In 2008 in Canada 3,705 died from suicide (Statistics Canada). That is over 10 per day. Major depression and bipolar disorder account for 15 to 25 percent of all deaths by suicide (CTV, Oct. 3, 2011). In 2005, among US adults, there was a life time prevalence of Bipolar Disorder of 3.9% (NIMH). So my people are disproportionately represented among the victims of suicide. This comes as no shock to me.
I have always known that the disease that affects me, and several of my friends, is sometimes fatal. It is part of the symptomology of our illness. We live with that. Our families live with that. Sometimes we don`t make it. When you live with chronic illness, it is amazing what you can know and still keep moving. I think for most Canadians, getting up most days and wondering to yourself if you are going to be able to hold out today, would scare the crap out of them. I think being constantly assaulted by ideas about the best, least messy way of going would push the most stable of people into my end of the mental health spectrum.
Once you have seriously considered suicide (and I think keeping the necessary materials on hand at all times and having a roster of good plans counts) it never completely leaves you. It is always plan B. As a good friend of mine says `don`t worry, you can always kill yourself tomorrow`. This is how I live. For the record, I am not currently in danger of dying. It is just that it is never far from my mind.
What kills me (yes, it`s a horrible pun. I could not help it) is the way the suicidal are treated. Suicide attempts are brushed off as `cries for help`, or minimized, ignored and scorned. First, if you need to yell that loud for help – YOU NEED HELP. Professionals take note: HELP THEM. Cancer patients who develop metastatic tumors are not histrionic, they are having a relapse of a life threatening illness. No one tells them that they are taking up bed space and should get back to real life. This is real life. Even the much maligned Borderline Personality Disorder patient is suffering from a real illness, of which severe and persistent suicidality is a symptom. If I am sick and need medical attention, then I should not have to argue my way into treatment.
I have had to do this. I have actually had an emergency room doctor tell me that they only have bed space for people who have already attempted. Thanks for playing, but please come back once you have already damaged your kidneys with an overdose. Suicide is not reversible, suicidality is. In the best case scenario where you actually go for help, you pretty much have to prove you are a danger to yourself by outlining in detail your plan in humiliating detail. We are made to feel that we are abusing the system for trying to get into psych care. Psych hospitals are not all that much fun. If I want in, then something is very wrong.
I`m not saying that everyone should get to use up all the acute care resources they want rather than dealing with the underlying issues that cause the crises in the first place. What I am saying is that we need resources to deal with chronic mental illness and underlying issues. 30 minutes a week with a psychiatrist who does not have time to look up from their prescription pad is not going to cut it.
If you live with crushing depression, pathological insecurity, cognitive impairment and an inability to regulate your emotions then that is happening 24 hours a day. You can`t manage that on your own. You have a recognizable disease. You need medication, talk therapy, support and community based programs if you are going to survive. Without that a person will become the needy `frequent flyer`at the local hospital. They will take up acute care beds. They will make repeated attempts at suicide, with varying degrees of success or failure. They will be made to feel like an ungrateful parasite on the beleaguered health care system. This will not alleviate symptoms. At best it will put a band-aid on until that person stops being actively suicidal.
Or, I could be treated as a patient suffering from intolerable symptoms. I could be helped to find a psychologist and a psychiatrist who are covered by my health insurance, who will have the time and inclination to work with me to unravel the threads of my illness. I can be directed to skills groups like Dialectical Behaviour Therapy where I can be guided toward learning how to manage my emotional life without harming myself. If patients are given the right kinds of resources (and the complicated thing here is that each person is going to need slightly different things) then they have a fighting chance of becoming functional, contributing members of society.
Which is to say they won`t be taking up all the acute care beds all the time.
I am not naive, Ontario is broke and out medical system is a mess. We don’t have a lot of extra resources hanging around, right. So of course we can’t afford fancy extras like therapy for everyone that wants it. Wrong. Because if you don’t pay for appropriate treatment for the mentally ill like me, you end up with one of two things. One, people will die. There will be some people who don’t make it to acute care and actually die of suicide. As I mentioned above that is about 10 people per day. They have parents, spouses, children and friends who will suffer for the rest of their lives. So you choose – hydro subsidies or dead people.
Two, you end up with a large number of mentally ill people, who could be leading fairly productive lives, bouncing in and out of acute care. This will cost the taxpayer mountains of money, because regardless of how scandalous hourly rates for psychologists are, they are less than room and board in a hospital, doctors salaries, nurses salaries, medical intervention and associated costs for hospitalization.
So take suicide seriously. It is a dangerous symptom of a group of horrific illnesses. We can either deal with it appropriately, with respect and treatment, or we can stigmatize it, shame the sufferer and risk their lives. Cancer is another chronic condition, yet we are willing to spend any amount of money for diagnostic imaging, surgery, chemotherapy, radiation, prosthetic devices, reconstructive surgery, rehab and wellness groups to get those patients back to as functioning a life as possible (even if there is permanent impairment). I am glad we choose to do that, I just wish we could do that for my people too.