To think it's actually a lie when argue that suicide is always a selfish act, that others get hurt by it?

[ChristmasFuckOff]

Firstly, MNHQ as you always comment on these threads - this isn't somebody making a post about being suicidal. I'm not. Dunno why not because I probably should be and maybe I will be later this week but right now...no.

I'm sick of all the stuff out there saying how if somebody commits suicide, there will be people devastated. That it's always selfish. Often people who are suicidal say they don't want to be a burden, is that not actually a reasonable argument?

I think a lot of people out there, with friends and family, can't seem to understand there are others out there who literally don't have good relationships. So it doesn't affect anyone else.

Laura unless you were perceived to have been manipulative, I really cannot understand why a professional would treat you in that way. I tend to say "oh mate" sympathetically, pass them a tissue and hold the silence so they open up.

Risk assessment is very important, so whilst talking I would be assessing things like static vs dynamic risk, is there a well thought out plan, is there intent, is there impulsivity present etc. I would want to know why someone felt they couldn't stay in this life anymore.

A nurses job by definition is to promote health and illness, but not to prevent death. Many people that complete suicide do not have any sort of mental health problem. That idea has been difficult to swallow when I have mentioned it before, but it is the reality for many. Suicide is far more complex than that.

Fruit, you sound great.

I think the starting point has to go back to asking why, philosophically, we think we have a right to make suicide so hard. 5000years of literature versus the mhp jargon of 2016: I know which I turn to as a source of wisdom.

Fascinating about Japan.

Thanks have but I'm very newly qualified, perhaps I haven't become hardened yet?!?!? I do know that the moment I do, I will quit nursing...

Possibly I was perceived as manipulative, but even with all of these years of hindsight and life experience, and even with the detailed diaries I kept with long descriptions of my feelings at the time and verbatim transcripts of conversations with professionals - I still don't understand what I was saying or doing that could have been construed as manipulative, nor even whom I was supposed to be manipulating.

It just felt like a constant Catch-22. On the one hand, I was over-using NHS resources and expecting too much of family and friends to help me not to kill myself. On the other hand, I was being "selfish and cruel to your kind flat mates and poor mother" (quote from CPN recorded in diary at the time) in wanting to die. Even though I know I wasn't thinking very clearly (and by undisputed consensus, I was suffering some form of psychotic illness at the time), I could identify the logical irreconcilability of what I was being told. Surely if nobody else was responsible for my feelings, then I should not be held responsible for the feelings of others.

Sorry to be making this thread about me. I raise the Catch-22 I was in simply because I can see it playing put on this thread as well. I think it says more about society's overall attitude to mental health and suicide than it does about individual healthcare professionals.

Fruit it's interesting you say that you're newly qualified. Thinking back over my own experience, I often found the youngest and least experienced professionals the kindest and most humane. Its so sad that years of dealing with the suicidal can grind nurses down so badly. I know it's a job for which I would never have the resilience.

Laura it sounds like your CPN was rubbish and lacked empathy

"Thanks have but I'm very newly qualified, perhaps I haven't become hardened yet?!?!? I do know that the moment I do, I will quit nursing..."

I think health care professionals tend to withdraw/protect themselves/set new boundaries after they've had a few negative experiences and not been backed up by their employer (complaints/false accusations, etc).

Yes, please delay that moment for as long as possible!

I think I understand it better as I've tried to take my own life twice. I get that at that particular moment people genuinely think they would be better off dead, and that no-one cares. It pains me to say it, but maybe some people should be allowed to end their own misery? For example, if someone has a terminal illness that will cause a painful death and are terrified of not having control of their departure from this life? Who are we to insist that people must be kept alive? If someone has a severe mental health problem and has retained capacity about whether to live or die, and the prognosis is v poor, should these people be forced to stay alive too? It's an interesting philosophical argument.

Sounds like you have an important contribution to make as most of your colleagues can never have that insight.

This thread has challenged hugely my views on assisted suicide and euthanasia for mental health reasons. After my own experience of attempting suicide, I felt very strongly that it should be illegal as a means to protect vulnerable people. But having read this thread, and having heard the voices of people talking about how the worst part of their loved one's suicide was the secrecy and violence and the finding them afterwards - I am now very much leaning towads changing my mind.

But I think what we also need is better care for the suicidal. We all now accept that MH services in this country are declining fast, and that people whose distress is seen as "untreatable" (ie when attached to personality disorders, autism, long term substance abuse) are now largely left to suffer alone. But I do think that we need some sort of hospice-type model to offer holistic emotional and spiritual care with no explicit goal of reducing suicides. There's so much evidence-based research which shows that simply things like art and gardening can help suicidal people feel less isolated and can make life seem more meaningful.

*simple things

Who are we to insist that people must be kept alive? If someone has a severe mental health problem and has retained capacity about whether to live or die, and the prognosis is v poor, should these people be forced to stay alive too? It's an interesting philosophical argument.

No, they shouldn't be forced to stay alive.

As you know, my husband is unwell and his prognosis is he will always be unwell. Meds and therapy have done nothing to change it. They have just kept him out of hospital.

