Accountability needed to save lives as suicide data severely lacking

[timgcap=John Broderick proposing to Sandra Russell after both finished the Cork City Marathon in 2010. Picture: Des BarryJohnBroderickinquestSandraRussellengagement_large.jpg[/timgcap]

I was stopped in my tracks last week by a beautiful picture in this newspaper of lovely young Sandra Russell being kissed by a handsome man called John Broderick as both of them finished the Cork City Marathon in 2011.

The back story to the picture briefly won him the title of “the most romantic man in Ireland”. 

John had proposed to Sandra as she went across the finish line and produced an engagement ring he’d carried the whole way.

Underneath the picture there is another, that of John’s widow Sandra as she emerges from the inquest into his death last summer. She is plainly devastated. 

The contrast with the stunning picture of young love from 2011 could not be more stark.

To lose your husband and the father of your young daughter a few years into a happy marriage is as horrible a tragedy as can happen in any life.

Except it gets worse. John took his own life. 

I know, from going through this horror at a remove with friends and relations, that the grief after suicide is the worst there is. 

On top of the loss, there are the questions, which can twist and turn in the guts of the people left behind for years on end. 

I have seen several such bereaved friends learn to smile again and hopefully Sandra will too.

She has yet another load to bear, however: Her gorgeous young husband died less than 24 hours after being discharged from University Hospital Kerry as being fit to return to work.

John had presented at UHK because he had made an attempt on his own life. He apparently told doctors he didn’t want to be admitted and wanted to return to work.

Surely that’s what suicidal people tend to say?

Should the hospital take the word of a person who has just made a serious attempt to kill himself or should they be mindful of the fact that a person who was admitted to hospital with suicidal ideation is 200 times more likely to complete suicide than the general population and make every effort to admit him?

The hard fact is that if John had been admitted to UHK on August 28 last he might now be recovering with his wife and daughter. 

The hospital told the inquest he didn’t meet the criteria for an urgent admission to hospital under the provisions of the Mental Health Act.

If that’s the case, isn’t it time we had a close look at those criteria? And at the Mental Health Act?

Isn’t it time to review the guidance given to our frontline hospital staff when it comes to risk assessment for suicide?

It will be impossible to do this without hard data as to how many people complete suicides in health facilities or shortly following discharge. 

These data do not exist.

Pat Buckley, the Sinn Féin TD for Cork East, has been asking Dáil questions and badgering the health authorities for these statistics for years. 

The most recent answer he got from the HSE dates from October last year and states baldly that the executive does not collect data on the number of people who die by suicide following treatment by its services for mental health issues. 

The letter explains that there is no formal feedback mechanism between the coroners’ courts, which determine the cause of death, and the HSE.

My own efforts to get the same information from the HSE this week have so far failed.

This is an absolute disgrace. It is clear that people are dying following recent risk assessment in HSE services and there is no accountability — and no possibility of improvement — because there are no data.

It’s hard not to feel that the lack of urgency around this issue stems from complacency around these deaths in society at large, as if we have gone from stigmatising suicide to normalising it. Wake up.

 

While some of these deaths are hard to predict and prevent, the very fact that a person has presented to the health services often means the life could be saved.

Most importantly, it should mean that it is the responsibility of the health services to save it.

That’s a tough, sometimes impossible ask, but it’s an ask health professionals face every day when it comes to other serious illnesses so why not suicidal ideation?

The Connecting for Life suicide prevention strategy (2015-2020) is full of promises about the development and delivery of standard clinical guidelines on suicide prevention and the expansion of training to frontline staff. 

The many families of those who have been “let go” by the health services and have ended their own lives have seen its implementation failing.

Even the most basic suicide prevention measure — making it more difficult to achieve — seems not to be fully implemented. 

The strategy speaks of the need to review prescribing practices so that potentially lethal doses of drugs are not handed to suicidal people in blister packs.

The inquest into the death of 26-year-old Tipperary woman Hollie Gilson took place two weeks ago, just a week before that of John Broderick. 

Hollie died on May 17, 2017, following an overdose of two drugs she was prescribed to treat her mental health problems, Naproxen and Fluroextine.

She may have taken 256 Naproxen tablets. Her family said at the inquest that she was regularly given a month’s supply of different medications which they regularly took off her and handed back in small doses.

This young woman made four suicide attempts between Christmas 2016 and May 2017. 

She made her final attempt on her own life in the hour after being discharged from South Tipperary General Hospital.

The doctor who had carried out a risk assessment on Hollie before her final suicide attempt said her previous overdose was impulsive rather than planned, she had no psychotic symptoms, regretted what she had done, and denied she had any further desire to self-harm. 

She had agreed to start a therapy programme two days later.

The jury in this case returned an open verdict, directed by the coroner who felt Hollie may not have intended to kill herself but may have had a false sense of security given the previous attempts on her life which she had survived.

She is dead, however. That is what her loved ones must cope with. 

And the hard fact is that she killed herself having been released from one of our hospitals with drugs prescribed by the State health service.

“Accountability” is a word which is over-used. When it comes to deaths by suicide following discharge from our hospitals, accountability is what we need, however.

Not because “heads must roll”. But because lives must be saved.

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