Two events in my own life over the past few weeks have led me to mention this complex and difficult issue. A tragic suicide in the family of a friend has shocked and saddened me. Secondly my dear friend, former colleague and head of the Dept. of Mental Health at Bristol University, Professor Gethin Morgan, has written a superb paper “Predicting Suicide Risk’ which will appear in the British Psychiatric Bulletin in the Autumn. At a time when we have been applauding NHS workers once a week, not only for their skill and professionalism, but also for their sensitivity and compassion, the paper reads as timely and humane. It emphasizes the importance of good communication between primary care and hospital care in monitoring changing risk, and the way intensity of suicidal ideas can fluctuate often over quite short periods. I would like to mention two phrases in the paper. The author cautions that professionals working with suicidal patients, should never identify with their despair. This does not, of course, mean facile optimism, but frank acknowledgement of problems, while at the same time offering hope and often small practical steps to move forward to a better place. The other phrase which Professor Morgan uses is “A prevented suicide is a statistical non-event.” This is a sobering thought for professionals working in this emotionally demanding field. I can remember the suicides of about twelve patients during my busy professional life, but only three letters from patients who thanked me for saving their lives. And I suppose they might have been guilty of hyperbole. So although going forward mental health professionals must never identify with a patient’s despair, we must also recognise that suicide is not uncommon, and indeed is the most common cause of death in young men in the UK. When I look back on patients under my care who killed themselves, some did leave me with questions about whether they might have been better supported and helped. There were others who left me with a feeling of inevitability, in that over long periods, nothing in their lives had worked for them, and their bonds with those involved in their lives whether family, friends or professionals came under enormous strain as well..
To conclude, here is an entirely personal reminiscence. I broke the news of death by suicide to many people, usually other health professionals, sometimes family members. A characteristic involuntary gesture was that the listener would bring their hands to the solar plexus, as I suppose the shock was felt like a punch under the sternum.