Scotland's Silent Deaths BBC Scotland Investigates

They are in this black fog, that it is, it's like wading through

treacle. There is absolutely no, there's no light in any tunnel

there. This is as black as you are ever going to get, you know. Give

it another hour, another half hour, I wouldn't be able to make that

call for help because I'd have gone that step further where I couldn't

even ask for help any more. From the blackness, people are

calling for help - begging for help, but are we hearing them? Are we

lighting their way out or are people dying needlessly? She would

still be here with her kids the now. If she didnae listen to the doctors,

but she did listen to them. Do you feel she was actually asking for

help? She was screaming for it. were banging our heads against a

brick wall. We were saying something has to be done, please do

something- but they kept on saying no, this is how it's going to be.

Tonight we look at evidence that those reaching out for help have

been failed just when they need it This programme is about something

you might think is rare and unlikely to affect you - suicide.

But it's actually the most common cause of death for young men in

Scotland. And our suicide rate over the last ten years has been up to

80 percent higher than that in England. I've been hearing that -

unbelievably - people who are suicidal and asking for help are

being failed. Some of the most compelling evidence comes from here

- Dundee. Incredibly, it comes not from hospitals, but from the police

who find themselves having to treat the suicidal like they are

criminals. Officers do try to get them help but, surprisingly often,

there's nowhere for some of them to go - so the police have no option

but to arrest them. DCI Gordon Milne walked me through the process.

Being formally arrested at the charge bar. Being led to the cells,

physically held by an officer the whole time. Some are even strip-

searched. You go in through the passage to your cell door. At this

point your club it would be removed. The items would be searched and

placed outside and then you'd be given the alternative of what we

call harm prevention suiting. One size fits all. Degrading! I can

imagine where my head would be at this stage. Yes, yes. No, this is

certainly for us a last resort. We have tried a number of options

This is me in sell 33, left alone now, just to have my thought. If I

was really suicidal, I wouldn't want to be here. Getting here is a

pretty awful process. So if I was in those depths of despair... I

really wouldn't want to be here. Tayside Police realised they had a

problem - but how big? They decided to collect information not just on

how many people killed themselves, but how many attempted or

threatened suicides they were called to. We've had exclusive

access to that data - at last we can see the reality of what's

behind Scotland's high suicide rate. Government statistics show that on

average four people a month kill themselves in Tayside. But police

figures show that they actually deal with over 150 incidents

involving attempted or threatened suicide in the same time frame.

Extend that out across the whole of Scotland, there is a significant

number of calls every day every week every year every month

involving people who are in mental health crisis. It is a significant

issue and I think it's a significant issue not only for the

police and the other emergency services but for society in general.

This would appear to be the first time that we've actually measured

in its true sense what impact this is having. It's not just the

numbers - when I studied the data more closely, it's the level of

distress that jumps out. There are cases involving children - 15 and

even nine years old. Numerous near- suicides - even people saved at the

last minute with a noose around their neck. But what really struck

me was how often police try and get someone admitted to the NHS Mental

Health system but are turned away. So in every work place there could

be someone beside you experiencing these problems. What I'm starting

to wonder is whether people asking for help aren't getting what they

I arranged to talk to one person who has attempted suicide twice -

she's still very vulnerable so wanted to remain anonymous.

