Assisted Suicide Isn’t Care: How the UK Abandons the Chronically Mentally Ill

There are some for whom depression is a singular and shocking experience. Like a car crash that leaves that someone for dead. Recovery is often strained and complicated but, once it is achieved, the affected person enjoys a semi-regular life. They might, thereafter, be a little more vulnerable to ‘the blues’ than before and experience a deadening of the senses now and then. But they will never find themselves quite as despairing as that fateful day or night when they considered taking their own life. Such instances of depression are not unlike a health scare which drives the patient to seek out a new life for themselves. They take their medicine and start an exercise regime, and it keeps them well.

There are others for whom depression is not an accident or a blunt force trauma but a wasting disease—and therefore a way of life. Like gangrene, syphilis, or leprosy, the mind cannibalises the body until the fuel runs out—and whatever remains of that life will be packed into a box to be buried and forgotten. Like these wasting diseases, this depression resists being treated and can therefore only be tolerated. It is individuals who fall into this latter category of depression who are at risk under the UK’s ‘Terminally Ill Adults (End of Life) Bill’—otherwise known as the ‘assisted suicide’ or ‘assisted dying’ bill. 

This new legislation intends to ‘allow adults who are terminally ill … to be provided with assistance to end their own life.’ For the time being, this has been limited to physical illnesses, but there are fears around how improper safeguards and regulation, coupled with increased activism, could see the legislation extended to offer assisted suicide for broader ‘quality of life’ issues—including protracted and treatment-resistant mental illnesses. 

Whilst some consider this to be ‘slippery slope’ rhetoric—far-fetched concerns which will never come to fruition in a sensible society—the current draft of the bill approved by the House of Commons already makes accommodations for people who are depressed and suicidal. 

As Canada has demonstrated in the expansion of their ‘Medical Assistance in Dying’ (MAiD) service, assisted suicide, when taken to its logical conclusion, has to include mental illness as well as prolonged socio-economic deprivation (which too often go hand-in-hand). 

It is easy to imagine how a ‘caring’ government or medical board would permit assisted suicide for psychological illness to avoid looking hypocritical in their philosophy of autonomy and kindness. Such authorities have, after all, ruled that it is acceptable to abort a healthy child until the minute of its natural birth and endorsed the removal of healthy sex organs if someone identifies as the opposite sex: this, too, is done in the name of ‘self-realisation’ and ‘kindness.’

But is it autonomy and kindness which define a ‘good life’?

This is a question I have had cause to ask myself, time and time again, over the course of my life. Those who watch me from the outside would say, “Of course! You’re young and bright and full of energy. The world is your oyster.” And it is true. When compared to the lives of my ancestors and the people with whom I grew up, I have a terrific life. I went to a respected university. I have a talent—writing—which I have the freedom to use. I am privileged to have a platform in fashionable magazines. And when I speak, world leaders will occasionally listen. I am, by anyone’s metric, very lucky. Yet, from a young age, I have also suffered with intense depression. A depression which has proved, to date, to be incurable.

I was ten years old when I first tried to kill myself.

It was a quiet and undramatic thing, if such a terrible thing can be quiet and undramatic. It was during the summer holidays. I crawled under my bed and lay there—silent. For two days, I drank and ate nothing, and I hoped it would kill me. 

I had my reason to despair, even at that age. It was not some morbid or curious impulse. I was not a disturbed child. I had never tried to hurt myself or anyone else. Suicide was not something I had ever read about or seen on TV. I did not even know there was a word for what I was attempting at the time. Starving myself was my last attempt at escape. I had already tried begging for help and running away.

My parents were both beating me—they had been for as long as I could remember. There did not have to be a reason. Whether I was good or bad, I could be deprived of food. It kept me subdued and malleable, I think. If some part of me was being intolerable, I would find myself being flung into a cupboard to be lock away and forgotten. I was not permitted to socialise with children outside of school, and I could not read with any fluency, turning what might have only been a frightening and painful childhood into a vast swamp of terror and isolation.

On rare but hideous occasions I was also being raped. My terror of this, in particular, was compounded by the knowledge that I was ‘becoming a woman.’ I did not want to have a child, but I knew I there was noting I could do to stop it if these attacks kept happening.  

As suicide methods go, it was neither quick nor painless. After a time, my head pounded and swam, and my toes grew cold. I developed a shake that seemed to vibrate every part of me from deep inside until I began to drift in and out of something which was not sleep but akin to sleep. Each time I ‘awoke’ from my thoughts, I’d be gripped by an intense panic. 

At first the panic was psychological—the voice in my head would become loud and frantic, telling me to stop and find something to drink. I resisted it until the panic and the voice ceased to touch me. It was only towards the later end of the second day when the panic became intensely physical. There was no voice in my head, only limbs, almost independent of me, seeking to pull me out and seek survival.

It was then I discovered I had some visceral life force hiding within me—independent of me—that wanted to live even when I—that voice and feeling I identified as “myself”—didn’t. The encounter with this thing—its animal rabidness and cruelty—so shocked and frightened me that I crawled out from under my bed and sought out the cup of juice it demanded, and I have been in negotiation with that entity ever since.

Under the new bill, a person who wants to die and deliberately chooses to stop eating and drinking in order to bring about their death will qualify for assisted suicide. The Royal College of Psychiatrists have expressed concerns about the bill potentially including those suffering with mental illness, Alzheimer’s, or anorexia. Will the physical expressions of their illness qualify them for assisted suicide, also?

The Mental Capacity Act—the standard criteria used to assess a person’s ability to give informed consent to medical and financial decisions—is regarded as inefficient for the assisted suicide bill. The present draft also demonstrates little concern for how personal circumstance can impact a person’s ability to cope with the pain and despair caused by physical illness. “Treatable needs such as intolerable pain, financial hardship and inadequate care or housing can make a person want to die,” says the Royal College of Psychiatrists. “Yet the Bill makes no provision to assess unmet needs at any stage, nor consult others involved in the person’s care or life.” 

