Last month I wrote to the Lead for the National Suicide Prevention Strategy for England. The current lead, Professor Louis Appleby, has a prominent social media presence and naturally many of his considerations relate to suicide and strategies that might prevent it.
In my communication I expressed a determination, like all healthcare workers, to help address suicide and its consequences. I shared my view that to do so we need to keep our minds open, to listen, hear, and engage with all voices.
Whilst I am not on social media I have followed discussions on suicide prevention on twitter for some years now. I have noticed, at least what appears to me, a pattern: that the Lead for the National Suicide Prevention Strategy for England does not seem to engage on social media with those who have experienced less than positive experiences of psychotropic medications. Experiences including akathisia, impulsivity and suicidality.
In my communication I said that I wanted to seek a better understanding of suicide prevention and that I planned to share this on my blog.
Professor Appleby replied to say that I was “wrong” about Social media. As a National lead for Suicide Prevention he expressed concern that I was “threatening” him with “public exposure” on my blog and that he would “not be replying further”.
The following film presents missed opportunities, in particular the potential role of prescribed medications as risk factors for suicide . This film presents a timeline from 2002 to 2019 in relation to England’s National Suicide Prevention Strategy.
A Timeline of Missed Opportunities:
If anybody wishes to share discussions that they have had with the National lead for Suicide Prevention for England on social media in realtion to the potential role of psychiatric drugs and suicidality or suicide please add a comment below. If you would wish to do so anonymously please contact me at peter@holeousia.com and I will ensure this.
I have responded to many tweets by Prof Appleby. To the best of my recollection he has responded once to me but I do have memory impairment so cannot be completely certain about this. I commented on a graph of historical suicide rates in the UK and he agreed with my comments about the graph. I had said that suicide rates were falling before SSRIs came to market and therefore subsequent falls could have been for reasons other than SSRI prescribing. I also suggested that had SSRIs not come to market, perhaps the suicide rates might have fallen faster than they have done. I stress again I do have significant cognitive impairment and memory issues but some things do seem to stick in my mind quite well.
Thank you for sharing your recollections of your social media correspondence with Prof Appleby.
I am sure that as a National Lead for Suicide Prevention Prof Appleby will be open to listening and engaging with all voices. Learning from “significant adverse events” requires this (as Sir Robert Francis found): otherwise statistics gathered may not fully capture lived experience.
I have responded to Professor Appleby’s tweets on many occasions, and have asked him to comment, but each and every time I have been ignored. I have even tried posting gifs of tumbleweed blowing down a road, and nothing. Nada. Zilch. I suspect the professor is most reluctant to discuss the role of psychiatric medications in relation to suicide. It is the elephant in the room that its difficult to get any psychiatrist (except your good self) to discuss. Despite Professor Appleby’s coyness on the subject, it’s one that he would do well to acknowledge if he is remotely serious about his position of responsibility. I for one find it very difficult to take him seriously when he hides in this rather cowardly and shortsighted way.
Thank you for sharing your thoughts and experiences of trying to engage with Prof Louis Appleby in relation to this subject.
I would hope that any national lead for suicide prevention would be open to all voices and not feel “threatened” by completely open discussion of potential contributors to suicide.
I have never had a response from Professor Appleby on social media even though I’ve tried to engage with him on a numbers of occasions. I had hoped through relating my experiences of withdrawal from Venlafaxine and subsequent suicide attempt that this would have elicited some response, so it’s very disheartening when you receive no reply and puzzling that this wouldn’t be an area of concern. David Healy found evidence in clinical trials that the rate of suicidal acts and completed suicides in patients treated with SSRIs compared to placebo is 2 and a half times greater on the active drug than on placebo. Worryingly, he found that even healthy volunteers on SSRI antidepressants became suicidal on the drugs. I cannot fathom why Professor Appleby has never responded, is it wilful blindness or is it that he’s simply not interested? Surely if you are involved in the implementation of a national suicide prevention strategy you would want to know the role of psychiatric drugs in inducing suicide?
Thank you for sharing your attempts to try and engage with the National Lead for Suicide Prevention for England. Improving scientific understanding requires engagement. There is a professional duty to listen and consider lived experience and to respond to such vital candour. My worry is that without such an approach that further harm may happen and more lives will be lost to suicide.
We have tried many times to flag up to Prof Appleby – and others ostensibly working on #suicideprevention – what we have found and are finding about the huge role played by the effects of antidepressants etc. on suicidality and suicides. There has been no acknowledgement or engagement – by Prof Appleby (or indeed any others).
It seems that there is a binding pact with the medical profession to completely IGNORE anyone trying to raise these issues.
