The Samaritans hotline (a general distress helpline) is there to listen. Nothing else. They do not provide treatment, judgement or the like. Sometimes that is enough. More importantly its anonymous. You will not be sectioned by phoning them
To be sectioned (ie detained against your will), you _have_ to be assessed by a doctor within 24 hours. You need to be deemed a risk to yourself or others(by at least two doctors) before you can be held any longer.
You cannot be fired for being sectioned in the UK.
So whilst the UK is very far from being perfect in terms of mental health (lord knows we have a multitude of problems, some alluded to in the article) it is not as bad as described in the parent thread.
In fact, you even still accrue vacation time while off sick, I was off sick for a year and when I came back HR came to me with the news that I had extra holiday to use the next year because it been rolled over from when I was off sick.
If you're sick while on holiday you can even try to claim the days back although most people don't as that's seen as taking the piss a bit.
But in general you will be paid full wages for intermittent sickness (ie three days -> couple of weeks)
As you are sectioned you will have a doctor's note by default, so there is no chance of being fired. (employment tribunal will back you up on that. However there is a cost(capped at £750) to that nowadays [thanks david cameron, you utter shitfacewankstain])
There are a number of rights for returning to work as well after a long sickness.
Should that fail, there is still nominally a safteynet of universal credit. However that has become rather inhumane recently (thanks again David you shitbag.) but it is not as inhumane as unemployment insurance in the US.
Three years ago I made a plan to take my own life. Instead of pushing through I contacted a local suicide hotline, it was completely anonymous. I just talked for a bit, but that little moment helped me to find the courage to talk to a family member and that led me to go into therapy which I completed a few months ago.
Initially I was very scared telling my therapist about being suicidal, exactly sketching those horror scenarios. But when I finally talked about it, nothing happened. I remained into complete control of my own therapy the whole period. It helped me turn my life around and I'm incredibly happy I took the leap of faith to start talking about it.
The odds of someone dying through suicide after a suicide attempt is very small (only 2%), but those odds greatly increase if inpatient treatment is provided, instead of reducing. There is a reason for that, and clearly your experience doesn't provide that reason. The stated reason psychiatrists give for this is that only the very serious cases get committed, but research doesn't back that, and for specific institutions (and you have no control over where you end up) it is definitely not true.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710249/
Suicide after inpatient treatment in a psychiatric facility is actually getting close to enter the top-10 causes of death. Whilst that doesn't directly contradict what you're saying, it comes pretty close.
In the Netherlands, it is now actually true that more than 50% of suicides happen with psychiatric help, which mostly means getting locked up. Given that less than 1.5% of the population ever gets committed (but rising fast, especially for kids), that's pretty incredible.
And in a bunch of published cases it isn't even the case that people were committed for a suicide attempt, but for an outburst that was then diagnosed, for example as autism. Suicide came, years later, after years of treatment, a progressively worsening situation, and months in isolation in such a facility, in one case with the person locked up without his glasses.
Wouldn't "the system is mostly good at only putting extremely high-risk people into those facilities" cause the same correlation if it were the case?
Would it be surprising if "people leaving any general hospital" were more likely to die of whatever they had been there for than "people who didn't need to go to hospital"?
Of course the criticism is that they only take the worst problems (even though refusing "complex" cases obviously contradicts that more than a little bit in my opinion). Likewise other studies that assess the ability of professionals to predict who will commit suicide keep coming with very disappointing results, so frankly, I find it hard to believe they could select the serious cases even if they fully intend to do so.
But the group that gets help has a bigger suicide rate compared to the group that doesn't. Quite a bit bigger. So it depends what you believe.
1) do you believe the criticism that they are able to select serious cases (but are unable to prove that in studies specifically checking that) ? Then it is unknown how effective their treatments are, and until they quantise "seriousness" it is impossible to check how effective they are.
2) do you believe the selection process is mostly random and the criticism is invalid? Then the treatments are counterproductive and they cause suicide. That does not (necessarily) mean they mistreat patients. For example, often the inability to leave gets blamed for job, family, and generally the future prospects to evaporate, which in turn causes suicide, which seems to me to find support in the observation that it's most often just after treatment ends that the actual successful suicide happens. The treatment causes suicide, but not directly.
We should make the exceptions that there are plenty of studies about specific institutions where abuse of patients does happen and it is definitely the institution itself that causes suicide.
All the downsides you listed apply to jail time also, but the food is more terrible, the environment more restrictive, and the opportunities for extricating yourself (if you are reasonably cogent) are greatly reduced.
