Joy Hibbins

@joy-hibbins | contributor
I’m the founder of the charity Suicide Crisis which runs a Suicide Crisis Centre in Gloucestershire. We’ve been providing services for more than three years and have never had a suicide of a client under our care. Our work is now starting to attract national attention. I have bipolar disorder, a post-traumatic syndrome and have personal experience of suicidal crisis.
Joy Hibbins

World Suicide Prevention Day: Connection, Communication, Care

The theme of this year’s World Suicide Prevention Day is connection, communication and care. They are all extremely powerful when helping a person who is at risk. I run a Suicide Crisis Centre in Gloucestershire. When you are working with clients who are at risk, the connection you have with them is paramount. It’s the reason they will call you at 3 a.m. when they are at the point of suicide, when they wouldn’t havecalled another service or indeed anyone else. One of our former clients wrote a poignant phrase on social media to describe the connection he has with us: “You remain in my pocket for life, supporting, guiding and aiding my recovery.” It shows how a strong connection can help sustain a person even when you are absent and indeed even after they have left your services. It is as if the person carries you with them. They need never feel alone or unsupported. The connection is built through communication, the second “c” in this year’s theme. Listening is at the heart of this. Only through really listening and understanding can we start to know how to help. Nonverbal communication can be just as important, though. I recall going out to the home of a woman who had contacted us because she was intending to end her life that night. I had never met her before. Her husband opened the door to the house and when I walked into her room she was on the bed, crying. She was highly distressed. She looked so vulnerable and unwell that my instinctive reaction was to put my arms around her and hold her for a few moments. It was a spontaneous response. An expression of care and concern can sometimes be expressed so much more quickly and emphatically by aphysical gesture. On another occasion, a client at our Suicide Crisis Centre who we had seen several times asked me if I would hug him. I did not realize at first how profoundly important this was to him nor what it represented. I knew his wife had recently left him and he later revealed that one of the last things she said to him was that his physical appearance disgusted her. He had never lacked confidence in his appearance until then, but now he could not look at himself in a mirror. He even tried to shave without a mirror. He later told us he had expected us to recoil from touching him. He felt we would be reluctant to hug him because he believed himself to be “repulsive.” He said our willingness to hug him and to hold his hand when he became particularly distressed helped in his journey to believing himself to be physically acceptable. Perhaps the most important thing to communicate is that we care. A client at the point of suicide needs to know this. When I was under mental health services myself, I didn’t have a sense of being cared for, and some clients report having also felt this way. My impression has been that staff may have a fear of showing they care or they deem it unwise to do so. Recently I accompanied a client to a meeting with her mental health clinician where she said she felt it did not matter to her team whether she survived or not. She felt they did not care. I received an email from her clinician a couple of days later which stated very clearly, “We do care.” It was a moving email. It left me with a feeling of such sadness for both of them. There was a gulf between them; the clinician cared, but the patient didn’t know it or feel it We need to communicate it. We need to be brave enough to say and show that we care. Whatever fears some clinicians may have about this, the fact that you care can help keep a person alive. It doesn’t cause a dismantling of professional boundaries. It is not “misunderstood” by clients, in our experience. Caring does not need to be excluded from a professional relationship. People who are reaching the point of suicide have often detached from the people around them. They may have placed barriers around themselves to prevent people from reaching them at that point. We may need to work tenaciously to connect with them. I know from my own experience the power of a caring and kind approach. It can be so totally disarming. It has the power to break through the most carefully constructed barriers. It can be expressed in your tone of voice, your words, your bodylanguage and your actions. It’s perhaps your actions that express it most powerfully, though. “Would you stay up all night to help someone stay alive?” The answer most of us would give is yes. That action shows so much about your commitment to helping someone stay alive, the fact that it matters to you that they survive and the fact that you care. You communicate so much through that. If you have a person who may be in the final hours of their life, one of the most powerful ways to help them to stay alive is to help ensure they know they are cared for and that their life matters to you and to other people. As professionals, we should not be afraid to say it or show it. We need to have the courage to care. Contact the Suicide Crisis Centre at  http://www.suicidecrisis.co.uk. If you or someone you know needs help, visit our  suicide prevention resources  page. If you need support right now, call the  Suicide Prevention Lifeline  at  1-800-273-8255 . Image via Thinkstock.

