Tuesday, 23 August 2016

MindPlus: Coping Strategies - Managing Life after a Suicide Attempt

Welcome to the second (and final part) of the series on managing suicidal feelings. Read the first part here. It is four months since I posted the first part. Many apologies for the delay. I had my own challenges to deal with (not anything of a suicidal nature) but issues which took me to dark places but brought me back into the light. I am glad to be back sharing with you. Hope you've had a good summer break.

On to our topic today. You have managed to get our loved one to a place of safety or if you are the one going through this experience, you have managed to get some help for yourself perhaps by calling a friend who helped you get to hospital. What happens now? Those issues that led to the suicide attempt will not just vanish into thin air. The most important thing is that the person is safe...right now. Let's take a deep breath and work through the issues in stages. We will do this using scenarios that are typical of what we may find in a mental health clinic. (These are not profiles of real people but representative of what people can present with.) I am using a UK mental health service model.

Life after a Suicide Attempt: Scenario 1

23 year old Ruby took a cocktail of tablets and copious amounts of alcohol two weeks ago, following the break up with her boyfriend. She is now back at home following three days of hospital admission and a referral to her local community mental health team. Her friend Ally has been supporting her. Ruby attended her first appointment with the local mental health community team yesterday. She told the community mental health nurse that she no longer felt suicidal, She was much better during the day but felt low at night when she was alone in her flat. She is also not sleeping very well. They agreed on the following treatment plan:

  • The nurse will visit Ruby at home next week to see how she's coping.
  • The psychiatrist will see her in three weeks time when her medication will be reviewed.
  • Ruby needs a night routine that will help her break the pattern of loneliness: She is an avid reader. Ruby has decided to start reading again. She will also socialise in the evening with friends twice a week until 9pm.
  • Ruby may also benefit from having a specific time that she goes to sleep at night. This will help her body recognise a time for sleep. 
For someone like Ruby who is willing to engage with mental health professionals and is also able to come up with coping strategies of her own, she may be one step closer to getting her life back together.

However for some people, things are not so straight forward. this brings us to our second scenario:


Life after a Suicide Attempt: Scenario 2

25 year old Dauda was admitted to hospital following a hanging attempt. His dad cut him loose just after he'd tried to hang himself. He is not interested in using mental health services and just wants to be left alone. He will not admit that he was trying to kill himself. He says he was just trying to see how far he could go. This is not his first attempt.

Dauda has the profile of someone who is clearly at high risk of another suicide attempt. He would have to be monitored closely following discharge from hospital. My guess is that Dauda would probably be in hospital for a while and possibly detained under the mental heath act, provided the legal provisions are met. (See below)

This is a likely community treatment plan for Dauda following discharge from hospital when he is considered safe enough:

  • Some medication to regulate/treat  mood/thought if suitable. 
  • Close monitoring by carers/parents/partner who will be involved in care/crisis plan and liase with mental health team.
  • Close monitoring, care/crisis plan and treatment by community mental health team
  • Dauda will have a dedicated MHP (a mental health professional - nurse or social worker) who will see him every week or fortnightly as assessed.
  • The dedicated MHP will look at strategies to reduce risk: how Dauda can use help from mental health services and community support networks as prevention to reduce suicide risk.
  • Regular review by psychiatrist every three months or as and when necessary during a crisis.
In certain circumstances where the risk of suicide is considered too high for someone to remain in the community, that person can be detained in hospital against their will. In the UK, this is legally allowed under the Mental Health Act 1983. Most countries have jurisdictions that allow a person to be detained in hospital for their own safety, provided certain conditions are met. One of this is that they have a mental illness and that the risk they pose to themselves is such that they cannot be treated in the community. However, many people who attempt a suicidal act do remain in the community for follow-up treatment by mental health professionals.


