Losing a friend to suicide
*Names have been changed and all opinions and perceptions of events reflected in this article are purely the writer’s own.
We lost Y in August 2019. Being a witness to his progress through the mental health safeguards in the NHS and seeing them fail one by one opened up discussion about the system and its shortcomings. And yet, what more could they have done?
When Y first presented with a mental health crisis, he was initially placed into the care of the mental health crisis team and began sessions with a professional within that team. After some time, it was decided that he was stable enough to be transferred into longer-term care with a different professional, but he had already formed a close bond and was uncomfortable with the prospect of changing care practitioners.
Because of the way the NHS is structured, there is sometimes a lack of continuity of care as the system often operates with very limited resources and trained personnel.
Because of the way the NHS is structured, there is sometimes a lack of continuity of care as the system often operates with very limited resources and trained personnel. I was disappointed when I found out that the mental health services had suggested a transfer to a different team. There was a good chance this move would discourage him from continuing to engage with the mental health services. Indeed, Y eventually ended up losing contact with the services for a variety of reasons, one of them being that he was referred on to another healthcare practitioner.
As doctors, we are bound to the guidelines and best practices, and this sometimes means losing the close rapport you build with patients when you then have to refer them to a different practitioner despite them wishing to continue their care with you. You can try to coax them out of their reluctance and to ease the transition to the best of your ability, but the fact remains that the patient will have to establish a bond with yet another person.
Y’s contemplations of suicide, and indeed, general conversations about being allowed the freedom to choose one’s own death, also led to many heated discussions amongst our circle of friends. As people intending to enter a healthcare profession, we are often so fixated upon keeping people alive that we end up never having reflected on the opposite: what happens when a person wishes to die?
Society often views those who wish to die as having something “wrong” or “unbalanced” about them, and that they are making an uninformed, rash decision that they will come to regret.
Many people’s instinctive reaction to the conversation surrounding suicide is a vehement, “No, you shouldn’t do it. There are plenty of other ways to solve your problems.” Society often views those who wish to die as having something “wrong” or “unbalanced” about them, and that they are making an uninformed, rash decision that they will come to regret. This can result in people coming across as dismissive of someone’s suicidal thoughts, or defensive of their opinion that life is sacred.
As a medical student, you will definitely encounter patients who struggle with such thoughts at some point during the course of your training. It can be very difficult to find the appropriate words to conduct a consultation and to respond with compassion, especially if you haven’t had any experience dealing with situations like these before. People who are at risk of suicide or self-harm are most often in a very dark place, and you can feel like you need to be the one to provide advice and to personally help them out of their plight. At times like these, it is essential for you to remember that as a medical student, you are not in a position that requires you to manage a patient on your own. At this stage in your training, taking the time to listen attentively and respond with kindness is more than enough.
Outside of your medical training, you may also have people in your personal life that you know have struggled with such thoughts. Often, the conversation surrounding death, and choosing when to die in particular, can be very polarising, and as such, people often do not get the opportunity to talk about it in a safe, non-judgemental space with trusted friends. Equally, it can be an uncomfortable topic for you to discuss, and it can be, to some extent, difficult to demonstrate care and empathy, especially since you now aren’t professionally bound to do so. It’s important to be there for patients and friends that need you, but it is just as important for you to know your limits and capabilities. If you are uncomfortable with the situation at hand, help them find an appropriate source of support. Just because they confide in you, doesn't mean it is expected of you to know how to help them. Sometimes they just need a hand to hold to find the courage to seek the help they need.
Unfortunately, Y’s story is not an extreme example of what a significant proportion of medical students and healthcare professionals battle with. Depression and suicide are extremely prevalent in the medical profession - we are all expected to be high performers without much room for failure, and that can lead to a lot of stress and worry when people cannot keep up. For us in medical school, that can come in the form of being unable to keep up with the workload of the medical course and unexpectedly failing exams - HERE is a post that discusses this issue and how best to manage it.
Mental health remains a terribly taboo topic, especially in countries like Malaysia. Just because less people are talking about it doesn’t mean the problem is less prevalent.
Losing Y forced me to reflect on a lot of things, ranging from mundane talks in his living room to systemic inadequacies. These lessons continue to guide me during my medical training, and I hope that this article has provided you with some food for thought. Mental health remains a terribly taboo topic, especially in countries like Malaysia. Just because less people are talking about it doesn’t mean the problem is less prevalent. For there to be change, there needs to be a realisation and recognition that suicide and mental health issues are increasing within the population. We as a nation have a responsibility to help change mindsets and we can first and foremost start with ourselves.