A timeline of missed opportunities

This film presents a timeline from 2002 to 2019 in relation to England’s National Suicide Prevention Strategy.

The film presents missed opportunities, in particular the potential role of prescribed medications as risk factors for suicide.

Music credits: [all made free to share under common license by Dexter Britain]
(1) ‘Perfect I am Not’
(2) ‘From Truth’
(3) ‘Chasing Time’

Film credits:
(1) ‘A message from Professor Louis Appleby’ for Zero Suicide Alliance (April 2017)
(2) ‘Remember Amy’ a Presentation by Beverley Thorpe for (AD4E) A disorder for everyone (July 2019)

Thanks to Millie Kieve for kindly agreeing to let me use the recording of her January 2004 phone call to Manchester Coroners Office.

Thanks to Marion Brown and Beverley Thorpe for their help with this film

This film is for all those affected by suicide.

A definition of Akathisia: “presents people with a tortuous fight to stay alive. It is so uncomfortable, distressing & under-recognised by the medical profession that people often turn to ‘suicide as their only option. They literally think they are losing their minds.”

AKATHISIA:

Are you or someone you know suddenly unable to stop moving or agitated?

If so, and you recently started, stopped or changed the dosage of a medication, you may be suffering from akathisia. This disorder is also characterized by inner restlessness, anxiety, agitation, impulsivity, aggressiveness, insomnia, irritability, and hostility. Akathisia can lead to violence/suicide.

Akathisiais a disorder, induced as a side effect of medications (including SSRIs and antipsychotics), which can cause a person to experience such intense inner restlessness that the sufferer is driven to violence and/or suicide. It has been said, ‘Death can be a welcome result.’ For reasons related to the strong political and lobbying power of pharmaceutical companies, akathisia is rarely explained as a possible side effect of medications, and medical professionals and the general public know very little of the existence of this disorder.” (MISSD)


House of Commons, Suicide Prevention Report, 2016-2017

Anti DepAware archive

Mille and the Tsar, AntiDepAware, 9 Nov 2019

A Word to the Coroner, AntiDepAware, November 15 2019

Problematic Advice From Suicide Prevention Experts, Ethical Human Psychology and Psychiatry, Volume 20, Number 2, 2018. By Heidi Hjelmeland, Katrina Jaworski, Birthe L. Knizek, and Ian Marsh

Centre for Suicide Prevention, Manchester

Working with the government, by Professor Louis Appleby, British Journal of Psychiatry, Volume 193, Issue 3September 2008 , p. 191

RSM Health Matters, Podcast, Episode 1: Antidepressants, Antibiotics and The Gender Pay Gap, April 2018, Professor Sir Simon Wessely and Professor Clare Gerada

Do Antidepressants Save Lives? A Comment On The 2016 Interim Report On Suicide Prevention By The House Of Commons Health Select Committee, by Professor Carmine Pariante, Huffpost, 6 Feb 2017

‘Mental health drug epidemic for children in Scotland’, Herald, by Helen McArdle, 27 October 2019

Suicide risk and the SSRIs, by Wessely S, Kerwin R, JAMA. 2004 Jul 21;292(3):379-81.
[Note: Professor Sir Simon Wessely has made available his extensive publications, though unfortunately he has not included this publication]

Treatment Emergent Violence To Self And Others; A Literature Review of Neuropsychiatric Adverse Reactions For Antidepressant And Neuroleptic Psychiatric Drugs And General Medications. By Clarke C, Evans J, Brogan K. Adv Mind Body Med. 2019 Winter;33(1):4-21.

Letter to the Editor: Newer-Generation Antidepressants and Suicide Risk in Randomized Controlled Trials: A Re-Analysis of the FDA Database. Hengartner M.P., Plöderl M. Psychother Psychosom 2019;88:247–248

Research News: SSRIs double the risk of suicide and violence in healthy adults. BMJ 2016; Ingrid Torjesen, BMJ 2016;355:i5504

9 Replies to “A timeline of missed opportunities”

  1. From: Dr Peter J Gordon
    To:
    (1) Professor Louis Appleby,
    (2) Professor Sir Simon Wessely,
    (3) Professor Wendy Burn
    (4) Mr Paul Rees
    Subject: Suicide prevention: a timeline

    Friday 17th January 2020.
    Time sent: 14.43
    With a request for delivery and read receipt.