In summary:

Coping strategies are very important in keeping a suicidal person safe in the community. Coping strategies would include

  • Non-isolation (Making sure the person is not left on their own for long periods)
  • Medication where appropriate to deal with low mood and/or thoughts of suicide
  • Care/Crisis/Safety management plan
  • Using support network of family, friends and other community networks where appropriate.
  • Engaging with mental health professionals.
  • Dealing with issues (stressors) that led to the suicidal act ( debt, bereavement/loss, drug use, relationship difficulties, etc) 
  • Helping the person develop some insight, an aptitude for containment of suicidal feelings and tolerance of frustration
  • Talking and reaching out for support when feeling low
  • Using 'safety scales' to work with and reduce level of risk: what works on the scale of wellness or not. This will also help the person identify their coping mechanisms and what they can work on to develop this further. It would involve checking with the person weekly or fortnightly to see how they are progressing on a scale of 1 - 10.  A scale 9 would mean the person is at very high risk of completing a suicide but even then it is still helpful to ask why it is a 9 and not yet an actual attempt! If it is a 5 (50-50) you want to find out why it is a 5 and not 1 or a zero risk? What needs to happen for it to be a zero? How can they get from 5 to 0? Find out what would get the suicide risk considerably lower and use this for an action plan. Work slowly and steadily where motivation is low. But this coping strategy is only safe when used in conjunction with other coping mechanisms and risk analysis for a complete risk management strategy. 
  • Helping the suicidal person become an expert on their own safety: (This can be particularly useful where the person is not comfortable with reaching out.) This is where the MHP works with a person to identify what works for them in a crisis. I also find that this works particularly well with some people who have borderline personality disorder and find it difficult forming trusting relationships with mental health professionals or family members. For instance they may choose not to engage with the community team but will attend the local hospital accident and emergency if they feel they are at risk of a suicide attempt. Or they may only call/see their designated MHP when in a crisis. This requires considerable trust from the MHP for it to work as a coping mechanism. But it does work for some and helps the suicidal person feel in control of managing their own risk. The keyword here is insight. If the suicidal person has a lot of insight as to their presentation and risk, the 'self as expert' approach helps with developing containment and tolerance of suicidal thoughts. This  approach can prove to be an effective coping strategy as part of a wider risk management plan.
©Adura Ojo - MindPlus - All rights reserved

Useful Links: WHO Factsheet on Suicide
                        HelpGuide.org on Suicide Prevention
                       NHS UK: Suicide, Getting Help & Prevention

Advice and posts on MindPlus is for reference purposes only. We highly recommend seeing a mental health professional for a proper consultation. 

Monday, 23 May 2016

MindPlus: Is my Cousin Depressed?

For our initial sessions at the MindPlus Clinic, Doc Ayomide and I decided to use vignettes to explore various mental health issues. The vignettes are based on profiles that we would typically encounter during consultations. This week, the topic is depression. Doc Ayomide is advising  'Mike' who is worried about his cousin, Mary.

                                                          *   *  *  *  *

Dear Doc Ayomide,
My cousin Mary is not sleeping well. She gets like two hours sleep a night and this has gone on for the last six weeks. For the rest of the night she is wide awake and paces around her room. She manages to eat one small meal usually in the afternoon and nothing else. She says she does not feel like eating. She also believes that she is worthless and that there is no point to anything in life. She broke up with her boyfriend two months ago. I'm worried about her because she is staying at home a lot and has missed work for three weeks. She is based in Lagos. A friend of mine suggested she could be suffering from depression. I would be grateful for your advice.

*    *   *   *   *
Doc Ayomide

Hello Mike, 
It does sound like your cousin Mary is depressed. 
Poor sleep is one of the commonest complaints, especially among us Nigerians, and the fact that she’s not slept in days is not unsurprising. Not that lack of sleep proves depression — it doesn’t. In fact, just about any mental health problem can affect sleep. 
Why it matters is that it’s the most obvious thing people can go to the hospital for, and also the thing you can use to hopefully persuade her to go if she’s reluctant. (I noticed, though, that you didn’t mention her position on seeing a mental health professional.)
The other symptoms point to depression, too. Her lack of appetite, her feelings of worthlessness and hopelessness, and her general loss of interest in usual activities (including work). These are all very typical in someone experiencing a depressive episode, and I would not be surprised to learn that she may have been having suicidal thoughts. 
And that last part is why my advice is that Mary should see a mental health professional as soon as she possibly can. 
Because what may look like someone who just needs to eat may be much worse underneath. And keep in mind that she herself may insist that it’s nothing. Just try to as gently and as firmly as you can manage, insist that she at least try seeking help.
I hope this helps.
Doc Ayomide

P.S. In case you’re wondering why I didn’t say anything about the breakup you mentioned: that’s because it’s not the main thing right now. The main thing is for her to be getting help. Once that’s happening, the rest can be sorted out in time. You understand? All the best, Mike
* * * * *
If you would like to write in to MindPlus for advice, email: adura.ojo@gmail.com
Please use the title 'mindplus' as your subject. All MindPlus clients are anonymous.
Doc Ayomide is our resident psychiatrist on MindPlus.

