Tag Archives: suicide

My First Podcast

My first podcast has been released by Nurse & Midwife Support to coincide with RUOK Day. 

It’s about suicide and nurses and mental health and social media and stuff.

You can access it by clicking here or on the picture below.

Many thanks to Mark Aitken at Nurse & Midwife Support for interviewing me back on 10th October 2019 (World Mental Health Day) for this podcast.

For those who don’t listen to podcasts, below is a copy of the transcript that I have pirated from this webpage:

Mark Aitken: I’m at the Australian College of Mental Health Nurses 45th International Conference in Sydney. My guest today is Paul McNamara: Clinical Nurse Consultant, Consultation Liaison Psychiatry Service at Cairns and Hinterland Hospital and Health Service. Welcome, and hello Paul!

Paul McNamara: G’day Mark, thanks for having me.

MA: It’s great to have you here today Paul. Today, we will discuss suicide and support for nurses, midwives and students at risk of suicide and following the death by suicide of a colleague. Paul, as you report in your blog on your website (meta4RN.com which I’ll get you to talk about shortly) you cite a retrospective study into suicide in Australia from 2001 to 2012 that uncovered these alarming four findings:

  1. Female medical professionals are 128% more likely to suicide than females in other occupations.
  2. Female nurses and midwives are 192% more likely to suicide than females in other occupations.
  3. Male nurses and midwives are 52% more likely to suicide than males in other occupations.
  4. Male nurses and midwives are 196% more likely to suicide than their female colleagues.

They’re incredible statistics. Quite disturbing I think, Paul. Would you please tell our listeners a bit more about that? But also, your role and meta4rn.com and why you wrote the blog about suicide that you’ve titled Nurses, Midwives, Medical Practitioners: Suicide and Stigma.

PM: Sure. The hospital that I work in, I’ve been there off and on for nearly 20 years now. Back in the early 2000’s three of the nurses who worked there died by suicide. That was a bit of a shock to us all. It happened within a fairly short amount of time, about 18 months I think it was. It felt like knock, after knock, after knock. A lot of us, myself included, were standing around looking at each other. Looking at our colleagues on the nursing team and thinking, “Oh Christ, what could we have done better? What could we have done differently?” That’s really stuck with me. Then with my role, I work as a mental health nurse in the general hospital. Not everyday day of the week, but certainly every week of my working life I will see people who have attempted to take their own lives and have survived it and been admitted (medically or surgically) to be patched up. While that’s happening, I’m providing the mental health input.

I guess that suicide is just an everyday part of my working life. A bit more than I would like, sometimes, to be honest. When it effects my colleagues, that gives it an extra resonance. It was with those thoughts bouncing around my head when I saw that paper come out with that data. That was published in November 2016, it was written by a pretty impressive bunch of people. They were all doctors on the team. I think one of them was a PhD doctor, not a medical doctor, but the rest of them were medical doctors from various specialties. The bits of that story that were picked up by the mainstream media were about the escalated risk to doctors of suicide. The mainstream media didn’t really pick up on the escalated risks to nurses and midwives, which were actually a bit higher than the risks for female doctors. Interestingly, male doctors don’t kill themselves at a greater rate than blokes in other professions. So, it was very much about nurses and midwives. As we know, most nurses and midwives are females. The whole thing has just got a bit of a resonance for me. It worries me. I guess the title that I gave it, it was speculative. I wonder about the stigma around suicide as we (nurses and midwives) get exposed to suicide stuff so much. I wonder whether we stigmatise ourselves around that. That was what the blog post was all about.

MA: Thanks Paul, I think you make some really interesting points there. Would you tell our listeners a bit about meta4rn.com? People will obviously want to access this blog once they listen to this podcast. I think it’s a really important blog, so what is it and why did you start it?

PM: This could be the cleverest thing here today Mark..

-Laughs-

MA: Apart from us.

PM: That’s right. Meta4rn.com is a homophone, it’s a bit of a play on words. It can be read two ways: metaphor, as in using an analogy to get a point across. A lot of education happens that way, where we use metaphors. I think particularly amongst nurses and midwives, you’ll be at a nursing station saying, “You do it this way because it’s a bit like a…” We use that kind of language a lot. We use metaphors a lot, and I threw on RN at the end because that’s what I am, an RN. Another way to break down that name is meta, which is like if we were having a conversation about another conversation. That would be a meta conversation. A lot of the stuff I talk about on the blog is a conversation about nursing conversations. That was where the idea for the name came from. Every now and again, I feel a bit self-conscious about it because it is a little bit wanky.

I came about setting up that blog because at the time I was working in perinatal mental health. By definition, my patients were women aged somewhere between 15 and 45. That demographic had the best and quickest uptake of social media and smartphones. This is going back to 2009/2010 when I first started mucking around in that space. If you remember back to then, iPhones were still a relatively new idea. I think they had been on the market in Australia for a year and a half, two years. It was women within that age bracket who were buying them first using social media the most. I was saying to the organisation that I was working for at the time that we, as perinatal mental health, should be getting in that space where the women are. But it was a government organisation, bureaucracies are a little bit sluggish. They didn’t really want to act on that, so I left the organisation behind and just set it up representing myself as a nurse (not the organisation). But I put myself up on social media in that space. Initially, because I was still working in perinatal mental health, it had a focus around that. But the funding for that role disappeared, so my focus has become much broader since then.

MA: It certainly has grown, as has your following. You’ve got a lot of subscribers to your website and I get regular emails and information.

PM: Yes.

MA: If people want to subscribe they can just google meta4rn and they can become a subscriber to your site and get access to some of the great information on your blog?

PM: Yes, and look, only if you want to. It won’t be too spamy, I tend to write about one blog post a month now. So, you can do that. If you don’t want to subscribe, if you’re like me you’re probably sick to death of too many emails. Just have a look around and see if there’s anything of interest for you.

MA: Navigate it via the website?

PM: Yes.

MA: You’re an excellent speaker about the importance of nurses and midwives blogging, or being active on social media. Indeed, Paul and I are at the 45th International Mental Health Nurses Conference in Sydney. We have been here since the beginning of this week. We’re recording this podcast on the 10th of October which many of you will know is World Mental Health Day. So, happy World Mental Health Day to you all! May you commit to your own mental health self-care and support. Paul, I think that’s vital. You gave a great session yesterday about nurses and social media. Could you talk a bit more about that please?

PM: The session was 45 minutes long so I definitely won’t give you that much information. But look, the short story is that we (as nurses and midwives) now have access to telling our stories and more access to the public conversation than what we have ever had before. I used some data to back this up, so it’s not just a dopey opinion. But I think maybe if we went back 10 years in time it would be frustrating to hear mainstream media talking about nursing issues without actually talking to any nurses. That still happens now, of course. But, from my point of view, I think that rather than getting frustrated about the mainstream media why don’t we take control of what we do have? This is things like social media; Twitter, blogs in particular, YouTube, Facebook. Make it separate from your personal accounts. I find Instagram a little bit harder to use in a professional sense, but I’m playing with it. I’m probably the wrong demographic to really be good at Instagram. All of these social media platforms are free to access and give us the opportunity to get our voice out there and join in on those conversations. People get to hear from us now, whether they want to or not. I think that’s a really important power. I think that we’d be foolish to ignore it.