Joy Hibbins

Mental Illness: What Psychiatrists Shouldn't Say to Patients

I run a Suicide Crisis Centre and a Trauma Centre in Gloucestershire. Many of our clients have had experience with mental health services before. I also have mental health diagnoses myself and have been under services in the past. I’ve noticed that psychiatrists and mental health clinicians seem to use certain phrases quite frequently. It can be helpful to look at the impact upon patients and how they may interpret the phrases. 1. “It’s your choice/decision to end your life.” When saying this, a clinician is likely to mean, “You have responsibility for your own safety.” However, the patient may place their own interpretations on the phrase. A clinician said this to me when I was in crisis in 2012. We know it has been said to a number of our clients. When I heard it, I felt like it gave more validity to my “decision” to end my life. Our clients report that it makes them feel as though mental health staff do not care whether they end their life or not. That’s clearly not the intention, but it can be the effect. The phrase causes me concern because, in my experience, most people who are at the point of suicide are so highly distressed or unwell they are not thinking as they usually would. The decisions they make at this point are not those they would make if they were well. For this reason, I wish clinicians would avoid using the phrase. 2. “You are not ready for therapy.” A number of our clients have been told this and patients across the country are hearing it, too. It has become so prevalent recently that service user groups wonder if the real meaning of this is, “We do not have enough psychologists to meet the need at present.” Many people cannot access this services. If you have more severe and enduring mental health diagnoses, have experienced more complex trauma or indeed have a higher suicide risk, then you are likely to be referred instead to secondary services. These services provide experienced psychologists, but there are not enough of them to meet the current need. 3. “I can’t wave a magic wand.” The likely definition is, “There is no instant fix.” Clinicians sometimes say this to patients or their care providers. This can feel dismissive. It can suggest the patient or care provider has unrealistic expectations of what treatment is available or is expecting an instant “cure” for their illness. However, I have yet to meet a client who expected an instant answer. They are simply trying to get the help they need. Patients can find the “magic wand” phrase very invalidating. It can also be used at times when a psychiatrist feels powerless to provide the right help in a timely manner within the current system. 4. “You are a very complex mental health case.” We hear from some of our clients that psychiatric staff say this to them. It can make someone feel they are so complex that they can’t be helped. In reality, it may be an indication the psychiatrists do not fully understand them and have not yet worked out how best to help them. The real meaning can be, “We haven’t yet worked out how to treat your issues effectively. We may not understand you very well yet. Therefore, you seem complex.” 5. “You are choosing to continue drinking.” The meaning is, “It is your responsibility to reduce your alcohol intake.” This promotes ownership and accountability, but it can feel unsupportive when said to a person who is alcohol dependent and who has mental health issues. It can fail to take into account why the person may be using alcohol, to try to manage intense emotional pain or the symptoms of mental illness. If you are mentally unwell, then it will affect the choices and decisions you make. The patient may struggle to reduce their alcohol intake if their mental health issues are not properly addressed and treated. 6. “You will need to talk to a psychologist about that.” If you are experiencing symptoms of post-traumatic stress disorder or dissociation and you seek help from a mental health clinician, then you will often be told you must wait to see a psychologist to talk about these issues. If you have to access this via secondary services, then you may wait months. This can be horrendous for those of us experiencing such distressing symptoms. We wish mental health clinicians could help us to manage post-traumatic symptoms in the period we are waiting for psychological therapy. 7. “This patient is difficult to engage.” The patient often feels it is their issue that they can’t engage when they hear this. A better phrase would be, “We haven’t been able to engage this patient.” It places responsibility on clinicians to help the person to connect with them. If a person is not engaging with a service, then it’s likely you are not providing the kind of help they need. You may not fully understand what their needs are. A variation on this is, “This patient cannot accept help.” In this case the clinician seems to suggest that an aspect of the patient’s psychological makeup means they cannot accept help. Once again, it’s likely the help you are providing is not the right help for them or you are not interacting with them in a way they find helpful. I hope clinicians might consider modifying some of these phrases. My aim is not to criticize but to explain the impact of their words. In giving these examples, I appreciate the excellent and highly skilled work psychiatrists and mental health professionals do. Indeed, many of us owe our lives to the empathic understanding and timely intervention of a psychiatrist. Image via Thinkstock. You can find information about the Gloucestershire Suicide Crisis Centre here. If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255. You can reach the Crisis Text Line by texting “START” to 741-741.

