Monday, 12 March 2012

Suffering in Silence

"30 year old male, suicidal, depressed"

These types of jobs are quite tough to deal with. They don't require any treatment that we can give. All we can really do is take to A & E with is as much use as a chocolate teapot or refer onto a GP. What we can do is talk to them, but often they are in that position because they are not good at opening up. Least of all a complete stranger. We arrived at the flat and our patient, James, cut a sorry looking figure. He looked scruffy, unshaven, bags under his eyes and his clothes appeared dirty. He invited us in and sat on the sofa. It was a friends flat. He was just staying as he'd just come out of a long term relationship and had no where else to go. I sat there while he told me about the past year of his life and to be fair, it sounded pretty shit. His marriage had broken down, he was struggling with only seeing his children weekly, his new relationship had also ended badly and a number of relatives had died. He'd lost everything as far as he was concerned. 

He went onto tell me that three nights previous, while drunk and feeling particularly low he had tried to kill himself by means of an overdose. Obviously, it was a cry for help and he was feeling ashamed of doing it but it happened all the same. Tonight he was having the same feelings and was scared of what he might do. I'm not ashamed to admit that i've suffered anxiety and depression and you do feel very alone. Being consumed by unfamiliar feelings can be suffocating to say the least. It is no wonder the people who are most fragile are left with thinking being gone would be the simplest fix. Suicide is often spoken about as being a cowards way out. It's considered selfish for the family and friends that are left behind and something I have rarely spoken in depth about, with a patient. I asked him straight up.

"What about your kids, your family, you friends?"

He agreed. He said he had a loving family and good circle of friends. He also had a good job, but what he did say, was that when you are depressed none of that seems to matter. He admitted he was wallowing in self pity but at the same time he could not face the prospect of having to start a life all over again, and from personel experience, that prospect is a daunting one. It all got too much for him. Maybe he felt ashamed, embarrassed, I don't know, the fact was the feelings he was having were real. He had taken an overdose of Amitripyline after seeing his GP for sleeping problems. It's an anti-depressant often used to help mild sleeping disorders and is often prescribed without looking at the core problem. James was depressed, he needed to talk to someone, not be drugged into a fake sleep. When he wakes, the problems will still be there and they were. He wasn't keen on being prescribed the drug either but with the targets and time constraints GPs face a quick prescription is more practical than a heart to heart. His objection to the drug stemmed from the fact he didn't want to admit he was depressed and because he knew drugs were not going to fix anything. He was a very level headed guy and I admired his honesty. He was being completely frank about his feelings especially as we had never met before. I think that is what he needed.

I explained our problem in terms of options too him and he agreed A & E wasn't the place for him. I offered a GP referral but he didn't want that either. He was all to aware of the social stigma around mental health disorders and didn't want it on his medical records. He feared it would effect his future employment and to be fair, I spoke about similar fears in 'Mental Health in an Ambulance'. The funny thing was that James knew exactly what he had to do. It was a lifestyle change that was needed and all he had to do was buck the trend he was in. Calling an ambulance was his way of admitting what had happened and I was more than happy to be that person he needed to talk to. It did get me thinking though, about how intricately balanced peoples lives are. We are creatures of habit and if that is disrupted it can easily seem that the world is ending. The old adage of 'what doesn't kill you makes you stronger' was very true in this case. We left James at home with a plan on how to move forward. I was confident he would turn things around and perfectly happy that he wouldn't do something stupid. 

This job raised a lot of questions around mental health. People who have never suffered with mental health problems or don't know they have, have no idea where to go for help or even what to say when they do. All they have is the social stereotyping, perpetuated by the media and employers alike which make the idea of asking for help an unattractive one. Stress, depression and anxiety are becoming so common place, yet in many areas of employment, admitting to one, can halt your career in an instant. Feelings are pushed under the carpet and bottled up until drastic actions are taken as the only conceivable way out. Things are getting better, but for some it's not quick enough. Help needs to be readily available, confidential and easy to access and this can only be done with the full support of the government and NHS. Yes, it will cost money but like everything, in the long term it will save. It's just a shame there is such short sightedness when it comes to Mental Health.


  1. Excellent post, highlighting the fact that, despite GPs handing out anti-depressants like sweets, the medical profession can only be of limited help to people going through such times. The human-to-human response you described sounds well-placed and well-delivered. All services need to keep the humanist spirit alive and not reach for simplistic "solutions" which often cause more harm. Well done on all counts.

    1. Thank you. Really appreciate that. If the government claim is true that 10% of the NHS budget is on medication is giving GPs more power really financially viable!

  2. Definitely agree with the comments above! Sounds like you were well placed to visit him that day, thank god he realised and reached out in time, hope it made a difference for him. For me, I can understand the limits a GP has for appropriately diagnosing and treating depression and exhaustion, but from my experience of frankly quite laughable suggestions given to me when i've seen GPs for problems including oral contraceptives for post natal depression and a "happy diary" , theres a worrying void where those who struggle to convey problems until its too late or those that dont cry for help end up struggling through it alone or lost completely :(

    1. Thank you! You are right, a lot of advise is flimsy at best and doesnt go anywhere near fixing the problems that exist! The might as well write a prescription for 'Do a Happy Dance'!

  3. As ever excellent insight thank you. I agree there is a lot of confusion around Mental Health cases and until we are all educated a bit better we will sadly keep believing all patients with MH probelsm are a risk to OUR fact more a risk to their own!

    Self-harm is a cry for help and often known as "Screaming in Silence" It is not "unfinished suicide" but sadly the result can be death as the need for resolution completely overwhelms.
    If we can cope with one crisis per month can we cope if all 12 arrive at same time?

    Mental illness is a complex issue where a lot more understanding needs to be shown.Education re "the Cinderella service of the NHS" must include Cinders need for parity with her sisters!

  4. Very well said. Thanks for the comment! Appreciated!


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