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#WHY HAD I NEVER ONCE HEARD HE MADE MUSIC DESPITE HIM REGULARLY PROMOTING IT IN VIDEOS!!!!
unnamed-atlas · 6 months
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Okay. Why are we as a collective not talking more about Xisuma's music? I've listened to a total of two songs and I'm absolutely enamored
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mx-requests-forum · 7 years
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[Fulfilled] Left Alone
Prompt: ChangHyuk + they're the only two left in the dorm and CK takes the opportunity to confess
Fulfilled by Moderator ReeLee~
Words: 1791
AO3 Link
"Have a good holiday, you two!" Hoseok calls from the doorway, waving at his only two dongsaengs left in the dorm now. His Santa hat flops to the side when he whips his head away, gleefully turning to face his week of freedom as he closes the door with a resounding thud.
Minhyuk and Changkyun glance to each other, a question hanging in the silent air.
What to do now?
The older chuckles a second later, turning and flopping down on the sectional.
"All alone, now~" Minhyuk says, a smirk painting his handsome features. The sight alone is enough to make Changkyun melt. It practically makes his heart stop mid-beat. Changkyun gulps nervously, muttering some excuse about having lyrics to write, and escapes from the room without waiting for a response.
Minhyuk only watches him go, amusement sparking in his eyes. Before, he’d been questioning his decision to not leave the dorm for the holidays. Now, after seeing the maknae reacting so nervously to him, he knows he’s made the right decision.
 I don’t know if I can do this, hyung…
Changkyun stares intently at the text he’d sent to Jooheon a whole two minutes ago. God, why has the older picked today of all days to take a century answering the simplest of texts??
Finally, just before the maknae sends another desperate plea for help, a new message comes in.
We’ve discussed this, Kkungie… You get alone with Minhyuk-hyung, tell him how you feel, and everything will be alright again. So, man up and do it. God knows the group has been suffering because of this…
He’ll say no, hyung. I know he will. Then it’d have just been better if I stayed quiet…
Changkyun-ah, stop that right now. You’ll do fine. Just… idk… plan something special and work from that. Pay for dinner, put on some music… Let loose a little ;)
Changkyun pauses, very much unsure if Jooheon had truly been the one to send that last text. His suspicions are confirmed at the next message.
Srry Kkungie… Kihyunnie-hyung stole my phone
You can’t say it was bad advice! comes a second later, only this time from Kihyun’s own phone. Jooheon answers back a second later complaining about the older butting in on a private conversation, to which Kihyun fires back a defense about having to because Jooheon had been ignoring him. Changkyun sighs exasperatedly, locking his phone and setting it aside. Of course those two were still together… They’ve been together for only a month, so they’re still in that honeymoon phase.
Changkyun just can’t wait until Jooheon gets put out by Kihyun’s incessant nagging and breaks up with him. He’s missed having his favorite hyung by his side…
The maknae pouts, staring up at the ceiling. He’s got to admit, Kihyun’s advice had struck a chord with him. Maybe if he were to order some of Minhyuk’s favorite pizza for dinner, and maybe put on some music… Maybe then he’d be able to get this thing off his chest he’s been hiding for months.
 Hours later, there’s a knock at the front door. Minhyuk glances up confusedly from the television, frowning at the unplanned interruption in his regularly scheduled programming. He’s just about to drag himself up off the couch to answer when Changkyun suddenly bolts through the room, flinging the door open, and flinging money into the stranger’s hands only to receive a pizza box in return.
Minhyuk’s heart just about flips over in his chest at the sight, and his mouth immediately begins to water.
“What’s this, Kyunnie?” Minhyuk asks as Changkyun walks over with the biggest pizza Minhyuk has ever seen in all his life in his arms. It smells delicious, all that cheese and bread and sauce mingling together to create the best of aromas.
“I thought you might be hungry,” Changkyun explains, a slight blush coming to his cheeks, "so I ordered us some dinner." Minhyuk coos, moving over to make room for the younger. He reaches over to pull at Changkyun's chubby little face, only releasing his grip once he's decided the maknae's whined enough. Then they dive in, all thoughts of teasing thrown aside by the sight of the fresh pizza.
 One thing any member can say about the other: when food is in the picture, you're sure not to get a peep out of anyone until it's all gone. Which doesn't take long, mind you, as all the members are used to starving themselves during promotions. Some don't even do it on purpose half the time. They're just all so busy they don't even think to eat until it's too late.
Once the pizza is sufficiently devoured, Minhyuk wipes his greasy hands off on his jeans and sighs contentedly as he turns his attention back to the television.
"That was a great idea, Kkungie," Minhyuk compliments, smiling a little as he watches Changkyun pick at the box nervously out of the corner of his eye. He's so cute when he's so nervous, the older can barely even stand it without kissing him right then and there.
"H-Hyung..." Changkyun mutters, chewing on his bottom lip. Minhyuk hums for him to go on, but the younger doesn't seem to be able to even look in his direction. Instead he looks over at the sparkling Christmas tree Kihyun had insisted they put up before everyone left in the corner, and then at the tea lights and holiday-scented candles he's sure Minhyuk had lit while he was hiding in their room. Kihyun is always sensitive to smells, and doesn't like it when Minhyuk lights things like this when he's around...
Of course, that could also just be because it's Minhyuk that's doing it, as he never has issue with Hoseok's different candles...
There's a soft tune playing on the television in front of them, and between that and the dim—some may say romantic—lighting, Changkyun suddenly feels a swell of pride within him. He returns his eyes to Minhyuk, smiling as he does so. The expression seems to lighten up the whole room, in Minhyuk's most unbiased (completely biased) opinion, and he finds himself smiling in return.
"Do you wanna dance, hyung?"
Minhyuk can't help but laugh at the seemingly silly question. But, he nods before he can talk himself out of it, deciding to go along with the maknae's suggestion. He stands, holding out a single hand only half-hidden by his overly-sized sweater. Changkyun's grin only grows as he takes it, and lets the older lead him closer to the hall where they'd have more room to sway about.
Changkyun can swear Minhyuk can hear his heartbeat as he's pulled close to the older's chest. He's suddenly very thankful for the dim lighting, as it helps to hide his growing blush at their proximity. The sounds of the emotional scene pour out from the television, and Changkyun can't help but gulp loudly as the male lead begins to pour his heart out to the beautiful woman in front of him. He licks his lips nervously, pulling away slightly mid-sway to meet Minhyuk's warm gaze.
"Hyung..." he murmurs, feeling the older's grip tighten on his waist. He takes comfort from the touch, using the pressure to ground himself in the moment. "Hyung, I like you. I like you as more than a friend, as more than a bandmate... I like you more than I know I should, but I can't help it." Minhyuk remains silent, just smiling down at his dongseng and showing no sign of having heard him. Changkyun frowns a little, wondering of the older had even listened. "I'm sorry if this affects our friendship negatively, or if you're angry with me because of this. But, I can't help it. It's how I feel, and—"
"Changkyun-ah," Minhyuk chuckles out finally, a hand drifting up to cup the younger's cheek. His eyes are shining brighter than any Christmas light Changkyun has ever seen, and the gaze leaves him breathless. "You don't think I know? I'm sorry to break it to you, but you're a very easy man to read. I could tell the moment you became attracted to me."
Changkyun gulps nervously, replaying all the times since he's come to the realization of his own feelings Minhyuk has given him side-glances, winked at him, made less-than-family-friendly jokes to him... He'd never dared to hope all that had been this beautiful man's attempts at flirting with him... Minhyuk's repeated laughter brings Changkyun's mind back to the present, and he playfully slaps at the older's chest.
"Why didn't you say anything, then?" he demands, pretending to be upset despite them both knowing how truly relieved he is.
"Because I knew you wanted to tell me yourself," Minhyuk tells him simply, shrugging. "I didn't want to take the moment away from you."
"I wish you had," the younger mumbles, his eyes falling to Minhyuk's sweater. "This was so nerve-wracking," he admits, earning another laugh from his hyung.
"Well then," Minhyuk says, his index finger hooking under Changkyun's chin and forcing him to look up. "Allow me to lift the burden a little~" He then leans in and kisses the younger, a swift, simple brush of the lips that makes the maknae's heart practically burst from his chest. He pulls back all too quickly for the younger's taste, earning an even bigger pout than before.
"You really think that'll make up for playing with me all this time?" Changkyun asks, already leaning up on his tiptoes to get closer to Minhyuk again. He goes in for only their second kiss, his eyes falling shut as he presses himself as close as he can get without knocking the man over with his body. Minhyuk laughs amusedly against the kiss, his arms dropping to loop around the younger's waist.
 The two wander back over to the couch, their lips practically glued to each other as they go. Their hands wander around each other's bodies, seemingly trying to map out every curve and slope they'd only glanced at before. They get to know each other better without words but with action, the drama still playing before them but long-forgotten.
 Eventually, the drowsiness from eating such a heavy dinner hits them, and they're left a bit breathless from their silent conversation. They still peck at each other's lips and skin, not wanting it to end, but with less of a curiosity than before.
They fall asleep like this, cuddled up together on the sectional, holding onto each other like their lives depend on it. When they wake up they can't tell for a moment if they're still dreaming or not, the events of the night before all seeming like a wonderful dream they never want to wake up from.
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nevillelongsbottom · 7 years
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ok so i heard it was the lovely @ff-sunset-oasis’s birthday this week and i wrote you a little something!! <3 i hope you like it!! i love your blog sm tbh
seventy-eight Sometimes, when wars are over and when depression becomes a permanent bedfellow, bad decisions are made – and sometimes, these decisions are made all too knowingly.
Percy knows exactly what he’s doing; he plans it meticulously, carefully, in the only way he knows how. He reads books and implores librarians to let him into sections past padlocks, and studies; if anyone were to come into his house, which nobody does because they’re afraid of him as if his pain is palpable, they’d think that he was all but back to normal, drowned in a stack of old books and papers so lengthy that just looking at one could send Ron to sleep.