I’m not suggesting for a moment that each and every nurse, midwife or student listening to this podcast should go out and create a social media portfolio. That’s not going to be everybody’s cup of tea. But there were some people who were wondering about it, and I would encourage you to explore that space. Nurse Uncut, the NSW Australian Nurse and Midwifery Foundation companion website, they’ve got a blog role there that includes some great examples of nurses and midwives who have got blogs out there. Some of them are really really good, many of them are much better than mine in terms of the way that they look and the clarity of information that they present. But I think that if you’re thinking of having a go, have a go. My only suggestion or caution around that, as a mental health nurse so of course we’re big on boundaries, if you are going to go and do that be really intentional about setting up a professional social media portfolio quite separate to your personal stuff. So, my holiday snaps and what have you, to show off to family and friends are not under my own name. You wouldn’t be able to stumble across them easily, but if you were to Google Paul McNamara mental health nurse or Paul McNamara Cairns you will get bombarded with stuff that I want you to see. I’m mindful that some of my patients, colleagues and bosses will search for me on Google. Usually not with sinister intent, but more out of curiosity. I want to be in charge of what they see, and that’s what that’s all about.

MA: Thanks Paul, I think that’s really useful information. It’s a bit outside of our key or core topic today but it’s still some very useful information for nurses and midwives. Also, I would add that there’s some very useful information on using social media and blogging effectively. But also, in relation to your regulatory requirements on the Nursing and Midwifery Board of Australia website. So, if you’re kind of worried about how you’re presenting yourself, check those out first to make sure that you’re considering the regulatory requirements of your registration.

PM: And, look, I feel like those are fairly common sense guidelines. The short version is: don’t be a dick, and you’ll be fine.

MA: Good point Paul. Paul, you and I have been speaking about suicide and our concern for the profession, for nurses and midwives in relation to this since we first spoke at the beginning of Nurse & Midwife Support in 2017. In fact, you contacted me and raised your concern in relation to this issue. Indeed, the effect that the suicide of several colleagues at your health service had on you and other members of the team. Would you please share with our listeners why you think this issue is important for us to discuss? In relation to nurses and midwives? Indeed, getting it out into the open.

PM: I was really thrilled when Nurse & Midwife Support launched. I don’t know whether it’s a coincidence that that launch in March 2017 coincided with that paper I was talking about, which was published in November 2016. It was probably too short a lead time to have caused an effect, but the timing was great anyway. The advantage that Nurse & Midwife Support have over the Employee Assistance Programs or going off to see your GP is that it’s specifically targeted to nurses and midwives. It’s 24 hours a day, 7 days a week, which reflects the shift working nature of our jobs. For many and probably most of us anyway. Having that great degree of flexibility is really important.

A downside is probably that it’s all phone based. For a lot of us, at a time of emotional distress we’d really appreciate that face to face contact. But this is a good first step and I’m really pleased that it’s there. I’m the mental health guy who wanders around the general hospital, and I hear mixed reports about peoples experience with the Employee Assistance Program. Some people have had a terrific service, but not all. Particularly, if people are carrying concerns that they think may jeopardize their employment or their registration, accessing support via your workplace is scary. Being able to go beyond the workplace, far far away down to the other end of the telephone has that advantage around that. So, if the way that you manage your stress is that you’re really hitting the booze or doing something that might get you judged poorly in your workplace, I think it’s a great advantage to have somebody far away from the workplace that you can have that conversation with. So, if you do need to go back to your workplace and discuss that part of the issue, you may be able to go back with an at least partially formed solution. I think that that’s the great advantage.

MA: Thanks Paul. Just to clarify for our listeners, Nurse & Midwife Support provides brief intervention counselling and referral pathways. If you phone our service and you need face to face counselling, as Paul suggests, then we’re able to give you some referral options so that you can access that service. But I think in the first instance, it’s often really useful to phone a service like Nurse &Midwife Support, talk through the issue and get some options in terms of where you may go next. Paul, you state in your blog that suicide is a complex matter, that does not lend itself to easy understanding or simple solutions. However, something we know about health professionals is that they know that there are mental health services and supports. Health professionals know that these services can be accessed by people who are feeling suicidal. The data that you cite, and the research suggests that health professionals have an actual or perceived barrier to accessing these existing supports. You posed the question, I wonder what that barrier is? Paul, what is the barrier?

PM: I need to really clarify that I don’t know, that’s probably something for another team of researchers to explore. I can’t pretend that I know for sure but I imagine, through conversations with colleagues, that one of the barriers is about embarrassment. Shame. Nurses and midwives tend to be empathetic creatures, but because we’re so immersed in other people’s traumas we sometimes put up barriers which sometimes include some really irreverent defences. Like, if someone comes in after a suicide attempt, I have heard people say, “Why don’t they do it the proper way?” Stuff like that. When we say stuff like that, in front of each other, it doesn’t really give us permission to disclose that we’re at that point or getting close to being at that point. So, I think that sometimes the defences that we use so that we can go back to our job from day to day may accidentally stigmatize accessing support for each other. That’s what I was really trying to argue in that blog post. That we should just be a little bit careful about the ways in which we talk about suicide, for our patients and/or vulnerable colleagues. Let’s reach out to our colleagues, give permission and actually encourage them to come out and say that it’s ok to put up your hand if you’re going through a really rough spot. It would be foolish to pretend that that alone would make a big difference, but it would help.

MA: Thanks Paul. Do you think that there is a specific stressor, or there are stressors that prompt nurses to commit suicide rather than seeking help?

PM: Again, I’ll throw in the disclaimer that I won’t pretend to have all of the answers. But think about us, as nurses and midwives, and think about our psychopathology. We’ve probably got more empathy than the general man in the street. We’ve been attracted to do a job which almost in essence means that we’ve got to put the needs of others before our own needs. Anyone whose held their bladder for an 8-hour shift would recognise that. While you’re running around putting in catheters for other people, it’s not unusual for us to put the needs of others before us. I wonder whether that’s a part of the reason that nurses and midwives are overrepresented in suicide data, we’re not good at putting ourselves and our own needs first. Throw in on top of that, many of us do shift work so being sleep deprived makes us more emotionally vulnerable. We get exposed to other peoples’ trauma face to face. We’re up close and personal with our patients physical and emotional traumas. We’re the people who go behind the curtain and get exposed to those really raw emotions. For us to pretend that that’s not going to have a knock-on effect, would be a little bit foolish.

MA: Thanks Paul. On this day, World Mental Health Day, the 10th of October, we obviously place the spotlight on mental health. Do you think that there’s a lot of untreated mental health amongst nurses and midwives? Or indeed, untreated mental illnesses amongst nurses and midwives?

PM: Yes, we’re overrepresented in those common mental health problems such as depression and anxiety. We’re more likely than our patients to experience depression and anxiety, and I’m guessing for some of those reasons that I was just talking about before. There is, yes.

MA: Do you think that a more widely utilised facility for clinical supervision for nurses and midwives would improve their mental health and wellbeing?

