Suicide and Suicide Review

The National Health Service reviews all recent suicides that it has heard about. It is usually informed through the coroner's office, as most of those who die this way will not have been involved with mental health services. Some however will have been under active treatment. There are pros and cons of doing this.
Some cons are:
  • family and friends are grieving and does not necessarily want a 'review' to take place
  • suicides are thakfully rare. but this limits the amount we can learn about day to day care
  • a 'review' can be seen to assume that a mistake has been made - which is usually not the case
However, there are also some pros:
  • family and friends also typically want any necessary lessons to be learnt
  • patterns can be picked up un and interventions made for the future
  • sometimes there are failings that need action taking
nat conf inqIn the UK, there is a 'National Confidential Enquiry' which looks at all cases of suicide or unexplained death that have been in contact with mental health services in the last 12 months. You can read more about this and they produce an annual report. For 2012, this tells us there were around 4000 suicides of which 3000 were in men, the commonest method was hanging followed by self-poisoning [firearms being more common in the USA], and 27% had been in contact with mental health services in the previous 12 months.

Some patterns are also visible. Deaths by Carbon Monoxide poisinging have fallen hugely thanks to cars now having catalytic converters,a dn fell again hugely before that a few decades when 'coal gas' was replaced by 'natural gas' for domestic heating and cooking. Paracetamol overdoses fell then pack sizes were limited. Tricyclic antidepressant overdoses have been falling as this group of drugs is prescribed less. Sometimes a simple population-wide intervention can make a big difference - especially for the individual who may have that extra second to think again if a means of suicide is not so easily available. However, it is also clear that those who wish to kill themselves in a determined manner are able to do so - and it is not likely that anything will prevent this as we cannot keep the whole population under permenant review.
There are also a group in which choosing to die by suicide is in many ways a rational choice. This will often be those who have struggled with mental illness through many decades. In this group, there are rarely lessons to be learned about what 'should' have been done to stop the act [because usually the care offered was as complete as you would wish]. Instead, there are lessons to learn about allowing people the autonomy to choose their health care as we would in any other illness, the right to say 'enough' to yet more therapy or medication. This does not mean recommending suicide as a choice to make, but it can mean not pressuring people to chose other things that WE think they need. We can learn lessons about how WE can walk with compassion and tears alongside those who are in this group. Sometimes WE are the ones who need to take medication or have therapy for our own anxieties and not place these on others.

There is currently a debate as to whether the current 'global economic crisis' is contributing to deaths by suicide. There is a clear link between debt and poverty [see this other article on Mind and Soul], but actually suicide rates have not risen that much - indeed they have been falling in the Uk since a peak in 2006.
For the family and friends of the person involved, suicide is a huge event, sometimes called the 'special scar' as it leaves a very particular type of bereavement where people ask 'could I have done more?', or 'should I have spotted something?' and so on. The bigger picture also gives answers as suicide is something that can be studied and changes can be made. We need, as with so many questions about suffering and similarly big topics, to walk the line between offering compassion and tears as well as offering hope and a plan for change.
Rob Waller, 09/04/2013
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