wasn't the thing I wanted to do but the only choice seemed to be that

suicide was the only way it was So for any of us, when things go

wrong, we'd like to think that the health authorities would react

quickly and take us seriously. I'd said I'm feeling suicidal, I'd

been told, no you don't, which is like actually, I am. Go and have a

cup of tea, you'll be fine. Don't worry, it'll just go away. I'd had

somebody say, don't cry in public, it upsets other people. And it all

felt very much about people protecting themselves and about

other people rather than about you and where you were at. I had

someone say, well if you're still able to ask for help, then you're

not suicidal enough and I'm like you're just like, but this is all I

know to do now. This is all that actually I can get my head round

and the next stage, I guess I don't want to, sort of - sounds a bit

like the second time round. But I knew that actually, give it another

hour, another half hour, I wouldn't be able to make that call for help

because I'd have gone that step further where I couldn't even ask

for help any more. In Glasgow I was to hear a story that wasn't so much

about the system not appearing to care. Here there's a family who

believe that failings led to their Karen McAllister killed herself

last year. She was mother to three- year-old Tegan and two-year-old

Millie. She always said she wanted babies. She actually didnae think

she was able to have them and I was in here and she went to get a

pregnancy test and she was gone to actually ask the lady, check to see

if she was able to have kids, if it came back negative and she phoned

me and she was pure screaming down the phone, you're going to be an

auntie! She was so happy, and then after Tegan she fell pregnant quite

fast with Millie, but she was really happy with that though, so

she was. It was all she ever wanted, was kids. But last year Karen was

returning from a trip to see relatives with her two young

daughters. She suddenly developed what is now thought to have been a

severe form of post-natal depression. Tegan says, Mummy was

crying on the train. You say to her what happened on the train? Mummy

was crying, on the floor crying. What did you do? I gave Mummy a

cuddle. Karen went to a police station in real distress - they

took her to her GP and she was admitted to a local mental health

unit. But she walked out, and after a frantic search, was found at home.

Karen was close to being sectioned - detained against her will for her

own safety. But instead her mother agreed to watch her and bring her

to the Southern General to be admitted the next morning.

doctor said the bed wasn't ready, to come back later and Karen said,

I don't want to go back, I need to just stay here, could I just stay

and have a cup of coffee, read a magazine? He said, if it's only for

an hour you can stay, but if it's any longer, so I waited to find out

how long it was going to be. He said, no the bed will no be ready

until half past six, come back at half six. Go home and get a nice

relaxing bath. Karen did go home and run a bath. She barricaded the

door. When her partner kicked it in, he found her there. What had

actually happened at the house? had went home and went and had a

bath and she had slit her both, is it both wrists? She had done a wee

slit on her tummy and put her knife Keeping their memorial garden tidy

gives Karen's children the chance to nurture memories of their mum in

How would you say they're coping? think they're coping OK. I think

with them being so young, they don't really understand anything.

It's when they get a bit older, that's when we're going to start

explaining what happened to their mum. If they ask star in the sky.

Tegan does say about her mum's up in the sky. Even if you put up, say

if you get a balloon, Tegan lets the balloon go, it's gone up to

mummy. The balloon's for her mummy. If that doctor had kept her in the

hospital, she would still be here. Like she asked. Just makes me angry

that somebody actually can make that choice and somebody's telling

them they're really unwell and somebody's not really caring, just

saying, just go home and come back later. Just makes you really angry.

Do you feel she was actually asking for help? She was screaming for it,

screaming for it. What happened to Karen is obviously a tragedy - her

children have lost a mother, the rest of her family are still

struggling to cope, but what does her death tell us about the system?

Looking back at the last week of her life - much of the system

worked. At first, she did get treatment at her local community

mental health unit. And later, a clinical psychiatrist did consider

sectioning her and insisted she needed constant supervision till

she got to the Mother and Baby Unit. But the family feel it broke down

when she was allowed to go home, where she took her own life. Having

met the family, what a terrific story. It seems, though, that the

thing that is hardest to get their head around his when Karen was at

her most desperate, she herself realised she needed help, and when

she was effectively begging for If Karen was failed, then the worry

is that other suicidal people might be too. We may think of suicide as

something that's extremely rare - but actually, anyone, particularly

young men, can find themselves struggling with these thoughts, but

If the system isn't functioning - One in four of us will develop and

mental health problem some time in our lives. During that time there

may be moments we are feeling despair and weak are contemplating

suicide. It can happen to me, any mental health problem at some times

in our lives. During that time there may be times, there may be

moments when we feel despair. We feel life isn't worth living and we

contemplate suicide. That can happen to anybody. It could happen

to me, and it could happen to any of my family. And what I would want

to know is that there, when I feel like that, when somebody that I

know feels like that there is help and support and somebody that they

can turn to at a time of crisis. That doesn't sound a lot - but

there's another family who feel their relative didn't get that help.

