Paul Wilkinson- Series 2 - Suicide

[00:00:00] Cheryl: Welcome to the podcast from Cambridge University Medical Education Group of CUMEG for short. This is a podcast from the University of Cambridge Clinical School, focusing on medical education. We discuss a range of topics that medical educators are dealing with. I'm your host, Cheryl France, Head of CUMEG .

Today we welcome back Professor Paul Wilkinson, Clinical Dean of the University of Cambridge Clinical. In Paul's role as a Clinical Dean, he focuses on ensuring that students get the best medical education possible. He also addresses a range of issues. Last time Paul was on the podcast, he helped us understand more about the impacts of racism in medical education and the steps we can take to improve.

Today, Paul will be talking to us about the importance of talking about suicide and the actions individuals can take.

For some listeners, this may be a difficult subject. Listener's discretion is advised.

Welcome, Professor Paul Wilkinson. It's wonderful to have you chatting with us again today. Could you perhaps start by telling us more about yourself and your roles?

[00:01:10] Paul: Yes. My main job is as Clinical Dean of the medical school here in Cambridge, where I oversee all aspects of our teaching and assessment and welfare of our medical students. The other bits of my job are that I'm a Professor and on Honorary Consultant in Child and Adolescent Psychiatry.

Before I took my job as dean about two years ago, my main role was as a researcher in child and adolescent mental health, and one of my main areas of research was suicide and self-harm.

[00:01:39] Cheryl: So today we want to talk about that part of your role and how you help some individuals through some of the most difficult times in their lives.

Before coming to this interview today, I was looking at the Office for National Statistics Measures of Wellbeing Dashboard. This provides a measure of the quality of life in the UK for adults over the age of 16.

The latest measures were disturbing. There's been a long-term deterioration of how people in the UK rated each of the following: satisfaction with their life, how worthwhile they feel in the things that they do, and when they were asked about their happiness and anxiety levels the day before those dipped as well. We are looking at a long-term deterioration of how people are rating their own self-satisfaction.

When we hear things in the media often saying, well, COVID is to blame. Although these statistics are right up to date, they're today's figures, so this suggests that mental wellbeing continues to decrease in the UK. Is this something that you are finding as well?

[00:02:57] Paul: Yes. There's no doubt at all that people's wellbeing has been getting worse over a significant period of time, certainly well before Covid. And we see that at the more extreme end and seeing more people with mental illness. And there's lots of reasons why. And some of them include the fact that people aren't as connected as they were before, social pressures are stronger, especially with the internet, which particularly affects young people, there's more poverty, there's more inequality.

All of these things contribute to making the population's mental health worse. This obviously happened before COVID, but COVID has added to that. It's caused stresses to people in so many ways. Being directly ill with COVID. So many families have been bereaved the effect of being in lockdown and missing out on normal social experiences. The economic effects, people losing their jobs, the economy generally being in a worse state. All of these things continue to have an effect, even though our intensive care units aren't full of patients with COVID, the mental health effects are still with us.

[00:04:02] Cheryl: Which is really quite sad and I recognize for many, this is a difficult topic to address.

Although I think it's really important that we do have this discussion, and I know for many individuals they'll find it hard of how best to talk to someone if they think somebody might be vulnerable or considering taking their own life. Can you help us to understand what the best approach would be?

[00:04:30] Paul: I think every person is different, but what we know for most people is that somebody showing they care and asking how they are is something that is way more likely to help them than to cause any problems. And that's for several reasons. Firstly, when people are struggling mentally, a lot of them are very critical of themselves and think that, well, no one really cares about them and nobody should care about them, and therefore they're not worthy of getting help. They're not based on truth. They're based on people's illness. And actually asking people how they are and showing you care can make them realize, hey, actually people can help me. People do want to help me. I deserve to be helped. And people often find that beneficial. And the most important thing, first off, with somebody who's struggling is to be able to talk about their problems and know that people care about them. So we'd always say, if you're worried about somebody, ask them.

One of the common worries is that if you ask people directly, Do you have suicidal thoughts that you'll plant those thoughts into somebody's head and increase the risk. The evidence is really clear that isn't the case. If people have got suicidal thoughts, they have suicidal thoughts; no one's going to be inspired to think about it because somebody asked them about it and said, the evidence suggests that doesn't happen.

In fact, what does happen is if you ask people about whether they've got those thoughts, it gets them opening up. It gets them talking about their problems, it gets them starting to seek help. And we know one of the big factors in people who complete suicide is people's lack of social connectedness. And if somebody feels they're not connected and no one can help them and nobody cares, they're more likely to try to take their life.

So if they know that somebody cares about them. They're going to feel better about themselves and think it's way more worthwhile to live. Also, they'll think that actually if I went, people would really miss me and therefore I'm not going to do it because it'll hurt somebody else. And certainly one of the most reassuring things I hear when I meet with young people who are struggling and they say they wouldn't try to take their life. I always ask them why? And if they say it's because it'd really upset my Mum. I then think, yeah, actually they've got a good reason. I'm much less worried about this young person than somebody who can't give me reassurance like that. So, I guess to summarize, just asking people about these things shows you care and that in that reduces the risk it doesn't increase it.

