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The White Wreath Assoc Ltd is a
National organisation and we correspond with all Governments across
Australia. WHITE WREATH ASSOC LTD- ACTION AGAINST SUICIDE RECOMMENDATIONS In our
view and in the view of scientific research suicide is caused by neurological
abnormalities. Mentally well people have an instinctive reflex to survive. A
normal individual cannot turn off/override this reflex or what the Greeks
refer to as Eros-life force. In an individual with a neurological condition
commonly referred to as a mental illness this life force can become death
force or what the Greeks refer to as Thanatos. Survival instincts are located
in the Limbic System of the brain. All current suicide prevention strategies
fail because they do not acknowledge the neurological base of mental illness.
Mental illness is a 1) Chronic, 2) Progressive, 3) Neurological Disorder
affecting the, 4) Structure, 5) Function and 6) Chemistry of the Brain. Assessment
of mental illness should always cover these six points, currently it does not
. THE
FOLLOWING ARE OUR RECOMMENDATIONS: - BY THE WHITE WREATH ASSOCIATION LTD
& PETER NEAME WHITE WREATH ASSOCIATION RESEARCH OFFICER 1a. All
patients should have a full physiological/neurological examination, not just
a "mental health assessment," "psycho-social assessment"
and "risk assessment". For e.g. scars, burn marks and frequent
cut/slash marks are noticed on the patient's skin and the patient say that
they have never self harmed/attempted suicide it is tempting to say that they
are hiding/lying-attention seeking, personality disorders etc. The truth may
well be that the patient is in fact very ambivalent about their self-harming
behavior. At one interview they will admit that they will self-harm at
another interview they will deny that they will self-harm. 1b. The fact that
they can burn or cut themselves without pain is a feature of both localized
reduction in pain sensation and disturbance of the limbic/serotonergic system
of the central nervous system (i.e. the brain) At present the tendency is for
professionals to interpret signs of self-harm as willful attention seeking by
manipulative antisocial personality disordered patients. Rejection by the
mental health system leads to further suicide attempts and a high-completed
suicide rate. The fact is any mental illness from anorexia to schizophrenia
can involve self-harm/self destructive behavior. 2. Self
referral and or referral by relatives should be treated as an emergency- if
the patient refuses admission then compulsory provisions of the Mental Health
Act should be used. 3.
Public safety is paramount when one talks of patient's safety this must
automatically mean public safety. The link of suicide with murder is almost
without exception ignored by researchers and planners in relation to suicide
policies and responses. Professor Hughes in "Suicide and Violence
Assessment in Psychiatry", Gen.Hospital psychiatry 1996 says, "It
is estimated that 17% of Psychiatric emergency service patients are suicidal,
17% are Homicidal, and 5% are both suicidal and homicidal". "Murder
is one of the strongest predictors of suicide with a 30% suicide rate found
amounts murders in 4.
Threats of suicide and self-harm including actual self-harm should be treated
as if they were actual attempted suicides. In simple terms people are either
suicidal or not suicidal. Personal judgments' about highly moderately,
vaguely, possibly suicidal, should not be used/they are dangerously
misleading. 5.
Prisons have best practice suicide prevention. Key features are: - a. If an
individual or his family says they are suicidal he/she is treated as
suicidal. b. No one grandiose professional can make an arbitrary decision
that a patient who was seriously suicidal one day is no longer suicidal the
next. c. High risk assessment teams made up of five people determine change
in observation category. Each individual on the team must personally feel
safe about the patient before there is a change in observation category. In
simple terms no senior clinician can heavy other discipline/members to agree
with him or her, as currently happens in the mental health system. We believe
this is a good model to follow and would be happy to assist you and help to
set up such a system. (This could put Old up there with best practice suicide
prevention) 6. All
terms must be defined. For e.g. risk means, risk of suicide, murder and
violence. Assessment means, a step-by-step process starting with a
disciplined outward physical examination/observation before any verbal
questions are asked. Again we are happy to take part in training
professionals. This is a practical skill and needs to be taught on the
job/workplace possibly with the assistance of a training video. If you are
honest, assessment skills as they are currently taught in universities and
places of training are appalling. In reality many professionals miss obvious
suicidal behaviors/clues. Accurate assessment is the rock on which the
service rests. Safety, patient safety means public safety, therefore part of
this issue is asking the family/loved ones, are they happy with the plan of
action. Minimum periods of observation should be at least five days in the
hospital for example, 48 hours cat. Red or constant observation for example
(refer also to high risk assessment teams mentioned earlier) suicide
literally means: - self-murder. 7. In
more than 80% of completed suicides and other mental health disasters someone
close to the patient and or the patient themselves have tried, in good faith,
to get help from professionals but been turned away. This is
both an attitude and training problem/issue. Our concerns are reinforced by
the real life experiences of our member s and supporters and the recently
released Sentinel Events Committee Report of the NSW Government. 8.
History: - history taking/currently patients are asked only about their immediate
family where as patients should be asked if there is a history of "
Nervous breakdowns" (the term mental illness means raving lunatic to
most people and they will simply deny it), early death suicide, self harm,
drug and alcohol use to the point where it destroys family life/for at least
3 generations i.e. grandparents and further back if possible, family history,
anywhere, is the one of the strongest indicators of both suicide and murder. 9.
Suicide is special and specially prepared professionals should always be
called in before patients are turned away/released. 10.
Professionals must be accountable or nothing will change/many psychiatrists
see suicide as a nuisance and a "red herring". To the best of our
knowledge no Old Psychiatrist has ever been held accountable for the death of
a patient. 11.
Mental Health Act/legislation must have provisions written in to ensure early
admissions for suicidal patients (this was always the case for hundreds of
years/such provisions only being removed as part of the
de-institutionalization/ anti Psychiatry policies of the last 20 years. 12. The
hard scientific or factual evidence is that suicide, violence and murder are
caused by morphological changes in the brain combined with low serotonin.
Simply the structure, function and chemistry of the brain are not normal. The
newer Selective Serotonin re-uptake inhibitor drugs (S.S.R.I.s) are said to
be safer in terms of it being harder to overdose on these drugs. However
recent suggestions are that SSRIs (Zoloft, Prozac, Effexor, etc etc etc) may
cause up to three to five times the rate of suicide in young
people/particularly below 20 years of age. There are a number of lawsuits
against drug companies, and at least one recent murder in There is
no scientific evidence that serious mental illness is increasing, it occurs
at the rate of 3% of the population everywhere regardless of drug use, child
abuse, child rearing practices, stress, modern life pressures, youth of
today, on and on ad nauseum. There is evidence that depression is the
"In disease" and that prescribing of all psychotropic medication is
increasing. We
recommend that anyone that is to be commenced on medication altering mood,
feeling and thinking ability (Psychotropic medication) should be commenced on
this medication in hospital. The
reality is that it is extremely difficult to get the right medication for the
right patient. Practically all of the newer anti-depressant and
anti-psychotic medication takes 4-6 weeks to get to therapeutic levels. All
psychotropic, psycho-active substances have serotonergic affects on the brain
i.e. from alcohol and cigarettes to street drugs, from speed to Prozac. This
combined with the fact that the scientific evidence is that there is a cause
and effect relationship between low serotonin and suicide, murder and
violence. In our
view this means that these drugs should be commenced in hospital where
patients are under observation/protection/place of safety. It is also a
clinical observation that in the first few days of commencing an
anti-depressant the suicide rate dramatically increases. 13. Most
of what we have said requires very little" New Money". If you are
really serious about suicide then all of these areas must be covered i.e.
funding professional/clinical practice public safety legislation |