    National Suicide Prevention Strategy: a timeline of missed opportunities https://holeousia.com/2020/01/15/a-timeline-of-missed-opportunities/

    This film presents a timeline from 2002 to 2019 in relation to England’s National Suicide Prevention Strategy.

    The film presents missed opportunities, in particular the potential role of prescribed medications as risk factors for suicide.

  2. To:
    (1) Professor Louis Appleby, Lead for the National Suicide Prevention Strategy for England
    (2) Professor Rory O’Connor, Co-Chair of the Academic Advisory Group to the Scottish Government’s Suicide Prevention Leadership Group.
    (3) Nadine Dorries, MP, Parliamentary Under-Secretary of State for Health and Social Care
    (4) Jeremy Hunt, MP
    (5) Professor Sir Simon Wessely, President of the Royal Society of Medicine
    (6) Paul Rees, CEO of the Royal College of Psychiatrists
    (7) Professor John Crichton, Chair of the Scottish Division of the Royal College of Psychiatrists
    (8) Clare Haughey, MSP, Minister for Mental Health, Scottish Government
    (9) Nicola Sturgeon, MSP, First Minister for Scotland
    (10) Scottish Government, DGHSC@gov.scot

    Subject: Suicide prevention

    From: Dr Peter J Gordon (retired NHS Psychiatrist)

    Tuesday 11th February 2020

    Dear Professor Rory O’Connor, Professor Appleby, Sir Simon Wessely, Professor Wendy Burn, Professor John Crichton and Paul Rees,

    SUICIDE PREVENTION
    The following short film, made by me, has been widely viewed since I published it almost a month ago: A timeline of missed opportunities.

    I shared the link to this film with Profs Appleby, Wessely, Burn, and Mr Rees the CEO of the Royal College of Psychiatrists, on the 17th January 2020 [with a request for delivery and read receipt.] I have had no reply whatsoever.

    Professor Appleby said on the last day of 2019 “My greatest wish for the year ahead is about young people, whose suicide rate has risen over the past decade. That we offer them a more hopeful future. That people in power listen. That their voices will matter.”

    It would be concerning to consider that legal advice might be inhibiting the “open dialogue” that the current President of the Royal College of Psychiatrists has said that she seeks.

    I would be grateful for a substantive, constructive, and meaningful reply from you as leads on Suicide Prevention to the opportunities raised in this short film.

    A timeline of missed opportunities:

    Yours sincerely,
    Peter J Gordon

  3. From: Department of Health and Social Care [mailto:DoNotReply@dhsc.gov.uk]
    Sent: 28 February 2020 13:05
    To: Dr Peter J Gordon
    Subject: Your recent correspondence

    Our ref: DE-1204751

    Dear Dr Gordon,
    Thank you for your correspondence of 11 February to Paul Rees and Professors O’Connor, Appleby, Wessely, Burn and Crichton regarding suicide prevention. Your email has been forwarded to the Health and Social Care Department and I have been asked to reply.

    I appreciate your concerns.
    Every suicide is a tragedy which has a devastating and enduring impact on families and communities.

    That is why, in January 2019, the Government published the first Cross-Government Suicide Prevention Workplan, which sets out an ambitious programme across national and local government and the NHS. It will see every local authority, mental health trust and prison in the country implementing suicide prevention policies.

    We have made further investment of £1.8m to support the Samaritans helpline and £2m for the Zero Suicide Alliance, which aims to achieve zero suicides across the NHS and in local communities by improved suicide awareness and prevention training and developing a better culture of learning from deaths by suicide across the NHS.