Our petition at the Scottish Parliament PE01651 has gathered a huge collection of harrowing and important submissions. This is the full petition evidence published to date: http://www.parliament.scot/GettingInvolved/Petitions/PE01651
These 3 submissions to our own Petition (PE01651) refer specifically to suicide issues:
http://www.parliament.scot/S5_PublicPetitionsCommittee/Submissions%202017/PE1651_MM.pdf
http://www.parliament.scot/S5_PublicPetitionsCommittee/Submissions%202017/PE1651_OOO.pdf
http://www.parliament.scot/S5_PublicPetitionsCommittee/Submissions%202018/PE1651_RRRRRRR.pdf
Also – this submission for PE01627 (http://www.parliament.scot/GettingInvolved/Petitions/PE01627)
http://www.parliament.scot/S5_PublicPetitionsCommittee/Submissions%202018/PE1627_FF.pdf
Thank you for sharing this institutional blindness, which seems to be willful. Such an approach departs from ethical principles and indeed from a range of messages delivered from those in genuine positions of power, such as: ‘freedom to speak up’ – – ‘everyone matters’ – – ‘duty of candour’ – – ‘fully informed consent’ – – ‘realistic medicine’ – – ‘core values’ etc etc
I hope that the Suicidal Behaviour Research Laboratory (SBRL) at the University of Glasgow, which I understand is led by Professor Rory O’Connor, will take the ETHICAL approach. Otherwise learning and science will be hindered and more lives will be lost.
Perhaps this very serious matter would benefit from media cover and high quality investigative journalism?
I have not shared in public this initially ‘confidential’ email communication, April 2016, with Prof Louis Applebly before now. I am utterly horrified to see what we are seeing now in 2019, and think that this needs ‘outed’ in the public domain. Thank you for this opportunity. My exchange copied (in full) below.
From: Marion Brown
Sent: 07 April 2016 22:10
To: Louis Appleby
Subject: a confidential note – on Drs and suicide
Dear Professor Appleby
I have seen the article in current ‘Pulse’ about Drs and suicides.
My late husband was a GP – who took his own life, aged 58, in 2011. This was actually a year after he had retired – an ill-health retiral due to increasingly problematic mental health issues. He was taking antidepressants (long-term paroxetine) and had been living with ‘treated’ Addison’s disease since diagnosed at age 31.
In the course of my own work as a psychotherapist in private practice since 2012, I have heard several most alarming confidential accounts of very troubling experiences, and indeed deeply suicidal compulsions, that some people describe with the commonly prescribed medications – the antidepressants and so on. Many people find themselves on cocktails of antidepressants, anxiolytics and sedatives. I have become very concerned that these medicines may indeed be causing ‘more harm than good’ for some people – and have been especially worried by the apparently blatant lack of recognition of these potential issues within the medical profession itself. Antidepressants (especially SSRIs and SNRIs) are still seen as ‘safe and effective’ by most of the practising GPs I have spoken to – and medicines are all that most GPs have to offer ‘on the NHS’ for people presenting with symptoms of excess stress (depression, anxiety, insomnia etc.), which of course (workplace stress) is widespread within the NHS system itself.
I take it that you will be fully aware of the work of David Healy (http://Rxisk.org ), Joanna Moncrieff and the Council for Evidence Based Psychiatry http://cepuk.org/ . The BMA Board of Science is currently working on this very issue.
My hunch would be that these ‘medication issues’ (many people suffer terrible problems when and if they try to withdraw from these psychiatric medications) will be a further major factor in the cases of suicides by doctors themselves. I have come to realise that my late husband’s may have been a case in point – although there were other complicating factors .
I have been particularly jarred by the Alps crash story.
http://www.madinamerica.com/2016/04/the-germanwings-crash-flying-under-the-influence/
There are no easy answers unfortunately.
Sincerely
Marion Brown
From: Louis Appleby
Sent: 13 April 2016 15:35
To: Marion Brown
Subject: RE: a confidential note – on Drs & suicide
Dear Mrs Brown
Thank you for writing – I’m very sorry to hear about your husband.
My review has mainly been about doctors under increasing emotional stress and finding it hard to cope with GMC investigation. The problem is often that their distress goes unrecognised, even by themselves, and they receive no support or treatment of any kind, whether antidepressants or psychological therapy.
With best wishes
Louis Appleby
Thank you for sharing this 2016 communication with Professor Louis Appleby in relation to your husband’s death.
I agree that it is vital that professionals consider the potential for antidepressants, and psychotropics in general, to be contributors to suicidality and completed suicide. My own experience with paroxetine has made this clear to me – and as other contributors to this post have outlined – there is now clear evidence for a direct association between antidepressants and suicide.
I would expect Professor Louis Appleby and his Scottish counterpart, Professor Rory O’Connor, as National leads for suicide prevention, to be engaging with this research and with those sharing evidence of experience: this is evidence that I consider to be overwhelming. The submissions to the Welsh and Scottish petitions on Prescribed Harm reveal this. As does the work of Altostrata and Antidepressant Aware. There are of course many others who are raising this issue on a daily basis yet are also encountering silence and stone-walling.
Thank you.