PM: It’s about the only thing that stopped me from going mad. I probably am still a bit mad, but my clinical supervision has been such an important part of my practice. In Queensland, anyway, clinical supervision has been available to any mental health nurse working in the public sector since 2009. Interestingly, in the guidelines before that which were implemented in 2003 in Queensland, nurses were explicitly excluded from it. The rationale for that was a really good one, which is that it would cost a lot of money. But, it’s really important. We do emotional labour. We need to make sure that we look after ourselves.

Clinical supervision, just for those who don’t know a whole lot about it, it’s a bit of a dopey name. The analogy I use is say, a lot of our listeners will hold a Bachelor of Nursing or a Bachelor of Midwifery. Some of our listeners may hold a masters in this space, but not many of us will actually be bachelors or be masters. So, the name doesn’t necessarily accurately reflect what’s going on now. Clinical supervision was named about 100 years ago by psychotherapists. They were addressing their patients, one on one, who were talking through their problems. If they didn’t feel 100% confident that they weren’t making mistakes with the way that their sessions were progressing, they could tap a trusted colleague on the shoulder and be able to discuss the case with them. The colleague was then able to give supervision and support, to minimize the risk of harm to the patient.

That’s where the name comes from, it’s a bit icky for nurses and midwives. We’ve come from a fairly bullying culture so the idea of supervision sounds like scrutiny. It’s not. It’s very much about support and I was really thrilled to see in April this year that the College of Nurses, the College of Midwives and College of Mental Health Nurses in Australia put out that joint statement saying that Clinical Supervision should be available to all nurses and midwives, not just mental health nurses. All nurses and midwives in Australia should be given that opportunity to reflect on their practice so they can care for themselves. It’s not a self-indulgent thing, as this will enable them to provide better care for their patients.

MA: Thanks Paul. Just to pick up that point you made, because I do hear this when I’m around the traps talking to nurses and midwives around the bullying culture in nursing. I know some of our listeners will be very interested in this.

PM: I’ll be fair dinkum with you about this Mark. I think as a bloke, I kind of have managed to stand apart from that. It’s a bit weird, we’ve got two men here talking about nursing and midwifery. I think 89% of general nurses are female and 99% of midwives are female. So, it’s weird that blokes are talking about this, and I think that as a man I’ve probably dodged most bullets around bullying. But I hear it from my colleagues. A lot of it isn’t necessarily intentional. It’s about what happens in our workplace, we’ve got this busy stuff going on in busy wards that are crisis driven. There’s always a crisis going on. When something that would normally be addressed with empathy, kindness and calmness. Being met with an invitation for tea in the staff room, I think nursing has a culture where it’s like, “I can see you’re upset, but let’s get on with it.” I think that that emotional neglect is probably the biggest source of bullying that I’m aware of. But I know that through my gender, I’ve got blind spots around bullying.

MA: Thanks Paul, and what are you doing to look after your own mental health? A part from clinical supervision?

PM: Well clinical supervision is number one. My wife Stella is also a nurse, so we speak the same sort of language. We kind of look after each other. We’re really good at going to restaurants and going on holidays. We make a point of doing those sorts of things, to give ourselves treats. We’re working to get a benefit out of our nursing work. A personal benefit. More recently, I’ve recommitted myself to being a bad tennis player and an awful guitar player. Bought myself a new tennis racket and a new guitar, and I’m determined to be a little less crap at both.

MA: Well I look forward to seeing you in a band soon Paul. Just one last question, do you have a cut through message that will support nurses and midwives to seek help? Who may be at risk of suicide?

PM: Yes, don’t leave it until it’s too late. I think we’re almost predisposed to go; “Oh she’ll be right, she’ll be right, she’ll be right.” Don’t leave it until it’s crisis point would be my idea. If you’re going through a bit of a rough patch, don’t be shy about picking up the phone to Nurse a& Midwife Support. If you’ve got a decent GP who you can have a yarn to, that would be the next best port of call. He or she can make a referral to a credited mental health professional such as myself or maybe a psychologist or someone who can provide that one on one emotional kind of support. Just prioritise your health. I’m playing a tricky little emotional blackmail on your listeners now, but even if you don’t want to do it for yourself, it would be really good for your patients if you’re not overwhelmed by depression and anxiety. If you’re a bit motivated by helping others, you can do that by helping yourself.

MA: Thanks Paul, great advice. Well I can’t believe we’ve come to the end of another podcast, we could talk about this all day! Thanks Paul, we’ve had some great conversations since we met in 2017. We’ve talked about Nurse &Midwife Support today; mental health, suicide and the barriers for nurses and midwives accessing support. We’ve talked about stigma, the research, we’ve provided some strategies for overcoming stigma and the elements to supporting nurses and midwives at risk of developing mental illness and suicide. Paul, do you have any final words of wisdom for our listeners?

PM: Wisdom? No. But look, good luck out there. We know it’s a difficult job. You deserve to be cared for.

MA: Thanks Paul. If you found this podcast useful, please share it with other nurses, midwives, graduates and students. Feel free to rate us on whatever platform you’re listening on. That will help to elevate us and for other people to actually find our podcasts. This is important, because your health matters. Look after yourselves and each other, we’ll have some information attached to this podcast that will provide you with access to Paul’s blog, his website and indeed some services that can support your health and wellbeing. Take care, and I’ll speak to you next time.

 

Three Links

The podcast and transcripts:
www.nmsupport.org.au/resources/podcasts/discussing-suicide-jon-tyler-paul-mcnamara

Suicide info:
www.nmsupport.org.au/mental-health/suicide

Nurses, midwives, medical practitioners, suicide and stigma
www.nmsupport.org.au/news/nurses-midwives-medical-practitioners-suicide-and-stigma

 

End

That’s it. Thanks again to Nurse & Midwifery Support – what a terrific back-up for me and my colleagues.

As always, your feedback is welcomed via the comments section below.

Paul McNamara, 10 September 2020

Short URL: meta4RN.com/podcast

 

Clean Hands. Clear Head.

Part 1. Clean Hands. Clear Head.

“Clean Hands. Clear Head.” is an animation of a mindfulness script that distills the content of my 2016 blog post “Hand Hygiene and Mindful Moments” into a short (less than 2 minutes) video. The voice part was recorded on an iPhone at a hospital sink #authentic. The visuals were done on Prezi.

Here’s a link to the Prezi version of “Clean Hands. Clear Head.” prezi.com/jehramlhdkcm

Addit 29/03/20: to my surprise, some people want a text version. I won’t write out the whole thing (too long, a bit dull), but below are some key phrases:

This is my mindful moment.
The anxiety and tension will be washed away.
I will rub in the resilience and kindness that sustains me.
After 20 seconds or so I will pretend I’m TayTay, and shake it off. 🙂
I will smile, then will intentionally slow my breathing.
Me and my hands will be safe.

Feels free to use/modify PRN. I would be grateful for source attribution as “meta4RN.com/head”
Just in case it’s handy here is a PDF: CleanHandsClearHead
And here is a MS Word version: CleanHandsClearHead

Part 2. Surviving Emotionally Taxing Work Environments. March 2020 version.

