Wednesday, 11 March 2020

THE REALITY OF LIFE AFTER ATTEMPTED SUICIDE | TW




I’m all for using previously popular posts as inspiration for new content, and the success of my post ‘THE REALITY OF LIFE OF LIVING WITH SELF-HARM SCARS’ last April, has inspired my thoughts around this new post about what it’s really like to continue living after you’ve attempted suicide. Another inspiration for this post came in the form of someone sharing an in-depth look into their suicide attempt story after finally recovering from jumping off a bridge and ending up in a coma and with a lot of broken bones and internal injuries. This person’s aftermath was obviously a completely different journey to my own, especially physically, but it inspired me to talk more about the consequences to a suicide attempt rather than my usual concentration of the run-up to one and the actual act of it.


I’d like to also give a trigger warning (TW) to this post because after the media shared the means which Caroline Flack used to commit suicide, there was a lot of controversary in the mental health community around the necessity of disclosing this information. Some people worried that it would trigger others to follow suit and some thought it completely inappropriate and unnecessary to talk about the method. Personally, I agree that it isn’t relevant to tell the general public such details, so for this post, I will talk about the method of suicide I used only where it is necessary and relevant such as when I talk about the physical aftermath. If you’re concerned that this information will be upsetting, then please don’t continue reading this post! If you do read on and it becomes triggering, please use healthy and safe coping mechanisms and speak to a professional for help and advice.

THE PHYSICAL AFTERMATH

This is probably the only area where talking about the method I have used is relevant, so I thought I’d get it out of the way quickly! I also thought I’d talk about this aspect first because it is probably the most immediate because all of my suicide attempts have been through overdoses of paracetamol. 



The very first overdose I took in 2009 was completely impulsive and without any planning or knowledge of what the consequences would be; I kind of just thought it’d be like in the movies where you swallow a ton of pills and lose consciousness. Of course, paracetamol doesn’t kill you that way. The thing is, once I’d learnt how it does kill you (by damaging your liver), and what the treatment to counteract that risk is, I sort of found comfort in that knowledge. That sounds wrong, but it’s the truth. I just mean that I felt secure in the fact that I knew what to expect from it because I appreciate a forewarning with all things in life in general; not just this!


I thought that I deserved the prolonged pain that liver failure causes, but I also believed that if someone found out what I’d done and the antidote treatment was forced upon me, I deserved the affect that treatment had too. I thought this because I quickly found out that I’m actually allergic to the antidote treatment (commonly known as Parvolex) and need an antihistamine and anti-sickness medication throughout the duration of the treatment (it can take about twenty-one hours to drip through). I also have incredibly bad veins and thought that I deserved the pain and stress of the numerous attempts to insert a cannula; which occasionally ended in the insertion of a central line, mid-line or – on one occasion – an IO. You’d think that maybe these physical consequences to overdosing would stop me doing it; as though in the moments when I was being sick, I’d be thinking ‘I’m never doing this again’ because I felt so awful. However, not only did I think I deserved these consequences, I was also so desperate for relief from the many thoughts and feelings that motivated the suicide attempts that I really didn’t care if I’d be vomiting and in pain. Sometimes, being physically poorly was a welcome break from having poor mental health. Of course, you can have both at the same time, but – for me – there’s always one in the foreground and when I overdose, that puts my physical health in front and allows for little attention to be paid to my mental health. Almost as though it was a distraction technique. 


There’s probably been three worst physical aftermaths I’ve gone through. The first, was when I was hospitalized, and the Doctor didn’t believe I was allergic to the antidote treatment and refused to give me an antihistamine. My lips swelled so bad that I felt like a glamour model with a trout pout(!) and my throat swelled up to the point where I ended up on oxygen in the resuscitation room and being given a ton of antihistamines! It was so scary because even though I could barely breathe, I was still conscious so I can remember the entire experience and that feeling of not being able to get enough oxygen into my lungs. It was almost like a panic attack; just multiplied by one hundred! 


