Transportation of Suicidal patients to hospitals

Singapore - Transportation of Suicidal patients to hospitals in Singapore.

“Suicide is the leading cause of death for those aged 10-29.
There are 3 times more deaths from suicide than transport accidents.
Males account for close to 70 % of all suicides.
For every suicide, at least 6 suicide survivors are left behind.”

Singapore has the highest suicide rate amongst the South Asian countries.
It is tragic that Singapore’s youth aged 10-29 are turning to suicide. The Youths are forced to face multiple pressures in this intensely competitive and disruptive technological age. They are under pressure from their parents, their peers, their schools, their workplaces, their bosses, their bank accounts, and the big one – their futures. Many Singaporean millennials have expressed deep anxiety over having FOMO (the fear of missing out) on opportunities and advancements that will make them relevant in the future.

Young people are not the only ones choosing the suicide way. The pervasiveness of the elderly committing suicide is a troubling trend in Singapore. The number of suicides by older citizens aged 60 and above in 2018 has gone up to 150 which is a significant number of cases in view of the small population statistics.

Singapore has dealt with suicides by criminalizing them – imposing fines and an up to a one-year prison sentence on suicide attempts, as stated in Section 309 of Singapore’s Penal Code, which also notes that it is a crime to aid and abet the suicide of another person.

Treatment, rather than prosecution, is a more effective response to people fighting such extreme depression that they actually want to take their own lives.

What is Depression?
feelings of severe despondency and dejection.
"self-doubt creeps in and that swiftly turns to depression"
synonyms:    melancholy, misery, sadness, unhappiness, sorrow, woe, gloom, gloominess, dejection, downheartedness, despondency, dispiritedness, low spirits, heavy-heartedness, moroseness, discouragement, despair, desolation, dolefulness, moodiness, pessimism, hopelessness; 

Depression among Men and Women

Both men and women can experience depression, but the signs and symptoms can be different.
Although the primary symptom of depression for many is often a feeling of sadness, men may have a higher tendency than women to feel anger, demonstrate aggressive feelings, and engage in substance abuse.

Due to the different symptoms, and because men are typically less likely to talk about and seek treatment for depression than women, many men may have undiagnosed depression.

American Statistics

According to the American Psychological Association, an estimated 9 percent of men in the United States have feelings of depression or anxiety each day, and 30.6 percent of men experience a period of depression during their lifetime.

Depression is a mood disorder that affects a person's thoughts, feelings, body, and behavior. Doctors may refer to depression as major depression, major depressive disorder, or clinical depression.

Depression is more common in women, affecting 10.4 percent of women compared with 5.5 percent of men in the U.S. However, the number of men who die by suicide is four times the number of women.

One of the reasons for this could be that men are less likely to get a diagnosis of depression. Depression is a significant risk factor for suicide.

Some symptoms of depression are the same for men and women. These include:

1. feeling sad, tearful, low, guilty, or empty
2. losing enjoyment in pleasurable activities
3. appetite or weight changes
4. too little or too much sleep
5. feeling agitated or tired
6. having trouble concentrating

Not everyone with depression will experience all of these symptoms.

Some symptoms of depression are more likely to affect men than women, which could be due to genetic, hormonal, biochemical, or social factors. 

Men with depression

Men with depression may notice the following behavioral changes:

1. drinking more or taking drugs
2. avoiding family or social situations
3. working obsessively without taking proper breaks
4. finding it hard to keep up with work or family responsibilities
5. becoming more controlling or abusive in relationships
6. engaging in risk-taking behavior, such as gambling or unsafe sex
7. attempting suicide

One theory is that these behavioral changes occur as a result of men trying to mask depression and adhere to so-called "masculine norms." This attempt to conceal depression may cause men to lash out or engage in self-destructive behaviors.

Difference between Men and Women for depression

Depression affects the emotional state of both men and women, causing low mood.

Women with depression may express this as sadness, but some men may be less comfortable outwardly expressing this emotion. Changes to their emotional state can, therefore, become apparent in other ways.

Early signs of depression in men can include an increase in:

• anger
• frustration
• aggression
• irritability

These differences may be due to societal expectations of how men and women express emotion. It is likely that men will be less willing to show certain emotions, such as sadness if they feel that others may judge or criticize them for it.

Men with depression may experience thoughts of suicide.

Physical signs of depression in Men
Depression is a mental health condition, but it also has physical symptoms. Men with depression may experience:

• headaches
• tightness in the chest
• joint, limb, or back pain
• digestive problems
• tiredness
• sleeping too much or too little
• feeling restless or agitated
• eating too much or too little
• unintentional weight loss

Some of these symptoms may arise because of the effect that depression has on a person's brain chemicals. Depression changes the levels of serotonin and norepinephrine, which are brain messengers that govern pain and mood. Shared brain cell pathways may link depression and pain.

