Advances in psychiatric treatment (2013), vol. 19, 292–294 doi: 10.1192/apt.bp.111.009878

article Hey kid, are you OK? A story of suicide survived† Kevin Hines, Alys Cole-King & Mel Blaustein

Kevin Hines survived a serious When I was very ill the voices were negative suicide attempt in 2000 and his life Suy mmar and mumbled terrible things into my head. By is now dedicated to suicide preven­ Kevin Hines gives a high-impact and deeply September 2000 I could feel nothing but intense tion. He travels the world delivering poignant account of his suicidal crisis, which inspirational presenta­tions, has emotional pain. I feared that I was a burden to my culminated in an attempt to end his life, and an made numerous media appearances family and friends, and that they would be better and runs a website and blog (www. inspirational account of his recovery and return off without me. I began to think seriously of suicide to mental well-being. kevinhinesstory.com). His forth­ and searched online for ways to die. Twisted people coming book, Cracked, Not Broken: who promote suicides actually said “Good luck!”. Surviving & Thriving after a Suicide De claration of interest Attempt, will be published by Roman A.C.-K. has received funding to develop and deliver Nobody ever asked & Littlefield. Alys Cole-King is the Connecting with People emotional resilience, a consultant liaison psychiatrist compassionate care and suicide awareness One night I decided that I just couldn’t carry on in the Betsi Cadwaladr University training, and was the instigator and executive and stayed up all night agonizing about what I Health Board and Director of Open had decided to do. I since found out that my father, Minds Alliance Community Interest producer of the U Can Cope film. Company. She sits on the All-Party who was extremely worried about me, called my Parliamentary Group for Suicide doctor, who told him not to worry and that I would and Self-harm Prevention and is On 25 September 2000 Kevin Hines, a 19-year- be OK. I wrote seven or eight versions of a suicide the Royal College of Psychiatrists’ old student, attempted suicide by jumping off the letter, settling on the one that held the least anger. spokesperson on suicide and self- It didn’t occur to me that any suicide note, however harm, also sitting on their Patient Golden Gate Bridge in San Francisco. Incredibly, he Safety Group. She works nationally survived. The following is his very personal account written, let alone an actual attempt, would break with medical Royal Colleges, of what happened, his journey back to mental well- my family in two. Although my parents were trying voluntary bodies and academics. being, and reflections on what might have prevented to be supportive I just couldn’t tell them the depth The Connecting with People training of my despair. Nobody ever asked me if I was forms part of the RCPsych education him from trying to take his own life. experiencing suicidal thoughts, so I didn’t feel able programme, the BMJ Masterclass and the Royal College of General Kevin’s story to disclose them to anyone. The next morning my Practitioners accredited Primhe father begged me to go to work with him, given his Diploma in Mental Health. Mel ‘In High School, I was an athlete, active in student worry. I lied, pretending to be fine, knowing that I Blaustein is the Medical Director of government, on the debating team with a flourish­ was going to end my life that day. I didn’t want to Psychiatry at Saint Francis Memorial ing social life and a supportive family. Aged 17, die, but I thought I had no option; I could no longer Hospital, an acute inner-city unit 4 I was diagnosed with bipolar disorder (type one miles from the Golden Gate Bridge cope with my intense emotional pain. (GGB), where he sees many suicidal with psychotic features). At first I was in a state patients. In 2004, as President of the of total denial, confusion and was embarrassed “Get off the bus, I gotta go!” Psychiatric Foundation of Northern and ashamed to carry the label. I was affected There is a categorical difference between believing California and chair of its GGB by the discrimination associated with mental you have to do something and actually wanting to Taskforce, he initiated the seventh campaign to gain approval of a illness. Although I pretended, I did not follow my do it. As I took a bus to the Golden Gate Bridge I barrier on the bridge. In 2009 he was treatment plan. I drank alcohol, despite being told made a pact with myself “If anyone asks me if I’m awarded the ‘lifesaver Award’ by that drinking while on psychiatric medication OK, I’ll tell them everything.” I was the last one off the American Foundation for Suicide was very dangerous. The doctor said I needed a of the bus at the bridge. Even though I was crying Prevention. Correspondence Dr strict routine of talk therapy, medication, exercise, my eyes out, in obvious distress, not one person Alys Cole-King, Liaison Team Office, Ablett Unit, Glan Clwyd Hospital, education as to my disorder, proper diet, and a asked me if I was OK. The driver said, “Come on Bodelwyddan, Denbighshire LL18 proper sleeping pattern. I followed none of this. kid, get off the bus, I gotta go!”. Quite the opposite 5UJ, UK. Email: alys.cole-king@ I felt alone and hopeless and saw no future. I of what I was searching for. wales.nhs.uk experienced severe mood swings, heard voices and I walked up and down the bridge for 40 minutes, saw things that existed for no one but me. At some openly crying, desperate for someone to notice my point in all of this I experienced my first suicidal distress. During my time on the bridge hundreds †This is the third of four articles in this issue of Advances discussing thoughts, which grew more intense as time went of people saw me. Cars and bikes drove past on suicide. See also pp. 276–283, on. I felt I had lost my freedom. I wasn’t allowed to the road, joggers and runners came past in both 284–291, 295–301. This article is go out late. My family constantly walking on egg directions and hordes of people walked passed me open access. shells. My friends tried to help but they could barely but no one seemed to notice or care. Eventually a tolerate my abrasive behavior. beautiful woman approached me. I thought that she