Also, ironically, being in jail on suicide watch is preferable to being in general population.
My basis for making that comment is that at least ostensibly you get due process in the legal system.
Hope you came out the other side in a good place.
[0] That's how long it took for me to get a court date at which point I was released with time served (2 weeks). Getting out of the mental hospital never even required a lawyer (though I'd still recommend retaining one if you're ever in this situation).
Some justice here. Instead of singing songs about rights abuses in whatever country they decided not to like at the moment why don't they look and fix things under their own fucking noses.
Maybe I'm just lucky to have ended up with psychs who will take on more risk to avoid having to commit people, but it's at least a little more complicated than you imply.
The fundamental problem there is that plenty of people have won lawsuits against hospitals/doctors when their loved one mentioned suicide in some way, was not involuntarily committed and then proceeded to kill themself. The amounts involved in those lawsuits tend to be high. In contrast, very few people have won lawsuits against hospitals/doctors who involuntarily committed them when they probably shouldn't have been, and even if they do, the monetary harm that they can recoup is probably pretty small.
This results in very perverse incentives for the institution. In your case either the people involved in your care had a very high personal risk tolerance, or it happened in a state where there is less precedent on handing over megabucks to the families of people who commit suicide.
I'm bipolar, and when I was untreated I would frequently (as on every other day) spend hours locked in a doom-spiral of self hatred, incapable of breaking myself out of it. I could recognize what was going on at some level, and that if I were pulled out of the spiral I would be fine, but in the moment trying to escape that pain seemed to only have one solution, even if I knew I normally wouldn't want to die.
I would basically have to try and hold myself together long enough for my wife to find me and help me back to sanity. Each time I got a little closer to failing. Getting access to medication was life changing.
I am enterally thankful she took away deadly instruments, encouraged me to find reasons to live and recover, and ultimately seek treatment. Whereas you would have just left me to irrevocably take my own life in response to temporary problem that had a medical solution readily available.
:)
For the record, I never wrote, said, or claimed that, and your claim is inaccurate. Please refrain from making false claims about me.
As for the concern about basic rights, I fundamentally agree. For some people, perhaps, they will never get better and in those cases we should have a path to assisted suicide. In all cases, we should do our best to help suicidal people, who are ultimately suffering a lot. I don't think most people who are suicidal want to specifically die more than they want an end to their suffering, to which they see no realistic alternative other than death (which I assure you remains quite scary even when you're really depressed.) I think giving them an escape other than death is morally obligatory and humane, where it's possible.
Is this actually true? I know it's said quite often, but there are countries with much much higher suicide rates where firearms aren't nearly as ubiquitous. Eg Lithuania.
The amount of people who die to suicide is higher in the US because you are much more likely to actually die if you use a gun to commit suicide than other common methods. Higher access to guns increases the rate of people who successfully kill themselves. (Which is probably a bad thing. In general those who survive suicide attempts are happy that they lived.)
The rates in the US are high because of access to guns. It's well understood in public health that easy access to means and methods is one of the factors driving high rates of death.
The rates in Lithuania are high because of a number of other factors -- high alcohol misuse probably being important. Also, there are plenty of guns in Lithuania, and firearms are one of the most frequently used methods.
In general one usually gets more meaningful results when a) comparing geographically and/or culturally similar countries for things like these. E.G the UK has half the mortality rate of the US, Canada and the EU have 2/3 of the US rate. And b) compare trends, not single values. E.G. US rates are rising (which I as a layman would interpret as speaking against the firearms thesis), while the rates of Lithuana and Japan are falling.
This is particularly true if they call you during the bad 1% and directly ask you to stop them from doing the thing.
Consider instead the case where you're a recovering gambling addict who's asked me to make sure you don't gamble again. One night I find you in the pokies room, so I take your wallet and tell you I'll give it back tomorrow morning. I agree that this is theft and possibly morally wrong; however, I don't agree that it breaches your right to self-determination, since most of the time you seem pretty determined not to gamble.
I disagree with the claim that many suicides are like that, I don't think the suicide from the article was like that, and the word "consistently" is doing a lot of heavy lifting.
Intuitively I feel that it's like two different people are making decisions about the one body, and the finality of suicide means the suicidal part of someone is wiping out the future for both, and should thus be prevented.
Again, though, the majority of suicide victims aren't suicidal for large periods of their lives. I feel that in the cases where someone is only briefly suicidal during the worst troughs of mood, the suicidal 1% of a life would wipe out the non-suicidal 99%, which is a monumental loss to inflict.
