The whole issue of “suicide intervention” really isn’t lying down for me at the moment.
The response from that commentator on The Other Way Around continues to bother me. (I am a ‘reflector’ – I can’t help it.)
I have been thinking about the number of suicide interventions I have been involved in, the training I (haven’t) had, the legislative dilemmas, the responsibility and the responses from other agencies. None of it is sitting well with me.
Part of the problem stems from identifying what a call from a suicidal person actually means.
In my experience, if someone calls the Crisis Team and expresses suicidal thoughts it is rare for the Crisis Team to do very much with the caller. Sometimes they even simply suggest calling the police.
Compare that to the police who will inevitably send a unit to the location.
This is a huge difference in approach and I cannot understand it.
I have had arguments with Crisis Team staff on many occasions. This doesn’t exactly please me but it has always been down to differences of approach. In a recent example, the person I spoke to on the telephone was quite comfortable to assume that the person in question was drunk because they had spoken to them on the telephone. As a result of this they were quite comfortable in refusing to engage in any way and refuse to do anything to assist in resolving the issue. Leaving officers with an apparently suicidal person and no powers to do anything.
In another example I have heard of a situation where the Crisis Team have called the police because they were now “concerned” for the welfare of an individual who had been to see them and now could not be found.
This led to six hours of frantic police activity before the person concerned was located. By this time it was too late.
It transpired that the person had attempted suicide two or three times in the preceding week, had been to their GP, been referred to the Crisis Team who sent them home with medication.
12 hours later they had taken their own life.
The authors comment as well mocks me for not being medically trained. It’s not a medical issue – “In reality it’s just a difficult person you don’t know what to do with?”
That *I* don’t know what to do with?
Why is it a police issue?
From experience, these and many other examples and the comments I can only therefore assume that simply being suicidal is not enough to fully engage the services of a mental health team.
And whereas the police will treat all suicidal people as “immediate priority” or “high risk” that this risk assessment is not shared by those operating within the mental health services.
This is something I am finding very difficult to reconcile.
Who is right and who is wrong?
Can you accurately grade the level of risk in someone who is suicidal? Can you do it over the phone?
There is an old wives tale which suggests that the people who call the police saying that they are going to commit suicide are not really going to go through with it.
The myth suggests that those who are intent on ending their own lives with just go off and do it without telling anyone.
I wouldn’t like to suggest that this is accurate but in my experience it can go either way. Usually – and I base this purely on empirical evidence – the cases where someone else reports concerns for someone who is suicidal tens to be the ones which don’t end so happily. I have no idea if it is statistically true – I don’t actually think it is.
However, in just about every single one of these cases where someone has suddenly disappeared when you start asking questions it is quite clear that there is a history leading up to this point. It usually comes from friends or family members who will talk about how the person was depressed (clinically diagnosed or not) or may have had a significant negative life event or who had tried or talked about suicide in the recent past.
When my friend took his own life four years ago it was a complete shock to me. But that is only because I didn’t know the history. When his wife frantically banged on my door to say that he had gone missing I flicked into “work mode” and started asking the usual questions. At this point I learned that he had been very down for ages, had been to his GP, had been thinking or dreaming about suicide and had been prescribed anti-depressants.
I thought he had seemed “down” but he had hidden it well from me. He had been more honest with his partner.
None of us had assessed just how bad his depression was. Not even the doctor.
What strikes me is that whilst this is all building up – whether someone seeks help or not – the response never seems to be what you would classify as an emergency response.
I would like to be corrected on this but it seems that most people are sent away to continue to self manage the issue.
The author of the comment on the previous blog criticises me for thinking that by being suicidal it automatically makes someone “ill.”
I don’t think I have ever said this exactly and I have learned that this does not seem to be the case.
Trying to loosely categorise suicidal people has led me devise this, very unscientific, list:
1: truly suicidal
2: potentially suicidal
4: cry for help
5: attention seeking
6: drunk and 1-5
How do you determine between them? How can Crisis Teams take such a different risk assessment on the same facts than the police will take.
How do you determine the difference between 1 and 5 or 6 if both are hanging over the edge of a bridge?
Ultimately the police (and ambulance / fire) are most likely to be the services dealing with such a situation.
Which takes us back to training. With the exception of trained negotiators, police officers have had no suicide intervention training and there is nothing within the police service which provides any form of after care for a suicidal person. There is no “suicide intervention” department. We crisis manage and then refer back to the health service.
There are charities and voluntary services out there who can help but I don’t think we have really and properly tapped into their resources.
Another stark difference can be found when you look at what happens if someone calls the police and says they are suicidal and if someone calls The Samaritans and says the same thing.
The Samaritans are a charity and are not beholden to Article 2 of the Human Rights Act of course but their staff are probably a damn site more effectively trained to deal with a suicidal caller than a police call taker.
Police response is to send a unit. The Samaritans don’t do that.
The upshot of all this, it would seem, is that the only organisation who routinely and consistently treat a “suicidal” caller as presenting an immediate high risk are – the police.
Why is this? Have the police become so risk averse that they daren’t do anything else? Is the health service not taking risk assessment seriously?
Is it because the police have been so heavily and scrutinised and criticised where things have not ended well?
Has this level of scrutiny and criticism ever been equally applied to mental health teams?
Is there as effective and intrusive a body as the IPCC looking into possible shortfalls in the Health Service?
If there isn’t – shouldn’t there be?
It all comes back to the question I posed in “Whose Line is it Anyway?” – if it isn’t a medical issue and the police have no powers or training to deal with it then who should take primacy in dealing with suicide intervention?
Put it it another way – why do we expect an agency with no powers or training or support services in suicide intervention to deal with suicide intervention?
This really isn’t computing with me and the more I think about it the more confused I get.
How can one agency say “this person is drunk and we aren’t helping” whilst another is left standing there thinking “What do we do now? We can’t just leave.”
Should police “just leave” after making a number of sensible calls for advice and assistance.
I am pretty sure that the subject of suicide intervention is probably worthy of a national summit. A national summit involving all interested agencies and charities.
Would anyone in a position of authority like to organise one because this needs thrashing out?