Monday, 11 June 2012

What’s the Point of Mental Hospitals? Suicide and Suicide Prevention

Modern psychiatric wards are light and airy

Monica is one of my blog readers. She often comments on posts. Her comments can be quite challenging. She has a very individual perspective, often making statements which force me to look more closely at my basic assumptions when it comes to mental disorder.

Monica’s most recent comments were in response to my last post, about Paul, a service user who killed himself while a hospital inpatient. Here, my implicit assumption was that it’s not a good idea to allow people to kill themselves if they suffer from a mental disorder and that as an AMHP I should make every effort to try to prevent suicide, including admitting people to psychiatric hospital, either informally or under the Mental Health Act.

As is often the case on my blog, Monica questioned this. She wrote:

“One good way to solve this problem would be to just not hospitalize patients for mental illness. If any deaths are due to conditions at the hospital, such as violence or accidents, they just won't happen if the patients are not in the hospital. Maybe suicides will still happen, in fact more of them since some hospitalized patients are there precisely because they are suicidal. So what? Some people would kill themselves, but suicide is the ultimate act of self-determination. If people are not smart enough to stay alive or have good reasons to prefer death, why should anybody prevent their suicide, and why should taxpayers pay for that?”

I could just dismiss this comment, but it does actually raise important issues – why do we try to prevent suicide? Are there times when mental health professionals, and indeed Society as a whole, should allow people to take their own lives? And what is the point in having psychiatric hospitals?

There is a very long standing and deep seated belief that suicide is a bad thing. Indeed, it was a criminal offence in the UK to commit, or attempt to commit suicide until as recently as 1961, when the Suicide Act was passed. The Christian Church regarded suicide as a sin, to the extent that people who committed suicide could not be buried in consecrated ground.

The Suicide Act, while decriminalising suicide, also created the offence of aiding, abetting, encouraging or procuring the suicide of another. Additionally, the Human Rights Act 1998 states “Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which the penalty is provided by law” (Article 2).

Taken together, these create a powerful imperative for a mental health professional, or indeed any individual, to actively work to prevent suicide, and negligence on the part of a mental health professional could lead to disciplinary action or even prosecution.

There are also National policies aimed at reducing the incidence of suicide. Saving Lives: Our Healthier Nation, published in 1999, aimed to reduce the death rate by suicide by 20% by 2010. A further document, National Suicide Prevention Strategy for England, published in 2002, made it clear that suicide was seen as a “major public health issue.” It stated: “Around 5000 people take their own lives in England every year. In the last 20 years or so, suicide rates have fallen in older men and women, but risen in young men.” It went on to say that in men under 35, suicide was the most common cause of death.

Monica talks about people who are “not smart enough to stay alive”. I’m not sure who she means here – is she talking about people with severe learning difficulties, who might endanger themselves by inadvertently running into traffic? Or perhaps young children, who don’t realise that fire can burn them? In either case, I would not want to live in a society that did not seek to protect such vulnerable people from the consequences of their actions.

Or perhaps she’s referring to adults of normal intelligence who act in ways that others might consider to be reckless or who take apparently needless risks, such as free diving, potholing, bungee jumping, or driving too fast.

The above examples all relate to mental capacity. If someone has the capacity to act in unwise ways, then of course they should be permitted to do so, as long as their actions do not adversely affect others. But if they lack capacity, such as through severe mental disorder, then I do believe, and the law supports this, that they should be protected and prevented from taking certain actions.

Monica is right to draw attention to the risks of being a hospital inpatient. Medical hospitals are often very dangerous places to be if you are ill – they can be repositories of nasty and potentially fatal diseases, and being in hospital can expose you to these if your immune system is compromised.

Similarly, Monica is right, in a way, to say that psychiatric wards can be dangerous places – there have certainly been a number of celebrated cases where restraint has led to the death of a patient, and there have also been instances where patients have been attacked and even killed by other inpatients.

So what would happen if there were no mental hospitals? Well, this has been tried. In 1978, in Italy, a law was passed that made actually made it illegal to admit people to mental hospitals. This experiment centred on Trieste. An interesting analysis of this can be found here.