The right to self-determination derives from an assumption of someone being in a clear state of mind, that's why we have plenty of conditions under which we withdraw that right.
But the 38 year old husband, the subject of the article, who was in an unstable mental state to the point where his wife felt threatened and left for the safety of their children was certainly not in command of his mental faculties.
Someone who is schizophrenic and bipolar and experiences a psychotic break after drastically changing their medication regimen is not in a sound state of mind, and they would be the first to admit it once their condition improves.
First you said they can't do it because they're mentally incapable of making the choice, now you're discussing whether a suicide is "clearly defensible". It doesn't matter if a suicide is "clearly defensible" or not. People don't have to defend their choices to you. That's the point of having the freedom to choose.
Where did you get that idea? This happened in the UK, which has a public health system.
Well, that's an enormous 'if'. Yeah, maybe it's different in that case. But it's not the common case.
Anyway, I didn't consent to being born, why shouldn't I be able to choose to stop living?
(No idea if that is true, but it is the claim.)
I also found when I finally broke down and sought help (not for suicide, granted) the process of trying to take advantage of my company's resources like paying for short-term counseling, etc. was incredibly frustrating. You couldn't get a hold of the people at the company we paid for the plan, everything on their site was outdated and badly maintained, they only covered certain therapists, and they happened to be therapists who make a point of specializing in treating pretty much anything with drugs, etc. Had I been on the edge of suicide or unable to eventually just pay for the care I needed directly, I can only imagine trying to navigate this process could've finished me off, emotionally.
If you can afford it at all, it can make a lot of sense to do this privately, to avoid a lot of this.
But I'm extremely fortunate that I'm both very well off and wasn't suicidal. And it was very apparent to me that if I was different in either respect, I perhaps wouldn't have been able to turn things around.
FWIW, you heard correct. This is true. (I don’t have any clearances myself, but I did work for a major defense contractor in the past, and a family member has some sort of above-top-secret clearance for his work.)
Don't trust phone counselling services. Ever.
Consider this: if the providers of these suicide hotline numbers actually cared about this stuff, they would provide an as pseudonymous as possible way to contact them that makes it as impossible as possible (in a mathematical/cryptographical sense) to identify the caller (think about Tor).
Additionally, the hotline operators would advocate very strongly for a right to encrypt and right of privacy.
But this is not the case, which should convince any rationally-thinking person that all of these claims of anonymity are fraud.
https://www.lifeline.org.au/media/igzp1al2/lifeline-australi...
This comment seems really extreme and it's a perspective I haven't really seen anywhere else.
I had a colleague, now retired, who was the president of state mental health associations, etc. who made the argument that most suicide treatment programs are really designed to protect practitioners and healthcare providers, not the patients. At the time I understood what he was saying, but didn't really understand it until later.
The way it came up with him was more about prediction and risk. He was talking about it because there's basically no way to know if someone is actually imminently suicidal. Most people who talk about it never even make an attempt, and there are lots of people who commit suicide suddenly without saying a word to anyone else ahead of time.
My colleague's point was this: if saying X is totally unpredictive of Y in reality, why react so strongly to saying X? The reason is because it's not really about preventing Y -- you can't -- it's because it legally and morally absolves you of responsibility.
I feel weird writing this because it sounds so cynical, but its a sad truth about the poor state of care of our fellow human beings in contemporary society.
Immediate tingling of danger -- but wondered if my suspicions might be little more than the product of a cynical mind. Didn't think so -- but thanks for the confirmation!
If it's actually unpredictive, then shouldn't committing someone -- taking full control of their life -- make the doctor more responsible for them and not less? Responsible for them not being able to work, pay their bills, etc. and ultimately making their life situation more precarious, thus increasing their mental stress.
https://slatestarcodex.com/2018/03/22/navigating-and-or-avoi...
I don't know if he's considered to be a controversial figure or not generally but he is a real psychiatrist so I'd argue he knows what he is talking about
This paragraph really resonated with me and with the initial thoughts I had whilst reading your comment; I'm pasting it here as I think it provides a very worthwhile perspective:
"And my second excuse is that in the end, this is not an adversarial enterprise. Psychiatrists commit people because they’re scared. They’re scared because they can’t predict what the patient is going to do – and on another level, they’re scared because they might get sued if they don’t follow the rules. If patients who aren’t going to hurt themselves know how to explain that they aren’t going to hurt themselves in a way that reassures their psychiatrist, and in a way that doesn’t leave their psychiatrist legally liable for not committing them, then everybody can be more comfortable and get on with the hard work of actual treatment."
