Shame, stigma and not making a fuss – why nurses fear seeking help when they reach rock bottom

There’s been an ‘exponential’ increase in suicide attempts among nurses during the pandemic. Here’s how to help yourself or a colleague in need

There’s been an ‘exponential’ increase in suicide attempts among nurses during the pandemic. Here’s how to help yourself or a colleague in need

  • Stigma means nurses are often not truthful about reasons for sick leave - blaming absence on musculoskeletal issues, rather than suicidal thoughts
  • One charity is campaigning to prevent suicide among healthcare staff and to improve the way trusts provide support
  • Advice on what to do if you feel suicidal, tips on supporting a colleague in crisis, and one nurse’s experience of recovery after a suicide attempt
Picture: iStock

In 2011 in England and Wales, 44 nurses took their own lives, according to data from the Office for National Statistics (ONS).

Over the following eight years, the numbers of nurses dying by suicide were broadly similar, rising some years, falling in others.

Figures from the ONS for last year, when the coronavirus pandemic placed healthcare professionals under extraordinary pressure, are not yet available. But data compiled by a charity that offers mental health support to emergency workers suggest that more than 220 nurses attempted suicide in 2020.

Charity’s mission to prevent suicide among emergency staff

The figures come from the Laura Hyde Foundation (LHF), a charity established by Liam Barnes and his family in 2017 after his cousin died by suicide.

Laura Hyde

Laura Hyde was a naval nurse at Derriford Hospital, Plymouth. LHF trustee chair Mr Barnes describes her as ‘the most perfect nurse, incredibly selfless, always putting others in front of herself’.

Did anyone know she was suicidal? ‘No,’ he says. ‘In fact, many colleagues thought she was the one furthest from it.’

Her death ‘ripped the heart out of our family’, he adds. ‘I remember the phone call as if it were yesterday.’

LHF, which recently launched a suicide prevention campaign aimed at emergency workers, has a mission ‘to care for those who care about us’ and it aims to do that in a number of ways.

One approach is to ensure a board-level champion is appointed in every trust or workplace who is dedicated to improving staff mental health, with workforce well-being embedded into the criteria for workplace inspections by regulators.

Stigma around suicide hides the scale of the problem

As well as offering support services, the charity is also trying to improve data collection around sickness absence and suicide to gain a clearer understanding of the scale of the problem.

Stigma around suicide means that emergency workers are often not truthful about the reasons for their sick leave, Mr Barnes says. They will blame their absence on musculoskeletal issues, for example, rather than suicidal thoughts. ‘There’s a fear of being struck off or letting colleagues down,’ he adds.

Mr Barnes also suggests that staff may be uncomfortable using support services based in the workplace. ‘No one wants to be seen walking into the “problem room”,’ he says.

All of this makes it difficult to gather accurate data on suicidal intent among nursing staff. But when LHF asked those who contacted its support services, 226 nurses said they had attempted suicide in 2020.

‘The figures are astounding, shocking – and show you the scale of the problem,’ says Mr Barnes.

Attempted suicide among emergency workers, including nurses, is ‘growing at an exponential level’, he adds, which makes the foundation’s suicide prevention campaign timely and necessary.

‘I felt alone, with nowhere to turn, and took pills to ease the pain’

A community nurse describes how the death of a patient triggered a significant decline in her ability to cope.

‘I’m a pretty proud and resilient person but I struggled following the death of a patient I had cared for over the past 13 months. I felt I hadn’t done enough. She was so nice and I really got to know her as a patient but also as someone I really cared about.

‘I started to struggle with her not being there, feeling guilty that I could have done more. I actually felt ashamed to feel like this. I felt I was being silly, making a fuss, given that a family had lost someone special.

‘My own family noticed a significant decline in my “bubbliness”, often finding me crying uncontrollably. This caused a few arguments with my husband who did his best to help but just didn’t understand what it felt like.

‘I felt alone, with nowhere to turn, and ended up taking some pills to try to ease the pain. My husband found me and I was taken to hospital, and I was urged to try to help myself with their support.

‘A colleague told me about the Laura Hyde Foundation. I was able to speak to someone within 48 hours and my therapist was able to treat me with the respect that I hadn’t felt for a while, making me feel human.

‘If you can relate to this, please don’t be scared to ask for help. It really can make things better.’

Pandemic diverted resources away from mental health support

The full impact of the pandemic and associated lockdowns on the nation’s mental health may not become clear for some time, but early signs suggest that it has been profound.

A report from Samaritans published in June says that as resources were diverted to fight the virus, people struggled to access support for self-harm and suicide attempts.

Yinglen Butt

And there is ‘some evidence’ of an increase in people having suicidal thoughts during the pandemic, the report adds.

Evidence from the RCN supports that claim. Pre-pandemic, from January to July 2019, there were 46 calls to the college’s member support services where the caller discussed suicidal thoughts. During the same period the following year, at the height of the pandemic, there were 75.

RCN associate director of nursing Yinglen Butt says: ‘Members have told us of the increasing pressure they experience and their need for extra support.

‘The RCN recognises the difference that support can make and we can signpost them to additional help if it’s needed.’