Ultimately, what this meant was the closure of traditional style asylums and their replacement with community mental health teams. In practice, this did not actually mean that there were no inpatient beds, it simply meant that CMHT’s had small units with 6-12 beds attached to them which could be used for crisis intervention within the locality in which the patient lived. Their use of the powers of compulsory detention under their Mental Health legislation was very rarely used. I would have no problem were this model to be consistently adopted as a means of mental health provision in the UK.

Monica states that “suicide is the ultimate act of self-determination”. If I knew that I had a terminal illness, and the quality of my life became worthless as the result of this illness, then I would certainly want to be allowed to end my life without undue interference.

Many people feel the same; those that can afford to, go to Switzerland for an assisted suicide. Others have challenged the right in the Courts to end their lives and to have someone to assist them – so far, with little success. I don’t think such people should generally be considered to come within the remit of the Mental Health Act.

But there are many occasions when otherwise physically healthy people express the desire and intent to end their life as a direct consequence of mental illness or mental disorder. People with serious depression or psychosis may hear voices that tell them to kill themselves. They may develop the delusional conviction that their loved ones would be better off if they were dead.

The point is that when they are in that state, such people lack the capacity to make an informed decision. Suicide in these cases ceases to be an “act of self-determination”. I believe that it should then be the job of a humane society to protect them, and to try to bring them back to a state of mental wellness such that they no longer believe that they should be dead.

There are times when admission to hospital is the only means of ensuring people’s safety. Ignoring their need is not an option.

19 comments:

  1. Thought provoking post. When I am unwell I am very suicidal, and have been hospitalized for this, as well as following several attempts.

    At the time I am ambivalent about being in the hospital, mostly wishing I could get out of hospital and get on with the business of taking my life.

    But I don't always feel this way... I'm bipolar... so my mood and outlook do change. When I am well I am always happy I didn't succeed, and glad that hospital took care of me until I felt better.

    That's what I hang on to now, the belief that these feelings will pass and that it is my mental illness that is lying to me and saying I'd be better off dead.

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  2. Thanks for the post. I didn't know about the Italian experiment. I find it interesting but not quite going far enough, since it did not even completely eliminate hospitalization, let alone medication in general or forced sedation and physical restraint. By the way, if a professional is simply not doing anything, is that still aiding and abetting suicide? If so, is that the case even if the patient did not start committing suicide (i.e. did not take pills, did not cut his veins, did not hang himself, etc.) and is not obviously about to do so (i.e. is not threatening to jump from a bridge, was not just caught while attaching the rope for hanging to the ceiling, etc.)? For instance, if a patient is depressed, how is the doctor to know if it's just that or the patient will attempt suicide? By "too stupid", I actually had in mind the case of people of normal intelligence, not mentally retarded people, children, dementia patients, etc. One may convince a doctor that s/he has the capacity to go bungee jumping or free diving, if the issue is even raised at all for an apparently normal adult, but is it even possible, at least in the absence of terminal illness, to show capacity when what the person wants is to commit suicide? Isn't it automatically assumed that suicide is irrational and that the suicidal individual must lack capacity? What would it take for a suicidal person to prove otherwise, and is that even possible? Shouldn't there be a way to do so or to give advance instructions not to be saved if and when attempting suicide some time in the future? I realize that withholding further treatment, resuscitation, feeding, etc., or even large doses of prescribed painkillers are sometimes used to allow nature to take its course if the person is physically ill, but I'm talking about active forms of suicide, even in the absence of physical illness.

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  3. Wow, that's rather harsh saying that taxpayer's money should not be spent trying to prevent people from completing suicide. And there are plenty of people with high intelligence who have attempted suicide. Doesn't mean they're 'not smart enough to stay alive', means that their mental health issues or life circumstances or emotional pain were too much to cope with at the time.

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  4. If preventing suicide against the individual's will would no longer be required or permitted, that would remove a threat to liberty. I don't just mean that people would be free to commit suicide. Many people are the victims of "concern" (or of the fear of legal liability) due to the mere possibility that they may kill themselves. That misguided concern may lead to their "treatment", including hospitalization. They can't really prove that they won't kill themselves because there is no way to do so. On the other hand, some people who want help, for instance who are seeing a psychologist or psychiatrist as outpatients, have to watch what they say, even if that means describing their problems in a less accurate manner, thus not getting help for the real and complete problem, to avoid the risk of unwanted hospitalization. If the risk was just not there, a number of people would kill themselves, but many others would get better treatment (or would be left alone but then, that would be their choice). Maybe there would still be some unwanted hospitalization for violence to others (although the right institution for such people is prison, and only after they commit a crime) or for gravely handicapped people who cannot take care of themselves (although that does not have to be for psychiatric reasons). However, removing this risk would still be an improvement.