Interventions cannot help all suicidal persons, but being acutely suicidal means one should get help _now_. It's exactly the same thing as a with a stroke or other imminent medical emergency.
This is something that I have had personal experience with, in family, friends, acquaintances, and even enemies, that I wished dead, then was not so thrilled, when my wish came true.
I hang out in circles that experience a lot of … “out of band” … issues. It’s a long story, and not one I feel like sharing on HN. Suffice it to say that I have seen this kind of stuff many, many times.
Getting treatment for mental health issues —and there are very many types of issues, and types of treatments— is important. One way to support people going through this stuff, is to avoid feeding the “shame machine,” and try to realize that we may not have the answers, so we can help people connect with those who do.
In reality mental healthcare feels like only a slight step up from antiquated methods from days long gone. Trying the medication roulette is like spending months at a time throwing darts blindfolded to see if anything helps, hurts or does nothing at all. Waiting months to see professionals who are burned out or just trying their best to not be completely overwhelmed by the demand but are unable to give meaningful care because of how overwhelmed they are. Or not even being able to see a therapist at all because it is cost prohibitive. And then consider basically having to do that on the side while you have your other obligations that you have to tend to. I wouldn't be surprised if only a fraction of people who need help get it, and of that fraction, only a fraction of them see a benefit. It basically boils down to society not caring, or barely caring at most.
In the end I suspect that the efficacy of mental healthcare has its limits, after all it is like trying to fix people after they have been broken, which is way harder than supporting people before they break, but that depends on social structures and support groups that are increasingly weak and strained.
Try to imagine a Random Controlled Trial protocol for a new depression medication. It is miraculous that any have been approved. It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo. Splinting the left shinbone helps only a small fraction of patients who have a fracture.
For validity, RCTs depend utterly on reliable sortative diagnoses. RCT fetishists (which exist, and are common) are mentally unable to process that fact.
You mean Kirsch & Kirsch 1997? Like, that particular study found a really, really small effect in the data submitted to the FDA (so the data chosen by the pharma companies). Even this went away when they used placebos with side effects.
More recent work has suggested that they work for severe depression, which is great but the trouble is that the vast majority of people with a diagnosis of depression don't have MDD (major depressive disorder).
I do agree that mental health is in it's leeches phase right now, and I am deeply concerned for people who end up having to engage with this system.
> It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo.
I responded to your claim with a little more colour on that particular trial in order to perhaps start a discussion around what we mean as depression.
Clearly, I didn't succeed at my aim, my apologies ;)
Edit: it's particularly the framing of the trials as "idiotic" that spurred me to reply, so I'd be interested in why you believe this.
> For validity, RCTs depend utterly on reliable sortative diagnoses
So, are you saying you believe an RCT can demonstrate a fact when whichever medication is being tested addresses the actual condition of only a tiny fraction of the participants, and even exacerbates some of the others' various conditions?
Such trials are not idiotic, except as a waste of money. Reporting their results as if meaningful is what I called idiotic.
Or, are you saying you know how to design the protocol for an RCT when you have no idea which, if any, of the participants actually suffer the condition your medication is supposed to treat?
Huh, that's a really good point (which I somehow missed in your original post).
That being said, it's incorrect that it's essential for RCT's to function, they'll still work, but with an attenuation based on the actual treatable population.
> Or, are you saying you know how to design the protocol for an RCT when you have no idea which, if any, of the participants actually suffer the condition your medication is supposed to treat?
Well I don't design said protocols, but I suspect the vaccine manufacturers may be able to point you in the right direction.
I think that your point about reliability of diagnosis is interesting, gonna need to think about it a bunch more, but in general, no diagnosis is without error (as most diagnoses are implemented as checklists, and there's some room for arbitrariness).
Just to note, if your point is correct then it's basically all mental-health, expectancy, placebo, psychotherapy RCT's are essentially worthless, which I suspect is not the right approach to take.
Does it matter if we can diagnose people effectively? Of course.
Does it make it impossible to run an RCT in the absence of effective diagnosis? Not impossible, but it definitely adds an interesting layer of complexity, as well as massively increasing the sample size required.
