I’d like to write to you about two issues but I’ll start with suicide because I saw you’re doing a project to create a suicide prevention pathway. The science isn’t good enough nor are the principles which are applied to psychiatric suicide practice.
I’ve written a document stating my position on the issue. It’s in two parts: the first talks about compassion and mercy especially in legalising assisted suicide and the other talks about the flaws and how suicide treatment could be improved.
I’ll sum up my thoughts here:
– if you want 100% of suicidal people to engage in the suicide system then there has to be legal assisted suicide available. Otherwise people who are certain they want to die will do so any way or attempt to without engaging with treatment. Assisted suicide is humane and incentivises suicidal people to engage who otherwise wouldn’t.
– people need the best scientific answer. The problem is there’s a lack of scientific suicide research. Psychiatric research is about syndromes so treatment effects are measured on multi-variable measures. Suicidal ideation is a common sub-measure in measures like the Beck Depression Inventory but significant effects on this one single symptom can be masked by effects on other symptoms. What’s needed is a retrospective meta-analysis looking solely at the effect of treatments on suicide both within syndrome research and across all syndromes to create suitable evidence based guidelines for suicide.
– there also needs to be scientific evidence and clinical guidelines for treatment resistant suicidal ideation. Basically this is necessary when the first attempt at suicide treatment fails. There’s nothing like this at the moment but it’s obviously necessary because standard treatments don’t work for everyone. Treatment resistant schizophrenia has guidance for treatment – alas it’s clozapine – so it’s logical that there should be something like this for suicidal ideation.
– I believe suicidal ideation is the worst state a conscious being can experience: when it wants to cease its life prematurely because it has become too awful to bear. Bearing this in mind any suicide treatments must be fast acting as well as effective. The aim should always be to minimise the duration of the personal torture of wanting to die. Psychiatric medication and psychological therapies take too long to work in my opinion. It is imperative that any suicide treatment is available quickly and works quickly.
These comments are drawn from substantial experience of unfulfilled, almost constant suicidal ideation over many years. The science is rubbish and the treatments aren’t good enough. Of all symptoms suicidal ideation is the most important but (as far as I am aware) there’s no suitable meta-analysis of old trial data. This is comparatively cheap and I’ve seen a review of 500 trials of job satisfaction on physical and mental health as well as a meta-analysis and funnel plot of publication bias using 1,000 trials so large reviews aren’t impossible. Psychiatric researchers have really failed in their remit to use the best science to tackle the suicidal ideation epidemic.
We do big ideas 