On a related topic, for the last few years I’ve facilitated many hour-long, interactive sessions called “Self Care: Surviving Emotionally Taxing Work Environments.” for my fellow nurses at the hospital where I work. As at March 2020, I’m not confident that we’ll have an opportunity to meet face-to-face as a group all that often, so I’ve tweaked the session, tried to cut-down on the rambling, and have switched from hour-long interactive, to 20 minutes of well-intentioned, a tad-amateurish, youtube video embedded below:


Self Care: Surviving Emotionally Taxing Work Environments. March 2020 version.
(video, 20 mins)

Here’s a link to the Prezi version of “Self Care: Surviving Emotionally Taxing Work Environments. March 2020 version”: prezi.com/xcejt9pgd0b3

Part 3. References & Resources.

I’m recycling and combining a lot of old ideas for the March 2020 version of  “Self Care: Surviving Emotionally Taxing Work Environments.” Self-plagiarism? Nah – it’s a groovy remix of some favourite old songs. Regular visitors to meta4RN.com may recognise the repetition, and be quite bored with me using the website as a place to store updated versions of old stuff. Sorry about that, but it’s just so damn convenient. 🙂

Here are the resources and references used in the presentation: (because I’m recycling old ideas this list is ridiculously self-referential).

Australian College of Mental Health Nurses [www.acmhn.org], Australian College of Nursing [www.acn.edu.au], and Australian College of Midwives [www.midwives.org.au] (2019) Joint Position Statement: Clinical Supervision for Nurses + Midwives. Released online April 2019, PDF available via each organisation’s website, and here: ClinicalSupervisionJointPositionStatement

Australian Government (24 March 2020) Coronavirus (COVID-19) current situation and case numbers
www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert

Basic Life Support Procedure
https://qheps.health.qld.gov.au/__data/assets/pdf_file/0030/607098/pro_basiclifesprt.pdf

Eales, Sandra. (2018). A focus on psychological safety helps teams thrive. InScope, No. 08., Summer 2018 edition, published by Queensland Nurses and Midwives Union on 13/12/18, pages 58-59. Eales2018

Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks

Employee Assistance Service (via Queensland Health intranet)
qheps.health.qld.gov.au/hr/staff-health-wellbeing/counselling-support

Employee Assistance Service (via Benestar – the company that CHHHS contracts out to)
benestar.com

Football, Nursing and Clinical Supervision (re validating protected time for reflection and skill rehearsal) meta4RN.com/footy

Hand Hygiene and Mindful Moments (re insitu self-care strategies) meta4RN.com/hygiene

Lai. J, Ma. S, Wang. Y, et al. (23 March 2020) Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open.
jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229

Lalochezia (getting sweary doesn’t necessarily mean getting abusive) meta4RN.com/lalochezia

Nurse & Midwife Support nmsupport.org.au  phone 1800 667 877
– we have specifically targeted 24/7 confidential support available

Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma

Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories) meta4RN.com/nurturers

Queensland Health. (2009). Clinical Supervision Guidelines for Mental Health Services. PDF

Spector, P., Zhiqing, Z. & Che, X. (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies. Vol 50(1), pp 72-84. www.sciencedirect.com/science/article/pii/S0020748913000357

That was bloody stressful! What’s next?
Web: meta4RN.com/bloody
QHEPS: https://qheps.health.qld.gov.au/__data/assets/pdf_file/0038/555779/That-was-bloody-stressful.pdf

Zero Tolerance for Zero Tolerance (a reframing of reducing aggression) meta4RN.com/zero

End

Thanks for visiting. Let’s join the kindness pandemic to offset some of the crap that goes with the COVID19 pandemic.

As always, your feedback is welcome in the comments section below.

Stay safe.

Paul McNamara, 25 March 2020

Short URL: meta4RN.com/head

Creative Commons Licence
Clean Hands. Clear Head. by Paul McNamara is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Diagnostic Overshadowing

Consultation liaison psychiatry services (CLPS) are, typically, based in a general hospital setting to provide the dual services of mental health clinical assessment/treatment and clinician support/education. The clinical and education roles overlap – a lot.

A significant part of the CLPS job is undiagnosing mental illness. Undiagnosis is often correcting a misdiagnosis, and also serves to validate the emotions and experiences of people (Patfield, 2011; Lakeman & Emeleus, 2014). It is not unusual for CLPS to be asked to see somebody who is emotionally overwhelmed or dysregulated. Sometimes this is in the context of mental health problems often in the context of significant stress. Naturally, we do not want to ‘psychiatricise’ the human condition. Of course, you cry when you are sad, and of course you are anxious when, like Courtney Barnett in ‘Avant Gardener’, you are not that good at breathing in. Of course, you’re frustrated when you are in pain or do not understand what’s going on.

Validating understandable and proportionate emotions is important.

It is equally important to make sure that somebody who has experienced mental illness previously does not have every presentation to the hospital/outpatient clinic seen through that lens. That is called “diagnostic overshadowing”; which is a significant problem.
Diagnostic overshadowing is where physical symptoms are overlooked, dismissed or downplayed as a psychiatric/ psychosomatic symptom. It must be one of the most dangerous things that happen in hospitals.

The President of the Royal Australian and New Zealand College of Psychiatrists, Professor Malcolm Hopwood, said in May 2016, “I sometimes think that the worse thing a person can do for their physical health is to be diagnosed with a mental health disorder.” Prof Hopwood cited stigma and discrimination in the health sector as contributing problems to early mortality amongst people with mental health problems.

People, hospital clinical staff included, are often shocked when they find out that people diagnosed with mental illness die between 10 and 25 years younger than the general public. Although suicide is a contributing factor to high mortality rates amongst this part of the community, it is alarming to note that the overwhelming majority – 86% – of people with mental health problems who had a premature death did not die from suicide (Happell & Ewart, 2016).

About 60% of people who experience mental health problems experience chronic physical health problems too. Poor mental health is a major risk factor for poor physical health, and vice versa (Harris et al, 2018).

The lived experience

Diagnostic overshadowing happens outside of hospitals too. In the example below, understandable and proportionate human emotions were misinterpreted as psychopathology. The cascade of events that followed makes for a sobering read:

Eight years ago I was diagnosed with bipolar affective disorder (BPAD) and recovered enough to commence a PhD. Unable to obtain travel insurance for a conference due to my diagnosis, I disclosed the reason to my supervisor. Unfortunately, he began to see all stress (normal to a PhD student) as BPAD symptoms and decided I was incapable of completing the PhD and progressively began to discriminate against me. My mental health started to decline. I imagine this must have validated his belief that I was an unsuitable student.

I received some help from the university, with an advisor indicating that my supervisor was undermining my work. The advisor was promoted. Despite not knowing me, his replacement did not believe my account and disagreed with my psychiatrist’s assessment of my mental state. Other staff and graduate students joined the belief that I could not cope, alienating me from the entire department.

After almost 18 months of fighting, I was once again depressed and felt defeated. I left the degree and lost my scholarship. It was one of the hardest things I have done. After, I was unable to gain employment; overqualified for most positions, lacking experience for the rest, and no references. After five months of constant rejections and lingering grief from losing the PhD, my self-worth and coping ability were so diminished, I made a very serious suicide attempt. I was so distressed that I could not see another solution.

Seven months later and I still have no paid employment. I have been undertaking volunteer work to regain some meaning in my life and have set myself up for the long-term with a new field of study. However, this does not pay the bills, and living like this is taking its toll. Sometimes I do not know where my next meal will come from, I have lost friends because of their attitude towards mental illness, and have withdrawn from health-related activities because of a lack of finances. Most days I cope and can find meaning in what I do, some days are much harder.