Consider a pre-trial objective: "We will be testing this medication on patients who have already indicated that it helps with their affliction. Participants will be sorted into groups that get one of (a) a placebo, or (b) reduced, (c) increased, or (d) unchanged dosage relative to the dose they have reported to be effective enough relative to side effects." Such a trial could actually be useful, but good luck getting the epistemology sticklers to sign off on it.
Also, antidepressants characteristically have history-dependent effects. Often, suddenly going off one renders it ineffective if resumed. So good luck with the ethics.
Also: I would like to see the word "affliction" in more medical papers.
I hope you will find gruntling, in time.
But, they are required by law to escalate the issue if they believe self-harm is imminent.
Encourage others to do the same.
Most importantly, Resist the temptation to give advice (unless it’s solicited).
Don’t ask “have you tried X?”… instead ask “what can I do to help you get through this”.
As long as we keep rewarding it by pressing the "rightthink" button when we see it it will keep happening, just like every other cheap gesture that appeals to the lowest common denominator.
"I'm feeling suicidal, let me call the hotline."
"I called the hotline and now I feel better, everything's great."
"I'm feeling suicidal, let me call the hotline."
"We've notified law enforcement. The police are on their way."
https://en.wikipedia.org/wiki/Suicide_legislation#United_Sta...
If it were me, I would call a professional therapist before calling a government hotline in the US. This is not medical or legal advice.
Afraid CPS will take your kids away? Well guess who goes to the orphanage if you bloody off yourself!
Going to jail is probably better if suicide was inevitable, but if it's inevitable, a person probably wouldn't be calling the hotline.
I think if the hotline was anonymous and untraceable and directly connected a person to a therapist who specialized in that sort of thing with no strings attached, it would be an invaluable tool. Unfortunately it is not that. It certainly could be.
This is 1000% missing the point. They've already decided that being dead is better than being alive with their current life situation. And you're saying they should voluntarily make their lives worse?
Can you imagine: You're at rock bottom, thinking about taking your life. Then someone comes along and says "Hey what if you don't and we lock you up and take your kids. Want to live now?"
Do you see how ridiculous that sounds?
Not every contrarian take makes sense even if it blows your mind on the first reading.
Do you think that people deserve to know that they can be involuntarily held if someone even thinks they're going to kill themselves?
I'd rather make this known and push for laws to be changed. Because I'm telling you that a massive number of people don't reach out to people because of these (real, valid) fears.
Even if it's true in the United States, it may or may not be as severe as the OP suggested. Could depend on the state or county or whatever. The OP write with position of authority that he lacks on a subject that is literally life or death.
He quit his job a couple of days later and has been fine since, so maybe the person on the phone can make a judgement call on whether it's a recurring issue that needs professional help, or something that is an extreme response to an isolated incident and the person will be fine after they're "talked down from the ledge".
So the question is do you want to play roulette with your physical freedom.
I really hope you are very wrong about what you wrote, otherwise you live in a really cold and frightening place. There sure is a hotline where you can just talk to someone, without losing your job, right? right...?
But it's mostly true. Do you just want people not to talk about the flaws in the system?
As long as involuntary detention for suicidal people is law, I would never ever ever tell anyone about any suicidal tendencies.
Not being honest about what happens when you call a hotline is also horrible. "Haha! Got you! Police are on the way!"
I can't imagine the dread if that happened to me, knowing my life is about to get way worse even though I'm already at my bottom.
Anyone saying "well suicide is worse!" is completely missing the point.
I have what is essentially a terminal illness and the fuck cancer resonates
You just want to turn to those people and say "I'm dying". While they are trying to be supportive but they completely miss the mark because they don't get it
Similar things can be said about people regarding addiction
Where as "trapped in that system" could be as long as a few decades before one eventually dies.
You should seriously understand what you are signing yourself up for if you call one of those numbers on yourself or someone else.
For one you are volunteering that person for involuntary incarceration in a mental health facility for an unspecified and potentially unlimited amount of time.
Need to show up to work tomorrow to avoid losing your job? That probably isn't happening.
Need to pay your bills to avoid losing your house? That might not be within your capabilities for the next several months or longer.
Kids need to get to school? CPS is likely going to be handling that for the indefinite future if they don't have another guardian because you aren't going to be around to do it and you are no longer fit to be a legal guardian anyway.
I'd probably rather end up in Jail than in that system.
Simply put, in our society indicating you are suicidal is a defacto crime and you should never do it(including and maybe especially to a psychiatrist/psychologist who maybe taking on legal risk if they don't institutionalize you after the admission) unless you are ready to suffer the consequences.