The second occasion was in 2012 when I was detained under the Mental Capacity Act after refusing treatment for the overdose and the Doctors decided to sedate me and put me onto a ventilator and life support machine in the Intensive Care Unit. Unfortunately, the general anesthetic was too light, and I woke up whilst on the ventilator. I can remember feeling the tube down my throat and that it was nipping my lip. And I remember feeling someone inserting a catheter into my bladder but I couldn’t move or even open my eyes and the only reason the staff realized I was awake was when I felt a tear trickle down my face and I heard someone say ‘her heart rate’s going up!’ Ever since that experience, if I’ve needed a general anesthetic for something (like my tendon surgery), I’ve made sure the staff were aware that I might need more sedative than they think. 


The final instance was when I went AWOL whilst a sectioned inpatient, the Police found me surrounded by empty boxes of tablets and I was taken to the medical hospital where I refused the antidote treatment. Initially, the Doctors attempted injecting me with mild sedatives so that they could administer the treatment but I was so hell-bent on killing myself that when the cannula was put into my foot I used my toes to pull it out and was being constantly being restrained by staff. In the end, the Doctors put me to sleep under a general anesthetic and I was placed on life support for two days. When I was woken up, I was so sick that I couldn’t keep any food down and slept for about three days straight! 


There’s been other overdoses where I’ve purely taken them because my hallucinations have told me to and I haven’t actually wanted to die, but the physical aftermath has still been bad… There was one time when a Doctor had fourteen attempts at inserting a cannula before giving up and putting in a central line; that was painful. There was another instance where my terrible veins meant that a Doctor in Accident and Emergency (A&E) decided to put in an IO and after drilling into my shin bone, discovered that actually, my bones were too dense to take the antidote medication and I was left in pain for hours before they could get take it out and get another cannula in. These instances were probably more upsetting than the others because I hadn’t actually wanted to die so I had sat through all of the procedures.



MENTAL HEATLH ASSESSMENTS & BEING SECTIONED

My local hospitals have this procedure where as soon as you’re medically fit from self-harm or a suicide attempt, you have to see the Psychiatric Liaison Team (PLT). Of course, if you’re refusing treatment and things then this can hasten and change but where you’re co-operating with the medical staff, that is the priority. Sometimes I think that this is slightly backwards because there are times when if I could have spoken to the mental health team from the moment I went through the A&E doors, I might have coped a lot better with the admission for the antidote treatment. It might also have helped the medical staff to better support me through the admission if the mental health team can give them more information and an increased understanding into my reasons behind what I have done. This post is about suicide though, and where an overdose has been a suicide attempt, I’ve always refused treatment which has meant that I’ve had assessments whilst not being medically fit.


Assessments will usually differ depending on who is seeing you and what the purpose of the assessment is. Normally the first instance is a bit of an informal chat with PLT who will then decide if you need further mental health intervention and what that should be. Alternatively, where someone has discovered, by some means, that I’ve overdosed and I refuse to go into hospital, the Police can be called, and they can use their sectioning powers under section 136 of the 1983 Mental Health Act. Where this is the case, you have to have a Mental Health Act assessment with two Psychiatrists and an AMHP (Approved Mental Health Practitioner) who will then decide whether you require an admission to a psychiatric hospital and if that admission should be forced through detaining you under the Act or offering for you to go in voluntarily.