Advice given on MindPlus is for reference purposes only. We highly recommend seeing a mental health professional for a proper consultation. 

*Anonymity is 100% guaranteed. Your emails will be shared on this blog along with the advice given. Emails may be edited to preserve anonymity and for brevity purposes. Unfortunately, we are not able to provide personal consultations on this blog.* 
*For personal consultations, contact Doc Ayomide directly by email: talktome@docayomide.com

Tuesday, 17 May 2016

On the Sofa with Adura: Yejide Kilanko

As part of the HerStory series which looks at the issue of sexual abuse and rape in Nigeria, I had the opportunity to chat with Writer and Children's therapist, Yejide Kilanko recently. Yejide's debut novel, Daughters Who Walk This Path, a national bestseller, was published by Penguin Canada in April 2012. The novel has been translated into German and Thai. Yejide was named one of the top five hottest up-and-comers on the Canadian writing scene by the Globe and Mail.

Tell us a bit about yourself.

I was born in Ibadan, Nigeria. Left Nigeria in 2000 to join my husband in Maryland US. Now live in Canada and work as a therapist in Children's Mental Heath.

You're also a writer. Please share with us how that started?

Yes, I'm also a writer. I started writing poetry when I was 12.

Wow. So when did you start writing novels?
At the University of Ibadan, I was a member of my hall of residence and department press organizations. Those were good training years. I wrote the poem that evolved into my first novel, Daughters Who Walk This Path, in 2009.

Sounds like that was a good place to begin honing your writing skills?
It was.
Aha...what was the title of the poem?
Silence Speaks
What was the motivation for writing that poem?
June 2009...I had just finished my masters in social work and had been hired as a child protection worker. As part of my job, I had to conduct sexual abuse investigations and this was one of the most difficult things I've had to do. I wrote silence speaks because I process life through my poetry.

I just read the poem. Sexual abuse is a scourge in our society. What saddens me is that nothing seems to have changed all these years.

It is a shame that nothing has changed. :(
So your first novel 'Daughters Who Walk this Path' is loosely based on your experiences as a Child Protection officer dealing with abuse investigations?

Yes. Decided to set {the novel} in Nigeria because after I shared the poem, (before I decided to write the novel), some friends made disclosures to me. These were people I grew up with and I had no idea.

Would you say that child sexual abuse is largely a hidden problem?
Oh yes.
How can we start to tackle this culture of silence, in your opinion?

In many ways our culture across tribes enables the secrecy. We need:

Sex education at schools.

Sex education at home.

Giving children age appropriate information about their bodies, sex, privacy.
When you say our culture across tribes, do you mean generally?
The notion of respect when it comes to any adult should not be an absolute when it promotes and covers violation.
Totally agree. What would you say to the parent who says: "I don't want to introduce my child to sex early by talking about it oh"

In Nigeria, Canada or elsewhere, there's that stigma.

To that parent, I would say you're doing your child a big disservice. Parents would be shocked by the amount of the information their children have thanks to peers and the Internet.

Would they rather not give them the right information?
Children as young as 11 are having sex. We know that children younger than that are being sexually abused.
So parents should educate themselves so that they can educate their children. Thanks for that. 
Now let's talk about your other works.
I published a novella called Chasing Butterflies in 2015. It's set in the US and explores domestic violence. It was part of a 100k manuscript I had split into three books. The other two books, full novels, set in Nigeria and the US also explore the themes of relationships, marriage, cultural expectations and self determination. I'm hopeful that a publication date announcement will be made soon. Chasing Butterfiles is available on Kindle. It was a fundraiser for Worldreader.

I need a picture of you

*Hands over pic* Is that ok?

Yejide Kilanko
Your smile says it all. More than okay o.

I smile a lot. I always say it's better than screaming

That is a great attitude to have. 'Smiling better than screaming'. 
*Taking note* :) Must remember that. Thank you so much, Yejide.

It's been my pleasure. If what I have to say will help someone, it's all worth it. Thanks for what you do.

Author websiteyejidekilanko.com
Twitter YejideKilanko
Books available on Amazon and Barnes& Noble.
All images published with the author's permission.
©Adura Ojo - HerStory - On the Sofa with Adura
All rights reserved.
frown emoticon.