Friday, July 7, 2023

What should good suicide prevention look like?

Meghan is an autistic person who is an instructor at E4 Texas at the University of Texas (Austin) and an EPC-USA board member. This is a follow-up article to: Suicide prevention is love not paternalism.

Meghan Schrader
By Meghan Schrader

In regard to my earlier posts about a bioethicist suggesting that disabled people kill ourselves, I thought that maybe I should do a follow up article about what good suicide prevention looks like. I've made the case that suicide prevention is love, however, it is true that people with suicidal ideation have been subjected to oppressive, dangerous, and traumatic measures in the interest of preventing suicide. I am not asserting that it's loving to strap someone to a chair and leave them alone in a room.

In order to understand what good suicide prevention should look like, we need to understand what good mental health care should look like. The best mental health care I ever received was when I was empowered to choose how that will happen. For instance, I once admitted myself to an inpatient program. When I did that, I was able to go to the building where the program was housed and talk to a counselor, where I was given a choice about whether I wanted to be admitted that day or whether I wanted to come back in a week, after I had more time to think the choice over. I chose to be admitted. No one wants to spend their time in an inpatient psychiatric unit, but the fact that I was able to admit myself in a calm, autonomous manner made the experience less traumatic. Inside the facility, doctors took a multi-pronged approach to treating my refractory mood disorder, including multiple kinds of cognitive therapy, art and music therapy, checking for vitamin deficiencies, and even doing a genetic test to see if my genes could tell them what medication might be better for me. There was decent quality food, and the patients were allowed to do things like use the computers and our phones. There was a general sense of camaraderie among the patients, and the program evidenced a non-judgmental attitude towards people. I felt cared for and respected. That’s the kind of intervention that I mean when I say that “suicide prevention is love.”

That’s what mental health care should look like, but sometimes it doesn’t. Although I strongly oppose the assisted suicide movement’s concept of “autonomy at all costs,” it is true that disabled people often find ourselves fighting extreme paternalism and dysfunction that doesn’t need to exist. I’ve heard stories of people who were subjected to wrist restraints and full body cavity searches because they walked into an emergency room crying and saying, “I need counseling, I just wish that I could get hit by a bus or something.” Some mental health facilities can be microcosms of Hell, with unsympathetic staff and warehousing of patients who, because of their situation, do nothing but scream 24/7. If one was fighting suicidal ideation before walking into such a place, one could leave that environment thinking that suicide was actually a good idea. That’s certainly not love.

Suicide prevention that is rooted in love needs to be culturally appropriate. People of color, people with disabilities, and members of the LGBT community may have specific mental health and peer counseling needs that need to be integrated into suicide prevention. Some people with suicidal ideation will recover much faster if they have access to pastoral counseling. Some people who are culturally or linguistically diverse need a psychiatric team that speaks their native language. That is love.

Loving suicide prevention needs to be preemptive. Our society wastefully has decided that it would rather stick mentally ill people with disabilities in psychiatric institutions then provide accommodations and resources that might have prevented mental health problems from developing in the first place. I’ve literally been advised to admit myself to a group home and live on welfare for the rest of my life because the powers that be have decided not to make simple accommodations for my learning disability. That’s very selfish, and is of course linked to the calculating utilitarian perspective that many right to die leaders espouse. Things do not have to be that way, though, we can have a society where we dedicate resources and evidence based practices to ensuring that disabled people’s suicidal ideation isn’t caused or exacerbated by our environment. That’s love.

In short, there’s a right way to provide suicide prevention, and a wrong way to provide suicide prevention. We need to find a better balance between an ethic of, “Oh, you want lethal drugs because you can no longer stand the constant fear that you’re possessed? Well, your body, your choice,” and, “Oh, you’re having suicidal thoughts? We should strap you to your bed, and feed you nothing but Ensure for two weeks.” Suicide prevention based on love needs to be a balance between a patient’s instinct about their own needs and what their physicians are observing, where people come up with collaborative solutions about how to address the situation. By doing that, we can have suicide prevention based on love, justice and equality, instead of extreme paternalism and abuse.

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