After 30 years of this we know that he won't recover. He will have better moments and he has a lot of good in his life and a lot to live for, but if at any point he decides he can't live like this any more why shouldn't he be able to end it in a dignified way? It's obviously different if someone is psychotic because they probably don't have the capacity? or if someone is going through a period of MH problems. But after 30 years of it and knowing nothing will change?

It's really nice to be able to talk about this issue because it's something I've always been scared of mentioning. Scared of being judged for my opinions.

It is a weakness of the modern age that we can't talk about death.

U2, would you wish also to be able to help him/be with him?

Who is anyone to judge unless they have been in that position themselves? Life is so complex, and can be brutally hard at times. I know for myself that if I am ever diagnosed with a terminal illness that would cause me to have a painful death, or lose quality of life, I will take matters into my own hands. I want to enjoy my time on this planet!

U2, would you wish also to be able to help him/be with him?

I think I probably would be with him, yes.

I hope that doesn't make me sound like some kind of evil person. I love him so much, he means the world to me. Seeing him in pain hurts me. I couldn't turn my back on him if that is what he really wanted to do and I was sure his decision was one made in sound mind (not psychotic)

I can't imagine having to make that decision, but I know I wouldn't let him do it alone.

Trouble is, the language of risk assessment is not conducive to a genuine dialogue.

I cannot imagine confiding in or feeling a connection with someone when they are simultaneously doing this:

"Risk assessment is very important, so whilst talking I would be assessing things like static vs dynamic risk, is there a well thought out plan, is there intent, is there impulsivity present etc. "

It is a language of control, of the professional institution claiming authority over the patient's lived experience. In many ways it is similar to the authority role of the priest.

I can't help wondering whether Fruit is succeeding because of her training or in spite of it.

On the contrary U2, how could you be his true partner if you were in denial about the reality of his life?

I think people who are suicidal often believe that they are a burden to those around them, and therefore they are not acting selfishly by taking their lives.

The problem is that their perception of reality is often horribly warped, perhaps because of depression or whatever, and while they might genuinely think nobody will be devastated by their death, they are hugely mistaken.

A friend of mine committed suicide a few years ago, leaving two small boys without their dad. They had already lost their mum a few months earlier. I have tried and tried over the years to understand what must have been going through his mind at the time, and I can only conclude that he thought that his kids would be better off without him. Nothing could have been further from the truth, and the tragic impact of his death is still being felt in a very real way, years later.

I hope you are ok, OP. If you are depressed, please understand that it affects your judgment. I'm sure that there are people who care about you, even if they aren't good at showing it.

I know the source of this is "only" the Roman, Suetonius, not Cleopatra herself but I am always very moved by the bit when the soldiers rush in and accost the servant who had helped Cleopatra die and say very sarcastically "was that the right thing to do?" And the servant says very simply "yes, it was entirely the right and proper thing to do".
The 17th century audience were, I guess, as fascinated as us by the idea of your life being your own to continue, or not, of that being your choice, with no fear of punishment by a Judeo-Christian god.

Fruit you sound a lovely cpn. I've met some shitty hospital nurses and Doctors who were frankly dangerous, but every cpn I've had or worked with has been amazing.

U2 you sound amazing and so strong. I can't even contemplate how you do it.

Hope you can effect some change, Fruit. The only effective psychiatric nurse I've ever met was a young, newly qualified one on a ward. She was lovely, empathetic, and actually listened.
My experience is different from unborn's, unfortunately. I've found CPN's to be consistently crap, especially the Home Treatment team. What a bunch of head-tilting, nodding dogs they were. I've always been profoundly disappointed in the approach of MH practitioners as a 'service user' (ugh), and I say that as a nurse of 25 years who understands the pressures.

But I think what we also need is better care for the suicidal. We all now accept that MH services in this country are declining fast, and that people whose distress is seen as "untreatable" (ie when attached to personality disorders, autism, long term substance abuse) are now largely left to suffer alone. But I do think that we need some sort of hospice-type model to offer holistic emotional and spiritual care with no explicit goal of reducing suicides. There's so much evidence-based research which shows that simply things like art and gardening can help suicidal people feel less isolated and can make life seem more meaningful.

This would be a fantastic thing to implement.

Ooh I'm not a CPN! I'm a detox nurse in a 4 walled holiday home! I do work on the bank as a band 4 for the crisis/home treatment team though! There are many young men that I look after on a day to day basis that could be at risk of suicide, due to loss of control, uncertain future, and being locked in a small room for many hours a day.

There are ways to go about assessing risk. Yes, difficult direct questions must be asked like "do you intend on taking your own life?" "Do you have a plan?" "What is the likelihood of you going through with this plan?" However this should be done in an empathic way. There are also huge indirect indicators for risk. For example, whilst a woman was crying on the phone stating she "just wanted to end it all", there was a concerned neighbour on the other line outlining he was worried about his neighbour who had gone home with a large piece of rope and now he was drilling in his loft. The latter would be prioritised over the former, as the risk could be immediate and the method deadly.

As I previously said, not everyone who is suicidal has a mental health problem, the crisis team should (in my eyes) focus on keeping people who lack capacity around ending their own lives. Another point to note is that engaging with home treatment teams is not compulsory - unless you are under a community treatment order!

Fruit is a four walled holiday home jail or hospital?

The prison stats about MH issues are quite sad. My youngest's dad has spent time in Durham (amongst others) and the story's he told were awful.