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    1. I was a mental health nurse & drug counselor for 20 years.

      I agree with Monica.

      It's not about 'ignoring their need' it's about liberty, self determination & personal sovereignty.

      These are inalienable rights in my opinion & therefore are not for anyone else to decide when they do, or do not apply, be they nurses, social workers, doctors or governments.

      Once you decide that you know better than the individual whose life & body belongs to them, & you use force & violence to take away their liberty & inject their bodies with drugs against their will, you lose any moral high ground.

      It becomes about YOUR needs not theirs.

      I also agree that this threat of force & often the implied threat of force, prevents people in distress from trusting the very services who they may otherwise feel able to reach out to.

      This power differential people in psychological distress & those claiming to want to 'care' for them, has been at the root of ALL the crimes against humanity that psychiatry has historically been responsible for.

      The medication many are forced or coerced to take are known to cause heart attacks, diabetes, insomnia, anxiety, suicidal thinking and violent behavior.

      3 new studies have shown psychiatric drugs provide no benefit & are dangerous:

      "SSRI antidepressants and the ‘atypical’ antipsychotics have failed decisively to demonstrate therapeutic benefits in clinical trials and in clinical practice.

      Instead, these drugs have triggered debilitating, chronic illness and even life-threatening risks: antidepressants increase the suicide risk and trigger serotonin syndrome, which is potentially fatal.

      Antipsychotics undermine normal metabolic, cardiovascular, hormonal function, resulting in cardiac arrest, obesity, metabolic syndrome and diabetes"

      childhealthsafety.wordpress.com/2011/08/17/three-new-studies-show-“psychiatric-drugs-provide-no-benefit-and-are-dangerous”/

      The Pharma/Psychiatry complex claims it treats mental disorders by balancing brain chemistry.

      Yet, they have no physical brain chemical tests that can determine any imbalance.

      So, not only is there any evidence that psychiatric drugs address the fundamental cause of people's suffering, their is overwhelming evidence that they cause harm.

      There is also increasing evidence of psychiatric drugs being the cause of the very thing they claim to treat.

      The power, control & corruption of the pharmaceutical industry over health care generally, but psychiatry particularly, is now well established & must be addressed by professionals who have a conscience.

      I suggest people research companies such as Merck, Bayer, Glaxo Smith Kline & the repeated criminal deception, smearing & bribery that they have been caught perpetrating, which include the selling of known HIV infected blood products to Africa, & the pandemic of autism, cancer & auto immune diseases caused by vaccinations.

      My son was given autism by the DPT vaccine at the same time as I was vaccinating drug users for Hep B. I will never give or receive another vaccine in my life after learning the iatrogenic damage they are causing.

      Delete
    2. There are repeated cases of vaccines being discovered to contain state of the art experimental sterilants which were administered to women in Africa, Asia & South America WITHOUT CONSENT.

      There are numerous horrific cases of pharma companies using bribery of child protection services to test drugs on children in care & psychiatrists carrying out mind control & brainwashing experiments on behalf of the military, often causing lifelong trauma, complete loss of all memory & even death.

      Sounds crazy right? Google it. (MK ultra. Dr Ewan Cameron (former head of the World Psychiatric Association) Tavistock Institute. Mind control)

      These companies are responsible for the death of millions of people.

      Prescribed drugs are the number 3 cause of deaths in our society after heart disease & cancer.

      They kill more people than all illicit drugs put together.

      This is the reality of forced incarceration & medication & it is abhorrent.


      Currently, mental health services are run in the interests of big pharma, doctors & nurses rather than what service users find helpful & as long as the NHS has a monopoly on healthcare, this is unlikely to change.

      The principle of non violation must be respected, particularly as so many people needing help have been sexually & physically abused as children.