Questions for Reflection

Assuming that you – the person reading this – is a health professional, we have some questions we would like you to reflect on.

Have I ever witnessed a person’s mental health history influence how their presenting complaint was investigated or treated?

How does my workplace prevent mental health stigmatising and diagnostic overshadowing?

What can I do to support good holistic patient care without falling into the trap of diagnostic overshadowing?

References

Happell, B. & Ewart, S. (2016). ‘Please believe me, my life depends on it’: Physical health concerns of people diagnosed with mental illness. Australian Nursing and Midwifery Journal, 23(11), 47.

Harris, B. Duggan, M. Batterham, P. Bartlem, K. Clinton-McHarg, T. Dunbar, J. Fehily, C. Lawrence, D. Morgan, M. Rosenbaum, S. (2018). Australia’s mental health and physical health tracker: Background paper. Australian Health Policy Collaboration issues paper no. 2018-02, Melbourne, AHPC.

Lakeman, R. & Emeleus, M. (2014). Un-diagnosing mental illness in the process of helping. Psychotherapy in Australia, 21(1), 38-45.

Patfield, M. (2011). Undiagnosis: An Important New Role for Psychiatry. Australasian Psychiatry, 19(2), 107–109.

Seriously mentally ill ‘die younger’. (2016, May 10). SBS News. Retrieved from https://www.sbs.com.au/news/seriously-mentally-ill-die-younger

PDF version

A one page PDF version [suitable for printing] is available here: DiagnosticOvershadowing

Citation

McNamara, P. & Callahan, R. (2018). Diagnostic Overshadowing. News, Summer 2018 edition (published December 2018), Australian College of Mental Health Nurses, page 17.

End Notes

The article above is a tidied-up version of a blog post that Bec and I collaborated on in October 2018 (see meta4RN.com/shadoworiginal). This is not called self-plagiarising, it’s more like doing a studio version of a demo tape. 🙂

Many thanks to Sharina Smith for encouraging us to submit the article to ACMHN News.

Paul McNamara, 15 December 2018

Short URL meta4RN.com/shadow

 

 

Diagnostic Overshadowing [original, now updated]

Source: I had a black dog, his name was depression https://youtu.be/XiCrniLQGYc

I work in a general hospital doing mental health clinical work and education. The two roles overlap. A lot.

A significant part of the job is undiagnosing mental illness. It’s not unusual for us to be asked to see somebody who is emotionally overwhelmed or dysregulated. Sometimes this is in the context of mental health problems, often it’s in the context of significant stress. We don’t want to psychiatricise the human condition. Of course you cry when you’re sad. Of course you’re anxious when, like Courtney Barnett in ‘Avant Gardener‘, you’re not that good at breathing in. Of course you’e frustrated when you’re in pain and/or don’t understand what’s going on.

It’s important to validate understandable and proportionate emotions.

It’s equally important to make sure that somebody who has experienced mental health problems previously doesn’t have every presentation to the hospital/outpatient clinic seen through that lens. That’s called “diagnostic overshadowing”. It’s a real problem.

Diagnostic overshadowing is where physical symptoms are overlooked, dismissed or downplayed as a psychiatric/psychosomatic symptom. It must be one of the most dangerous things that happens in hospitals. The President of the Royal Australian & New Zealand College of Psychiatrists, Professor Malcolm Hopwood, said in May 2016, “I sometimes think that the worse thing a person can do for their physical health is to be diagnosed with a mental health disorder.”

It often comes as a shock to people when they find out that those diagnosed with mental illness die between 10 and 25 years younger than the general public. The next shock comes when discovering suicide accounts for only about 14% of premature death. [source: ‘Please believe me, my life depends on it’: Physical health concerns of people diagnosed with mental illness]

It’s a big deal. About 60% of people who experience mental health problems experience chronic physical health problems too. Poor mental health is a major risk factor for poor physical health, and vice versa. [Source: Australia’s mental and physical health tracker 2018]

Diagnostic overshadowing happens outside of hospitals too. In this example, understandable and proportionate human emotions were misinterpreted as psychopathology. The cascade of events that followed makes for a sobering read:

Questions for Reflection

Assuming that you – the person reading this blog post – is a nurse, midwife or other health professional, I have some questions I’d like you to reflect on.

Have I ever witnessed a person’s mental health history influence how their presenting complaint was investigated or treated?

How does my workplace prevent mental health stigmatising and diagnostic overshadowing?

What can I do to support good holistic patient care, without falling into the trap of diagnostic overshadowing?

End

Sincere thanks to Bec (aka @notesforreview on Twitter) for giving permission to share her tweets re mental health stigma and diagnostic overshadowing. Her first-hand account is a powerful cautionary tale.

Paul McNamara, 1st October 2018

Short URL meta4RN.com/shadoworiginal

Update as at 15th December 2018

Bec and I tidied-up this blog post and it’s now been published.

See meta4RN.com/shadow

Clinical Care and Clinical Supervision

On Monday 17th September 2018 I’ll be presenting to the Cairns & Hinterland HHS palliative care team regarding clinical care and clinical supervision. It is planned as an interactive session accompanied by visual cues to give the discussion a bit of structure. Consequently, the transcript/dialogue of the presentation can not be included here.  The visual presentation itself doesn’t use powerpoint slides. It uses the prettier (and free!) platform Prezi instead: http://prezi.com/gtsqjgs9zdby

This page serves as a one-stop directory to the online resources used to support the discussion, and as an easy way for me to find the presentation. 🙂

I’m recycling and combining a lot of old ideas for the session (there’s that self-plagiarist vs groovy remix of favourite old songs thing again), so this list below is ridiculously self-referential:

Care goes in. Crap goes out. Ian Miller @ The Nurse Path, 30 May 2017
thenursepath.blog/care-goes-in-crap-goes-out

Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks

First Thyself (the core source of info for the visual aspects of this presentation) meta4RN.com/thyself

Flowchart courtesy of Dr Alex Psirides (aka  on Twitter), ICU, Wellington, New Zealand, sourced here:

Football, Nursing and Clinical Supervision (re validating protected time for reflection and skill rehearsal) meta4RN.com/footy

Hand Hygiene and Mindful Moments (re insitu self-care strategies) meta4RN.com/hygiene

Joseph Heller quote from Catch-22 (1961):
“People knew a lot more about dying inside the hospital, and made a much neater, more orderly job of it. They couldn’t dominate Death inside the hospital, but they certainly made her behave. They had taught her manners. They couldn’t keep death out, but while she was in she had to act like a lady.”

Living Close to the Water (re #dyingtoknowday and emotional intelligence) meta4RN.com/water 

Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma

Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories) meta4RN.com/nurturers

Sample Clinical Supervision Agreement (no need to reinvent the wheel – start with a wheel that works and tailor it to your needs) meta4RN.com/sample

Woody Allen quote from Without Feathers (1975)
“I’m not afraid of death; I just don’t want to be there when it happens.”

End

That’s it. Please feel free to play with the pretty prezi: prezi.com/gtsqjgs9zdby

Also, as always, please feel free to leave comments in the section below.

Thanks for visiting.

