Every time I get to a certain roundabout in town I think of BB.
BB had been engaged in counselling for a while and felt she was coming to grips with the aspects of her life that caused her anxiety and stress. She had engaged with mental health services whom she saw weekly. Except when her work would ring to request she fill in for someone else, we met weekly to talk about her use of illicit substances to self-medicate.
BB was a high funcitoning substance user who had had one too many home visits from the police. She was fearful of losing her children to child protection services. In short she’d woken up to herself and was making the changes she’d spent years talking about. And she was doing a good job of turning her life around.
Six months of intense counselling and BB reported feeling that she was in control of her life, her work situation had improved, her newly acquired assertiveness had increased her self-esteem and she had been drug free for four months. She said there was no way she’d ever go back there and I believed her. Her sobriety toolkit was now well stocked and she knew how to keep herself safe in high risk situations and places and around people whom she identified as “trouble”.
We agreed it was time for her to continue the journey alone, to try those new tools and exercise her new found strengths within herself. In our final session BB wrote a list of important people and their phone numbers. The contact details of people she felt she could ring and talk to if things got tough. There were at least fifteen numbers on that list.
Eight months on …
As the sun streamed though my north-facing office window I replaced the phone in its cradle. My thoughts returned to BB.
My emotional response to the person on the other end of the phone was flat. I gave the information asked for, dates of counselling sessions and the reason the file was closed. And then I sat and stared at the clouds … Why?
Why BB? Why?
When had your life become so desperate? Had you relapsed to drug use? Lost your children to fostercarers? Experienced another incidence of domestic violence? Had you lost your job? When did you lose hope? The questions cycled around going nowhere and my mind closed in on me. Why?
It’s a question that has no answer and never goes away. Those of us left behind to deal with another’s suicide are forever affected.
What had made BB let go of her newfound grasp on life? As clinicians we’re trained to deal with our emotions as they relate to clients, and we’re practiced at “Keeping Calm and Carrying On”. However, the sense of helplessness and powerlessness remains.
We are taught to ‘anticipate’ a client’s death from suicide at some point in our careers and we’re advised how to debrief with peers and the EAP (Employee Assistance Programme). Being able to talk to others in the workplace about the experience is a bit like a psychological autopsy and is part of the process of reflective practice. It’s therapeutic and a release.
We also look at how the suicide may have affected our ability to practice and help manage the issues relating to feelings of blame and failure. Despite being told to ‘anticipate’ a client’s death at some junction of our work it does not make it any easier to cope with when that ‘anticipated’ event plays out for real. Clinicians are affected by client suicide, without a doubt. And those effects are emotional, psychological and philosophical. They are constantly evolving as they lay the foundation to build a more grounded approach to client vulnerability and distress.
BB’s suicide has affected me in ways that scar, but the experience has led me to reflect and resolve to keep asking the hard questions. Those hard questions in the midst of suffering, mental illness and substance abuse … the suicide prevention questions, that lead to a suicide plan and increased support and care of our vulnerable clients at risk of self harm.