It’s a cold winter’s day when he finishes his work, and all the windows in the house are shut, the floorboards filled with heating charms. He’s wrapped in a cardigan and a mug of tea is steaming at his desk; all of his books have been returned to the library, leaving no trace of what he’s been doing. No-one will know. No-one ought to know.
His family will think he’s dead, and probably for the better; he’s been a disappointment for years. He decides to leave a note on his desk, anyway.
I made too many mistakes. I’m sorry. I’ve let you all down.
He thumbs the Time Turner in his hands – it’s such a familiar shape to him now that he could recreate it in his dreams – and smiles vaguely, watching the snow fall outside as he lets it spin through his fingers.
-
The first time Regulus sees Percy, it’s in a wizards’ café tucked just off of a Muggle street; he’s sitting on a table too big for just him and neatly filling in the Daily Prophet crossword. The only seats left in the place are those opposite Percy and, despite himself, Regulus takes a seat in one of them.
“Fifteen across,” he says, “it’s title.”
Percy looks up. “Excuse me?”
“Bird with the French name. The answer is title.”
A smile slowly breaks across Percy’s face, and Regulus thinks that it looks a little bit like the sun rising in the early morning. “So it is,” he says softly, and sketches it into the paper.
-
He takes a part-time job at Flourish and Blotts under the name Thomas Pinch, to be referred to exclusively as “Thomas” and not “Tom”, save he remind anyone of He-Who-Must-Not-Be-Named, narrowly avoiding the Invisible Book of Invisibility scandal by about three days and ending up on the receiving end of much of the manager’s frustrations.
His visit from Regulus is both expected and not; the visits becoming weekly is something he never could’ve anticipated, nor is the way his heart thrums when he sees Regulus coming through the door.
It’s so easy, in the end. He’d expected a challenge, a fight, and what he has is a boy who visits on Percy’s lunch break to help him with the cryptic crossword.  
“School’s going to start soon,” Regulus says one sunny afternoon; Percy’s halfway up a ladder replenishing their stock of Fantastic Beasts and Where to Find Them in preparation for the season at the time, and simultaneously eating a cheese sandwich. “I won’t be able to come here anymore.”
“You can write,” Percy suggests. “And there are always holidays.”
“I’ll miss you,” Regulus says pointedly, as if Percy is missing some kind of message; the Weasley pauses, glancing down over his shoulder, and Regulus flushes bright red, as if he’s realised what he’s just said. “That is, I, er, enjoy spending time here. It’s... it’s nice, here.”
Percy has to hold in his own laughter as he slots the last book onto the shelf, landing on the floor with a half-reckless leap. “I’ll miss you too,” he says. “But I’m always here.”
Suicidal ideation has never seemed so far away when Regulus blushes.
-
Percy could letter-write the hind legs off a donkey, and Regulus responds keenly in kind; it feels lonelier, true, without Regulus, but he takes a promotion into full-time work and throws himself into the busy schedule of trying to control a bookshop full of magical books; he has moments of wonder when he gets home and Oliver the owl almost claws him in the face in keenness to pass on a letter, and they remind him of what life was like before the war – before the Ministry, even. (He blames bad democracy on his eventual downfall.)
It’s Christmas Eve when he next sees Regulus; Percy’s on the closing shift and the only person in the shop, which is quiet save for panicked last-minute buyers, and he doesn’t look up when he hears the bell ring – he does, however, look up when he hears Regulus awkwardly clearing his throat.
“Oh, hello,” he says, unable to hide his surprise. “What are you doing here? Shouldn’t you be with your family?”
Regulus shrugs. “I’ve spent enough time at their Christmas Eve party; I think I’ve fulfilled my socialisation duties for the day.” He pauses, and swallows. “I wanted to see you.”
Nobody will know, so Percy closes up early.
-
“I think I might die next year,” Regulus says quietly, just before he leaves. Percy looks to the floor.
“You won’t,” he says weakly. “I’m here.”
-
Percy puts a radio in the shop after Christmas, because the silence without Regulus is starting to drive him half-demented; he’s never entirely sure what station to tune in to, and sticks to Radio 1 after an unsuccessful stint with the pirate station Radio Caroline, with the occasional switch to Radio 2 when he’s sick of the same hits over and over.
“Baby, oh baby; you look so good to me, baby...” He glances up from between the pages of Transfiguration Today as he hears the familiar sound of an owl hitting the window, and with a wince, he pulls it open, letting Regulus’s owl in. “What are you doing here?” He passes a treat from his pocket to the owl as he unfolds the parchment.
After I graduate, I’d like to move in with you, if you’d have me.
Percy chuckles to himself and glances over at the owl, who’s looking at him expectantly; he quickly writes his answer, shutting the window behind him.
-
Regulus probably isn’t used to the vague squalor of Percy’s flat; it’s tiny, all crammed in, taken over half by unruly piles of books and by neatly folded piles of clothes (Percy doesn’t have enough money to buy furniture – he only barely has enough to pay the rent and buy food, but he functions well enough without) – he’d been given fair warning, but he still looks surprised by it, running his finger over the wireless sitting atop a pile of books (Percy had eventually been made to take it home on the grounds that the customers didn’t much appreciate popular Muggle music).
“You know, as best I did trying to imagine it, I couldn’t really picture you sleeping on the floor,” Regulus says, glancing down at the mattress on the floor.
“As I said, you don’t have to stay with me if you don’t want to,” Percy shrugs. “I’m well aware that I live in a dump, but so long as I can read and sleep, it suits me just fine.”
“No!” Regulus says, startled by his own enthusiasm. “I mean, this place. It’s fine. I want to stay here.”
Percy smiles. “You can have the mattress, then.”
-
Waking up at Percy’s is always an experience: Regulus regularly forgets where he is and squints through the sunlight, stretching out to accidentally bat Percy in the face where they’re squeezed together on the mattress.
“Ow,” Percy grumbles sleepily, reaching up to rub his eyes.
“Sorry,” Regulus says apologetically. “I’m used to... a little more space.”
Percy smiles. “You really don’t have to stay. I’m sure you want more bed space.”
Regulus folds his arms. “I’m going to stay, alright? I’m here for you, whether you live in a squat or a mansion.”
Percy leans in and kisses his cheek, pulling himself to his feet and stretching out his weary joints. “That’s sweet of you, considering this place really is a squat. Would you like some tea?” Regulus nods. “I’ll make breakfast.”
“I’ll make it,” Regulus offers.
“When I say breakfast,” Percy says, turning round in the doorway, “I really just mean toast. I’ve got it.”
Regulus laughs.
-
Over time, Regulus grows to appreciate the wireless just as much as Percy did at Flourish and Blott’s; he’s alone most of the day while Percy is at work, and while he spends most of his time amusing himself with Percy’s literature stacks, and though he discovers the radio mostly as an accident when he switches it on while he’s making himself lunch, he quickly learns to love it.
He also quickly learns why Percy knows most of the charts, word-for-word.
He’s never had much confidence in being a Death Eater, but it begins to waver, day by day, faster and faster; he learns more and more about what’s really going on, and it turns his stomach. Percy tries to cheer him up, and while he’s glad for it, it doesn’t really work, not when he knows what’s coming.
He makes his decision with all the windows in the flat open and his head out one of them, watching people walk along on the streets below; from wherever the wireless is behind him, Teenage Kicks is playing, and he whistles along as he tries to swallow his fate.
-
“There’s something I have to do.”
Percy knew what those words meant the minute he heard them, and knew what he had to do; but he’s no better than Regulus alone, and it’s such a hopeless endeavour that it’s more of a suicide attempt. The caves are dark and damp and horrible and his heart aches inside his chest – everything had been going so right, and now reality has come crashing back through.
But he’s doing something useful, for once, and this way it means that Regulus isn’t alone. It’s not a loss at all; it’s something he holds on to in the dark, and when Regulus is screaming so loud the echoes off the walls are deafening.
Regulus is holding onto him when the Inferi come, his grip so tight in his pain, and Percy bumps their foreheads as he scrabbles for his wand, breath coming in unsteady gasps against Regulus’s cheeks. “Regulus?”
“Yes?” he rasps, lifting his face to feel the warmth of Percy’s breath.
“I’m glad I’m with you,” Percy says, and then the Inferi are upon them.
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smolharray · 5 years
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Dating Zayn Malik
Here's a taste of my writing.. (Also, these small situations are all just random little ideas, no hate towards anyone or anything mentioned!)
Dating Zayn Malik as a fellow artist was not easy. Everyone knew that Zayn was an extremely private and introverted guy, especially for a celebrity. He rarely appeared on interviews or TV shows, is usually inactive on social media other than a tweet every so often and does not promote his music in any way, much to his fans' dismay. Although they respected his choices and were always highly proud of his achievements despite his inactivity on the media. They also loved his music, how real and genuine it felt to listen to it, especially because it's 'hand-made' by Zayn.
You however, are the exact opposite of your beloved boyfriend. You loved interacting with your fans, online or offline, no matter where you are, you can always be spotted chatting with them, taking selfies, giving autographs. It felt like you owed it to them, and it was the least you could really do for those who unconditionally supported you regardless of your relationship with them- strangers.
You regularly promoted your music, always performing live at concerts, TV shows and even talk shows like Ellen, The Late Late Show With James Corden, The Tonight Show Starring Jimmy Fallon and many more. You also made regular appearances at radio stations, Buzzfeed and hundreds of magazines for your modelling career.
Acting was much less common, but it was still something you did. A couple of main roles, a few cameo or special appearances did much to boost your name as an 'all-rounder celebrity'.
So to say the least, dating Zayn Malik was not easy. In fact, your personalities clashed a little too much for the idea of even being friends, let alone being a couple.
