and morbidity and mortality benefits
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. These need to be addressed.
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 but it requires a different mode of thinking and a vision of a better society..
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 to affect the rate of suicidal ideation. More importantly though: it's necessary. Completed suicides 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 never driven to choose self-death as a recourse. Without this commitment people with disabilities and other citizens will continue to die earlier and that's not a good thing….in fact, it's a bad thing.
Public health cancer strategies have made smoking the choice of a pariah and made significant gains in reducing morbidity related to smoking. Public health suicidal ideation prevention programmes could confer significant benefits for the people who are saved from the awful mental state I've lived with most of my adult life and one of the benefits would be, in my opinion, a reduction in mental health morbidity and mortality.
Thank you for taking the time to read my views.
On 24/01/2014 12:02, Elizabeth Blow wrote:
Hi Arj, Yes please do email your points over. We are asking people to respond under the following headings: 1. Tell us about you: I am a carer I am a person with mental health problems Other 2. Please tell us about your experiences of physical health care for people with mental health problems 3. What were the good things about physical healthcare that you received? 4. What physical healthcare or support would you have like to have received? 5. What could the Government do to implement better physical healthcare nationally? All response will be treated in accordance with our confidentiality processes, but anonymous quotes may be included in our report. I look forward to receiving your answers! Thanks, Lizzie Public Affairs Officer 020 7840 3150 -----Original Message----- From: Arj Subanandan [mailto:arj.name@googlemail.com] Sent: 24 January 2014 10:04 To: Elizabeth Blow Subject: Re: Still time to respond to Reducing premature mortality for people with mental health problems APPG first session Many thanks Lizzie. I'll do what I can. The form isn't the best approach for me. Would it be okay to email my points to you? In solidarity Arj On 24/01/2014 09:44, Elizabeth Blow wrote:Hi Arj, Thanks for your message. The deadline is 5pm today, so please do submit before then! The form can be found on our website: www.rethink.org/allpartymh Best wishes, Lizzie Public Affairs Officer 020 7840 3150 -----Original Message----- From: Arj Subanandan [mailto:arj.name@googlemail.com] Sent: 24 January 2014 09:44 To: Elizabeth Blow Subject: Still time to respond to Reducing premature mortality for people with mental health problems APPG first session Hello Elizabeth I hope you're well. I came across the APPG on Rethink'site today from a Mind campaigner email. Is there still time for me to respond and if so when is the deadline? Best regards Arj For information on our email policy, including confidentiality and viruses, visit http://www.rethink.org/emailpolicy Rethink Mental Illness is the operating name of the National Schizophrenia Fellowship, a company limited by guarantee. Registered in England Number 1227970. Registered charity no. 271028. Registered Office 89 Albert Embankment, London, SE1 7TP.For information on our email policy, including confidentiality and viruses, visit http://www.rethink.org/emailpolicy Rethink Mental Illness is the operating name of the National Schizophrenia Fellowship, a company limited by guarantee. Registered in England Number 1227970. Registered charity no. 271028. Registered Office 89 Albert Embankment, London, SE1 7TP.
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