In concrete terms, no attempt is being made to stop a lack of public resources—long waiting lists for treatment, social housing shortages, debt, caring responsibilities, a lack of available therapists—from being a barrier to accessing assisted suicide. A cynical person might say this is a sleight-of-hand method for dealing with the backlog facing NHS and social care services. If not the intended purpose, then it is a helpful consequence.

When vocalising despair, one is always told that “there’s help out there,” but the reality is—there is not. Whether one is in intense physical or mental pain, treatments in the UK are costly and limited—both in terms of their availability and their effectiveness. 

Therapy under the NHS is prescribed in 8-12 week doses. If you’re not ‘cured’ by then, you are sent to the back of the queue, antidepressants in hand, to apply for more help.

Charities are largely responsible for filling the gaps in NHS support. These services are limited in scope because they rely on volunteers and donations to fund their daily operations. What services are on offer can differ vastly between regions, turning ‘adequate help’ into a postcode lottery. If you have developed a chronic illness and are feeling suicidal, you had better hope you live in Surrey rather than Cumbria, for example.

There are private options, but these remain inaccessible to most people, and it is these people who will gravitate towards assisted suicide in their periods of despair because the services they need are unavailable.

I like to think I am a person who is well recovered, given the circumstances. I can take myself out and about in my own little world without panic or fear. I can work, if not with the diligence and reliability upon which I might once have prided myself. I can socialise and maintain friendships and sometimes support other people in their needs and ambitions. I have the respect and admiration of some wonderful people. And there have been many times in which I have been able to whisper to myself, “By God’s mercy, I am alive.” 

But I’d be lying if I said I was a ‘well’ person, despite my best efforts. Indeed, I write under a pseudonym for the first time in my life because I am ashamed of the indefatigable ways in which I continue to fail to meet ‘basic’ expectations, and I do not want my friends to know about my history and that I still struggle with it. 

I fail to work a 9-5 without suffering a breakdown every 6 months. I lack appetite enough that I find myself—unwittingly—on the floor after months of malnourishment. Expressions of love frighten me and I consider a serious attempt at suicide 3-4 times a year. It is difficult to explain that I am not unhappy—not exactly. I despair often, but that despair is punctuated by moments of great pleasure, pride, excitement, and contentment. I laugh most days and find things for which I am grateful even if the depression is once again growing intense. Rather, there is a vulnerability about me—an emotional volatility—which is somehow not quite my own and possesses me completely when it comes upon me. 

I have sought help many times in my life—then and now. I’ve tried almost every drug available in the UK, and some that are not, therapies of different scope and ambition, intense exercise, yoga, sea swimming, mindfulness, support groups, dietary changes, moving home, changing jobs, changing attitude. None seem to take the edge off for anything more than a few days, weeks at best. And each failed attempt invites a new despair. 

Like others living with chronic depression, I might spend the best part of my life learning to accept that there is no cure for me—or die in the attempt. At least when a doctor, therapist, or chaplain tells me there is ‘help’ out there for me they are not agreeing with my assessment that my life is worthless. They do not share in my despair or confirm my suspicion that the situation is hopeless, even if they know from experience that the infrastructure does not exist to help someone like me—someone who is easily seduced by the idea of suicide when things take a turn for the worst again.

The notion that life is never quite as bad as we might imagine it is a benevolent lie in which we all partake for the benefit of one another. I lie and convince you that ‘life is not all that bad,’ and you tell me the same lie, and somehow it makes both of us feel better, if only for a time. The ‘assisted dying’ bill brings an end to this silly but life-giving game and says, ‘Maybe you would be better off dead?’

And I think, “Would I not be the perfect candidate?”

If I am honest as to why I have not yet succeeded in killing myself, despite considering it often, it is that I do not want it to hurt. It is not that I shelter some splinter of hope about me. I endure because there is no foolproof ‘way out’ of life that would not cause me intense physical pain or traumatise someone else—and in that regard I have become a coward.  

The potential introduction of assisted suicide into the UK makes me afraid of my own unpredictability in a way I have not been for some time. For the moment, what I fear most about my instability is the unpredictability of it—knowing I shall almost certainly come out on the other side of an intense bout of depression but never knowing how much and how long I will have to suffer before that happens. But should assisted suicide be introduced, I wrestle with a new prospect: “Should I endure even though I have a painless escape?” 

Equipping me with a choice of a painless death will be done in the name of ‘kindness’. But offering me a painless way out is about the least-kind thing someone could do for me. I realise now that if I have a source of hope, it might be the certainty of my own cowardice. I know with some confidence I shall never manage to kill myself because there is no sure method that is also tranquil. If I can therefore be assured of anything, it is that I shall have to find some other way to tolerate being around myself.

And I find myself growing defiant at the idea that government can define what constitutes ‘a good life.’ By their metric, a great number of people in this world should be contemplating assisted suicide—for the good of themselves and the people around them. And I think, ‘How dare you!’ I’ll kill myself when I decide my life is worthless and not before, thank you very much!’ (And I’ll be so determined in it, I certainly won’t need your help!)

It is this kind of irony that makes me smile, in spite of it all.

Am I a bit broken? Oh, yes. Is it possible to fix me? Lord knows. Am I useless? More often than I’d like. Am I a burden upon society—my friends, my employers, my family? Yes, probably. Sometimes. But is a ‘burden’ the worst thing someone can be in this world? It is my earnest hope that it is not. And so, yes, my life is often not worth living. But I live it. Until its worth becomes apparent to me again. 

Again, and again, and again.