Paul McNamara, 2nd September 2018

Short URL: meta4RN.com/care

 

#WeNurses Twitter Chat re Communication and Compassion

On 21st December 2012 (Cairns time) nurses from the United Kingdom and Australia came together on Twitter using the #WeNurses hashtag. The planned Twitter chat was used to discuss issues raised by the much-publicised death of a nursing colleague – Jacintha Saldanha.

This curated version of the Twitter chat demonstrates nurses using social media in a constructive manner, and responding to the issues surrounding Jacintha’s passing with thoughtfulness and grace. This was in sharp contrast to the shrill, insensitive and ill-informed way the matter was discussed elsewhere on social media and in mainstream media in the UK and Australia.

I’ve used sub-headings in red to structure the chat as per the themes that emerged.

WordCloud created from the full transcript of the #WeNurses Twitter chat

Preliminary Information.
1.

2.

Introductions.
3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Setting The Tone.
14.

15.

16.

Communication and Confidentiality.
17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

Mobile Phones.
38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

Social Media.
54.

55.

56.

57.

58.

59.

Individualising Communication & Confidentiality.
60.

61.

62.

63.

64.

65.

66.

67.

68.

69.

WiFi for Hospital Patients.
70.

71.

72.

73.

74.

75.

76.

77.

78.

79.

80.

81.

Compassion.
82.

83.

84.

85.

86.

87.

88.

89.

90.

91.

Prank Call.
92.

93.

94.

95.

96.

97.

98.

99.

100.

Targeted Crisis Support.
101.

102.

103.

104.

105.

106.

Clinical Supervision (aka Peer Supervision, aka Guided Reflective Practice).
107.

108.

109.

110.

111.

112.

113.

114.

115.

Supportive Workplaces.
116.

117.

118.

119.

120.

121.

122.

123.

124.

125.

126.

127.

128.

129.

130.

131.

132.

133.

134.

135.

Preventative/Early-Intervention Resources.
136.

137.

138.

139.

140.

The 6Cs (Care, Compassion, Competence, Communication, Courage & Commitment).
141.

142.

143.

144.

145.

146.

Integrating Defusing Emotions into Clinical Practice.
147.

148.

149.

150.

151.

152.

153.

154.

Finishing-Up: Key Learnings.
155.

156.

157.

158.

159.

160.

161.

162.

163.

164.

Closing Remarks.
165.

166.

167.

168.

169.

170.

171.

172.

Farewells.
173.

174.

175.

176.

177.

178.

179.

180.

Explanation

These Tweets were initially compiled using a social media aggregation tool called Storify
storify.com/meta4RN/communication-and-compassion

Unfortunately, Storify is shutting-down on 16 May 2018 and all content will be deleted.

I’m using my blog as a place to mimic/save the Storify pages I created and value.

End Notes

This archive of Tweets relate directly to two blog posts I wrote at the time. If you’re interested in elaboration re the context at the time, please visit these pages:
Questions of Compassion meta4RN.com/questions-of-compassion
WeNurses: Communication and Compassion meta4RN.com/WeNurses

As always, please use the comments section below for any feedback/questions.

Paul McNamara, 3rd April 2018

Short URL: meta4RN.com/Chat

First Thyself

First Thyself – Surviving Emotionally Taxing Work Environments

On 28th April 2017 I’ll be presenting a session at the Ausmed “Breaking Point: Ice & Methamphetamine Conference” in Cairns. More info about the conference here: https://www.ausmed.com.au/course/ice-methamphetamine#overview

The nature of nursing will mean that we are likely to be are exposed to a range of challenges.

Feeling unsafe, witnessing violence, tragedy and dealing with trauma are some examples.

This emotionally taxing environment can result in tension with colleagues, family and friends.

This session will begin day two of the conference by creating an opportunity to discuss the following:

What are the professional implications of working in challenging areas of nursing and healthcare?

How can we maintain unconditional positive regard?

Why self-care matters and how to practice what we preach!

What’s all this then?

“First Thyself” is planned as an interactive session accompanied by visual cues to give the discussion a bit of structure. Consequently, the transcript/dialogue of the presentation can not be included here.  The visual presentation itself doesn’t use powerpoint slides. It uses the prettier (and free!) platform Prezi instead: prezi.com/skmu0lbnmkm5/first-thyself/#

This page serves as a one-stop directory to the online resources used to support the discussion.

I’m recycling and combining a lot of old ideas for the session (there’s that self-plagiarist vs groovy remix of favourite old songs thing again).

Here is the online presentation: Prezi

Here are the resources and references used in the presentation:

Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks

Football, Nursing and Clinical Supervision (re validating protected time for reflection and skill rehearsal) meta4RN.com/footy

Hand Hygiene and Mindful Moments (re insitu self-care strategies) meta4RN.com/hygiene

Lalochezia (getting sweary doesn’t necessarily mean getting abusive) meta4RN.com/lalochezia

Nurse & Midwife Support nmsupport.org.au  phone 1800 667 877
– we have specifically targeted 24/7 confidential support available

Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma

Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories) meta4RN.com/nurturers

Spector, P., Zhiqing, Z. & Che, X. (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies. Vol 50(1), pp 72-84. www.sciencedirect.com/science/article/pii/S0020748913000357

Zero Tolerance for Zero Tolerance (a reframing of reducing aggression) meta4RN.com/zero

It’s OK if you forget everything about today’s talk, just don’t forget that there is 24 hour support available via 1800 667 877 or https://nmsupport.org.au

End

Please have a play with the pretty Prezi prezi.com/skmu0lbnmkm5/first-thyself/#

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 30 March 2017

Short URL: meta4RN.com/thyself

 

 

Nurses, Midwives, Medical Practitioners, Suicide and Stigma

Trigger Alert – this blog contains info re suicide which may be unsettling for some people.

Alarming Data

Click to enlarge. To keep the data handy, save the image to your phone.

Click to enlarge. To keep the data handy, save the image to your phone.

A retrospective study into suicide in Australia from 2001 to 2012 uncovered these alarming four findings:

Female Medical Professionals 128% more likely to suicide than females in other occupations
(6.4 per 100,000 vs 2.8 per 100.000)

Female Nurses & Midwives 192% more likely to suicide than females in other occupations
(8.2 per 100,000 vs 2.8 per 100.000)

Male Nurses & Midwives 52% more likely to suicide than males in other occupations
(22.7 per 100,000 vs 14.9 per 100.000)

Male Nurses & Midwives 196% more likely to suicide than their female colleagues
(22.7 per 100,000 vs 8.2 per 100.000)

Data source: Milner, A.J., Maheen, H., Bismark, M.M., & Spittal, M.J. (2016) Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012. Medical Journal of Australia 205 (6): 260-265

Suicide is a complex matter that does not lend itself to easy understanding or simple solutions. However, something we know about health professionals is that they know that there are mental health services and supports. Health professionals know that these services can be accessed by people who who are feeling suicidal. The data suggests that health professionals have an actual or perceived barrier to accessing these existing supports. I wonder what that barrier is.

Stigma?

Could it be that nurses, midwives and medical professionals suicide at a greater rate than the other occupations because of actual or perceived stigma? We have the peculiar privilege of providing care for strangers who are/have been suicidal, but perhaps we aren’t so good at extending that nurturing care to ourselves and each other.