Julie Brown's son Daniel took his own life in January last year.

Daniel was a very complex character. There were behavioural problems

over the years but nothing that I would have thought would have ever

led to this. Daniel had told his GP he had been sexually abused when we

was younger. He been referred to mental health services but didn't

always keep his appointments. Daniel also had a daughter. After

his relationship with her mother broke down, he rarely saw her. And

It was the last year, it was the last year of his life literally

where he'd started suddenly self- harming. For her not to be in his

life or to think badly of him was the ultimate - there was just no

way around that. One night in January 2011 his sister, worried

after she couldn't contact him, went round to his Aberdeen flat. He

was drunk and had made a noose - so she walked him round to their local

psychiatric hospital at Cornhill. And so she left him at that point

and then she gets a phone call from him saying you're never going to

believe this, and he said they've told me I have to phone NHS 24. And

he thought that was funny because he knew what they're supposed to be

doing, you know. So he was trying to get into a psychiatric hospital

for help? Or at least to speak to somebody about how he was feeling

and what was happening at 3 o'clock in the morning, and he was told

phone NHS 24. At this point he had already been placed on a three

month waiting list for a psychiatric appointment. So again

just sent off, off you go. Come back if it gets worse, is what he

was told. Was he on that waiting list when he died? Yeah. So he had

tried to get help for himself, he realised he needed help? Oh yeah,

completely. The root of Julie's frustration is that she feels there

were chances for the authorities to help her son that were missed - he

was being seen by medical staff because he was self-harming and

attempting suicide, but instead of being sent home again to cope on

his own, she wanted him to be in the safety of a hospital. He's

walking around with a noose in his back pocket, he chucked himself

over a wall at Cornhill at 3 o'clock in the morning and chaps on

the door. He goes to his doctor, he tells his doctor, I'm having

suicidal thoughts. He goes to the hospital because he's cut himself

so badly that it requires deep stitching, and you're telling me

that he doesn't fit the criteria to be sectioned. I would love to know

what criteria that is because for me that's bucketloads, you know.

Now, I'm not saying that in Daniel's instance sectioning would

have worked. I've no idea, but the point is he wasn't even given that

chance, and that's exactly what I want. I want people - to have a

You cannot say for sure they will come out the other side. You have

no way of knowing. But you at least deserved a chance. Even Daniel's

family admit he was an awkward patient. Doctors are convinced he

did not meet the strict criteria that would allow him to be

sectioned. And the health board involved said they don't remember

seeing him at the hospital. But what is striking, in retrospect you

can see the warning signs. He asked his GP for help. He missed

appointments, overdoses, episodes of self-harm. He is waiting for

psychiatric assessment and his sister takes him to Cornhill. All

things that might point to his eventual suicide nine weeks later.

What Julie seems to have come up against his assistant that saw her

son as difficult to help. Yes, he probably was because his needs were

not all contained nicely with in mental health. They contained some

drug and alcohol misuse and he did not always turn up for appointments.

But there are lots of people who have these different things going

on in their lives, so what is a system that does not just to that?

I met the family at the time. I conveyed a belief we need to learn

what we could from that tragic experience. One thing I found

concerning is the fact Daniel had a number of contacts with the NHS

over a prolonged period of time. Because he did not attend

appointments or follow up opportunities, the NHS took the

view he did not require assistance. In fact, I think it was a signal of

something that with hindsight we should have picked up on.

Daniel failed? In a general sense, it can be said he was failed. If

you say that in an ideal world, all the organisations, agencies

involved could potentially in read signs, pick them up and act upon

them, then act accordingly. Do you think people in distress don't

necessarily have a diagnosis of a psychiatric illness, there are help

they need in the system? There is a gap in the system. It is something

we need to look at. Grampian Health Board and the police in Dundee are

saying people in crisis have been failed. It is partly because they

don't fit neatly into the definition of someone mental health

services can treat. We don't have a service which addresses suicidal

thoughts. We don't have a service that helps people with their pain

around that issues. We see it as in the realms of mental health

services, but it is not. Everyone would like to see a halfway house,

a place of safety and comfort her. It is not a police cell, it is not

an NHS establishment for mental health disorders, it is a place of

solace to take in individual who does not need acute treatment at

that time and were there are people who are prepared to talk and listen.