292 Hey kid, are you OK?

would be the one to save my life. Instead she asked perfectly. As discussed in our companion articles me to take her photo, which I did (several times). As in this issue of Advances (Cole-King 2013a,b), I handed her camera back she simply said “Thank increasing hopefulness, resilience and reasons for you” and walked away. To me this was proof that living can reduce suicide risk. Kevin has a very no one cared, and that I had no other option. It was powerful message to health professionals: ‘People then I realized I had to end my life. I clambered onto are not killing themselves because they want to – the barrier and quickly jumped. they are killing themselves because their illness or distress is telling them to’. I didn’t want to die The millisecond my hands left the hand rail, I knew Current approaches to treatment I’d made the biggest mistake of my life. I realised that I didn’t actually want to die… I just couldn’t Our first article in this short series (Cole-King cope with my emotional pain. During the 7–8 2013a) reviews pragmatic clinical strategies seconds it took to fall to the water I thought “I don’t which can help in both immediate and longer-term want to die. God please save me.” By all accounts suicide mitigation. That article was co-authored I should be dead. In the cold waters I bobbed by Kevin and includes some of the strategies that up and down trying to stay afloat. I felt I would he finds beneficial. drown, and then as if my prayers were answered, a sea lion literally came to my rescue, nudging me What can we learn from Kevin’s story? to the surface until the Coast Guard boat arrived. Kevin is one of the 30 or so individuals to have I have since found out that this is a recognized survived a jump from the Golden Gate Bridge phenomenon of innate animal behaviour. since its construction in 1937. The bridge has I was rushed to hospital, where I nearly died. The claimed at least 1500 lives: 33 are known to have doctors worked swiftly to save my life. I shattered my T-12 and L-1 lower vertebrae and had horrific died in 2012. internal injuries. I was on an ITU for two weeks and Kevin was suffering from a severe mood a psychiatric ward for several months. Recovery disorder, but bridge suicide victims include people didn’t come easily. I was in and out of psychiatric from all walks of life with and without mental wards six times in the next nine years. Since then I disorders. Kevin’s story highlights the feelings have remained well and out of hospital apart from a of a severely depressed individual. He writes of brief admission a couple of years ago, following an feeling alone and hopeless, with no prospects, a alteration of my medication. I am blessed, lucky to burden to family and friends, and experiencing be alive and thankful for every breath. I live with intense emotional pain. He is at the bottom of a my wife and my dog. I travel the world spreading black hole. He sees no options, yet still desperately the message of the importance of routine when hopes someone will intervene. living with a mental illness, emotional well-being and prevention of suicide. I am happy and healthy. Saving lives I am free of land mines and I am filled with hope Suicidal feelings are too often a temporary and for my future. sometimes impulsive response and individuals are “Are you OK?” usually very ambivalent towards them. For those There is no doubt whatsoever in my mind that under 25, suicide is the third most common cause reaching out to someone in obvious emotional of death in the USA and the second most common pain could save a life. You just have to be open to in the UK. Suicide is rarely an act of free will, but the struggle of another. When you see someone too often a response to intolerable psychic pain – a in distress just ask the question “Are you OK?”. sought-after escape from emptiness, sadness, loss, If you are assessing any patient who you suspect shame, rejection and/or guilt. is experiencing thoughts of suicide please ask the The key is reaching out to people and helping direct question: “Are you thinking of harming them see that there is always hope, always help. yourself or ending your life?”. The answer may They just need to know how to seek the support. surprise you. It will most likely be the truth. If they It is for this reason that the U Can Cope film and are contemplating it they are more than likely to compassionate resources from the Royal College of say yes and you have the potential to intervene and Psychiatrists were developed (Box 1). help to save their life.’ Kevin is adamant that, had there been a bridge barrier, it is unlikely he would have jumped. A Discussion suicidal crisis is often short lived and if people Many suicidal individuals are ambivalent about can be helped and supported through it, they may living or dying. Kevin’s story illustrates this never feel that way again.