I have a suggestion for health professionals. If you ever come across a colleague who says something derogatory or stigmatising about a person experiencing mental health problems or suicidality, politely show them the data,. Save the chart above to your phone and show them that suicide is a bigger problem for nurses, midwives and female medical professionals than it is for people in other occupations. Say something like, “Suicide is an important issue for our colleagues too. Let’s both care for this patient like we would like to be cared for.”

You’re very welcome to share the chart above or this blog post with your colleagues – the short URL is https://meta4RN.com/stigma

There’s also a PDF version of the chart here: stigma

Hopefully, sometime down the track, the data will result in targeted support for the prevention of suicide by health professionals. However, we need not wait for our political masters, health bureaucracies and professional organisations before we walk-the-walk and talk-the-talk of fighting stigma.

If we see mental health/suicide stigma we should address it on the spot.

In the words of Lieutenant General David Morrison, “The standard you walk past, is the standard you accept.” As the data shows, it is dangerous for nurses, midwives, medical professionals and other health professionals to accept stigma.

alarmingdata

Support

It’s important to acknowledge that talking and thinking about suicide can be distressing. People in Australia can access support via:

Lifeline – 13 11 14

Suicide Call Back Service – 1300 659 467

MindHealthConnect www.mindhealthconnect.org.au

phone_hotline-40Outside of Australia and not sure where to get support? Google usually displays a red telephone icon and your country’s suicide support phone number when searching for a suicide-related topic.

End

That’s it. As always your comments are welcome in the section below.

Paul McNamara, 26th September 2016

The short URL for this page is https://meta4RN.com/stigma

Just in case you missed it above, here’s the original paper citation and link:
Milner, A.J., Maheen, H., Bismark, M.M., & Spittal, M.J. (2016) Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012. Medical Journal of Australia 205 (6): 260-265

A Blog About A Blog About Suicide

I’m going to keep this short.

On the eve of the second anniversary of the meta4RN.com blog we (guest writer Stevie Jacobs and I) have finally released her powerful, gutsy post “These words have been in my head and they needed to come out (a blog post about suicide).” I thought by opening up meta4RN.com to occasional guest posts I would save myself some time and effort. Ha! Stevie’s post has had the longest, most difficult gestation of all of the posts on this blog.

Why? It’s not because of Stevie’s writing – she writes very well – It’s because of the content.

It’s because we don’t know how to talk about suicide.

mindframe I remember as a 14  year old learning about suicidal ideation via the famous Hamlet soliloquy which starts: “To be, or not to be, that is the question…” Shakespeare didn’t seem to be as afraid as getting the tone/message wrong as Stevie Jacobs and I have been.

Luckily, we don’t have to navigate this tricky territory without a map. Mindframe – Australia’s national media initiative – have some very handy tips aimed (mostly) at media. They also have info for universities, the performing arts, police and courts. It would be silly to replicate all their information here – cut out the middle-man and visit the Mindframe website:
www.mindframe-media.info

The only thing I want to make sure is included here is that we, the health professionals, remain mindful of responsible use of language in social media, including blogs (and Facebook, Twitter, Instagram etc) . Melissa Sweet of croakey (the Crikey health blog) has used the term “citizen journalist” to refer to us non-journos who are active on social media. I have shied-away from that label because I have zero knowledge/pretensions of being a journalist. However, when it comes to talking about mental health and/or suicide, I reckon that those of using social media as health professionals should take some ownership of the “citizen journalist” tag.

Health professionals are used to being informed by evidence-based guidelines, right? That’s what the Mindframe guidelines are. They are guidelines for how language should be used by journalists. Those of us who are blogging/Tweeting/Facebooking/whatever can, if we choose to be safe and ethical, abide by the same code of good practice (here).

Let’s watch our language.

Let’s edit and re-edit.

Let’s reflect and think about our impact. Let’s do that slowly.

Let’s be safe. ethical and kind.

Let’s do no harm.

Let’s follow the Mindframe guidelines when we’re blogging about mental health and/or suicide.

End.

That’s it. Thanks for visiting.

If you haven’t done so already, visit Stevie Jacob’s guest post here: meta4RN.com/guest02 My favourite part is the middle part (the meat in the sandwich?) which is honest, powerful, raw and gutsy. I hope/think that the edits made have been in keeping with the Mindframe guidelines. If  not, that is my responsibility. Please let me know and I will fix it as soon as possible.

Paul McNamara, 23rd September 2014

Short URL: meta4RN.com/mindframe

These words have been in my head and they needed to come out (a blog post about suicide)

Trigger Alert – this blog contains info re suicide which may be unsettling for some people.

Guest Post: Stevie Jacobs has contributed this guest post to meta4RN.com

StevieJacobsStevie Jacobs is the pen name of a newly-minted Enrolled Nurse. The person behind Stevie is smart, experienced in life and has some awesome insight into the world of the student and new graduate nurse.

You can follow Stevie Jacobs on Twitter: @SJWritesHere

Stevie has contributed to other nurse blogs, including the excellent site Injectable Orange, by Jesse Spurr.

These words have been in my head and they needed to come out
(a blog post about suicide)

I am ‘Pro choice’.

I am a patient advocate.

I am a person advocate.

I support euthanasia.

I am pretty much of the opinion that if you have all the facts, figures and feelings figured out then you can go ahead and do pretty-much whatever you like. Even if it’s ‘bad’ for you. I can provide you with action plans and phone numbers and personal support, however ultimately, the choice my friend, is yours.

So when someone wants to kill themselves/suicide/take their own life (however you want to put it) what does my head feel about that? I’m not talking about obligations as a Health Care Professional, I’m talking about obligations as a human being. I can provide you with an ear to bend, a shoulder to lean on, I can find you professional help if you want, I can tell you that I don’t think you’re in a safe space and I want to get more support. For both of us. I can do all that. What I am stuck with is that if euthanasia is assisted suicide and I’m OK with that (OK meaning I won’t physically stop you nor judge you), does that mean I am ‘OK ‘ with someone’s suicide? Both have the same ending:, the removal of pain through the death of a person. I don’t know how my heart or my head feel about that.

Robin Williams was 63. That’s a long time to be living in pain. Yes, there are medications and therapies and support groups, but what if that starts to feel just all too much? That living is just all too much, a bit like ‘diabetic burnout’, where the person with diabetes basically gets fed up with ‘managing’ their diabetes and becomes unwell. That can happen with all chronic diseases. That can happen with mental health issues. Yes, some people have a depressive episode, it’s self-limiting and then they never have another one. Wonderful. For others, it just keeps on coming back, more painful than before.

To someone who is experiencing suicidal thoughts, suicide I can seem to be a rational method of pain relief. It’s the ultimate pain reliever for the person experiencing the thoughts.

For those left behind it can be devastating.