      Holding someone down & injecting them, or coercing them with the threat of violence or loss of liberty is merely repeating the abuse, however you justify it.

      All abuse is justified by those inflicting it on others.

      'She wanted it' 'You left me no choice' 'We're just trying to help you'

      Whatever. The words are different, but the methods are the same.

      It's interesting that the article seems to understand & accept the validity of someone with a terminal illness acting to end their life & although I happen to agree, making a case that this is somehow different from someone who has decided to end their life for other reasons is merely a subjective value judgment about what is OK & what isn't.

      The truth is, the mental health system is insane & abusive.

      No one has the right to violate your liberty unless you are a danger to others & never has a right to force drugs into your body.

      I believe this will one day be accepted & people will look back at these times as barbaric just as we do regarding the torture, lobotomy & abuse that has been committed in the name of Psychiatry.

      Delete
    3. From the perspective of someone who has been considered a "suicide risk" on many occasions, from my experience hospitalization IS the total last resort and more often than not a CMHT will endeavour to keep you at home with the help of crisis intervention and home treatment teams. Also, I think not enough has been said about the lesser extremes of hospital admissions..it's not all restraint and being pumped full of meds. I think when people are feeling impulsive and unsafe, but there is still a well enough part of them that knows they need help, hospital can be a brilliant and life saving place. I find it extremely offensive to say the people who have saved my life time and time again over the last 4 years, whether by helping me remain calm, listening to my anxieties, keeping myself from starving to death are "barbaric and insane".

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    4. I didn't say that Ruby.

      I'm glad that your experiences have been good as someone who has used services.

      I know there are many caring & humane people working in mental health, who respect other human beings & wish to help them.

      I sincerely hope that I was one of those people.

      My comments were about the system being 'barbaric & insane' because of the power that it gave to one group of people over another group of people to deny them self determination & liberty & to FORCE them to take dangerous, toxic, addictive, ineffective, mind altering drugs either using physical restraint or, more usually, coercion.

      These drugs are the main treatment modality of psychiatry & are developed, tested for safety & sold by the same companies.

      These companies have appalling records of safety & have been shown time & time again to falsify drug studies, bury studies that show that the drugs they sell to be used cause illness & death.

      They have also bribed doctors to prescribe these toxic chemicals on the basis of false science that they have paid for that asserts human distress is the result of 'illness' & 'chemical imbalance' which has no basis in fact!

      These companies care nothing for human life, & completely dominate all medicine, particularly psychiatry.

      The evidence actually supports the conclusion that they deliberately seek to categorise human emotion & experience as illness in order to command more profit.

      I worked with many survivors of organised paedophilia which was often perpetrated by 'carers', social workers, foster parents, police, judiciary, priests, etc.

      When you allow a group of people to have power over others, then that system will attract some people who wish to exploit that power differential.

      Medicine & psychiatry are harming & killing untold numbers of people. They are they 3rd biggest killer after cancer & heart disease!

      Yet it is invisible to most people.

      I hope that explains my remarks.

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  5. Some links:

    Dr Ewan Cameron & MK Ultra. This man was a war criminal but reached the top of his profession.
    http://www.youtube.com/watch?v=_28vZiwuXUQ

    Making A Killing. A documentary about the relationship between pharma & psychiatry.
    http://www.youtube.com/watch?v=JsqDyEMkLpQ

    Psychiatry : An Industry Of Death
    http://www.youtube.com/watch?v=IanwpbqoEcs&feature=related

    The Marketing Of Madness
    http://www.youtube.com/watch?v=IgCpa1RlSdQ&feature=related

    The Drugging Of Our Children
    http://www.youtube.com/watch?v=26e5PqrCePk&feature=related

    Guinea Pig Kids. Testing of drugs on children in care.
    http://www.youtube.com/watch?v=NQRISObQlz0

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  6. Think of the money that could be saved if no-one got any medication and then killed themselves!

    I hope David Cameron doesn't hear about this.

    The purpose of hospital is not just to pin people to the floor and inject them against their will - surely this is a minority of cases.
    Do scientologists have any helpful suggestions other scaremongering?