Initially, Zayn had objected to the idea of revealing your newfound relationship. In fact, you agreed, not wanting to ruin the first few months of dating. The feeling of a fresh, unknown and private relationship was a lot more beautiful than one could imagine, especially when it came to being a public role model. It felt much more meaningful and romantic when you weren't being plagued with fans, magazine rumours and always making it on the headlines if you're seen with the opposite gender. Of course, you don't blame them. Never did, never will.
Sometimes it's just hard to live in the spotlight when you want peace and alone time to spend with friends, family and loved ones.
However, as time went on, it wasn't really news to you that both you and Zayn were suspected to be involved with each other. Fans find things out a lot quicker than most could imagine, it was almost scary. However, Zayn's constant denial made you upset. What was wrong with revealing your relationship? It was common, even amoungst your past relationships. This ended in small arguments that were pointless, but eventually, to save your relationship, he gave in. Anyway, it would have been found out sooner or later and the both of you had been getting annoyed with the many articles being released, "Zayn Malik & Charlotte Parker infatuated with each other?", "Couple or 'Just friends'- Zayn Malik and Charlotte Parker", "Has Zayn moved on from his relationship with Perrie?", "Is Charlotte over her recent breakup with Cole Sprouse?"
-
"And what, Zayn? Why don't you want people to know about us? Is it something about me? Am I not bloody good enough for you?"
You knew it wasn't true. Zayn loved you with all his heart, and it didn't matter if you were a celebrity or not. Zayn didn't care about these things, he made that clear from the start.
But it was getting out of hand; the rumours. They knew, fuck, they probably suspected it from the beginning. What's wrong with telling the world?
"You know that isn't fucking true Charlotte. I love you, you know that. It's just-"
"What? Just what Zayn?"
Zayn remains silent, his brown eyes refusing to meet yours. Neither of you said a word as you sat in the piercing silence.
Zayn quietly turns to look at you, he knew you wanted it. Could he sacrifice his privacy for you?
-
Secondly, it is very well-known that Zayn has been in One Direction, and of course decided to cut all ties with his former bandmates. Except, you've been together while Zayn was still in One Direction, and friends when he joined the band. This meant that a friendship with the other boys was definitely going to happen. However, when a bandmate who just so happens to be closest to you leaves, it will lead to more drama. You cannot count the amount of times fans have pleaded- begged you to reconcile their relationship.
Some Directioners even accused you breaking the band because of your relationship with Zayn, which was absolute horseshit. The boys have stepped in to defend you, but it didn't stop some fans from blaming you whenever they found something that was close enough to be called 'evidence'. This was the exact reason why sometimes you wished Zayn would suck it up and apologise for leaving so abruptly and fix their friendship. However, if it were that easy, Zayn wouldn't have left. You don't blame him for not doing that.
Many useless articles have also came up with news whenever you were spotted spending time with the boys. Yes, the relationship has soured between the members, but did that stop you from being good friends with them? No. Problems only arose whenever you tried to fix it, and it didn't seem that either party were willing to cooperate with each other. Moreover, with their busy schedules and sizeable media exposure, it was hard to find a time and place to mend their friendship. So maybe, maybe when everyone had the chance to get together, you'd try.
-
"Can't you just try, for them? For me?"
Zayn sighs, holding his head between his hands. You knew he didn't want anything to do with them, but you never really understood how someone could abandon a 5-year friendship, especially if you've lived together more than half the time.
"Baby, you know how I feel about it. I'm just not ready. Moreover, it seems that none of the guys want to either."
His words only make you grit your teeth. The guys seem like they don't want to because none of you try to help the problem! Everytime you manage to gather the boys together, it always ends in shouts and awkward silence.
"Well... Fine then. I guess I can't force any of you."
-
Lastly, it's common knowledge within your fan base and even outside of it that you abhorred smoking and drugs. The visual made up for it's disgusting nature, but you still preferred to stay away from those cancer sticks. With such a negative view towards cigarettes, it was certainly a surprise when your company revealed you got together with Zayn, considering he smoked a ton.
Fans were worried that he had lead you astray and bombed him with hate for quite awhile, but once you cleared the issue up, many were questioning, why?
Some said this only shows how powerful your love was, that you could oversee a flaw in the Bradford man and still love him for him. However others said that this only proved you're there for his money, which didn't really make sense, considering you earned just as much, if not more for the amount of promotions you did. So that theory was long diminished.
Cigarettes were small, but to you, they held a lot more power than one could imagine. It was not only addictive after a few smokes and lethal, but it also seemed to be able to put a strain on your relationship with Zayn. You hated that those things had so much power.
-
"Baby.. I thought I told you no smoking inside the house! If you want to smoke, go to the balcony."
You sigh, coughing a little as the pungent smell of smoke stung your lungs. You honestly didn't know why Zayn turned to smoking when he could do other things to relax and let off steam.
"It's just a little smoke babe. Deal with it."
"Perrie did.. So why can't you.." He mumbled, clearly not realising just how loud and clear it was to you. Tears filled your eyes and anger ran through your veins. So this was what would end it all, a fucking cancer stick.
"Fuck you Zayn." You breathed out, wiping away your tears before slamming the door to your shared room shut.
You definitely did not miss the regretful look in his eyes, but honestly, you could care less at this point. If Zayn missed Perrie so much just because she could endure a goddamn cig in the house, he can have her all he wants.
-
You eventually made up with Zayn. He came over to your friend's place where you were temporarily staying at 3am, drunk while slurring out constant apologies. It truly did hurt you to see him like that, however, what he said, you would never, ever forget. He promised he would try to get over his habbit, just for you. It comforted you that you were able to get him to try his best to overcome this life-threatening habbit. Because hey, you might not have been able to endure it for him, but you potentially saved him from health issues in the future.
Of course, Zayn's smoking habbit did bother you a lot more than you would admit, it's just that you didn't show it to the public. It was a turn-off, especially the lingering scent on his body. Even after showers, the foul smell always lingered on him. After the fight, you had managed to lower his smoking frequency by a substantial amount, but it still wasn't enough to you. As a biology student in secondary school, your knowledge over the toll smoking can cause on a person's body was not small, and you've heard many stories from your teacher about how smoking almost lead to her father's permanent blindness. You were bent on not letting that happen to Zayn, let alone even getting close to that state.
His fans are more than thankful for that.
But they didn't just love you for helping his problem with smoking. In fact, they loved that once you appeared in his life, his mood seemed to always be playful and happy. How did they know that? Because of your weekly Instagram posts with him. Zayn may not be active on social media, but you constantly made it a point to give the fans a little taste of him outside of work. It seemed to do the trick, because many of them loved it.
There were also less Twitter rants made by him. It used to be common for Zayn to post whatever he wanted to say on Twitter without directing it to anyone, but he rarely did that anymore, and he kept to more positive tweets.
The part fans were most excited about was that Zayn seemed to quarrel less with the his ex bandmates. Their Twitter war likely came to an end because of you. Overall, fans were content with the positive influence you had on him.
"How does it feel to be in a relationship with Zayn Malik?"
The female interviewer asks, almost grinning with adoration when your eyes lit up at the sound of his name.
"It's difficult because of our differences. As many people know, he's much more introverted and less active than I am in the community, but despite those differences, it's still amazing. We love each other and that's all that matters. We give each other balance, and we're always there for each other whenever the latter needs support."
You pause, biting your lip.
"Zayn is the best thing that's happened to me. He's a great guy. I'm so thankful that I can have him in my life, even if I can't boast about our relationship."
The interviewer chuckles, many found it enduring whenever you talked about your relationship. She's not the first.
"Do you have anything to say to Zayn?"
Crossing your legs, you smiled shyly, tucking a strand of black hair behind your pierced ears. You had plenty to say to Zayn, but it wasn't practical to say it all out on camera. No matter how extroverted you were, baring your heart out to the world was still a hard no in your book.
You faced the camera, the corners of your lips curving ever so slightly.
"Zayn, I know you hate publicising anything about us, I know it's tiring when we go out together, especially when fans and paps disrupt our private time together. It's been hard on you, and I'm sorry. But we grew together as partners which is all that matters, and we learnt to give way to each other, even if it meant sacrificing a little. So thank you for putting up with me. I love you."
The interviewer quietly squeals beside you, clapping at your small speech. She then goes on to talk about how real your relationship seemed to be, as compared to other public relationships. But you listened to none of it, because, you were watching Zayn stare at you quietly from behind the camera, with watery eyes and the widest, goofiest grin on his face.