    The NHS Long Term Plan reaffirms the NHS’s commitment to make suicide prevention a priority over the next decade. This will see investment in all areas of the country by 2023/24 to support local suicide prevention plans and establish suicide bereavement support services.

    The Government’s aim is to put mental health services on an equal footing with physical health services so that people with mental health problems can access the most appropriate treatment and support when they need it.

    The Government has made much progress since the publication of the Five Year Forward View for Mental Health in 2016. For example, through its Improving Access to Psychological Therapies (IAPT) programme, more people than ever before are getting help with common conditions like anxiety and depression. However, the Government realises that there is still much to do.

    The NHS Long Term Plan represents the largest expansion of mental health services in a generation. It renews the Government’s commitment to increase investment in mental health services faster than the overall NHS budget for each of the next five years. Mental health will receive a growing share of the NHS budget, worth at least £2.3billion more in real terms per year by 2023/24. The Plan also includes a new commitment that funding for children’s and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending.

    Amongst other things, the NHS Long Term Plan will see:

    • IAPT services for adults and older adults with common mental health problems expanded to provide access for an additional 380,000 people per year;

    • new models of integrated primary and community mental health care, which will provide greater choice and support for 370,000 adults and older adults with severe mental illness;

    • services for people experiencing a mental health crisis expanded, with an increase in alternative forms of provision for those in crisis and NHS 111 being used as the single, universal point of access;

    • mental health transport vehicles introduced and ambulance service staff trained and equipped to respond effectively to people experiencing a mental health crisis;

    • mental health liaison services available in all acute hospital A&E departments;

    • an additional 24,000 women per year with moderate to severe perinatal mental health difficulties and a personality disorder diagnosis having access to evidence-based care;

    • at least 345,000 more children and young people aged 0-25 able to access support through NHS-funded mental health services and school- or college-based mental health support teams; and

    • new support for young adults, with tailored services extending beyond 18-25, ending the current ‘cliff edge’ of support and helping thousands more tackle any mental ill-health issues that can arise during the transition to adulthood.

    I hope this reassures you that improving mental health services remains a priority for this Government and the NHS.

    Yours sincerely,
    Anthony Moses

    Ministerial Correspondence and Public Enquiries
    Department of Health and Social Care

    Please do not reply to this email. To contact the Department of Health and Social Care, please visit the Contact DHSC section on GOV.UK

  4. OPEN LETTER TO UK GOVERNMENT DEPARTMENTS OF HEALTH & SOCIAL CARE & ALL THOSE RESPONSIBLE FOR PUBLIC HEALTH & SAFETY
    ENGLAND, SCOTLAND, N IRELAND & WALES

    3 March 2020

    UK NATIONAL SUICIDE PREVENTION STRATEGY: SSRIs/SNRIs and AKATHISIA risks

    We write to express extreme alarm at the way our concerns – expressed over more than a decade to a considerable number of individuals and groups, representing various committees, specialities, institutions and departments in the UK – have been, and are being, apparently quashed.

    Current ‘expert’ advice on suicide prevention, which is now accepted government policy, is that SSRI/SNRI drugs are prescribed to any patient who indicates they may be feeling suicidal or have suicidal thoughts. Our concern is that SSRI/SNRI drugs can themselves cause such suicidal thoughts/impulses – and also a very serious adverse drug reaction called AKATHISIA, the symptoms of which are so unbearable that they can lead people to end their own lives. This fact is not recognised by governments, the NHS or the public, and is not mentioned in the national ‘Suicide Prevention Strategy’, despite our efforts to draw this important issue to the attention of responsible individuals and departments. Many people ARE INDEED dying avoidable deaths by iatrogenic suicide – when suffering known and/or extreme and unrecognised adverse prescribed drug effects.