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    1. Actually, there is a product called EMPowerplus by TrueHope that seems fairly effective for the so-called mental illness but the Canadian government tried to ban it, probably to protect the interests of pharmaceutical companies selling psychotropic drugs. That being said, vitamins and supplements can still be obtained, it's just that they won't necessarily be in the perfect proportions contained in that product. I'm not selling that. I'm just saying.

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  7. I am exceedingly grateful for the products of "Big Pharma" because they allow me to lead a normal life.

    Never forget that mental health services save lives. The need to section people is sometimes a part of that. The illnesses that make people want to kill themselves often respond to treatment, and the clinical outcome is better if the professionals are fully engaged with the patients and are determined to treat the individual rather than see them as a nuisance.

    Humanati, you should have left the profession after much less than 20 years. It was not the right occupation for you.

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    1. "I am exceedingly grateful for the products of "Big Pharma" because they allow me to lead a normal life"

      If you feel they help you to do that, then I respect your opinion & choices because no one is better able to make decisions about your life & aspirations than you are.

      As long as you are fully informed about the side effects then it's your call.

      It is unlikely however, given that the drug companies carry out their own 'research' 'peer review' & publication of studies which are solely designed to sell their product regardless of the drugs efficacy, toxicity & side effects.

      There are many hundreds of cases of people becoming uncharacteristically suicidal & violent when on medication for mild depression.

      Research the numerous school massacres in the US. They ALL, without exception involve the perpetrators being on mind altering drugs or withdrawing from them...

      "Never forget that mental health services save lives"

      Yeah, some lives of saved, at least temporarily, but at what cost to personal liberty, dignity & self determination & how many are lost through psychtropic medications that poison the body & act as a blunt instrument on the emotional & cognitive expression of the human being?

      What about those told that they are 'ill' when they are reacting to sometimes horrific abuse or neglect?

      How many are intimidated by the threat of imprisonment & forced into 'compliance' in order to maintain control of their lives?

      & how many avoid treatment because they don't want to be drugged up or lose their liberty or right to make choices about their life, even if that sometimes means taking their own lives?

      Who are you or I to decide what is right for them? Just as I cannot decide what is best for you...

      I may not like your choices, but I respect them.

      The truth is that if people have the support of nurturing relationships with others who they can share their feelings with & feel listened to, they are much less likely to act self destructively or violently & these therapeutic aspects are all undermined by the power differential which lies behind every interaction.

      Care, with the option of force & a syringe ready, just in case...

      This dynamic mirrors many abusive relationships & is damaging in itself.

      Taking control over someone who has experienced it

      "Humanati, you should have left the profession after much less than 20 years. It was not the right occupation for you"

      I don't know why you say this, can you explain?

      II feel so thankful to have worked with so many amazing, courageous, fascinating people who trusted me enough to share their experiences & explore how they had learned to deal with them in both creative & self destructive ways....

      I was privileged to know these people as they attempted to find new ways to change the script they had been given by others & for me, a key part of this was them trusting me & others around them to respect their choices & to empower them, & not to automatically accept an invitation to 'control' them.

      Many people had learned how to elicit this reaction from carers as a form of 'intimacy' or feeling responded to...

      I learned so much & I always was conscious to attempt to 'do no harm' & to treat people as I would hope to be treated & to listen carefully to what they were saying, & respond to them without judging them.

      I learned so much from the people I worked with & it was a great privilege to experience the creativity, complexity, the beauty & the ugliness, the humour & courage we humans are capable of.

      I will always remember that we are able to overcome & grow bigger than those that hurt us & somehow turn pain & damage into understanding & compassion...

      Shit into gold! :o)

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  8. Some evidence which support my arguments.

    The evidence is growing exponentially now, despite the criminal suppression of information by big pharma, medicine & media.