Advances in psychiatric treatment (2013), vol. 19, 292–294 doi: 10.1192/apt.bp.111.009878 293 Hines et al

Box 1 Support for anyone in distress or those trying to help them

Together with Samaritans and the Royal College compassionate self-help resources on behalf International Association for Suicide of Psychiatrists, Connecting with People of the Royal College of Psychiatrists. These are Prevention (providers of emotional resilience and suicide available (online or as printed leaflets) to anyone The IASP is dedicated to preventing suicidal prevention training) are leading a coalition of in need of advice and support. They promote self- behaviour, alleviating its effects and providing a more than 100 organisations in the UK and help and give information about useful strategies forum for academics, mental health professionals, beyond – from mental health bodies to the and how to access help and support. crisis workers, volunteers and suicide survivors. Professional Cricketers’ Association – to spread • Feeling on the edge? Helping you get through it Its website includes helpful resources. the message that it is possible to overcome For people in distress attending an emergency www.iasp.info/index.php suicidal thoughts and feelings and that there are department following self-harm or with suicidal many resources available to help those who are thoughts Free online interactive cognitive–behavioural struggling to cope. • Feeling overwhelmed – helping you stay safe therapy U Can Cope For anybody struggling to cope when bad things Living Life to the Full www.llttf.com This short film, produced by their media happen in their life The Mood Gym and e-Couch Cognitive– partners Southwick Media Consultancy, shares • U Can Cope! How to cope when life is difficult behavioural therapy skills for preventing and inspirational stories and focuses on three people Designed to help young people to develop coping with depression. At https://moodgym.anu. for whom life had become unbearable but who, resilience and cope with current and future edu.au/welcome after seeking help, are now leading happy lives. difficulties in life. Its advice is just as helpful The film promotes three main messages: Support groups Details of numerous UK patient for adults. support organisations, self-help groups, health • Anyone can experience suicidal thoughts www.rcpsych.ac.uk/expertadvice.aspx and disease information providers, etc. Each • There is always hope www.connectingwithpeople.org entry is cross-referenced and details are checked • There is always help annually. At www.patient.co.uk/selfhelp.asp www.connectingwithpeople.org Samaritans Resources from the Royal College of A 24/7 helpline that offers people a safe space The Kevin Hines Story Psychiatrists to talk about what is happening, how they are www.kevinhinesstory.com Connecting with People and their collaborators feeling, how to find their own way forward. have developed a range of practical and Helpline: 08457 90 90 90; www.samaritans.org

Some suicidal people decide on a particular is preventable and treatable – by therapy, by method to end their life, so in addition to medication and by reaching out. We can all play compassion and practical support an intervention a role. should also include removing any means for suicide. Psychologist Richard Seiden studied Acknowledgement 515 people taken by the highway patrol from the We thank Professors Stephen Platt, Jane Pirkis, Golden Gate Bridge and followed them up after Thomas Niederkrotenthaler and Samaritans 25 years. He found that about 90% were still alive for reviewing this article and for their helpful or had died of natural causes. The bridge was to comments. be their chosen method and when this option was removed their intense suicidal impulse diminished. R eferences Seiden suggests that his findings confirm previous observations that suicidal behaviour is often Cole-King A, Green G, Gask L, et al (2013a) Suicide mitigation: a compassionate approach to suicide prevention. Advances in Psychiatric crisis-oriented and acute in nature (Seiden 1978). Treatment 19: 276–83. Suicide deterrents such as barriers, gun laws and Cole-King A, Parker V, Williams H, et al (2013b) Suicide preven­tion: outlawing certain chemicals are effective. But are we doing enough? Advances in Psychiatric Treatment 19: 284–91. as Kevin points outs, asking a depressed and/ Seiden RH (1978) Where are they now? A follow-up study of suicide or distressed person whether they are thinking attempters from the Golden Gate Bridge. Journal of Suicide and Life of suicide is an important intervention. Suicide Threatening Behavior 8: 203–16.

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