She adds: ‘We urge members who are struggling with suicidal thoughts to speak to someone. Help is available through our member support services.’

Understanding suicidal triggers and removing stigma

COVID-19 aside, the reasons why nurses become suicidal are numerous and varied.

For some, a combination of events triggers feelings of despair – a relationship breakdown, feeling stressed or bullied at work, money worries – while for others it is a single precipitating factor.

In 2018, for example, RCN data showed that members who made use of the college’s counselling service were more likely to have considered suicide if they were facing disciplinary action by the Nursing and Midwifery Council.

For nursing students, the pressures may be different but no less difficult to bear.

Suicide-Safer Universities, published by Universities UK and PAPYRUS, a charity that aims to prevent suicide among young people, quotes ONS data showing that in 2016-17 at least 95 university students died by suicide.

Suicide-Safer Universities offers a framework for understanding student suicide and mitigating risk.

Helplines can provide effective support

The document quotes nursing student Catherine Perrin-Griffiths who struggled with her mental well-being from a very young age.

Things improved after she contacted the PAPYRUS HopelineUK, a helpline run by trained suicide prevention advisers.

‘The advisers understood me, allowed me time to think carefully and clearly about where I was in life, and why I was feeling the way I was,’ she says. ‘They helped me to help myself.’

A growing awareness of mental health issues in the media, with celebrities and sports stars among those speaking out, offers hope that the associated stigma may fade and that nurses in crisis will feel more confident about seeking support.

Support for employees who are under investigation

Employers, too, may be compelled to do more to ensure staff well-being is prioritised, especially if they are alleged to have breached their duty of care.

In a case highlighted recently by the British Medical Association (BMA), the widow of a doctor who died by suicide was reported to be taking legal action against his employer and the regulatory body the General Medical Council (GMC).

Sridharan Suresh’s death came hours after he received a letter from the GMC informing him he was to face a tribunal.

A police investigation into alleged sexual touching of a patient by Dr Suresh was later closed with ‘insufficient evidence’.

LHF’s Mr Barnes argues that some employers are doing ‘good work’ in supporting the mental health of staff but plenty of others are not.

‘It’s a bit of a lucky dip,’ he says.

What to do and say if you or a colleague are in mental distress

What to do if you feel suicidal

Rethink Mental Illness suggests these ideas to help you through a crisis:

Just get through the day rather than focusing on the future.

Try to engage in activities you enjoy that will take your mind off what you are thinking.

Talk about how you are feeling with someone you trust.

Contact a healthcare professional, such as your GP or community mental health team.

Call 999 or go to an emergency department if you are in real danger of attempting suicide.

A crisis plan may also help. Written before a crisis occurs, the aim is to help you think about the support you may need if your situation deteriorates. You might list the names and numbers of people you know who can help you, along with ten things you can do to help yourself. Follow the link to the How to Cope factsheet on the Rethink website for a template you can use to make a crisis plan.

A list of support organisations for people with suicidal thoughts takes up three pages of a suicide prevention resource produced by the Laura Hyde Foundation, indicating that help for those thinking of ending their lives is plentiful.

Organisations such as Samaritans, Anxiety UK and the Campaign Against Living Miserably all offer confidential telephone helplines.

Beyond the wobble room – fostering a culture of support in the workplace

Change may be on the horizon. LHF is working with trusts to bring about organisational change in the way they address staff well-being.

‘This is about culture, access to support at work and destigmatisation, not just putting together a wobble room with some fruit in a bowl,’ Mr Barnes says.

At a fundamental level, it’s also about money. LHF says staff absence caused by mental health issues costs the NHS £500 million a year.

What does Mr Barnes think his cousin Laura would have made of his efforts to prevent other nurses ending their lives as she did? ‘Hopefully, she would be proud,’ he says. ‘We’ve helped thousands of people in her name.

‘But I’d give it all up in a heartbeat to have her back.’

How to help a colleague who may feel suicidal

The Laura Hyde Foundation (LHF) says it is entirely understandable to feel uncomfortable talking to someone you suspect is having suicidal thoughts. Encouraging them simply to talk about how they are feeling may be an easier way into the conversation.

Try to reach out to colleagues who may be struggling Picture: iStock

LHF suggests the following can help:

  • Let them know you care and that they are not alone.
  • Empathise. Say something like: ‘I can’t imagine how painful this is for you, but I would like to try to understand.’
  • Be non-judgemental. Don’t blame or criticise.
  • Repeat their words back to them. This shows you are listening and allows you to make sure you have understood correctly.
  • Ask if they have felt like this before and, if so, how their feelings changed last time.
  • Offer reassurance that they won’t always feel this way.
  • Encourage a focus on getting through the day rather than on the future.
  • Ask if they have a plan for ending their life and, if so, what that plan is.
  • Encourage them to seek help through someone they feel comfortable with – a counsellor or by calling Samaritans, for example.
  • Stick to any commitments you agree to.
  • Make sure someone is with them if they are in immediate danger.
  • Try to get professional help for the person.
  • Seek support for yourself.

Mind is among many organisations that have published advice on supporting someone who is feeling suicidal.