So, our people asking for something that is unachievable? I had heard

about the place which might have helped Karen Anne Daniel if it had

been available. This is the Edinburgh Crisis Centre run by the

charity, Penumbra. Nice to meet you. People at their lowest point can

phone, text or e-mail and be seen within hours. If I had no hope, I

wouldn't have contacted them, but I had no expectations anything would

be different. On the other hand, it was that it or die, so I ended up

staying overnight. It was comfortable and somebody cared

enough, even though it was the middle of the night that they would

take that time. Actually, you could stay overnight and you are worth

looking after. This service is unique. You don't need a

psychiatric diagnosis. The aim is to provide what ever support

someone feels they need. They may be feeling unsafe in their own

environment, so it is an opportunity to have some time out

of that. And to look at ways of managing their safety with support.

If you had not made the decision to phone Penumbra, where do you think

you would be now? I would be dead. I don't know why I am still alive,

it is a freak of nature, because that amount of tablets would have

killed me and that was my intention. I think the third time, I would

probably have got it right. Dundee, there is a man who realised

his son was failed by the authorities and set out to get the

truth. Did he know how good he was? On the ice, he was very cocky. He

did know his own ability. Martin's son, Ian was an elite hockey player

and was in the British team. He had been feeling under pressure at work

and had been drinking heavily. And then out of the blue, an overdose.

He made a second attempt a few months later. The same scenario.

And then a third the Thames where he jumped off a building and broke

his back. We thought it would end his hockey career. After the third

time, things took a turn for the worse and he would go missing and

go on drinking binges and disappear. Ever since the first the 10th, Ian

had been seeing a psychiatric liaison nurse. But the family felt

the care he received did not react to the severity of his condition.

Then one morning, Martin left for work. I've got to the end of the

road. I got a phone call saying he had hung himself. Both my daughter

and my wife found him. Martin could not believe his son had got the

appropriate care. He felt the warning signs were there, he had

had 15 appointments with a psychiatric liaison nurse. When

things got bad, his third suicide attempts, he was sent away with a

few phone numbers to call. There was never any progress after

his initial couple of visits. Things started to spiral out of

control. Somebody should have taken notice of that, and that is when I

decided I would complain to the NHS board with regards to how he was

treated. I got a letter back saying they sympathised with me and they

had done everything possible. The treatment he received was

appropriate for his condition. They felt they had done everything they

could for him. I did not think that at all. I disagreed with them.

Martin as the Ombudsman to review the care his son had received. The

review had found the board did not provide appropriate care. It

criticised the fact he did not have a care plan, and when he missed

appointments and his self harming increased, the NHS responded by

discharging him. It made me angry, shocked. I am surprised they have

not been more deaths. I am sitting in front of people in meetings and

they are telling me things have been done and guidelines have been

followed, but subsequently they did not. Either they did not know that

it did not happen, or they were Martin is now involved in a group

set up by the board and the Scottish Government to improve

services. He feels the Government is beginning to listen. Will that

mean real change? It is important we have the right services in place

to support people when they are experiencing distress. There is

evidence to demonstrate at times services are not necessarily

responding in a way they should and they are not giving it the level

priority it should. But even when they do reach out for support and

assistance, at times services have not followed up individuals as they

should have. It is important we address these, what are at times,

gaps in the system to make sure it is much more effective. The

evidence you have had from the Tayside area demonstrates what is a

challenging thing for us to tackle and there is certainly more we can

do. If changes happen it will be at least in part families that have

experienced suicide have spoken out. They are left with an emptiness

that cannot be filled no matter what happens next. You just live

your day, go to sleep, wake up. It all comes back to you. The fear is

now, it will be an implosion, a crashing down of nothing to do. The