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topicprinter · 7 years
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About this post: This isn’t a guide on clickbait or a how-to article. This post is nothing more than a fun little project for myself where I write about stuff I find cool.I’m just an average entrepreneur who finds certain marketing, advertising and business stuff fascinating. What I’ve wrote below is a look into the history of Clickbait, purely because I think it’s fascinating. That's it. Nothing more.Enjoy:..“Earn $57,426 Per Day Using This Weird Method”.“Down Syndrome Dumbass Licks Potato And Discovers Ancient Secret To Losing 2.1kg Of PURE Fat OVERNIGHT!!!”.“7 Steps To Enlarging Your Dick So BIG That You’ll Need To Rush Your Girlfriend To A&E Everytime You Fuck”.Clickbait. If you’ve spent 5 minutes on the internet you know what it is. It’s a word synonymous with deception, disappointment and disgust.Yet the internet is over-run with the stuff.So the question remains… “How come, despite the intense hatred towards clickbait, is it that so many advertisers continue to use it?”The answer is simple – It works!Clickbait has made – and continues – to make millions upon millions of dollars for individuals and companies smart enough to use is wisely.In this post I want to take a deeper look into the controversial phenomena that is clickbait, and get to the bottom of why it’s gathered so much hate, and what exactly makes it so powerful..What is Clickbait?.When most people think Clickbait they think internet scammers, yet in reality it’s more than that.Clickbait when boiled-down is simply an enticing short piece of text designed to arouse the curiosity or interest of a certain group, and compel them to take some sort of action to learn more.The action could be to click to a link, enter their email address for an e-book, or call a number for an information pack. This action is the first step towards the advertiser convincing the user to buy something!That’s all it is – the first step towards trying to make a sale. Now, many of you will have heard of the old-age sales motto A.I.D.A which stands for:Attention – Interest – Decision – ActionThis represents the stages of how a sale is made. It says that first you must get the attention of the potential customer, then get him interested in your thing, then get him to the point he decides to pull the trigger and get your stuff, and finally take action and hand over the cash.The selling of anything – whether it’s good, bad, great or downright god-awful – first begins with grabbing the attention of a potential customer.And that’s all Clickbait is – a tool to grab attention.So here’s the question…If ALL sales (regardless of quality) begin with the grabbing of attention… and if clickbait is merely a tool to grab this required attention… then why the fuck is it so universally hated?Buckle up. To find the real answer we need to take a quick trip down the ol’ time machine..Pre 1998: Before the Internet – When ‘Clickbait’ Didn’t Exist.Ahh the good ol’ days before technology reached fever pitch, when terrible fashion and fantastic music reigned supreme. But it was more than just a time when 5 hour drives across the country were passed with simple conversation, occasional naps, and desperate games of eye-spy.The world of business was entirely different.You see before the internet you were pretty limited in how you could grab the attention of the public in order to make a sale. You pretty much had newspapers, magazines, radio and direct mailings – and that was it!This meant it was much harder to be a successful entrepreneur for various reasons:.1) Advertising was expensive: Advertising in a local paper or small-circulation magazine would cost a few hundred dollars. Radio, national newspapers and large-scale magazines would regularly cost you a few thousand to run an ad.Even once you acquired someone’s mailing address, you’d have to factor in printing and postage costs to mail a promotional piece. Literally every attempt to make a sale cost serious money.This meant only serious businesses were around. You either had to have the capital or balls to give it a shot..2) You needed customers to buy more than once to be profitable – With advertising so expensive it would often cost anywhere between $20 to $200 dollars to acquire a customer to buy something. That meant you couldn’t make a profit of a one-off $30 purchase..Instead you needed them to keep coming back and buying from you. It meant your product or service had to be good. If the customer was disappointed they wouldn’t buy again, and you’d be at a loss.These two factors prevented quick money-grubbing individuals to get anywhere. They simply couldn’t make the economics work. They either didn’t have the money to give it a shot in the first place, or their product/service was so crap nobody came back for them to make a profit. The only businesspeople left tended to be delivering a decent product in return for any promises made.But even with a great product, you could have your ass handed to you if your advertising didn’t compel anyone to take notice.It was during this period that brilliant advertisers and entrepreneurs realised that by writing the headlines of the advertising in a sharp, punchy curiousity-arousing way – you could get more people to take action – which lead to more sales – and hence more profit.It was generally a good time for the mass public. Those who made bold claims and promises generally tended to deliver on them. Everyone was happy!But then came the rise of a medium which was to not only revolutionalise and rock the entire fabric of existence and society – but also the business world once and for all….The Internet: The Birth of Clickbait.Sometime during the late 90s / early 2000s the internet took off. And oh man what a time it was.The internet came into my life in my early teens. Slow-loading porn, the ability to download shit for free, and the ability to check out whatever weird interests I had lurking in my mind with total anonymity. Simply put it was magical! Soon pretty much the whole world was on the internet.Now for the businessman this was a golden opportunity. Until now reaching the masses was limited to print and radio – all which cost serious money.But now there was a new medium – one which had more people than any other out there – and the situation unlike other advertising mediums was entirely different:.1) Advertising costs were DIRT CHEAP: Unlike print and media, advertising on the internet was cheap. FILTHY CHEAP. It was ridiculous – I’m talking less than 1 cent per click equivalent.When Google launched Adwords in late 2000, cost per click costs were so cheap there was actually arbitrage available! Certain smart bastards who monetised their blogs, drove traffic to their blogs with Adwords at cheaper than the payout from Adsense! They literally made fortunes with ZERO risk.That aside for the everyday entrepreneur the unbelievably low advertising costs meant….2) You no could make a serious profit from one sale: As the cost of advertising was next to nothing, it meant that even with shitty marketing you could acquire a customer for pennies.This meant the sale of a $30 ebook would be close to all profit. This meant you didn’t need to have a good product. It could be dogshit. Sure the person would be disappointed and never buy from you again. Who the fuck cared! You had the whole world at your fingertips. Just keep selling to new folks and there was money-a-plenty!And remember people were used to businesses living up to promises, and bought relatively effortlessly. So the formula for making money was simple:Make a big promise – deliver shit – profit anyway!Now the big promise which lead the sale of these shit products was the same headline writing tactics used by the same well-meaning advertisers and businessmen before the internet. Internet shit-peddlers read a few headline-writing books and they cashed in nicely.As time went on internet users kept seeing big promises lead by these attention-grabbing headlines, bought with high hopes and received crap. Soon those headlines were hated the world over. Clickbait had been born!.Other rarely-understood factors.There were a few other key factors which deepened the hate of clickbait. While I won’t go into deep detail, I will mention them as I think they’re fascinating:.1) Email was and continues to be free – sending emails was free. With direct mail sending a piece of mail would cost you money. But with email you could keep spamming the shit out of your users without thinking twice.Subject lines for these email were naturally clickbait, which only deepened the hatred..2) You could get started for $5 - Advertising on the internet had no minimum fee to start. Where in a magazine or newspaper you’d have to pay a few hundred, if not thousands to run one ad – internet advertising allowed anyone with $5 to give things a shot. It meant any Tom, Dick or Harry could give making money a go.They did and the level of clickbait shot through the roof..3) Internet security sucked – Not only was there crap product which didn’t deliver on promises made, But it was easy to send viruses either through email or infected sites. Assholes did this for fun, and used the clickbait format to lure users. Clickbait was now linked to fucking up your PC!.4) You could make money defrauding users pretty easily – Many of the viruses mentioned stole credit card information and hijacked the modem dial-up connectivity (which used to connect via phone lines) and unknowingly dialled premium rate numbers charging $2 a minute!Forget delivering shit product, clickbait was now the starting point of downright theft!As you can imagine all this lead to recipe of hatred whenever users saw those big promise headlines.But it must be understood that the hatred for clickbait titles wasn’t with the text itself – but more the setting of high expectations through a headline, followed by large-scale disappointment..Clickbait Today and How To Use it For Maximum Effectiveness.Things have long changed since those early days of the internet. Online advertising is pricey. There’s better spam filters and internet protection. And users aren’t as gullible as before.But despite this…Clickbait is as rampant as ever!Can you guess why?Because it works!!! Truth is users still fall for clickbait. And not dumb fuck users by the way – just about everyone. Why do you think sites like Buzzfeed are thriving, while sites like PBS need government support?Truth is clickbait works – or more accurately the ability to grab the attention of your audience using compelling headline is vital if you want success in your business..How to Use Clickbait Effectively For Maximum Profits (Without Pissing Everyone Off).We need to re-define what we consider clickbait, and think in terms of attention-grabbing headlines.Admittedly the effectiveness of the old over recycled titles of yore such as “Amazing Ninja Secret Trick to Making $4984.42 Every Two Mins Without Lifting A Finger” don’t work anywhere close to as well as they once did.(Whilst this was once a great compelling headline, it’s now been butt-fucked into the dirt)However the art of writing compelling will never die. It has, and will always work.For example look at the title I chose for this post. I chose it intentionally with the intention of grabbing your attention to make you read this. But as you can see it has a little originality to it.It’s not my intention to make this post a how-to of writing quality headlines. But here’s an overview to it:Think of writing compelling headlines like you would with music – play the same tune over and over and everyone will grow sick of it. Instead put out something a little fresh and different, but with intention and understanding of what drives the audience to listen and you’ve got a winning formula..The Simple ‘Secret’ To Preventing Your Headlines Becoming ‘Clickbait’.Now it’s worth remembering that this title could have easily been classified as clickbait if this post was shit. (Those of you who think it is shit may consider it clickbait now).At the end of the day it should be understood that whether a headline is clickbait or not is determined by the following ‘equations’:Clickbait: Great Headline -> Shit Article or ProductNot Clickbait: Great Headline -> Great Article or ProductRemember quality headlines only became clickbait when the delivery of content or product doesn’t live up to the headline’s promise.Feel free to make bold big claims. But make it your aim to deliver on that promise. If you do your audience will look forward to your big promises. They’ll only magnify your reputation, and more importantly, your profit..Who Am I?My name is Ganon (not real name) and I’m an active entrepreneur with moderate success. What I love to do is write, and I do it for the fun of it. Hopefully you liked it - if you did let me know.(I posted this a few mins ago, but removed it as the title was itself too clickbaity in and itself. I get there's a lot of self-plugging in the sub and that wasn't my aim so I gave it a more toned-down title.)
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ionecoffman · 7 years
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A World Without Suicide
Steve Mallen thinks the signs first started to show when his son stopped playing the piano. Edward, then 18, was a gifted musician and had long since passed his Grade 8 exams, a series of advanced piano tests. Playing had been a passion for most of his life. But as adulthood beckoned, the boy had never been busier. He had won a place to study geography at the University of Cambridge and was reviewing hard for his final exams. At his school, Edward was head boy and popular among pupils and teachers. His younger brother and sister idolized him.
“We didn’t attach any particular significance to it,” says Mallen of what he saw as merely a musical pause. “I think we just thought, ‘Well, the poor lad’s been at the piano for years and years. He’s so busy ... ’ But these are the small things—the ripples in the fabric of normal life—that you don’t necessarily notice but which, as I know now, can be very significant.”
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Three months after Edward stopped playing, and just two weeks after he handed in an English essay his teacher would later describe as among the best he had read, police knocked at the door of the family home in Meldreth, a village 10 miles south of Cambridge. Steve Mallen was at home, alone. “You become painfully aware that something appalling has happened,” he recalls. “You go through the description, they offer commiserations and a booklet, and then they leave. And that’s it. Suddenly you are staring into the most appalling abyss you can ever imagine.”