Joy Hibbins

Why Mental Health Providers Shouldn't Say 'Difficult To Engage'

“He/she is difficult to engage.” It’s a term I have often heard used by psychiatric staff when talking about patients. I was described as “difficult to engage” when I was under mental health services and now that I run a Suicide Crisis Center, I frequently hear the same phrase used by psychiatric staff who signpost to us. The phrase makes it sound as though it is a failing or difficulty within us, an inability we have to make good use of the service being provided to us. In reality, it’s more likely the service was not providing what we needed and so we didn’t engage. That’s not a criticism of the service, but rather a recognition we are all individuals with our unique needs. The same service is highly unlikely to be appropriate for everyone. I wonder why statutory services don’t instead use the phrase: “We haven’t been able to engage this patient.” This places some responsibility on the service, instead of placing all the responsibility on the patient. I felt I was failing when I was repeatedly told I was “difficult to engage” or “unable to engage.” I still do. The language used still makes me feel there is something lacking in me, which meant I couldn’t find statutory mental health services helpful. The label can have a lasting and profound impact upon the patient. It may make you feel like you cannot be helped. It was in 2012 that I first came into contact with mental health services. I experienced suicidal crisis, following a traumatic experience and was subsequently diagnosed with bipolar disorder and a post-traumatic stress disorder (PTSD). I was placed under the care of the National Health Service crisis team and struggled to connect with them. A different crisis team member would come out to see me every day. It was too much for me to be able to try to connect with so many different people. When you’ve been through a traumatic experience, it can be hard enough to trust and connect with one person, let alone a whole team. It was also painful to repeat information about the traumatic event to each different team member. It meant I was constantly reliving the experience. This was one of the reasons why statutory services didn’t work for me. My particular experience of trauma created challenges for me in accessing the service. The type of services, which would have helped me, didn’t seem to exist at that time. So I set up a Suicide Crisis Center and a Trauma Center with the type of services which would have made a difference to me. Our services have evolved to provide what our clients say they want and need. My difficulty in engaging with statutory services showed me clearly that an individual approach is needed and we cannot provide the same thing for every client. We need to listen carefully to each client and understand what their needs are. A small number of our clients feel unable to be supported by more than one member of our team when in crisis. In our experience, it has been predominantly men who have told us this. It was perhaps hard enough for them to take the step of opening up to one person. It would have been too much to try to do the same with another person. For many crisis services, this would be a huge challenge, and maybe impossible to provide. We know if we don’t provide it, then the client may not continue with us. We might never see them again. If they are at risk of suicide, we have to find a way to provide it, if we can. A client who was at high risk of suicide spoke to me some months after his crisis and said, “If you had passed me on to another person, I wouldn’t have come back.” My experience of becoming a service provider has shown me the responsibility we bear in trying to do all we can to provide a service that is individually tailored to the person and meets their needs. It’s on us to try to help a person to engage, not to simply expect that they will. If a person wasn’t engaging, I would feel it was my responsibility to ask the questions. Why have we been unable to engage them? What do we need to do to make it possible for them to engage with our service? How can we ensure we do provide what they need? If we feel we can’t, then how do we help them to access a service which can? I never had the experience of being asked by mental health services, “Why aren’t you engaging with our service?” Perhaps if I had been asked, we could have explored together why it wasn’t working for me and what might have helped me. If we don’t ask or explore these questions, then the person may disengage completely and may be left with no services at all. If you are feeling suicidal, then that disconnection from services places you at much greater risk. We cannot simply label people as “difficult to engage” and somehow categorize it as the problem of the patient. We have a huge responsibility when providing services and part of that is to ensure we do all that we can to help a person to survive. “Zero suicide” has been talked about in recent years as an ambition. In my opinion, “zero suicide” is about doing all we can for each person to help ensure they survive. It requires us to really consider what each individual needs in order to survive and do everything we can to provide it. If we place labels on a person and consider it to be their issue they can’t engage with services, we may fail to keep trying. We need to be tenacious in helping people to survive. Joy runs a Suicide Crisis Centre in Gloucestershire. They have been providing services for three years and have never had a suicide of a client under their care. Click here for more information about the Suicide Crisis Centre. If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.