Nurses in the UK and Global are facing a crisis in terms of mental health. In September 2022 an article on US Nurses outlined:
‘Around 85% of nurses are women and female nurses have double the risk of suicide compared to women in the general population, according to a study published in JAMA Psychiatry that relied on pre-pandemic data.‘
Recently it was claimed that suicides within healthcare are being ‘brushed under the carpet‘ with the Laura Hyde Foundation concluding that more than 220 nurses attempted to end their lives during the first year of Covid in 2020. The Laura Hyde Foundation was set up in response to the loss of nurse Laura Hyde to suicide, and has since become a leading voice about the need for focus and support for healthcare professional mental health. The Foundation reported a 550% rise in demand for clinical mental health support from medical staff in 2020.
In many cases when the media reports suicide, there is a note in incredulity in the course taken. Comments such as ‘there was no sign’ are common place. Such is the case for the suicide of Stephen Bennett, 25 who was found dead at his flat in Plymouth on September 18, 2021. The subsequent inquest was told that there was ‘no explanation’ for the tragic loss of a ‘happy, kind, and loving man‘. This belies a belief that suicide is always recognisable before the event. Indeed the majority of prevention is predicated on the idea that it is possible to recognise risk and intervene. This is a view that I also tend to agree with, simply because opposing it seems defeatist and tragic against any hopes we have in preventing future suicides. My past work in suicide identification, ideation (talking about suicide intent), and prevention is dedicated to this belief. However, it is one step further to believe that outside recognition is always possible for potential suicide behaviour. Self-recognition and outside recognition is different, and crucially important.
Suicide is a complicated action. In some cases the movement towards suicide can be very sudden, typically associated with a significant emotional reaction or trauma, but not always. Sudden suicides differ considerably from planned suicides. Within academic and medicine these are typically regarded as ‘Impulsive and Non Impulsive suicides’ however I dislike the term as the decision to complete a planned (non-impulsive) suicide may be considered impulsive. That last push as it were, may be impulsive. Where as sudden and planned diminishes this ambiguity to an extent (no label is perfect). However, the point here is that in some cases there are causal impacts that can be traced back to the point of suicide, with artefacts left to clarify such as notes, recordings, or video messages (although these artefacts are problematic as well). Therefore with a number of suicides there is an outburst of incredulity at the action taken, which almost suggests intervention was possible. I firmly believe that in most cases intervention is possible, but not in the same way, particularly in terms of sudden suicide. Planned suicide can be identified by suicidal ideation, by mental health support, by referral to medical services, recognition of a change in behaviour by close members within the individuals community. Mental health issues are commonly associated with suicide, although it is perfectly possible to experience one without the other. Sudden suicide is much more difficult to plan to prevent, particularly if the action is in relation to a sudden trauma or emotional reaction.
Allow me a touch of anecdotal evidence to clarify my point. In my life I have attempted suicide to completion twice. The first was significantly planned and I have spoken about it at length in terms of my determination to end my life, to the point where I packed up my flat, made several video goodbyes and apologies, gave notice to my landlord, etc. It was a random number of chances that prevented me from dying that day, but I had been planning for months. The other time was 2 months later, where I begged myself to step off a platform. Of the two attempts that is the one that still gives me nightmares. The first I was totally in control, the second I was terrified, confused, alone, and desperate. Individuals who attempt suicide are more likely to attempt it again in the future. Statistically, 23% will repeat the attempt non-fatally, with 7% completing to fruition. I was, and still am, more statistically likely to eventually complete suicide, despite having no plans or intention. It is the reason that I practice healthy mental health daily, and keep close track of my stress levels and my mood.
Going back to that spit second moment when I stood at the edge of the platform, I begged myself to take one more step, to step off the edge, and everything would stop hurting. I kept visualising how quickly it would be over, how all I had to do was step one more step and fall. I was silently sobbing, while I mentally berated and urged myself to step forward, even just to fall forward. I don’t know how long I stood there, it felt like hours but it could have only been seconds. Again chance intervened, a train appeared and the light and sound dazed me enough to reflexively step back. Crestfallen and embarrassed at my perceived failure, I staggered on to the train and sat down. At this point I realised that the platform had had several people on it. In hindsight I came to wonder about those people. In my memory no one said or did anything. I was far to far forward, across a danger line, practically inside the dark tunnel (not a metaphor!) but no-one demanded I step back, no one spoke to me, no one approached me. That is not a recrimination, just an observation of a perfectly reasonable reaction of strangers to a situation they do not want to be involved in.
This is where we return to the point in articles and posts about not recognising the signs. Firstly, in the moment where I stood at the edge, I had not planned or shown any particular signs of intent. As I walked down to the platform I did not have any intent, the decision was sudden and terrifying. I had no time to prepare or reconsider, I simply tried. People were certainly aware of my troubles, but nothing indicated suicidal behaviour overtly. Next, the period of intervention. My life was saved by chance, the train startled me out of my intent and gave me time to reflect as I journeyed home. Granted the next 48 hours were not pleasant but the shock, the break of my focus in that 30 second window was enough to give me reflection to find an alternative to suicide, even if it felt more painful in the short term.
And this in a roundabout way brings us back to the issue of Nurses, Mental Health, and Nursing Suicide. Nurses are in a very precarious position be that as as overworked professionals, under pressure students, economically disadvantaged workers, or caring specialists continually driven to take on more and do more to support those in pain and suffering. Often it is combination of many of these factors, alongside a myriad of additional family, social, personal, and medical issues as well. Yet, it is very difficult to still identify intention or reason for suicide without recognisable signs such as suicidal ideation or potentially self-harm. In cases of the sudden decision to attempt suicide this is even harder to identify and prevent.
However, there are ways to support Nurses and currently throughout the UK there are some excellent interventions being considered and tested to support mental health for all healthcare professionals. Still more could be done, and crucially we need to understand and recognise nursing suicide as a extended issue not something that has appeared as a result of the pandemic and increasing pressures caused by government policies and economic troubles. As a suicidologist I have amassed a team of supporters and professionals with the joint interest in assessing nursing suicide current and past, and seeking to find new ways of prevention, risk recognition, and mental health support. This research continues, and I am looking for new members with experience and interest in nursing suicide to join the advisory team, and share their knowledge and experience. The search for funding is ongoing and I am hopeful to secure funding soon. Suicide is an ever important issue, something that has been raised in the public eye throughout the pandemic, and has the potential to continue to impact on the world as economic, political and social crisis continue. A key for prevention has to be understanding, and that is what we are trying desperately to do.
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