Three years back I joined a club no one wants to be a member of. I became a parent who lost their child to suicide. He was 20. I didn’t think it was possible. I trusted his doctors to take good care of him. I trusted they would tell me if there was a real risk of him dying, given I was his mother and prime carer. I thought they had the expertise to identify and address a crisis when they saw it. Suicide was not in the script.

I turn the events around his sudden death over and over in my head, and it makes no sense. He had been diagnosed with bipolar disorder 10 weeks before he died. Initially his response to medication was good but then he plunged into a deep dark depression, which I thought was being managed by his GP. All this time, he lived at home with me. None of the medical staff mentioned the word “suicide” at any stage.

When the coroner’s inquest was a couple of months away, a big brown envelope of medical and other documents arrived in the post. I was afraid to open it for fear of the poison that might spill out. After a few days of preparing myself, I sat down with the envelope on a groundsheet in the sun.

One of the many white A4 sheets was a photocopy of a health questionnaire, filled out and signed by my son two weeks before his death. It was designed to evaluate his state of mind over the two preceding weeks. It showed that his depression was the worst it could be, his score was the highest it could be.

My brain froze. He had been feeling severely depressed and suicidal for at least a month before he could take it no more. He wrote it down, but couldn’t talk about it.

My son had been on antidepressants for two weeks at that point. We were told they would start working after three to four weeks. He was given a slip of paper advising him to go to A&E or call the Samaritans in case of crisis. It was like sending someone with crushing chest pain home with paracetamol.

The shock of this revelation paralysed me. I took a deep breath before collapsing into a puddle on the floor, mourning the unnecessary loss of my son who asked for help but didn’t get it; who suffered silently while waiting for someone to understand him; who died alone on a cold day feeling worthless and hopeless. He didn’t deserve this.

There are hundreds of distraught and bewildered families like mine in this club whose stories have a common thread. A father told by the family doctor, “Now that your son is dead, I can tell you this was not his first attempt at ending his life.” Another parent said: “The GP knew our child wanted to end his life but they didn’t discuss that with us even though he was a minor.” Before ending his life, one young man had asked a mental health nurse to let his mother know that he was suicidal. She didn’t.

The first step in reducing risk is to ask about suicidal thoughts. Responses, however minor, require a compassionate, competent and timely response from clinicians. Safety planning comes next and is a collaborative process where patient and medical professional devise strategies for what to do when the ideas of suicide take hold. Then it is a matter of establishing a network of support with friends, family and the community as an essential part of keeping people safe for now and the future.

I was denied the chance to be there for my son when he needed me the most. My son’s answers to medical experts were largely ignored. I have found that suicide is a taboo subject not only in our society but also within the medical profession.

The doctor declared “suicides are not predictable or preventable” at the coroner’s inquest. His other argument was professional obligation of patient confidentiality.

Is confidentiality more important than helping someone at risk to stay alive?

“First do no harm” is a basic principle of medical practice. The Department of Health published a statement entitled Information sharing and suicide prevention in 2014. It states that practitioners should disclose relevant confidential information to an appropriate person – including family or friends – or authority to protect a vulnerable person from risk of death or serious harm.

Four years on, information is still not being shared with those best placed to help a suicidal person. Now, when there is a huge emphasis on care in the community, this is more important than ever before. The inadequacy of mental health services to cope with increased demand is worsened by a huge shortage of funds, psychiatrists and inpatient beds. A report published in 2015 said that unpaid carers save the government £132bn a year. They are a valuable resource if acknowledged as such.

The world of medicine is conservative and defensive. The GMC, Royal Colleges and NHS trusts should reassure practitioners that their decision to share information appropriately will be supported by them.

As a consultant anaesthetist working at a leading teaching hospital in central London, every day I am part of the extreme measures taken to save lives of patients with physical illnesses. Yet, healthy young people are allowed to die in the community from preventable causes in dire circumstances.

Confidentiality versus life. It’s a no-brainer.

• In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.
  

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