I can’t make up my mind. Do I have the ‘right’ to stop someone from suicide? I’m on the fence. The boundaries get blurred. I’ve experienced anxiety & depression, I’ve experienced suicidal thoughts & been ‘suicidally depressed’, I’ve had a family member suicide and I’ve known someone I followed on Twitter suicide. Which is a really fucking weird experience, quite frankly. Grief for someone who you ‘know’, but don’t ‘know’. 101 ‘What ifs?’. I could ‘see’ that something wasn’t right, but aside from checking in and offering an ear what else could I do? I’m at peace with those choices now, no longer haunted by ‘what ifs’. I’m sure that is not the same for their family and friends. I realised that what has stayed in my head is a photo of themselves they posted shortly before it happened. It’s their eyes. Their eyes haunt me. I can see something in their eyes I’ve seen time and time again. In my face. In the faces of others. I know those eyes so well. However good your mask is it’s in the eyes.

So, what to do? Who am I to tell anyone what to do? There isn’t really a clear answer. I think it’s really important to keep checking in on people: RU OK? I have RUOKed a few people and I will keep doing it. If it’s a ‘No’, and they express some ideas that worry you, it’s OK to ask “Do you have a plan?” If it’s a ‘Yes’, what then? Especially if you just don’t believe them. That’s trickier ground to navigate. I’m no expert on this. There are links at the end of this from people who are.

RU OK? It’s just a simple question. A simple, lifesaving question. I was on another planet from OK, and someone who barely knew me asked me that question.

It was like a thunderbolt.

It made me stop and think and choose to get help to make living less painful. Choosing to get help is hard. Getting help can be harder. What’s even harder is acknowledging that choosing to live is a conscious effort. It’s an effort. Accepting that medications and therapy and exercise and diet changes and avoiding triggers are now part of your life is an effort.

In time I hope that life will once again become effortless, but it might not.

Finally, after years of effort, I now think I am OK with that.

.

Post Script 1:

I wrote the above post a little while back. Normally when I have said all I have to say on a subject it doesn’t pop back in to my head. This post did. If I am honest, I have only scratched the surface. I have more to say. The way I write usually is like a good vomit on a night out: it all comes out in one go and it’s done and dusted and you’re up and dancing again. The other way I write is a bit more like a gastro bug: on and off with a bit of dry retching when you just can’t get it out. Then you’re done and you feel better.

Paul told me the ‘meta’ point of meta4RN is ‘talk about what you’re talking about’. So I guess that’s what I’m doing here. Rereading the above, reflecting on it and trying to work out quite what it is that I still feel I want to say.

We need to talk about mental health. We need to talk about suicide. We need to do it in a safe, appropriate and open way, but we do need to talk about it. Talking about it is hard. Talking about it can be terrifying for anyone. Talking about it when you’re a health professional is really damn hard. There are so many ‘what ifs’. What if they ‘lock me up’? What if they don’t? What if they think I’m not fit to practice? What if I lose my job? What if my colleagues find out? What if I have to be treated in the same hospital that I work in? What if…

I want to talk about how it feels to have suicidal thoughts. I want to talk about how it feels to be suicidally depressed. I’m not sure how to do that. I know that there are media guidelines for discussing suicide. As someone who is trying to describe a ‘lived experience’, I decided the best way for me to write was to let it all come out uncensored, and then give it to Paul to edit it using some of those guidelines and make it ‘safe’. I am in a safe enough space now to be brutally honest about how those suicidal thoughts feel, and far away enough from those thoughts to be able to talk about them without feeling ‘triggered’.

I can only speak for myself. For me there is a distinction between having suicidal thoughts and being ‘suicidal’ or ‘suicidally depressed’, as I have referred to it in the past. The thing about ‘suicidal thoughts’ is that the longer you have them the more rational they seem. For me suicidal thoughts are more of a hypothetical notion; it’s not something I am going to carry out. It’s an icy calm IF. IF things don’t get better, IF that was to happen, IF there isn’t another way out, IF the pain becomes unbearable, IF.

I know exactly how I would kill myself. I know exactly how I would spend the jackpot from a lottery win. I know exactly what I would get done if I had free access to plastic surgery. It’s all hypothetical.

It’s hypothetical. Until it’s not. Until I am suicidally depressed. Until I am in pain. Until the self-loathing I carry around with me every day takes over. Until I truly believe that the people in my life would be better off without me. Until I can’t see any way out aside from that way. And that place is not icy calm. It’s a messy, clinging on to something, anything to get through hour after hour, painful, emotional swamp. I feel emotionally swamped. I can’t think in a straight line. I can’t sleep. I can’t eat. The anxiety eats at my stomach. The panic attacks feel like I am dying of a heart attack. The after effects of which last for days. And nothing, nothing stops the pain. That’s how suicidal feels like for me. I know, however, that it is not what it looks like to other people. People see what they want to see. Even people who are trained to see more. I am brilliant at hiding it. I know how to put on my mask and polish up my armour. It is exhausting.

There are cracks in my armour, sometimes the mask slips. My fellow walking wounded can see though them, but for the most part the people I see every day wouldn’t know. I can make people feel so good about themselves. I can make people cry with laughter. Then, the second I am alone, the pain floods over me and I can barely breathe. I keep coming back to pain. It’s about pain. Not control, nor attention seeking, nor escape; in that moment it is about wanting that pain in my heart to stop. To. Stop.

It’s a horrendous place to live to be honest. It’s a half life. I had to choose to live better. To live for me. To get help – medications, counselling, CBT, exercise, diet. It’s a conscious choice. And what helped me make that choice was being asked ‘RU OK?’

.

Post Script 2:

So, turns out it’s not a verbal gastro bug. It’s verbal C.Diff. The words just keep coming out.

I think I need to make it clear that I am talking about a period of over 10 years. I need to make it clear that I am talking about the past. I might write ‘I know’, but I suppose really it is ‘I knew’. Deciding to share this is a decision that has been easy, but it is a decision that I have made because these words have been in my head and they needed to come out. There are more things I could say, about specific attempts, specific feelings. However, I don’t want to share them. I think that’s OK.

I need to make it clear that I support ‘RUOK’ & WHO suicide prevention strategies. I need to make it clear that if you judge me negatively based on what I have written or if it changes your opinion of me, then that’s your thing, not mine. I’m not asking for agreement or understanding, but I do ask for kindness.

I was asked recently what the best thing in my life is right now. Aside from Nursing, the answer is the people in it. I know that my people love me, and accept ‘me’, and that’s enough.

Black Dog Institute Healthy Living Study is a program to help those experiencing suicidal thoughts manage them: http://www.blackdoginstitute.org.au/public/research/participateinourresearch/index.cfm

Black Dog Institute Healthy Living Study is a program to help those experiencing suicidal thoughts manage them: http://www.blackdoginstitute.org.au/public/research/participateinourresearch/index.cfm

End.

Short URL:  meta4RN.com/guest02

Many thanks to Stevie Jacobs for sharing this gutsy piece of writing. Your sensitive, constructive feedback is welcomed in the comments section below.

It’s also important to acknowledge that talking and thinking about suicide can be distressing. People in Australia can access support via:

Lifeline – 13 11 14

Suicide Call Back Service – 1300 659 467

MindHealthConnect www.mindhealthconnect.org.au

phone_hotline-40Outside of Australia and not sure where to get support? Google usually displays a red telephone icon and your country’s suicide support phone number when searching for a suicide-related topic.

This guest blog post has a companion piece, which I have imaginatively called “A Blog About A Blog About Suicide” – the link is here: meta4RN.com/mindframe

Paul McNamara, 23rd September 2014