I have now located the ‘Pulse’ article 7 April 2016 which prompted me to write to Prof Louis Appleby at that time.
http://www.pulsetoday.co.uk/your-practice/regulation/gmc-to-spare-doctors-with-mental-health-problems-from-a-full-investigation/20031549.article
I have to say that it makes for deeply troubling reading, detailing “The proposals – to be ratified by the GMC board – will see investigations against GPs with mental health conditions carried out ‘only where necessary’ and treatment begun instead.” – especially when we take into consideration the words of Clare Gerada in the RSM podcast about Antidepressants from April 2018
https://holeousia.com/2018/05/01/rsm-health-matters-podcast-episode-1-antidepressants/
https://soundcloud.com/royalsocietyofmedicine/episode-1-antidepressants-antibiotics-and-the-gender-pay-gap?in=royalsocietyofmedicine/sets/rsm-health-matters
“I do also use antidepressants in my sick doctor service who might have had referral to the regulator because I know that they are going to get depressed. Unfortunately because there is so much hype we wait till the biological symptoms of poor sleep, anhedonia, weight loss or weight gain, rather than start to think well actually can we start them at an early stage to prevent depression.”
I have sent this message to the National Lead for Suicide Prevention for England (via his University of Manchester email address):
From: Peter, Sian, Andrew & Rachel
Sent: 15 August 2019 20:06
To: ‘Louis Appleby’
Subject: I wasn’t wrong about social media
Thursday 15 August 2019.
Dear Professor Appleby,
It seems clear that I wasn’t wrong about your lack of engagement in relation to the potential for prescribed medications to contribute to suicide.
Kind wishes
Dr Peter Gordon
Thanks for all your work. I’ll add my correspondences with Professor Appleby here also. As he will be busy. waiting for another response.
Here is ‘Margaret’s’ correspondence with Professor Appleby now 7 years ago regarding:
https://davidhealy.org/platonic-lies/
Thank you for sharing this blog-post which includes correspondence from England’s national lead for Suicide Prevention with ‘Margaret’.
Please do feel free to share correspondence with Professor Appleby here in relation to this most serious public health matter.
Kind wishes
Dr Peter Gordon
I’ve generally come to expect some unprofessional behavior on Twitter and I understand some professionals occasionally forget to mind their manners. However, Mr. Appleby’s repeated choice to rudely dismiss bereaved parents and avoid public dialogue about critical adverse drug effects is exceptionally disconcerting given his profession is suicide prevention.
I’ve respectfully posed relevant questions to Mr. Appleby via twitter. Unfortunately, he does not respect me with a reply. As the bereaved mother of a now-dead teen, I worry that Mr. Appleby’s refusal to acknowledge bereaved parents and address their valid concerns may cause further harm to bereaved families during an already stressful time.
Ignoring and dismissing the concerns of bereaved families can leave them with the impression that the factual knowledge of their loved one’s prescribed demise is somehow erroneous. The knowledge held by many bereaved families is often supported by medical experts’ reports and after-death blood tests. Therefore, it is possible that bereaved families might adversely experience Mr. Appleby’s outright dismissals as a destructive and very public form of gaslighting.
Suicide prevention programs should discuss ways to effectively reduce suicides that are precipitated by prescription drugs. Refusing to do so unnecessarily puts all families at risk of becoming bereaved families.
Thank you for writing Kristina and sharing your experiences. I am so terribly sorry about the loss of your daughter. Scientific progression requires us all being completely open to experience and doing so with natural empathy.
Like you, I would implore the National Leads for Suicide Prevention to listen, engage, and use their position of power to hear, and act on, the experience of those who have lost young folk to suicide and potential iatrogenic risks such as the prescription of SSRI antidepressants.
Kind wishes
Dr Peter Gordon
In the UK, psychiatrists who are members of the Royal College of Psychiatrists are regularly reminded to do their best to follow these College Core values:
https://www.rcpsych.ac.uk/about-us/what-we-do-and-how/our-values-and-behaviours/core-values-for-psychiatrists
Communication: successful conveying or sharing of information, ideas and feelings
Dignity: being worthy of respect
Empathy: showing the ability to understand and share the feelings of another
Fairness: treating people equally without favouritism or discrimination
Honesty: truthful and sincere
Humility: having a modest view of one’s importance
Respect: due regard for the feelings, wishes or rights of others
Trust: firm belief in the reliability, truth or ability of someone
Thank you for your kind reply, Dr. Gordon. I also appreciate reading some of the College’s core values you’ve highlighted. I recognize people sometimes make mistakes and fail to uphold shared organizational values. But while “to err is human,” my experiences shared here reflect a pattern of inexplicably poor choices and not an isolated error.
I personally strive to forgive those who trespass against me. However, I still chose to share my adverse experiences here because this topic is not about me, my dear daughter, nor any hurt feelings bad behavior can sometimes cause. Rather, bereaved families are asking that these critical issues be discussed because the silence leaves human lives precariously hanging in the balance.
Regards,
Kristina