Editorial

Citation

Caan, W. (2013), "Editorial", Journal of Public Mental Health, Vol. 12 No. 1. https://doi.org/10.1108/jpmh.2013.55612aaa.001

Editorial

Article Type: Editorial From: Journal of Public Mental Health, Volume 12, Issue 1

“Help me make it through the night”… Kristofferson (1970) sang. Recently, I went to the launch of an important report by the Samaritans (2012) on UK men and suicide: deaths are rising again and life events (like loss of occupation) and social circumstances (like debt) or maladaptive behaviours (like heavy alcohol use) characterise which sub-population are now dying. In the USA suicide has also been rising, parallel to the increasing economic depression (Research News, 2012) and despite collective, anguished ruminations, American clinicians have not made any impact on this population trend (Kamerov, 2012). This reminded me that here in England our Chief Medical Officer, Sally Davies, gave the keynote address to the annual conference of the Royal Society for Public Health, on “the future of public health” (London, 13 September 2012). She stressed that public mental health would become a priority for the next five years. Well, we know quite a lot about the risk factors for suicide (Samaritans, 2012), about harmful patterns that build up during the lifecourse (see the longitudinal Multicentre Study of Self-harm in England, http://cebmh.warne.ox.ac.uk/csr/mcm/) and narratives from patients, their relatives and primary care clinicians confirm that overt signs of distress or desperation usually appear for some time before suicidal behaviour emerges … although in my community experience often the meaning of these antecedent signs is only recognised in hindsight. If public mental health is going to be a priority for Public Health England, then does not some “joined-up” suicide prevention looks like a promising area in which to start work?

If we look at an identifiable group of newly-unemployed men, military veterans, there is evidence (Scott and Guo, 2012) that suicide among the military may be prevented by targeted educational and organisational changes. The Department of Health (2012) has now funded an existing online service (the Big White Wall) to target new, easily accessed support for veterans and their families. This is putting them directly in touch with mental health professionals and a peer support network. Already 2,400 users have joined this confidential service. In terms of alcohol, on 31 October 2012 the All Party Parliamentary Group met yet again to discuss minimum unit pricing – but this time we had new evidence from Canada that this really is an effective public health intervention, and is likely to reduce deaths from both suicide and murder (Tanne, 2012).

The statistics of assessing suicide risk need to be employed carefully and appropriately, because there are many potential antecedents. In the Royal Statistical Society we have used puerperal psychosis and guidance on use of the current Mental Health Act as an exemplary case in a multi-disciplinary discussion (Caan, 2013). If we misinterpret the risks before and after childbirth, puerperal psychosis can lead to both suicide and infanticide. In this issue, the variety of mental health laws in Africa is reported. In future it will be important to update such legislation to reflect both scientific evidence and the rights of service users – and for courts and clinicians to interpret such new laws coherently. We know that many people who kill themselves have a particular illness: depression. For generations, professionals have described various sub-groups of people with depression, with additional variations linked to patients’ age. Meticulous use of statistics (Goodyer, 2012) looks likely to give us a much more coherent description of the lifetime risks of developing depression, and of the sub-groups of patients it affects.

Individuals construct their personal “autobiography” (Robson, 2012) and studies of memory at the personal level are also revealing some specific links between depression, suicidal behaviour, memory and problem solving. Sometimes “life” brings surprising events where a degree of distress or desperation seems altogether reasonable, like consequences of the Fukushima nuclear accident (Rubin et al., 2012). Individual differences in people’s capacity for problem solving or communication need to be considered, in planning measures to prevent illness after such massive “events”, alongside official actions at the population level!

Good work environments in which, at a basic level, all employees feel involved and recognised become a powerful force for wellbeing (Kim, 2012). Conversely, insecurity, exploitation and a loss of identity are a recipe for despair. China has over 200 million migrant workers (roughly four times the whole adult population of the UK) and Xiang et al. (2012) have reported on suicide in that vast and rapidly changing nation. In this issue, the mental health of children “left-behind” by Chinese parents migrating for work is reported. The scale of such health needs is beyond anything we have to address in England – and the professional mental health resources are at a much earlier stage of development (Xiang et al., 2012).

In terms of Kris Kristofferson’s song above, some night a person’s distress may be focused on Why me? Why here? Why now? The Indian psychiatrist Jacob (2012) writes about our contemporary “body-mind-society division” and the clinical risk when services ignore “the individual patient experience, which has to be viewed through it immediate context”. Effective suicide prevention needs to span the different personal and social levels on which suicidal distress can fester:

There is a need to bring to the foreground patient experience in order for them to have an impact on mainstream psychiatric discourse (Jacob, 2012, p. 417).

The Royal College of Psychiatrists (2012) have produced a thoughtful leaflet for an individual who is feeling “overwhelmed” when bad things happen or the situation looks hopeless. In any setting, their practical tips on making a simple Safety Plan could help someone make it through the night.

Survival skills

A gram at just the right timeIs worth a kilo, far too late:Sometimes SafetyJust won’t wait.

As years and years pass,Most of us live from day to day:Professional “experts” need to learnTo help people live, in their own way.

News and views

Welcome to this new section of the journal where the Editorial Board highlight a selection of events, initiatives and perspectives of potential interest to readers.

International Conference: 24-26 June 2013 in Bristol, UK.

“Culture, Health & Wellbeing”

To find out more and to register see web site: www.culturehealthwellbeing.org.uk

Helpline and online support details.

The “Combat Stress” helpline supports both current service personnel and veterans:

Telephone: 0800 138 1619, Text: 07537 404 719.

“Big White Wall” is based on the premise that an individual has access to appropriate psycho-social support in the moment that they experience the need.

The service can be accessed 24/7 at: www.bigwhitewall.com and has staff (Wall Guides) who ensure the full engagement, safety and anonymity of all members. Big White Wall users are supported via the following functions:

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  a community of thousands providing peer support;

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  talking therapies in community groups and one-to-ones;

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  creative self-expression through art and writing therapies;

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  guided groups informed by recognised therapies such as cognitive behavioural therapy and interpersonal therapy;

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  relationship building using social networking practices; and

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  an “Extensive Useful Stuff” section for self-managing psychological distress.

The UK Government has recently invested in an increased capacity for the Big White Wall to give enhanced support to military veterans, using mental health expertise from the Tavistock & Portman NHS trust and the Royal College of General Practitioners.

Woody Caan