I honestly think that there are some questions you’ll be asked where it really doesn’t matter who you’re with and whether it’s a formal assessment or not. Here’s the five questions I can almost guarantee you’ll be asked:

1.       Did you leave a note for anyone?

2.       Do you really want to be dead or did you just want to escape something?

3.       Do you regret it now?

4.       Why did you do it?

5.       What do you want to happen now?


That last one is – in my opinion – a bit of a dummy question because I’ve found that it really doesn’t matter how you answer it, your answer is never really considered in their final conclusion/decision. If you think you’d benefit from being under the care of the Crisis Team and they think you’re not that poorly then your thoughts really won’t make a difference. There are probably professionals reading this who are thinking ‘I care what the Service User thinks!’ and it might be true; you might care. It’s just about whether that ‘care’ is enough for it to shape your opinion of the crisis. I can literally give so many examples where I’ve felt that my thoughts and what I want from the situation haven’t been listened to and it’s left me very reluctant to tell a professional what I think will help. Just a few days ago I said that I’d like to be on the caseload of the Crisis Team until my Community Psychiatric Nurse (CPN) is back at work, but they said that I’m well enough to not need that. It was hard to hear because I felt as though I’d put myself out there by asking for help, and that I hadn’t even been asking for a lot from them. It’s also slightly frustrating because I sometimes feel that when I voice that there’s something I don’t want to happen; they’ll go ahead and do it anyway! When you feel that you can’t win, how can you find the confidence to speak up?


A lot of people assume that if someone makes an attempt on their life then they should automatically be admitted to a psychiatric hospital and in all honesty, I used to think that and it was one reason why I was so upset and scared after surviving my first overdose. I was told after my first overdose that if they’d known at the time why I’d done it, I might never have been sectioned, but because it was so out-of-the-blue to everyone, I was detained under section 2 of the Mental Health Act. Even though I ended up on life support for the first time in 2012, the mental health team had decided that they still weren’t going to admit me to a psychiatric hospital and it was only when my Mum and Community Team stepped in that it was agreed to send me to the specialist hospital I spent two and a half years in. In the hospital I was told by staff that had I taken just one attempt on my life in their area (it was over 100 miles from home) then I would have been admitted. Instead, my records show that on my admission to their hospital, I’d taken over 60 overdoses (though most of them weren’t suicide attempts). It made me angry to think that mental health care is sometimes a bit of a postcode lottery and I recognized that even though I hadn’t always intended to kill myself, any one of those overdoses could have done just that!


 Being sectioned for the first time was terrifying because I hadn’t been under mental health services before, so it was like going from nothing to being thrown in at the deep end, surrounded by people hearing voices and self-harming. On the one hand, it helped, and I gained the confidence to tell someone that I could also hear voices, but on the other hand, I was terrified that I would still be there in years to come!


I think that there’s one main reason why mental health professionals don’t always section someone after they’ve attempted suicide – or at least, there’s one that I’ve heard of! It’s about avoiding the person becoming institutionalized and reliant upon services. It’s often referred to as ‘positive risk-taking’ and it’s when the professionals believe that a person should be trusted with the responsibility of keeping themselves safe. Personally, I think it’s a huge risk to take; I mean, you’re chancing someone’s life! But I understand the need for it… and sometimes I do even agree with it! It must be a hard job to make that sort of decision about someone because there have been so many instances where that person has gone on to succeed at taking their own life and the professionals are left being blamed for it.



COPING WITH ALL OF YOUR MOTIVATIONS

Just because a suicide attempt has been unsuccessful, it doesn’t mean that all the reasons why you did it, have gone away. It’s not unheard of for someone to come through a suicide attempt and feel as though they’ve developed a new passion for life and that they have seen that suicide isn’t the answer to all of the motivations they had to make the attempt on their life. Personally, the two biggest reasons I’ve had that have led to me attempting suicide have been the hallucinations and the memories of the abuse I went through when I was younger so obviously, those two things don’t just go away when I survive an overdose.


