In search of a place

This Panorama programme, presented by Ellie Flynn, explored issues that seem at the forefront of concern amongst both the public and mental health professionals: understaffed and underfunded NHS services, and the seemingly more 'modern' issue of the 'Pro-suicide' communities online.

We heard the story of Callie Lewis, who died by suicide in late 2018, and the events surrounding her tragic death. I was saddened in many ways when watching: for a young life lost, for the staff working in 'high pressure' services, for parents feeling let down by these same services. I also pondered public attitudes towards conversations and ideas viewed as 'dangerous', 'harmful', and needing, as Jacqui Morrissey (spokesperson for the Samaritans) suggests, to be 'buried'. 

Interviews with Callie's family describe the 'failures' they experienced, including phone calls not followed up and a lack of staff available to engage with Callie. Callie's mother Sarah shared her frustration at Callie having attended assessments with local CMNTs and her suicidal thoughts not being identified. Indeed, the presenter states at one point 'Again the assessors took her denial [of suicidal thoughts] at face value'. 

I felt frustration for both sides here. As a clinician or assessor one can only work on the information provided. In human to human interactions, 'Face value' is often all we have to go on. The program also highlighted the continuing lack of funding, training and support provided to NHS services, an issue I imagine many readers are familiar with and a situation that continues to show little meaningful improvement. Yet these concerns do not excuse the failures on the part of the trust in this instance, who acknowledged, albeit following a tribunal, 'gross' failings in their provision of care.  

The second primary concern of this episode, that of the 'Pro-suicide forums' online, is an area of particular research interest of mine, and one I have been fortunate to speak about at various conferences and events. The 'Pro-Suicide' online communities, one of which Callie posted in, are not a modern phenomenon. Their roots can be traced back to text-based 'Usenet' discussion groups that pre-date the 'Internet'. We hear how Callie searched online to discover these anonymous forums; she need not have searched far. Research from Recupero and colleagues in 2008 suggested that 11 per cent of all suicide content online was 'Pro-suicide'. The presenter and Callie's family spoke about their belief that accessing this content provided Callie with knowledge and encouragement to take her own life, and indeed they may be right (Marchant et al., 2017). 

However, whilst the programme addressed the need for improvements in service provision, greater accountability online and possible moderation of potentially harmful digital content, there is an issue that is left unaddressed – communication. Efforts to ban or block harmful content online have, thus far, consistently failed. A spokesperson for the forum Callie posted on stated: 'We offer a place to discuss the topic of suicide without censorship'. I was left with a question: how can we perhaps build these places in the real-world, where information can be balanced, and support provided if necessary?

- Reviewed by Hugo Metcalfe (Research Psychologist) 

Watch the programme now.

References

Recupero, R., Harmss, E. & Noble, J.M. (2008). Surfing for suicide information on the internet. The Journal of Clinical Psychiatry, 69 (6), 878–88.

Marchant, A., Hawton, K., Stewart, A., Montgomery, P., Singaravelu, V., Lloyd, K., & John, A. (2017). A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. PLoS one, 12(8), e0181722.