    There is little doubt that pharmaceutical psychiatry kills, maims & sickens many more than it claims to help & yet it is given the power to imprison, forcibly medicate, restrain human beings as it uses fraud, bribery & blackmail to consolidate control over 'health' care at the expense of untold numbers of people.

    http://www.cchr.co.uk/downloads/Community%20Ruin.pdf

    http://www.cchr.co.uk/downloads/violence-and-suicide-booklet.pdf

    http://www.cchr.co.uk/downloads/anti-psychotics-booklet.pdf

    http://www.cchr.co.uk/downloads/anti-depressants-booklet.pdf

    http://www.cchr.co.uk/downloads/Real%20Crisis.pdf

    http://www.cchr.co.uk/downloads/Psychiatric%20Hoax.pdf

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  9. People have a right to die, "Psychiatry" is a disgusting atrocity right along with "Psychiatric/mental hospitals/wards/institutions/etc" and all are just as disgusting as Auchwitz.
    U mad? too bad, trololol

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  10. "Mental illness"/"Mental disorder" etc, is nothing but your bigoted basis of discrimination against individual's mentality just as how racism targets and discriminates by color, religion/culture, ethnicity, etc.

    Your disgusting and pathetic idea that you have the right to detain people against their will based on their mind even if they have not committed any crime is disgustingly pitiful.

    anyone who is a believer in "psychiatry" "mental illness" "mental disorders" is no different than bigoted racists and concentration camps, you think you have a right to play god over another person's life based on their difference in mind? you'll go down as nothing more than a discriminatory bigot, U mad?

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  11. I too believe that at the end of the day and where all avenues have been tried an individual has a right to die when their lives becomes intolerable and unbearable.

    In the Netherlands, Belgium and Switzerland this right is enshrined in assisted death stautes for people with severe mental health issues. Although it rarely occurs in Netherlands and Belgium at present.It also requires detailed reports and you dont get to act on this in a crisis. It is a decision made when all else has failed.

    In my case and several others I know my choice is assisted death in a clinic in Switzerland if i prefer not to die alone. It is a back up and probably a suicide deterrant knowing I can now do this and have arrangements in place. I believe it prevents violent suicide for me .

    There is an arrogance and complete blindness of MH professionals who profess to believe that suicide should always be prevented as they have the 'cure'. They don't and as referred to above are very often the cause of severe distress and trauma in the response to crisis. You really think that locking up a severely depressed person will encourage them to ask for help next time? All of them ? Really? For some this works, for others ( including me) it is an end in itself.

    Why when I have capacity and insight should I not be allowed to consider this as an option.

    To the masked AMHP - do you hold the same position about choosing to end life if in severe pain /distress from a terminal illness with a physical basis. My thoughts , my plans are not pathological because I have a MH diagnosis. They are a real response to real pain that there is no longer a chance of healing from and it is my right to exercise my autonomy in this area. I may not get to Switzerland. I may decide on peaceful planned methods here albeit will then die alone. But it would not have been an impulse decision and as stated before may prevent the very violent alternatives that have come in to play before

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  12. I too believe that at the end of the day and where all avenues have been tried an individual has a right to die when their lives becomes intolerable and unbearable.

    In the Netherlands, Belgium and Switzerland this right is enshrined in assisted death stautes for people with severe mental health issues. Although it rarely occurs in Netherlands and Belgium at present.It also requires detailed reports and you dont get to act on this in a crisis. It is a decision made when all else has failed.

    In my case and several others I know my choice is assisted death in a clinic in Switzerland if i prefer not to die alone. It is a back up and probably a suicide deterrant knowing I can now do this and have arrangements in place. I believe it prevents violent suicide for me .

    There is an arrogance and complete blindness of MH professionals who profess to believe that suicide should always be prevented as they have the 'cure'. They don't and as referred to above are very often the cause of severe distress and trauma in the response to crisis. You really think that locking up a severely depressed person will encourage them to ask for help next time? All of them ? Really? For some this works, for others ( including me) it is an end in itself.

    Why when I have capacity and insight should I not be allowed to consider this as an option.

    To the masked AMHP - do you hold the same position about choosing to end life if in severe pain /distress from a terminal illness with a physical basis. My thoughts , my plans are not pathological because I have a MH diagnosis. They are a real response to real pain that there is no longer a chance of healing from and it is my right to exercise my autonomy in this area. I may not get to Switzerland. I may decide on peaceful planned methods here albeit will then die alone. But it would not have been an impulse decision and as stated before may prevent the very violent alternatives that have come in to play before

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  13. Well 3 years ago my 15 yr. old son, who has seizures, and brain damage from the seizures tried to kill himself. I don't know about any of you , but I wasted no time getting him help. He had a break down at school. Because another student threatened to shoot him... and they say my son is sick.

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