There are several ways to treat depression. Everyone responds to treatment differently, but a doctor can advise a person on which treatment may best suit their needs.

Treatment options include:

• medication
• talk therapy
• cognitive behavioral therapy (CBT)

Other Associated Treatment Strategies

Alongside other treatments, specific lifestyle changes and coping strategies can help a person manage depression. For example:

Regular exercise: Running or even walking briskly outside can produce endorphins and lift a person's mood.
Creating structure: Sticking to a daily routine may help make each day feel a little easier.
Breaking down tasks: When big tasks feel unmanageable, breaking them down into smaller tasks may help.
Yoga, mindfulness, or meditation: These practices may reduce stress and support well-being.
Talking to friends and family: Sharing feelings with others may make them feel less overwhelming.
Avoiding alcohol: Reducing alcohol intake may improve mood.

How to Help your friend who is depressed

If a person notices the signs of depression in a close male friend, partner, or family member, it is crucial to discuss this with them. Asking someone who may be experiencing depression how they are feeling is an excellent first step. Trying to be a good listener is essential.

Next, encourage them to make an appointment with their doctor. If they feel worried about discussing how they feel emotionally, remind them that they can start by talking about physical symptoms, which will often lead to a broader discussion about other symptoms.

It is essential to be patient when supporting someone with depression. Sometimes the behavioral signs of depression in men may cause relationship difficulties. Try discussing issues in a nonjudgmental way. A relationship counselor can help people improve their communication.

Summarizing Depression
Signs of depression in men may differ from symptoms of depression in women. Men are more likely to feel anger and aggressive feelings and to engage in substance abuse or risky behaviors.

Increased awareness of the signs of depression in men can empower those with this condition to get help.

Seeking help for depression is essential. Suicide is a leading preventable cause of death among men. Treatment can significantly improve a man's mental health and emotional well-being.

Major depression, also called clinical depression, is a severe but manageable mental health condition. With treatment, a person with depression can manage their situation and stay well. People with depression can go on to make a full recovery.

Mental illness is the number one cause of Military evacuation in the year 2018

The most common mental health issues were either depression or reaction to severe stress and adjustment troubles, according to the report.

Further, more men were evacuated for mental health issues than women, 142 versus 33, and more men, 645, were evacuated in general in 2018, compared to just 101 women.

Psychiatric Reasons for Medevac amongst USA Army Personnel

The U.S. military is one of the best trained military organizations in the world. However, war-zone stressors may compromise the psychological resilience of even the most conditioned U.S. service members. The purpose of this study was to investigate the contributing causes of medical evacuation (medevac) during the present war on terrorism. We studied 5,671 cases of medevac reports during Operations Enduring and Iraqi Freedom (OEF and OIF). Our data indicated that psychiatric problems were among the leading causes of medevacs during this period. In fact, from March to September 2003, psychiatric issues accounted for 7% of the medevac cases during OEF and 6% during OIF, ranking among the top five reasons for evacuation from each theater. With the use of the International Statistical Classification of Diseases and Related Health Problems (ICD-9), we found that “Top Level Mental Disorders” and “Persons without reported diagnosis encountered during examination and investigation of individuals and populations” were the two main psychiatric reasons for the medevacs. 

HI Flying - Air Ambulance International Statistics for the year 2018

In the year 2018, HI Flying carried out a total of 291 evacuations on Commercial and Charter flights out of which 66 cases amounted to real Mental health reasons for Patient travel back home.

There were close to 43 cases which had a psychiatric problem associated with a physical ailment during the transport.

Not able to recognize the psychological component to diagnosis could result in a patient being unhappy - post-transfer for such transportation would need a very sensitive Medical escort/s to understand and handle the medical evacuation situation.

Depression is quite common among health care providers

A confession of a Paramedic who was depressed.

Looking back on it now, it wasn’t the end of my marriage that resulted in my depression. In fact, my depression was what ended my marriage. I was uncommunicative and withdrawn, and my wife needed a husband, friend and lover, not the stranger that I had become.

I blamed it on the pressures of work and being new parents of a special-needs child. I was trying to be strong for my family, and I was raised believing that a man doesn’t pass his burdens off to his wife.

But in truth, my stoicism just isolated me more. In the years since, I’ve learned to recognize the pattern, repeated a number of times before I even got into EMS. I get overwhelmed by deadlines and commitments, isolate myself from my friends and loved ones in an effort to get more work done, and without any outside interaction, I lose any creative spark I might have had … which makes it impossible to get any more work done.