    Our efforts have been extensive, and most recently resulted in the online publication of a short film compiled by Peter Gordon, retired NHS psychiatrist, with input from several contributors: ‘A Timeline of Missed Opportunities’. This has already been widely shared on Social Media.

    https://holeousia.com/2020/01/15/a-timeline-of-missed-opportunities/

    Please watch this short film – and also read the Replies/Comments section (found at the foot of the blogpost) where further correspondence has been added, including a letter dated 28 Feb 2020 from the UK Department of Health and Social Care (Ref: DE-1204751).

    We are sharing this open letter on social media and with the press as we consider this to be a very serious matter indeed – where the lives of countless people are being knowingly and recklessly put at risk by national ‘Suicide Prevention Strategy’ and ‘Policy’. The public – and indeed prescribers – are being cruelly misled.

    We ask specifically that the KNOWN RISKS of SSRI/SNRI drugs in particular (and indeed other medications which can cause akathisia) be fully recognised NOW – and action taken by Governments, cascaded to EDUCATE all prescribers, healthcare professionals and the public on how to avoid or mitigate these risks.

    Examples of our appeals can be found in this collection of letters published by the BMJ a few months ago. https://www.bmj.com/content/366/bmj.l5102/rapid-responses

    Signed
    Marion Brown, Beverley Thorpe Thomson, Peter Gordon, Millie Kieve, Jo Watson, John Read, Peter Gotzsche, Catherine Clarke, Janette Robb, Stevie Lewis, James Moore, Bob Fiddaman, Dierdre Doherty, Kristina Gehrki, Fiona French, Alyne Duthie

  5. We thank the Helensburgh Advertiser, Scotland, for publishing our Open Letter (our concerns about the National Suicide Prevention Strategy sent to UK Governments 3 March 2020 – see above ‘reply’), in print and online, on 5 March 2020.

  6. Reply received from Department of Health and Social Care 1 April 2020

    Our ref: DE-1208072

    Dear Mrs Brown,

    Thank you for your correspondence of 3 March about suicide.

    I appreciate your concerns and I can assure you the Government takes suicide prevention very seriously. The NHS Long Term Plan reaffirms the NHS’ commitment to make suicide prevention a priority over the next decade. This is supported by commitments to implement a new Safety Improvement Programme across mental health trusts and rolling out suicide bereavement services in every area of the country by 2023/24.

    The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for ensuring that medicines, healthcare products and medical equipment meet appropriate standards of safety, quality, performance and effectiveness and are supported by clear and detailed product information which contains the relevant information to use the approved medicines as safely as possible.

    All medicines have the potential to cause side effects in some patients and product information is therefore made available to patients and doctors to inform them of the risks and benefits associated with a particular treatment. The product information is kept up to date during the lifecycle of the product and consists of the summary of product characteristics (for prescribers) and the patient information leaflet (for patients). The product information can be accessed on the Medicines and Healthcare products Regulatory Agency website at https://products.mhra.gov.uk/ and the patient information leaflet is supplied with each package of medicine.

    It is not government policy that SSRI/SNRI drugs are prescribed to any patient who indicates they may be feeling suicidal or have suicidal thoughts. This remains a matter for the healthcare professionals responsible for an individual’s care.

    There are clear warnings in the product information for selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) regarding the risk of suicide and suicidal behaviour, particularly when these medicines are taken by children, adolescents or young adults.

    The product information for SSRIs and SNRIs also includes a warning about the risk of akathisia which highlights that those who experience symptoms of akathisia should speak to their doctor and healthcare professionals are warned that increasing the dose may be detrimental.

    The risk of suicide and suicidal behaviours associated with these medicines has been kept under close review by MHRA with advice from its independent advisory committees. The warnings have been updated as needed following various United Kingdom and European reviews. The current product information is considered to reflect the available data regarding the risks of suicide, suicidal behaviour and akathisia.

