Falling through the gaps: the story of a suicide – Martin Strain, 34, was halfway through a four-month wait for an NHS psychiatrist when he killed himself — (The Guardian)

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The Guardian

Caroline Davies

Wednesday 18 February 2015

When Martin Strain felt he required psychiatric help for his long-term depression, he found himself assigned to a self-help course with 50 strangers and paper questionnaires for company.

He completed just four sessions. Two months later, the IT analyst from Batley, West Yorkshire, was dead. His wife, Lyndsey, found him at home. The cause of death, given at his inquest last month, was asphyxia. The verdict: suicide. He was 34.

Strain’s family do not seek to blame. But they believe his story highlights the small gaps in the mental health system through which hundreds of young men fatally slip each year. At the time of his death, he had already been waiting two months for an appointment with a psychiatrist, and had another two months to wait.

With an expectation that official statistics this week will show a rise in the number of suicides, mental health is firmly on the political agenda. The Liberal Democrat leader, Nick Clegg, is campaigning for a “zero suicide” approach, while the Labour leader, Ed Miliband, has said his party will “end the scandal of neglect” of child mental health issues if it wins the general election in May.

The suicide rate among men – last year the rate was three-and-a-half times that of women – has long been a concern. Men are usually less willing to use “talking therapies” and articulate their distress.

“There are hundreds and hundreds of younger men trying to kill themselves each year and the very least society can do is try and screen them very, very quickly,” said Strain’s father, Adrian.

In his last two years Martin was “bounced from professional to professional” during a round of “telephone assessments and failed telephone contacts” and “rarely seen in person” by South West Yorkshire Partnership NHS foundation trust (SWYPFT), his father told the recent Bradford inquest.

He had expressed suicidal thoughts, but not an intention to act on them. His case was not considered a serious enough suicide risk for him to be allocated a care coordinator, a professional with whom he could have built up rapport and trust.

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Strain attempted suicide in 2007 after redundancy. The attempt resulted in hospital treatment for his injuries and access to private psychiatric care through his work health insurance.

There followed three years of reviews with staff-grade psychiatrists, and an antidepressants regime that he was still on when he died. The couple, who did not have children, moved from Essex to be nearer to his family in Leeds for support and he got a new job with a financial services company in Bradford.

In April 2012, however, he felt he needed further help and called a local information and advice service called Kirklees single point of access, which assesses mental health cases. He reported being tearful, avoiding people, “hiding under the duvet” and, his notes indicated, had “occasional suicidal thoughts” and had thought how to do it but had not “actively planned it”.

But because he referred to a history of cocaine and alcohol misuse, immediate one-to-one psychiatric therapy was not considered appropriate, and he agreed to attend sessions with the Lifeline project, which helps with addiction disorders. It did not help, according to his wife, and he went along to just three sessions.

It was a catch-22 situation, his father, a teacher, told the inquest. Nobody knew whether the drug and alcohol use was caused by his mental health, or the other way round, and he was not offered access to the “dual diagnosis” programme that treats both conditions.

Two more years of antidepressants followed, but by February 2014, Strain again felt he needed more direct help. He stopped going to work and “hid under the quilt” at home. He was assessed by the South West Yorkshire trust on the telephone, and when asked about the regularity of thoughts of self harm, he estimated that he felt he wanted to be dead up to six times in two weeks. But, he said in the call, he did not want to let down his wife and four younger siblings. He wanted to “break the cycle” of how he felt. He was not judged to be at current risk of suicide.

Adrian and Caroline Strain at home in Leeds. Their son, Martin, and his wife had moved back to Yorkshire for family support. Photograph: Christopher Thomond for the Guardian

He agreed to go on the stress control course, a self-help course during which users rate how often they think of suicide. Strain’s scores began at “occasional” thoughts, but increased to “more than half of days” in a two-week period. This rang alarm bells with course organisers, who called him. Though it took several missed telephone calls and messages to finally make contact, they were assured by Strain he could keep himself safe.

He never completed the course. He was discharged back to his GP and the assessment process began all over again. In June, he was given an appointment to see a psychiatrist, but the first available date was 8 October. Though he could have got an earlier date through his wife’s health insurance, he had not got round to sorting it out. By that stage, his family believe, he had lost all motivation.

On 1 August he killed himself. Toxicology tests revealed no alcohol or drugs, apart from normal therapeutic traces of his antidepressants.

Recording a verdict of suicide, assistant coroner Dr Dominic Bell said Strain was “lucid and deliberate” in his actions, and said he had never revealed the severity of his condition, in terms of consideration of suicide, to his family, GP or mental health services.

Addressing the issue of care coordinators, Bell said: “If responsibility for assessing the nature of Martin’s condition was invested in an individual with appropriate expertise the severity and implications of his deterioration may have been recognised and acted upon.”

In the last two years of Martin’s life he was rarely seen in person

Adrian Strain

Strain’s wait for a psychiatrist is in keeping with the quality standard for waiting time, which is 18 weeks from the point of referral, the trust said in its serious incident report of his death.

Adrian Strain believes there was a lack of liaison between his son’s GP and the services Martin found himself using. “In the last two years of Martin’s life he was rarely seen in person,” he said.

His son was was adept at masking his feelings, and had an “effective and high level of social functioning”, the inquest heard. His wife said she had “probably seen him cry once in the whole of our time together”.

The family believe face-to-face assessments are crucial so body language can be observed, and treatment should be more proactive than reactive. Adrian Strain said attaching a community mental health nurse to GP practices could be very beneficial: someone who knows a patient’s history and care plan and has a rapport with them.

“Martin’s is not a unique case and there will be thousands like him suffering who are unsure of what services are available and of benefit to them,” his father said.