The next time Mallen heard his son play the piano, the music filled Holy Trinity Parish Church, a mile from the station where Edward caught the train to school every morning, and where he died by suicide on February 9, 2015. Steve says 500 people came to the funeral. Friends had organized a sound system to play a performance of Edward’s filmed on a mobile phone. “My son played the music at his own funeral,” Mallen says as he remembers that day over a mug of tea in a café in central London. “You couldn’t dream this stuff.”
I first talk to Mallen, who is 52, in November 2016, 21 months to the day since Edward’s death. His hair is white; his blazer, navy. He wears a white shirt and a remembrance poppy. He talks in perfect paragraphs with a default setting of businesslike, but it is clear that the abyss still falls away before him. He says it always will. But life has also become a mission, and in the two years since his son’s death by suicide, Mallen, a commercial property consultant, has become a tireless campaigner, a convener of minds. He has earned the prime minister’s ear and given evidence to health select committees. The study at his home is filled with files and research papers.
“As a father, I had one thing to do and I failed,” he says, his voice faltering for the first time. “My son was dying in front of me and I couldn’t see it, despite my education, despite my devotion as a father ... So you see this is coming from an incredible sense of guilt. I suppose what I’m trying to do is save my boy in retrospect. I stood next to his coffin in the church. It was packed with people—a shattered community—and I made him a public promise. I said that I would investigate what had happened to him and that I would seek reform for him, and on behalf of his generation.
“Quite simply, I’m just a guy honoring a promise to his son. And that’s probably the most powerful motivation that you could imagine, because I’m not about to let him down twice.”
* * *
Edward’s suicide was one of 6,188 recorded in the U.K. in 2015, an average of almost 17 a day, or two every three hours. In the U.K., suicide is the leading cause of death among women under 35 and men under 50. The World Health Organization estimates that 788,000 people died by suicide globally in 2015. Somewhere in the world, someone takes their life every 40 seconds. And despite advances in science and a growing political and popular focus on mental health, recorded suicides in the U.K. have declined only slightly over the past few decades, from 14.7 per 100,000 people 36 years ago to 10.9 in 2015.
A simple belief drives Mallen: that Edward should still be alive, that his death was preventable—at several stages during the rapid onset of his depression. Moreover, Mallen and a growing number of mental health experts believe that this applies to all deaths by suicide. They argue that with a well-funded, better-coordinated strategy that would reform attitudes and approaches in almost every function of society—from schools and hospitals to police stations and the family home—it might be possible to prevent every suicide, or at least to aspire to.
They call it Zero Suicide, a bold ambition and slogan that emerged from a Detroit hospital more than a decade ago, and which is now being incorporated into several National Health Service trusts. Since our first meeting, Mallen has himself embraced the idea, and in May of this year held talks with Mersey Care, one of the specialist mental health trusts already applying a zero strategy. His plans are at an early stage, but he is setting out to create a Zero Suicide foundation. He wants it to identify good practices across the 55 mental health trusts in England and create a new strategy to be applied everywhere.
The zero approach is a proactive strategy that aims to identify and care for all those who may be at risk of suicide, rather than reacting once patients have reached crisis point. It emphasizes strong leadership, improved training, better patient screening and the use of the latest data and research to make changes without fear or delay. It is a joined-up strategy that challenges old ideas about the “inevitability” of suicide, stigma, and the idea that if a reduction target is achieved, the deaths on the way to it are somehow acceptable. “Even if you believe we are never going to eradicate suicide, we must strive toward that,” Mallen says. “If zero isn’t the right target, then what is?”
Zero Suicide is not radical, incorporating as it does several existing prevention strategies. But that it should be seen as new and daringly ambitious reveals much about how slowly attitudes have changed. In The Uses of Literacy: Aspects of Working-Class Life (1957), a semiautobiographical examination of the cultural upheavals of the 1950s, Richard Hoggart recalled his upbringing in Leeds. “Every so often one heard that so-and-so had ‘done ’erself in,’ or ‘done away with ’imself,’ or ‘put ’er ’ead in the gas-oven,’” he wrote. “It did not happen monthly or even every season, and not all attempts succeeded; but it happened sufficiently often to be part of the pattern of life.” He wondered how “suicide could be accepted—pitifully but with little suggestion of blame—as part of the order of existence.”
Hoggart was writing about working-class communities in the north of England, but this sense of expectation and inevitability defined broad societal attitudes to suicide as well. It was also a crime. In 1956, 613 people in England and Wales were prosecuted for attempting to “commit” suicide, 33 of whom were imprisoned. The law only changed in 1961, but the stigma endured; mental health experts and the U.K. helpline Samaritans advise against the use of the term “commit” in relation to suicide, preferring “to die by suicide,” but the word still regularly appears in newspaper headlines. The same voices have strongly opposed the view that suicide is “part of the pattern of life,” ultimately giving rise to the idea that its eradication—or at least a drastic reduction—might be possible.
* * *
Traditionally, suicide has been viewed as a deliberate action, a conscious choice. As a result, mental-health systems have tended to regard at-risk patients in one of two ways. “There were the individuals who are at risk but can’t really be stopped,” says David Covington, a Zero Suicide pioneer based in Phoenix, Arizona. “They’re ‘intent on it’ is the phrase you hear. ‘You can’t stop someone who’s fully intent on killing themselves.’ So there is this strange logic that individuals who die couldn’t be stopped because they weren’t going to seek care and tell us what was going on. And those who do talk to us were seen as somehow manipulative because of their ambivalence. You heard the word ‘gesturing.’ So we have this whole language that seemed to minimize the risk.”
Covington is president and CEO of RI International, a mental-health group based in Phoenix that has more than 50 crisis centers and other programs across the United States, as well as a number in Auckland, New Zealand. A prominent and energetic speaker, he is also president-elect of the board of directors of the American Association of Suicidology, a charitable organization based in Washington, D.C., and leads an international Zero Suicide initiative. When he started in mental health more than 20 years ago, he was dismayed by the gaps in training and thinking he found in the system. Breakthroughs have come only recently, long enough for Covington to have observed and promoted a shift away from a fatalism—and a stigma—that was preventing any progress in reducing death from suicide while we eradicated diseases and tackled other threats, such as road accidents and smoking.
Covington credits a book and a bridge with accelerating that change. In Why People Die by Suicide (2005), Thomas Joiner, a professor of psychology at Florida State University, drew on the testimony of survivors, stacks of research and the loss of his own father to upend minds. He recognized the myriad pressures on a suicidal mind—substance abuse, genetic predisposition to mental illness, poverty—but identified three factors present in all of those most at risk: a genuine belief, however irrational, that they have become a burden to those around them; a sense of isolation; and the ability, which goes against our hard-wired instincts of self-preservation, to hurt oneself (this combines access to a means of suicide with what Joiner describes as a “learned fearlessness”; Covington calls it an “acquired capability”). “[The book] gave an architecture to what was going on that we had not seen before,” Covington says. “It was like a crack through the entire field.”
Then came the bridge—or The Bridge, the 2006 documentary about suicides at the Golden Gate Bridge. A swirl of outrage greeted its release, although anger was generally directed at the filmmaker rather than the toll of death and bereavement at the San Francisco landmark. Its maker Eric Steel also faced accusations of ghoulishness; The Bridge features footage of people falling to their deaths and subsequent interviews with their families. “This could be the most morally loathsome film ever made,” film critic Andrew Pulver wrote in The Guardian. Yet Steel intended to shock, and to expose an attitude to suicide on the bridge that exemplified society’s. “It hit the public psyche, it challenged core myths in a way that was extremely powerful,” Covington says.
In the 1970s, local newspapers launched countdowns to the 500th death on the bridge since its completion in 1937 (deaths have occurred on average once every two to three weeks). In 1995, a radio DJ promised a case of Snapple to the 1,000th victim’s family. Only when police intervened did official counting cease, at 997.
For decades the bridge’s directors have resisted calls, on financial and aesthetic grounds, for a safety barrier between the pedestrian walkway—which has a low railing—and the water 75 meters below. In 1953, one bridge supervisor argued that it was better that jumpers die there than on a pavement below a tall building. But in 1978, Richard Seiden, then a professor emeritus at the University of California, Berkeley’s School of Public Health, found 515 people who had been stopped from jumping from the Golden Gate Bridge between 1937 and 1971. Ninety-four percent were living or had died of natural causes.
The study, which Covington says was “ignored for 25 years,” suggested what several others have shown: Simply by removing access to danger, and an easy outlet for “learned fearlessness,” simple interventions can dramatically reduce suicide rates. On a bridge that could not be constantly patrolled, it also intensified calls for a safety net. Later, in 2008, the bridge’s board of directors voted in favor of one. Construction began only in May of this year. The steel net, to be placed six meters below the walkway, is due to be completed in 2021. It is designed not to catch people, but to deter them from jumping.
Anthony Gerace / Mosaic Science
Edward Mallen’s own Golden Gate Bridge was the train station he used every day to get to school. His father Steve will never know what went through his mind that day, but those who survive attempts to take their own life—and go on to talk about it—are being embraced in the fight for further understanding. As of 2005, a year before Steel’s documentary came out, only 26 people had lived after hitting the water below the Golden Gate Bridge at 75 mph. Those whose injuries—broken bones, punctured organs—do not kill them on impact typically then drown in pain. Recovered bodies have shown the effects of shark and crab bites.
Kevin Hines was 19 and suffering from severe bipolar disorder when he caught a bus, alone, toward the bridge in September 2000. His family knew that he had been mentally ill, and he was receiving treatment, but the voices in the young man’s head, which often came with hallucinations, willed him to take his life. They told him that he was nothing but a burden to everyone around him, and that if he revealed to anyone the extent of his suffering he would be locked up. “When you self-loathe long enough, and believe the voices, you lose all hope and suicide becomes an option,” Kevin says by phone from his home in Atlanta. “What people in that position can’t recognize is that the voice is nothing but a liar—a false reality created by your brain’s misaligning chemistry ... they believe the people around them don’t have the ability to empathize.”