    Healthcare professionals in the United Kingdom have been informed about the risk of suicidal behaviour associated with SSRIs and SNRIs via articles in the MHRA’s bulletin Drug Safety Update in April 2008 and December 2014, more information can be found at https://www.gov.uk/drug-safety-update/antidepressants-suicidal-thoughts-and-behaviour.In addition, guidance was published on the MHRA webpage in December 2014 at https://www.gov.uk/government/publications/ssris-and-snris-use-and-safety/selective-serotonin-reuptake-inhibitors-ssris-and-serotonin-and-noradrenaline-reuptake-inhibitors-snris-use-and-safety.

    The British National Formulary (BNF) states ‘the use of antidepressants has been linked with suicidal thoughts and behaviour; children, young adults, and patients with a history of suicidal behaviour are particularly at risk. Where necessary patients should be monitored for suicidal behaviour, self-harm, or hostility, particularly at the beginning of treatment or if the dose is changed’.

    Also, the National Institute for Health and Care Excellence (NICE) has produced a clinical guideline on ‘depression in adults: recognition and management’ that explains when prescribing antidepressants, potential side effects should be discussed with the patient and that:
    ‘A person with depression started on antidepressants who is considered to present an increased suicide risk or is younger than 30 years (because of the potential increased prevalence of suicidal thoughts in the early stages of antidepressant treatment for this group) should normally be seen after 1 week and frequently thereafter as appropriate until the risk is no longer considered clinically important.’ This can be found at https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#step-3-persistent-subthreshold-depressive-symptoms-or-mild-to-moderate-depression-with-inadequate

    NICE published a key therapeutic topic in March 2019 and a key point of this states an option for local implementation is to “monitor people who are prescribed antidepressants for an increased risk of suicide.” More information can be found at https://www.nice.org.uk/advice/ktt24/chapter/Key-points

    I hope this reply is helpful.

    Yours sincerely,

    Tamilore Bamidele
    Ministerial Correspondence and Public Enquiries
    Department of Health and Social Care

    ————————————————————————————————————————-

    Please do not reply to this email. To contact the Department of Health and Social Care, please visit the Contact DHSC section on GOV.UK

    1. This reply from the Department of Health and Social Care of the 1st April 2020 would appear to follow a standard template for patient concerns. I do not know about others but I am not reassured by what is offered for the reasons set out in the ‘Missed Opportunities Timeline’. These opportunities have NOT been taken up by National Suicide Prevention networks and indeed there has been NO reply from any of the national leads for suicide prevention. This is telling. The letter from the Department of Health and Social Care completely FAILS to address this stonewall: a stonewall that has prevented, and continues to prevent, any meaningful engagement. As such, more lives risk being harmed or lost.

      These are my initial thoughts. I would be interested to hear what other folk think.

      aye Peter Gordon

  7. Reply received 2 April 2020 from Scottish Government

    Our Reference: 202000019423

    02 April 2020

    Dear Marion Brown,

    Thank you for your email of 3 March to Scottish Ministers containing an open letter regarding the prescription of SSRIs/SNRIs and Akathisia risks. Your email was passed on to me to respond on behalf of Scottish Ministers as I work in the Mental Health Directorate in the Scottish Government.

    The Scottish Government has worked hard to reduce the stigma faced by people with mental health problems. As this stigma declines we would expect more patients to seek help from their GPs for problems such as depression. People with mental illness should expect the same standard of care as people with physical illness and should receive medication if they need it. We are also committed to improving access to alternatives, such as psychological therapies, that increase choice and best accommodate patient preference. However, medicine and psychological therapy are commonly used together to achieve better outcomes.

    Where medication is prescribed, this is a clinical decision, which should be discussed within the context of an individual’s long term recovery, and all prescribing should be in line with clinical guidelines and evidence-based practice. Medication should be reviewed regularly to achieve the best possible health outcomes and on-going support should be provided to patients who are prescribed medicines.

    The Scottish Government is currently preparing a position paper on the use of anti-depressants and this will be discussed by the Short Life Working Group on prescribed medicines which have the potential to cause addiction and withdrawal.

    Yours sincerely
    Craig Wilson
    AMH : Public Mental Health and Suicide Prevention

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