When I woke up from the coma on life support, and the auditory hallucinations were still there, I can’t even begin to explain just how disappointed and ultimately devastated I was. I think the fact that I was still so suicidal really motivated the mental health professionals in hospitalizing and sectioning me. In the beginning of my mental health deteriorating, in 2009, whenever I would self-harm, I would end up feeling better afterwards and the hallucinations would have silenced because I’d done what I’d been told by them. However, when it came to making a suicide attempt? Well surviving it really didn’t change anything. Out of all four of my suicide attempts, it was only in the 2013 one that I actually felt less suicidal afterwards. That instance was my ‘kick up the bum’ to make me see that I didn’t want these attempts and admissions to become my life and to begin to define me and who I am. I made the mistake of saying this to a really vulnerable inpatient and the next thing I knew she was attempting suicide in a desperate bid to feel better and put herself on the road to recovery. So, please don’t think that’s what I’m saying; that I’m recommending you do this in order to improve things! I’m not. I’m just saying that’s what happened for me. 


Finding that my motivations were still motivations and that my suicide attempt hadn’t succeeded in ridding me of them left me wondering whether it hadn’t helped me because I hadn’t died or whether I really needed to find an alternative way of coping. To be honest, it usually led to me revising my plans to commit suicide because I was still convinced that not being successful was the only reason the voices were still there, and the memories of the abuse. Of course, being in a psychiatric hospital and learning Dialectical Behaviour Therapy (DBT) meant that I was shown new, healthy, and safe ways of coping with these things; which included medication and skills like self-soothing and distraction.



STIGMA ABOUT METHODS

Even among mental health service users there’s a stigma around which method you’ve used to attempt suicide, but the most harmful place I’ve experienced the stigma being in was with the Police. I had numerous comments from Officers saying that if I had truly wanted to kill myself then I’d have hung myself rather than take an overdose that – even without the antidote treatment – may not ‘work.’ I mean, you’d think they were encouraging me to do it – when you’re as vulnerable as I was at that time it’s very easy to see a comment like that as a hint or recommendation and find yourself feeling as though what you have done wasn’t ‘good enough.’


Another aspect of the stigma on this topic is around how the different methods can have such a different impact on others. There are some methods that can affect the general public and complete strangers and these are often seen as the more ‘selfish’ methods because some believe that if a person is aware of the impact they will have on others and does it anyway then they must’ve only been thinking about themselves. There was recently someone hit by an LNER train and the company put out a tweet in response to messages from angry travelers who were furious that they were late to their meetings because the trains had all had to stop. LNER wrote that these people were forgetful of the fact that whilst the train company would endeavor to get them to their intended destinations, the person who had been killed would never make it home.


Can this stigma around the methods ever be a good thing though? You’d think not; but for some, the knowledge of what others will think of them if they attempt suicide with a particular method could dissuade them from doing it. But then, was that person genuinely suicidal if something like that could stop them from ‘seeing it through?’ If that person labels their feeling as suicidal then that opinion should be respected and believed. No family can ever really be comforted after a loved one has attempted suicide but does it in any way help them to know that it wasn’t done in a painful way? Would it help to know that their loved one wasn’t hurting physically?



BEING DOUBTED

I think that there are so many difficult emotions out there that if someone were to doubt you were feeling one of them it’d be hurtful; but for someone to doubt you feel suicidal is probably one of the biggest, most debilitating insults in mental health. Being suicidal is one emotion that can leave you feeling really vulnerable and it’s something that takes a huge amount of effort to tell someone you’re feeling that way. I mean, everyone knows that the second you tell someone – anyone, really – that you feel suicidal then something will pretty much always be done about it! Especially where that person is a professional such as a GP, Police Officer, Paramedic or Nurse. The whole ‘duty-of-care’ thing is so worn out in my life that it no longer means that much to me, so when someone uses it to excuse their need to do something (like ring the Police or detain me under the Mental Health Act) about my feelings, I tend to just think ‘it’s their job; they don’t actually care!