[00:06:58] Cheryl: That's really helpful. Thank you. Because that was going to be one of my questions, should you actually address this? And the answer is yes. And it goes back to, you know, often during COVID we were saying, call your loved one, make sure everybody's okay. And I wonder if we're forgetting to do that again?

So maybe it's an important message to say, Hey, let's make sure we reach out to each other, to your friends, to your family just saying hello to the person at the grocery store that might be the only person they've spoken to today. So it goes to show how important this could be.

[00:07:32] Paul: Absolutely. And a lot of studies on people who have nearly completed suicide but haven't ended up dying is that they tell us stories that if somebody had showed their care, I wouldn't have done it.

And likewise you hear from people who've thought about it, we're not going through with the act is they say, I was going to, but then one of my friends phoned and they were nice to me, and I thought, oh, actually it's worthwhile living. So just those little contacts saying hello to people can make an enormous difference.

[00:08:06] Cheryl: Thank you, and, and it shows we all have that responsibility, I think just to say hello and be kind.

[00:08:11] Paul: Absolutely.

[00:08:12] Cheryl: You know, we've said that before, but I think it's important to remember that.

So if you're worried about somebody you don't know very well, how should we go about supporting them or ensuring someone is looking out for them?

[00:08:25] Paul: It's really difficult to know how to help people you are not so close to, because I guess you've got to get the right balance by being supportive and helpful, but not being intrusive. And we don't always get that right, but that doesn't mean we shouldn't try. And I'd say if you're kind to people supportive, ask how they are. That's a positive thing to do. If they're struggling you may not be the right person to help them, especially if you don't know them very well. But what you can ask them is anyone helping you? Is there anyone else you're speaking to you about this? And they might say, yes, I see my therapist twice a week. In which case, you know, someone's helping them. But they may say no. And that may give you the chance to have the conversation about the help that is out there, whether it's going to friends and family or going for professional help. They may not have thought about doing this, or they may not have thought they deserve it.

And actually what you can do is without actually being their supporter, encourage people to get that support.

[00:09:26] Cheryl: I think that's really helpful to understand and I think putting it back into the context of being in a clinical school and perhaps students that may need support. We, we have had a whole podcast talking about some of the support that's out there, but since that podcast the university's improved a lot of the services.

Could you talk to us a bit more about what's happening at the university level and how we can support students.

[00:09:54] Paul: Yes. The university is very aware of the fact that we need to look after our students, as with other universities in the country. And so we have got extra funding and we are looking at what we do, so that both that there's more support available, but also that students and staff were aware that mental health is important and that it's everyone's business. And so we've got a big campaign going this term about looking out for each other. And I think it's really important that university does this.

We're looking in more depth at trying to improve our mental health support, and there's a review of that at the moment. But I think, this is all incredibly positive because I think all organizations should be thinking about the people who we look after.

[00:10:34] Cheryl: I agree, and it's wonderful to hear that there is a review and also that we are talking about it more so clearly based on what you've already said, it's important that we talk to each other more and we have these discussions.

So moving on from that, I think I know personally individuals that have attempted suicide and families that are living with the devastating consequences of someone who didn't get the help that they needed. So in those situations, I felt really helpless, and it's an incredibly sensitive and difficult topic. How do we get more people talking and helping others?

[00:11:12] Paul: I think it's about normalizing the fact that it's okay to talk about mental health. Fifty years ago, people with cancer were stigmatized and people would cross the road, if there's someone with cancer approaching them, that doesn't happen now. People with cancer are cared for and supported and lots of give money, lots of people give money to support people with cancer and cancer research, and that's very good.

It needs to do the same with mental health, that actually we accept that people do have mental illness sometimes and they deserve treatment. They deserve help. They'll often get better, and we need to fund research into it properly.

And it's a very difficult thing to challenge that stigma, but I think what's important is that we all do our bit. And I think that's by letting people know it's okay not to be okay. It's okay to be struggling. And it's a message I give when I give them introductory lectures to our students that it's really important you get help if you're struggling. And I share with them the fact that I'm somebody who's got recurrent mental illness and I've got help and found it really beneficial because I think hearing from other people that we've got problems and have had problems and have got help, helps them feel it's okay for them to be like that as well.

[00:12:29] Cheryl: I think that's really useful and, and a great message.

Overall, I've felt you've been really helpful today to gain better knowledge as to how we can support one another and that it's okay to ask questions and to talk to each other, and that we probably should be doing a bit more of that.

What would be your key messages for our listeners today that you want individuals to take away from this podcast?

[00:12:57] Paul: I think the key message is that we just need to look out for each other, and we need to ask each other how we feel and not assume that someone else is doing it. And if you're worried about somebody, speak with them. Because they may really value that conversation and the chance to open up and you can make a huge difference in that person's life.

[00:13:16] Cheryl: Thank you. I think that's a brilliant way to end this podcast. So let's get talking. I think that's really important.

Thank you once again for taking the time to be with us today and to help us navigate such an emotional topic.

[00:13:30] Paul: Thank you.

[00:13:32] Cheryl: I'm sure listeners will agree that your expertise in how to address suicide prevention has been very helpful.

If listeners want to learn more about this subject, please go to our website and we will have links to organizations that can provide further information. Please visit CUMEG website at www.CUMEG.cam.ac.uk

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