Abstract
It was a routine Monday for me at work and when we finished the Crisis Team hand over, the team leader received an urgent phone call from the service manager. When one hears that sad news or sensitive information is about to be shared, one’s heart always sinks. Fortunately, this has happened rather infrequently in my career – until now. Nearly every month over the past 6 months, I have heard about yet another suicide of a patient under the care of the team in which I work as consultant psychiatrist.
Bassetlaw is geographically a large area with a population of about 115 000. I have been the Crisis Team consultant in Bassetlaw since August 2017. Until the COVID-19 pandemic, there was an average of one patient suicide per year under the team’s care. Since the pandemic, this number has increased exponentially, with patients in varied age groups (from 20 s to 80 s) having committed suicide. It is a well-known fact that loneliness and isolation have a significant impact on mental health. Social support plays a key role in keeping us well and perceived lack of support can make people feel helpless and hopeless. This has an even bigger impact on the elderly population or people with multiple health issues, who are at increased risk of having mental health issues (De Mendonça et al., 2013). With shielding letters, one is never quite sure whether to prioritise mental health or physical health. As a Crisis Team, we have noticed that relationship issues and difficulties have escalated. Since partners are unable to have their own space, frustrations are vented between partners, leading to the deterioration of relationships.
I shared my feelings with an esteemed GP colleague who agreed and reported very similar concerns in primary care. Since primary care doctors deal with most mental health issues, he shed light on many more possible underlying reasons for the increase in suicide rates. There has been an increase in feelings of uncertainty, coupled with sleep disturbance, stress, anxiety and depression throughout the ongoing pandemic (Salari et al., 2020). People who would normally enjoy social interactions at work are missing these with home working. Financial loss due to unemployment, a well-recognised risk factor for suicide, has increased during the COVID-19 pandemic (Gunnell et al., 2020). Some professionals, such as teachers, have been concerned about their own health because they come into regular contact with children, who are known to be asymptomatic carriers; hence, increasing their anxiety. Last-minute cancellations of major operations have understandably led to increased apprehension. An increasing number of patients are reporting mental health issues, some with medically unexplained symptoms (De Mendonça et al., 2013). This patient cohort can be difficult to reassure over the telephone or through remote video consultations. Some patients do not seek help or fail to attend hospital appointments for fear of catching infection or a perception that services will be over-stretched (Gunnell et al., 2020).
We cannot ignore the elephant in the room: mental illness is not recognised by many patients. Traditionally, this applied to older people in rural areas (De Mendonça et al., 2013). Surprisingly, research shows that even many doctors would not recognise their own mental health issues (Galbraith et al., 2020). Some patients see maintaining good mental health as a luxury when struggling to maintain just their physical health.
I am convinced that these issues go some way to explain the increase in suicide rates. The increased prevalence of mental health issues during the pandemic does not appear to have been matched by an increase in resources to provide much needed psychological support to both patients and clinicians. Evidence-based self-guided online interventions and crisis helplines are needed to support people who might be suicidal (Gunnell et al., 2020). A formal debrief for clinicians in a secure, supportive and therapeutic environment is critical to acknowledge and address the normal response to traumatic events.