Another reason for doubting your intent with the suicide attempt comes in the belief that it was purely attention-seeking behaviour. I won’t lie; I’ve not had the comment about attention seeking for a very long time because – I think – that Services have improved to the point where professionals finally realize how offensive and dangerous this comment can be to someone struggling with their mental health. There was a point in my mental health journey where Doctors, Nurses, Police, and the Crisis Team regularly accused me of self-harming  and voicing my suicidal feelings for attention and not because I was actually unwell (I ended up writing a blog post on it back in 2014, you can read it here). These comments were really hard to hear and made me very reluctant to open up to professionals and talk about my thoughts and feelings; which often meant that my suicide attempts increased because I was unable to get the help and support I needed when thoughts of doing it had first started.



TRUST ISSUES

Attempting suicide can be a huge knock to your relationships with friends, family, a partner… everyone. Usually a suicide attempt comes off the back of keeping your thoughts and feelings a secret so as to avoid anyone stopping you from making the attempt. This reluctance to talk about things can sometimes leave loved ones and people who care about you, feeling let-down because you haven’t confided in them and trusted them with what you’re going through. There are probably people reading this who are thinking ‘how would she know how someone else is feeling?’ and that’s because I never really talk about when one of my best-friends; Vicki, committed suicide in 2010 (I did write a post about it back in 2013 though! You can read it here). Losing someone I cared about in that way, was obviously incredibly hard but it also ended up being slightly helpful because it allowed me the opportunity to see things from a different perspective. It gave me a tiny understanding as to how my friends and family must feel when I’ve attempted suicide. Some people might wonder why I still attempted suicide after learning how it made others feel, but I think it just illustrates how powerful suicidal thoughts and feelings can be; they can render anything that could derail you completely meaningless.


Sometimes, my conviction that nothing can stop me from carrying out my suicide attempt is enough to stop me from telling someone how I feel. I end up thinking ‘what’s the point in upsetting them when they won’t be able to help anyway?!’ People used to constantly go on at me for not ringing the Crisis Team before attempting suicide and I used to say that I honestly couldn’t see the point in telling them that I was feeling suicidal because nothing they could say would change that. Then I would have just poured my heart out to them for no reason, and I already felt so vulnerable that I couldn’t make sense of why people would expect me to make that worse and gain nothing from doing so.


Finally, on the topic of trust; I’ve known a few people who have committed suicide and it has seemingly come out of nowhere. I – and others around these people – have thought they were doing well and feeling better and then they’ve committed suicide. I guess it’s the same with attempts, except that person is still around to deal with their loved ones consistently questioning their happiness. Because how can they ever trust that it’s ‘genuine’ or that it will last if it hasn’t when you’ve previously thought that? There’s been so many times when I’ve reassured friends and family that I’m doing much better and that I’m coping with things and actually I’ve been struggling, or sometimes I haven’t been and it just comes from nowhere and all of a sudden I’m swallowing a ton of tablets!



TALKING ABOUT IT

Should we talk about suicide as much as we are? Should we talk about it more? Or less?


I’m definitely all about raising awareness of mental health issues and obviously suicide falls under that bracket, but does talking about it do any harm? 


There’s plenty of people out there who’ll tell you that reading about – or hearing about – suicide can be triggering and upsetting for them, but there’s also people out there who’d say that it’s a topic that isn’t spoken about enough and that we need to raise more awareness of it. I think there needs to be a balance between raising awareness in the hope that it’ll abolish stigma, and keeping it out of the headlines in case it triggers someone into remember an attempt or even actually trigger them to attempt to take their own life. Should people take a certain amount of responsibility in protecting themselves against some information the media put out there that they might find distressing? Yes, definitely. But in a world where the press is everywhere, how possible is it to completely zone out of current affairs and the latest celebrity news? And should we be avoiding it, or should we be working on building a resilience to this trigger? A resilience can be healthy but having to take a risk to build one can be very unsafe.

I hope that this post has been helpful to those who have attempted suicide and feel that they’re alone or misunderstood in experiencing the consequences and the aftermath. I also hope it’s helped others who have no personal experience, to better support someone who does and to gain an improved understanding of just what they might be going through now that they’ve survived their attempt.

Again, if this post has upset you or someone you care about please seek professional help, support, and advice!