Written: July 23, 2019
Ella and I were patients on the same psychiatric ward. We were both detained under section two of the Mental Health Act. She was perhaps the quietest and most withdrawn patient on the ward at the time. She seemed deeply depressed.
We all felt very protective towards her, because she seemed so young and vulnerable. Indeed, on the day I was discharged, I recall hugging her tightly and wishing I could take her with me.
A few weeks later, Ella took her own life. She was still sectioned in the psychiatric hospital at the time.
Ella had been allowed to gain access to items which she used to end her life. At her inquest, the psychiatrists said they had not restricted her access to them because they wanted her to “take more responsibility” for her own safety. But surely the state had taken responsibility for her safety at that point – she was detained under the Mental Health Act.
It is known that restricting access to lethal methods reduces the number of suicides: https://www.psych.ox.ac.uk/publications/168536.
I run a Suicide Crisis Centre which is independent from mental health services. Clients often tell us that mental health teams are emphasising that they need to take personal responsibility for managing their own crises. Perhaps the teams feel that this will discourage service users from becoming dependent or expecting that a service will “save” them.
It’s possible to argue that we should all take responsibility for trying to stay as mentally well as possible and use as many strategies as we can in order to do that. Indeed, that can feel very empowering. But we may all reach a stage when our strategies no longer work, and we need significant help. When we reach that point of crisis, it may be the least appropriate time to expect someone to be able to “take responsibility”.
When a person is in mental health crisis, their ability to think clearly is very often impaired. That’s the nature of crisis. Our thinking may be chaotic at that time. It is not always going to be possible for someone to think clearly enough to take steps by themself to start to navigate their way out of the crisis.
At the point of crisis, it is the time when you are least likely to be able to see a route forward, without support and care to do so.
There are ways to help empower people who are under the care of a service so they do not become dependent on it. These alternative methods do not involve telling someone in crisis to “take more responsibility.” Giving people more control over their care at an earlier stage, when they are not in crisis, can be an effective way of doing that.
As I wrote last year: “Our approach is to give clients as much control over their care as possible, but to actively and tenaciously work to protect them and help them to survive, when they are in crisis and at risk of suicide” (“Suicide Prevention Techniques: How A Suicide Crisis Service Saves Lives”).
Requiring someone in crisis to “take more responsibility” may heighten their despair, because they simply cannot do so at that point.
They have taken the step of asking for help, but have been told instead that they need to find their own resources. Surely they need to feel reassured that if they seek help, there will be support, kindness, empathy and care.
I know that the other patients on the ward continued to wrap Ella in care and kindness. They watched over her and alerted staff to the fact that they were extremely concerned about her suicide risk. But that responsibility of watching Ella should not have fallen on other patients.
Ella’s death should make us question to what extent the emphasis on service users “taking responsibility” has gone much too far, and risks causing a failure to adequately protect life.
As Ella had died while under the care of the state, in a psychiatric hospital, there was a jury at her inquest. The jury concluded that her death was a suicide which was “contributed to by her ability to gain access to items to aid suicide”. They took a different view from the coroner, who in my opinion accepted too readily the mental health service’s justification for not restricting access to certain items. The coroner commented that such restrictions would be “draconian.”
In writing this article, I recognise that for so many people, a psychiatric hospital provides a life-saving intervention. Indeed, my admission to psychiatric hospital was life-saving. It is heart-breaking that, in Ella’s case, this did not happen.
Please also see this article which challenges the approach of clinicians who tell patients that it is their “choice” or “their decision” to end their life : Suicide: why do mental health professionals tell patients ‘It’s your decision’?
In memory of “Ella”. Ella’s name has been changed.
Joy Hibbins is the CEO of the charity Suicide Crisis: www.suicidecrisis.co.uk
Sources of support: UK nationwide: The Samaritans can be contacted on 116 123. In Gloucestershire, the Suicide Crisis Centre provides face to face support: http://www.suicidecrisis.co.uk