Kevin was neglected by his birth parents, who had drug and mental health problems. As a newborn, before he was placed into foster care, they left him alone on the concrete floor of a motel in San Francisco and fed him Coke and stolen, sour milk. A landmark 1998 study published in the American Journal of Preventive Medicine, and cited in a report published in March by the Samaritans, showed that people with exposure to four or more “adverse childhood experiences” (known as ACEs, which include physical abuse, violence against the mother, exposure to substance abuse, or the imprisonment of a parent) were 12 times more likely to have made a suicide attempt in their lifetimes.
Kevin’s devoted adoptive parents were aware something was wrong, and helped him get treatment, but Kevin kept everyone in the dark. He told doctors he was following a plan he had not read and that he was taking his medication, which he only took sporadically, often while drinking until he blacked out. “I was a wrestling state champion, a football player, by all accounts doing great on the outside.” By the night before his bus ride, Kevin had suffered days of decline. “That’s when the bridge was the spot I decided on,” he recalls.
Anthony Gerace / Mosaic Science
Kevin rejects the notion that anyone “chooses” to take their own life. “It’s not a choice when a voice in your head, a third party to your own conscience, is literally screaming in your head, ‘You must die, jump now.’” He also challenges the idea that suicide is a selfish act, because to a person in extremis, compelled to believe they are a burden, living can feel like the selfish act. Yet he also remembers feeling how little it would have taken to deter him that morning in 2000. “I had made a pact with myself, and many survivors report this, that if anyone said to me that day, ‘Are you OK?’ or ‘Is something wrong?’ or ‘Can I help you?’—I narrowed it down to those three phrases—I would tell them everything and beg for help.” As he sat on the bus, where he remembers crying, yelling aloud at the voices to stop, nobody said anything. “It still baffles me that human beings can’t see someone like that, wailing in pain, and say something kind—anything,” he says.
As Kevin walked along the bridge and leaned over the rail, he thought help might have arrived when a woman approached him. “But she pulled out a digital camera and asked me to take her picture. She had a German accent. I figured the sun was in her eyes, maybe she didn’t see the tears. So I take this woman’s picture five times, hand her the camera, she thanks me and walks away. At that moment I said, ‘Absolutely nobody cares. Nobody.’ The voice said, ‘Jump now,’ so I did.”
It takes just under five seconds for a person to fall from the Golden Gate Bridge into the water below. “It was instant regret the moment my hand left the rail,” Kevin recalls. “But it was too late.” He opened his eyes deep underwater, his spine broken. “All I wanted to do was survive. I remember thinking, before I broke the surface, I can’t die here. If I do, nobody will know I didn’t want to die, that I’d made a mistake.” Kevin struggled to stay afloat while the coastguard came to his aid. He spent weeks recovering in a psychiatric ward and says it took years to be honest with himself about his mental health. He still works hard to stay stable, and has become a powerful voice in suicide prevention, as a researcher, writer and speaker. “Of the 25 or 26 people who have survived jumping from the Golden Gate Bridge and are still alive, 19 have said they felt instant regret the second their hand left the rail,” he says. “The act of suicide is separate from the thought of suicide.”
Removing the means of suicide has become a growing part of modern prevention strategies, whether or not they come with a “zero” tag. In the early 2000s, the U.K. Department of Health asked the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, based at the University of Manchester, to recommend a way to reduce suicides in mental health wards. “From our data, we said remove the ligature points that make it possible for people to hang themselves,” recalls Louis Appleby, a professor of psychiatry and the director of the inquiry. He also leads the National Suicide Prevention Strategy for England.
By 2002, wards were required to remove non-collapsible curtain rails in bathrooms and around beds. A later study by Appleby’s team, published in 2012, showed that inpatient suicide cases by hanging on the ward in England and Wales fell from 57 in 1999 to 15 in 2007. “There was also a broader effect, because mental health wards seem to have got safer more generally as the issue of safety became more prominent,” Appleby says. Outside hospitals, measures that have reduced suicide by specific methods, whether or not that was the intention, have included legislation to reduce the size of paracetamol packages (intended) and the conversion of coal-gas ovens to natural gas in the 1950s (unintended).
* * *
Edward Mallen and Kevin Hines had some things in common; they were young men suffering from severe mental illness. But while Kevin identifies his traumatic first months as a cause, Edward had no adverse childhood experiences. His father is not aware of a history of depression in his family, but can only surmise that genetic flaws created the fatal cocktail of chemicals that compelled him to end his life. Research in this field is evolving. Last year, scientists at Massachusetts General Hospital identified 17 genetic variations that appeared to increase the risk of depression, in an analysis of DNA data from more than 300,000 people, published in Nature Genetics. “There are vulnerability factors we all have and part of them are genetically influenced,” says Rory O’Connor, a professor of psychology at the University of Glasgow, where he leads the Suicidal Behavior Research Laboratory.
More significantly, Kevin and Edward both attempted suicide while seeking treatment for mental illness. According to the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, just over a quarter of suicide victims have had contact with mental health services in the preceding 12 months. Soon after the piano playing stopped, it became clear Edward was not well. Mallen remembers his son withdrawing. He became pale and looked unwell. He told his mother, Suzanne, that he was down, but never revealed to his parents he felt suicidal. Two weeks before his death, Edward saw his family’s general practitioner, who immediately referred him to an NHS crisis intervention team, recommending he be assessed within 24 hours. But when a triage mental health nurse with limited experience spoke to Edward, he downgraded the risk and recommended a five-day wait. Moreover, while Edward had turned 18 less than two months before his death, he had given permission for his parents to be told about his suicidal thoughts. They never were.
After an inquest in June last year, Cambridgeshire and Peterborough NHS Foundation Trust said in a statement that “while there are elements in what occurred that may well not have been foreseeable there were also things the Trust could have done better. The Trust has held an internal inquiry and also commissioned an independent report and it is implementing [their] recommendations.”
Mallen describes in an email his son’s case as “a haphazard fiasco of confused process, unclear responsibilities and tortuous post-tragedy contention which greatly deepened a family’s distress,” adding: “The real concern here is that this was not an isolated incident.”
The Zero Suicide approach started as an attempt to reduce deaths in mental health systems. At a meeting in 2001 at the Henry Ford Health System, which manages hospitals, clinics and emergency rooms across Detroit, Ed Coffey, then the CEO of its Behavioral Health Services, remembers discussing Crossing the Quality Chasm, a report published that year by the Institute of Medicine (now the National Academy of Medicine) that called for sweeping healthcare reforms. The report had triggered a debate about the idea of “perfect care,” and Coffey wondered what that might mean for mental health. “I remember a nurse raising her hand and saying, ‘Well, perhaps if we were providing perfect depression care, none of our patients would commit suicide,’” Coffey has said. (Coffey, who is now president and CEO of the Menninger Clinic, a psychiatric hospital in Houston, Texas, did not respond to requests for interview.)
Coffey took that as a challenge and set about reforming the Henry Ford Health System’s own approach with a new, Zero Suicide goal in mind. The initiative involved improvements in access to care and restrictions in access to the means of suicide. Any patient with a mental illness was treated as a suicide risk and asked two questions at every visit: “How often have you felt down in the past two weeks?” and “How often have you felt little pleasure in doing things?” High scores triggered new questions about sleep deprivation, appetite loss and thoughts about self-harm. Screenings would create personal care and safety plans and involve a patient’s family. Every death would be studied as a “learning opportunity.”
What caught global attention were the results that the Henry Ford system reported. In 1999, its annual suicide rate for mental health patients stood at 110 per 100,000. In the following 11 years, there were 160 suicides, but the average rate fell to 36 per 100,000. And in 2009, for the first time, there were zero suicides among patients. The stats were startling. But the strategy also faced criticism, partly in the way staff felt it made medical professionals hostages to fortune, with many already operating in a culture of blame. Louis Appleby also points out a lack of hard evidence to back up the strategy. But he does believe in its power to raise the profile of suicide prevention and compel mental health authorities to consider their own practices. At Magellan Health Services in Arizona, where Covington was an early adopter of Zero Suicide before moving to RI International, the network has reported a 50 percent fall in the suicide rate in the past 10 years. “We had an enormous pushback in our community and healthcare providers to get started,” he admits. “But as soon as the resistance gave way, ‘zero’ goes into the brain ... Once that seed plants, people get really excited.”
* * *
In 2013, Ed Coffey visited Mersey Care—which employs more than 5,000 people and serves more than 10 million across North West England—to talk about suicide prevention. In 2015, the trust, which sees more than 40,000 patients a year, became the first in the U.K. to adopt a Zero Suicide policy, which it ratified last year, committing to eliminating suicide from within its care by 2020. In a nondescript office at the trust’s headquarters at a business park in east Liverpool, I meet Jane Boland, a health administrator and Mersey Care’s suicide prevention clinical lead. When she started as a mental health clinician 18 years ago, she says suicide training did not exist. “We weren’t taught how to speak to someone who is suicidal,” she recalls. “It was talked about as an occupational hazard, an inevitability.” As part of Mersey Care’s new policy, Boland is responsible for delivering training to all the trust’s staff, from senior clinicians to receptionists and cleaners. “And these 5,000 people don’t exist in isolation,” she says. “They’re out in the city, on trains, noticing when people aren’t feeling great.”
The training begins with an online course designed to help staff look out for signs of distress. It also challenges the inevitability and selfishness myths around suicide. Boland gives talks too, and invites people who have been affected by suicide to share their experiences. She has even persuaded her own husband to talk about the death by suicide of his sister when he was 16 and she was 21. “He’d talked to me about it, but I hadn’t realized I was one of about four people he’d ever told,” Boland says. “Now he tells hundreds of people that there’s not a day goes by that he doesn’t think about this sister, and you can hear a pin drop.”