At the end of the spiral, I find myself slumped on the couch for days on end with an open Microsoft Word window on my laptop, with nothing but a title at the top of the page. But instead of writing, I’m doing drive-by witticisms on Facebook at 3 a.m., because making funny and sarcastic comments via keyboard is what passes for human interaction when I am depressed. It’s easier than making a real human connection — easier, and infinitely more unhealthy.

DON’T DENY DEPRESSION, FIX IT
My depression was easy to deny. I never felt suicidal, never had feelings of worthlessness, never wallowed in the proverbial dark pit of despair. I just had … nothing. No energy. No creative spark.

I was tired 24 hours a day, seven days a week. It was easy to tell myself that it was simply overworked, that too many night SSM shifts had taken their toll. I needed rest, not therapy.

It was close to two years ago, when I was going through a rocky patch with my girlfriend, when my ex-wife asked me out of the blue, “So tell me, when are you going to get help for your depression?”

I was surprised. Despite my doctor friend’s diagnosis, I had never admitted it to myself, much less to another human being. I vehemently denied it. I told her she didn’t know what she was talking about.

“I’m not depressed,” I protested. “I get up, and I go to work. I function, I take care of KatyBeth. I’m just tired.”

Her answer was to roll her eyes tolerantly.

“You function, but I’m a mental health nurse, and I’ve known you for 16 years. The way you are now is not you. If I administered a screening questionnaire right now, you’d be classified as major depressive.”

“Major depressives are fat ladies who sit in the dark all day, watch soap operas, eat bonbons, and contemplate suicide. That is not me. I am not depressed.”

“No, that was your mother,” she retorted. “You hide it well, and people who don’t know the real you would never guess. But I was your wife for 10 years, and I’m still your friend. I know what the real you is like, and this is not it. And if you’re not careful, you’re going to lose Nancy the same way you lost me. Fix it.”

FIX IT I DID
I’m still fixing it today. Medication didn’t work for me, and psychotherapy doesn’t tell me anything I don’t already know. When I find myself retreating from life, I rely on the awareness of friends and loved ones to call me on it, and I force myself to do those life-affirming things my depression tells me I’m too tired to do.

I go out to movies. I go for walks with my girlfriend. I take my kid fishing. I turn expensive ammunition into smoke and noise. I hit the lake on my jet ski.

Pretty soon, I discover that I no longer have to force myself to do those things. I look forward to them. I go on with living my life, and my energy and creative spark return.

The biggest hurdle is admitting to myself that I am depressed.

And so here I am, naked and exposed in a public forum, making a confession that, quite frankly, scares the crap out of me: "Hi, I’m Kelly, and I suffer from depression."

BREAKING THE CODE OF SILENCE
That’s not an easy admission to make, especially for me. I’ve been described a lot of ways; funny, passionate, uncensored, inspirational, confrontational, committed, uncompromising, even being an unreasonable and arrogant prick.

Morose has never been one of them. Only a very few people closest to me would ever even believe it applied. But it does.

I only admit it now because I am tired of reading stories of fellow paramedics committing suicide. I’m tired of seeing EMTs with just a few years in EMS burn out. I’m tired of seeing PTSD turn a partner and a good EMT into an emotional wreck because he was too afraid to reach out for help.

I’m tired of seeing marriages and personal relationships founder because of some twisted ethos that has us believe that the healers should never need healing themselves.

And if me admitting my frailties in front of God and everyone makes it easier for a reader to acknowledge that he needs help, then it will be worth it. That’s why I’m doing this in the most public forum available to me. It’s time to erase the stigma of mental illness.

It’s time to break the code of silence.

One poster on a Facebook page aptly described how EMS people deal with job stress: “We take all the pain and loss and death and horrible things men visit upon one another, and we put those feelings in a box so we can do our jobs. And then we slide that box out of sight under the bed, and we make jokes about the existence of the box.”

If we don’t air that box out now and then, it fills up, and what we put in it festers. It drives good people from our profession. It alienates many who remain and makes them less than the providers they once were.

Too many of us, it kills.

Recently, a friend formed a group on Facebook aimed at erasing the stigma of mental illness in EMS. It’s called the Code Green Campaign, and they offer an anonymous haven to share your stories of depression, or PTSD, or bipolar disorder, or whatever it is that plagues you. They have a website and they offer educational content, support and referral services.

Think of it as crowdsourcing EMS mental health care and peer support. Like the Code Green Campaign on Facebook, and share your story. Show your peers that they’re not alone and that admitting you need help is not weakness, it is a strength.

It’s easier than you think, and it’s empowering.

Hi, I’m Kelly. I have depression, but depression doesn’t have me.

As narrated by
Kelly Grayson, NRP, CCEMT-P, is a critical care paramedic in the United States.

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