Anthony Gerace / Mosaic Science
Mersey Care’s plan also includes easier access to crisis care, better safety plans for each patient and swifter investigations after deaths or suicide attempts, with a focus on learning rather than blame. Joe Rafferty, the trust’s chief executive, told me in May this year that it is too soon for the policy to have shown an effect on its suicide rates, which are 5.5 per 100,000 patient contacts (Rafferty says this equates to a death per fortnight on average, and places Mersey Care in the lowest 20 percent of mental health trusts).
“But the big win has been around culture and attitude,” he says. “Even two years ago I’d talk to senior colleagues about suicide and the conversation would finish with, ‘Don’t worry, we’re in the lowest quintile’ or ‘We benchmark very favorably’ ... The biggest change has been moving to an absolute view that the benchmark should be zero.”
Rafferty sees the Zero Suicide foundation he has discussed with Steve Mallen as a way to spread this thinking to other trusts, and to any organization that might be willing to change. Mersey Care is already trying to reach some of the 70 percent of suicide victims who do not have contact with mental health services in the year before they die. Boland works with local authorities and has delivered suicide training to Job Center staff in Liverpool. The trust is in talks about delivering training to taxi drivers and barbers.
Versions of a Zero Suicide strategy have also been adopted by NHS clinical networks covering large areas of the southwest and the east of England. The spread of the approach coincides with belated political focus on suicide. In January 2015, Nick Clegg, then the deputy prime minister, launched a new mental health initiative and called on the NHS to adopt a Zero Suicide campaign. Earlier this year, the health select committee welcomed the Zero Suicide pilots, but noted that the strategy had not been more widely adopted, while outcomes were still to be evaluated. The most recent Conservative manifesto made no mention of suicide, but reaffirmed government commitment to improving mental health care. The current government target, set by the independent Mental Health Taskforce, is a modest reduction of 10 percent by 2020. Meanwhile, mental health advocates are pushing hard for better funding for mental health research, which remains a fraction of that devoted to physical health conditions such as cancer.
* * *
As a businessman, Steve Mallen finds it hard to understand why, if not the moral case for suicide prevention alone, the economic case has not brought about more rapid change.
“We’re losing so many people who would have gone on to contribute to society,” Mallen says. He wants a new focus on earlier intervention, in schools and homes and general practitioners’ offices, to identify problems before they lead to crisis, and improvements in mental health literacy. “Edward existed in a family, in a friendship group, at a sixth-form college and nobody picked up what was happening to him,” he says. “Yet in retrospect when I think back, the signs were there.”
Edward’s death devastated his family. “He was empathetic, sharing, nurturing,” Mallen says, preferring not to name his other two children, who are themselves now approaching adulthood. “We never had a lot of squabbling. He also kept me and Suzanne in check. He was wise beyond his years. Losing any member of a family is difficult, but it’s like the heart has been ripped out of the middle of ours and that has made it practically impossible.”
Mallen, in common with the mental health experts I speak to, does not believe total eradication is possible. Suicide will always be more complicated than polio. But no one doubts that huge reductions can—and must—be made, and there is a growing body of evidence to show how. If there is one thing he could change first, it would be continuing shifts in attitudes.
“Why didn’t my son ask for help?” he says as he heads to the station for the train home to Cambridge. “If my son had been taught about mental health in the same way he was taught about diet, citizenship, physical health, he would have understood that it’s okay to feel shit. But despite his brilliance, he didn’t have the education to help him come forward. At the start of that eight-week period when he stopped playing the piano, he would have said, ‘Dad, I think I might need some help.’ And we’d have got him help.”
This post appears courtesy of Mosaic.
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A World Without Suicide
Steve Mallen thinks the signs first started to show when his son stopped playing the piano. Edward, then 18, was a gifted musician and had long since passed his Grade 8 exams. Playing had been a passion for most of his life. But as adulthood beckoned, the boy had never been busier. He had won a place to study geography at the University of Cambridge and was revising hard for his A levels. At his school, Edward was head boy and popular among pupils and teachers. His younger brother and sister idolized him.
“We didn’t attach any particular significance to it,” says Mallen of what he saw as merely a musical pause. “I think we just thought, ‘Well, the poor lad’s been at the piano for years and years. He’s so busy ... ’ But these are the small things—the ripples in the fabric of normal life—that you don’t necessarily notice but which, as I know now, can be very significant.”
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Three months after Edward stopped playing, and just two weeks after he handed in an English essay his teacher would later describe as among the best he had read, police knocked at the door of the family home in Meldreth, a village 10 miles south of Cambridge. Steve Mallen was at home, alone. “You become painfully aware that something appalling has happened,” he recalls. “You go through the description, they offer commiserations and a booklet, and then they leave. And that’s it. Suddenly you are staring into the most appalling abyss you can ever imagine.”
The next time Mallen heard his son play the piano, the music filled Holy Trinity Parish Church, a mile from the station where Edward caught the train to school every morning, and where he died by suicide on February 9, 2015. Steve says 500 people came to the funeral. Friends had organized a sound system to play a performance of Edward’s filmed on a mobile phone. “My son played the music at his own funeral,” Mallen says as he remembers that day over a mug of tea in a café in central London. “You couldn’t dream this stuff.”
I first talk to Mallen, who is 52, in November 2016, 21 months to the day since Edward’s death. His hair is white; his blazer, navy. He wears a white shirt and a remembrance poppy. He talks in perfect paragraphs with a default setting of businesslike, but it is clear that the abyss still falls away before him. He says it always will. But life has also become a mission, and in the two years since his son’s death by suicide, Mallen, a commercial property consultant, has become a tireless campaigner, a convenor of minds. He has earned the prime minister’s ear and given evidence to health select committees. The study at his home is filled with files and research papers.
“As a father, I had one thing to do and I failed,” he says, his voice faltering for the first time. “My son was dying in front of me and I couldn’t see it, despite my education, despite my devotion as a father ... So you see this is coming from an incredible sense of guilt. I suppose what I’m trying to do is save my boy in retrospect. I stood next to his coffin in the church. It was packed with people—a shattered community—and I made him a public promise. I said that I would investigate what had happened to him and that I would seek reform for him, and on behalf of his generation.
“Quite simply, I’m just a guy honouring a promise to his son. And that’s probably the most powerful motivation that you could imagine, because I’m not about to let him down twice.”
* * *
Edward’s suicide was one of 6,188 recorded in the U.K. in 2015, an average of almost 17 a day, or two every three hours. In the U.K., suicide is the leading cause of death among women under 35 and men under 50. The World Health Organization estimates that 788,000 people died by suicide globally in 2015. Somewhere in the world, someone takes their life every 40 seconds. And despite advances in science and a growing political and popular focus on mental health, recorded suicides in the U.K. have declined only slightly over the past few decades, from 14.7 per 100,000 people 36 years ago to 10.9 in 2015.
A simple belief drives Mallen: that Edward should still be alive, that his death was preventable—at several stages during the rapid onset of his depression. Moreover, Mallen and a growing number of mental health experts believe that this applies to all deaths by suicide. They argue that with a well-funded, better-coordinated strategy that would reform attitudes and approaches in almost every function of society—from schools and hospitals to police stations and the family home—it might be possible to prevent every suicide, or at least to aspire to.
They call it Zero Suicide, a bold ambition and slogan that emerged from a Detroit hospital more than a decade ago, and which is now being incorporated into several NHS trusts. Since our first meeting, Mallen has himself embraced the idea, and in May of this year held talks with Mersey Care, one of the specialist mental health trusts already applying a zero strategy. His plans are at an early stage, but he is setting out to create a Zero Suicide foundation. He wants it to identify good practices across the 55 mental health trusts in England and create a new strategy to be applied everywhere.
The zero approach is a proactive strategy that aims to identify and care for all those who may be at risk of suicide, rather than reacting once patients have reached crisis point. It emphasizes strong leadership, improved training, better patient screening and the use of the latest data and research to make changes without fear or delay. It is a joined-up strategy that challenges old ideas about the “inevitability” of suicide, stigma, and the idea that if a reduction target is achieved, the deaths on the way to it are somehow acceptable. “Even if you believe we are never going to eradicate suicide, we must strive toward that,” Mallen says. “If zero isn’t the right target, then what is?”
Zero Suicide is not radical, incorporating as it does several existing prevention strategies. But that it should be seen as new and daringly ambitious reveals much about how slowly attitudes have changed. In The Uses of Literacy: Aspects of working-class life (1957), a semiautobiographical examination of the cultural upheavals of the 1950s, Richard Hoggart recalled his upbringing in Leeds. “Every so often one heard that so-and-so had ‘done ’erself in,’ or ‘done away with ’imself,’ or ‘put ’er ’ead in the gas-oven,’” he wrote. “It did not happen monthly or even every season, and not all attempts succeeded; but it happened sufficiently often to be part of the pattern of life.” He wondered how “suicide could be accepted—pitifully but with little suggestion of blame—as part of the order of existence.”
Hoggart was writing about working-class communities in the north of England, but this sense of expectation and inevitability defined broad societal attitudes to suicide as well. It was also a crime. In 1956, 613 people in England and Wales were prosecuted for attempting to “commit” suicide, 33 of whom were imprisoned. The law only changed in 1961, but the stigma endured; the Samaritans and mental health experts advise against the use of the term “commit” in relation to suicide, preferring “to die by suicide,” but the word still regularly appears in newspaper headlines. The same voices have strongly opposed the view that suicide is “part of the pattern of life,” ultimately giving rise to the idea that its eradication—or at least a drastic reduction—might be possible.
* * *
Traditionally, suicide has been viewed as a deliberate action, a conscious choice. As a result, mental-health systems have tended to regard at-risk patients in one of two ways. “There were the individuals who are at risk but can’t really be stopped,” says David Covington, a Zero Suicide pioneer based in Phoenix, Arizona. “They’re ‘intent on it’ is the phrase you hear. ‘You can’t stop someone who’s fully intent on killing themselves.’ So there is this strange logic that individuals who die couldn’t be stopped because they weren’t going to seek care and tell us what was going on. And those who do talk to us were seen as somehow manipulative because of their ambivalence. You heard the word ‘gesturing.’ So we have this whole language that seemed to minimize the risk.”
Covington is president and CEO of RI International, a mental-health group based in Phoenix that has more than 50 crisis centers and other programs across the USA, as well as a number in Auckland, New Zealand. A prominent and energetic speaker, he is also president-elect of the board of directors of the American Association of Suicidology, a charitable organization based in Washington, D.C., and leads an international Zero Suicide initiative. When he started in mental health more than 20 years ago, he was dismayed by the gaps in training and thinking he found in the system. Breakthroughs have come only recently, long enough for Covington to have observed and promoted a shift away from a fatalism—and a stigma—that was preventing any progress in reducing death from suicide while we eradicated diseases and tackled other threats, such as road accidents and smoking.
Covington credits a book and a bridge with accelerating that change. In Why People Die by Suicide (2005), Thomas Joiner, a professor of psychology at Florida State University, drew on the testimony of survivors, stacks of research and the loss of his own father to upend minds. He recognized the myriad pressures on a suicidal mind—substance abuse, genetic predisposition to mental illness, poverty—but identified three factors present in all of those most at risk: a genuine belief, however irrational, that they have become a burden to those around them; a sense of isolation; and the ability, which goes against our hard-wired instincts of self-preservation, to hurt oneself (this combines access to a means of suicide with what Joiner describes as a “learned fearlessness”; Covington calls it an “acquired capability”). “[The book] gave an architecture to what was going on that we had not seen before,” Covington says. “It was like a crack through the entire field.”
Then came the bridge—or The Bridge, the 2006 documentary about suicides at the Golden Gate Bridge. A swirl of outrage greeted its release, although anger was generally directed at the film-maker rather than the toll of death and bereavement at the San Francisco landmark. Its maker Eric Steel also faced accusations of ghoulishness; The Bridge features footage of people falling to their deaths and subsequent interviews with their families. “This could be the most morally loathsome film ever made,” film critic Andrew Pulver wrote in the Guardian. Yet Steel intended to shock, and to expose an attitude to suicide on the bridge that exemplified society’s. “It hit the public psyche, it challenged core myths in a way that was extremely powerful,” Covington says.
In the 1970s, local newspapers launched countdowns to the 500th death on the bridge since its completion in 1937 (deaths have occurred on average once every two to three weeks). In 1995, a radio DJ promised a case of Snapple to the 1,000th victim’s family. Only when police intervened did official counting cease, at 997.
For decades the bridge’s directors have resisted calls, on financial and aesthetic grounds, for a safety barrier between the pedestrian walkway—which has a low railing—and the water 75 meters below. In 1953, one bridge supervisor argued that it was better that jumpers die there than on a pavement below a tall building. But in 1978, Richard Seiden, then a professor emeritus at the University of California, Berkeley’s School of Public Health, found 515 people who had been stopped from jumping from the Golden Gate Bridge between 1937 and 1971. Ninety-four per cent were living or had died of natural causes.
The study, which Covington says was “ignored for 25 years,” suggested what several others have shown: Simply by removing access to danger, and an easy outlet for “learned fearlessness,” simple interventions can dramatically reduce suicide rates. On a bridge that could not be constantly patrolled, it also intensified calls for a safety net. Later, in 2008, the bridge’s board of directors voted in favor of one. Construction began only in May of this year. The steel net, to be placed six meters below the walkway, is due to be completed in 2021. It is designed not to catch people, but to deter them from jumping.
Anthony Gerace / Mosaic Science
Edward Mallen’s own Golden Gate Bridge was the train station he used every day to get to school. His father Steve will never know what went through his mind that day, but those who survive attempts to take their own life—and go on to talk about it—are being embraced in the fight for further understanding. As of 2005, a year before Steel’s documentary came out, only 26 people had lived after hitting the water below the Golden Gate Bridge at 75 mph. Those whose injuries—broken bones, punctured organs—do not kill them on impact typically then drown in pain. Recovered bodies have shown the effects of shark and crab bites.
Kevin Hines was 19 and suffering from severe bipolar disorder when he caught a bus, alone, toward the bridge in September 2000. His family knew that he had been mentally ill, and he was receiving treatment, but the voices in the young man’s head, which often came with hallucinations, willed him to take his life. They told him that he was nothing but a burden to everyone around him, and that if he revealed to anyone the extent of his suffering he would be locked up. “When you self-loath long enough, and believe the voices, you lose all hope and suicide becomes an option,” Kevin says by phone from his home in Atlanta. “What people in that position can’t recognize is that the voice is nothing but a liar—a false reality created by your brain’s misaligning chemistry ... they believe the people around them don’t have the ability to empathize.”
Kevin was neglected by his birth parents, who had drug and mental health problems. As a newborn, before he was placed into foster care, they left him alone on the concrete floor of a motel in San Francisco and fed him Coke and stolen, sour milk. A landmark 1998 study published in the American Journal of Preventive Medicine, and cited in a report published last March by the Samaritans, showed that people with exposure to four or more “adverse childhood experiences” (known as ACEs, which include physical abuse, violence against the mother, exposure to substance abuse or the imprisonment of a parent) were 12 times more likely to have made a suicide attempt in their lifetimes.
Kevin’s devoted adoptive parents were aware something was wrong, and helped him get treatment, but Kevin kept everyone in the dark. He told doctors he was following a plan he had not read and that he was taking his medication, which he only took sporadically, often while drinking until he blacked out. “I was a wrestling state champion, a football player, by all accounts doing great on the outside.” By the night before his bus ride, Kevin had suffered days of decline. “That’s when the bridge was the spot I decided on,” he recalls.
Anthony Gerace / Mosaic Science
Kevin rejects the notion that anyone “chooses” to take their own life. “It’s not a choice when a voice in your head, a third party to your own conscience, is literally screaming in your head, “You must die, jump now.’” He also challenges the idea that suicide is a selfish act, because to a person in extremis, compelled to believe they are a burden, living can feel like the selfish act. Yet he also remembers feeling how little it would have taken to deter him that morning in 2000. “I had made a pact with myself, and many survivors report this, that if anyone said to me that day, ‘Are you OK?’ or ‘Is something wrong?’ or ‘Can I help you?’—I narrowed it down to those three phrases—I would tell them everything and beg for help.” As he sat on the bus, where he remembers crying, yelling aloud at the voices to stop, nobody said anything. “It still baffles me that human beings can’t see someone like that, wailing in pain, and say something kind—anything,” he says.
As Kevin walked along the bridge and leaned over the rail, he thought help might have arrived when a woman approached him. “But she pulled out a digital camera and asked me to take her picture. She had a German accent. I figured the sun was in her eyes, maybe she didn’t see the tears. So I take this woman’s picture five times, hand her the camera, she thanks me and walks away. At that moment I said, ‘Absolutely nobody cares. Nobody.’ The voice said, ‘Jump now,’ so I did.”
It takes just under five seconds for a person to fall from the Golden Gate Bridge into the water below. “It was instant regret the moment my hand left the rail,” Kevin recalls. “But it was too late.” He opened his eyes deep underwater, his spine broken. “All I wanted to do was survive. I remember thinking, before I broke the surface, I can’t die here. If I do, nobody will know I didn’t want to die, that I’d made a mistake.” Kevin struggled to stay afloat while the coastguard came to his aid. He spent weeks recovering on a psychiatric ward and says it took years to be honest with himself about his mental health. He still works hard to stay stable, and has become a powerful voice in suicide prevention, as a researcher, writer and speaker. “Of the 25 or 26 people who have survived jumping from the Golden Gate Bridge and are still alive, 19 have said they felt instant regret the second their hand left the rail,” he says. “The act of suicide is separate from the thought of suicide.”
Removing the means of suicide has become a growing part of modern prevention strategies, whether or not they come with a “zero” tag. In the early 2000s, the U.K. Department of Health asked the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, based at the University of Manchester, to recommend a way to reduce suicides on mental health wards. “From our data, we said remove the ligature points that make it possible for people to hang themselves,” recalls Louis Appleby, a professor of psychiatry and the director of the inquiry. He also leads the National Suicide Prevention Strategy for England.
By 2002, wards were required to remove non-collapsible curtain rails in bathrooms and around beds. A later study by Appleby’s team, published in 2012, showed that inpatient suicide cases by hanging on the ward in England and Wales fell from 57 in 1999 to 15 in 2007. “There was also a broader effect, because mental health wards seem to have got safer more generally as the issue of safety became more prominent,” Appleby says. Outside hospitals, measures that have reduced suicide by specific methods, whether or not that was the intention, have included legislation to reduce the size of paracetamol packages (intended) and the conversion of coal-gas ovens to natural gas in the 1950s (unintended).
* * *
Edward Mallen and Kevin Hines had some things in common; they were young men suffering from severe mental illness. But while Kevin identifies his traumatic first months as a cause, Edward had no adverse childhood experiences. His father is not aware of a history of depression in his family, but can only surmise that genetic flaws created the fatal cocktail of chemicals that compelled him to end his life. Research in this field is evolving. Last year, scientists at Massachusetts General Hospital identified 17 genetic variations that appeared to increase the risk of depression, in an analysis of DNA data from more than 300,000 people, published in Nature Genetics. “There are vulnerability factors we all have and part of them are genetically influenced,” says Rory O’Connor, a professor of psychology at the University of Glasgow, where he leads the Suicidal Behavior Research Laboratory.
More significantly, Kevin and Edward both attempted suicide while seeking treatment for mental illness. According to the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, just over a quarter of suicide victims have had contact with mental health services in the preceding 12 months. Soon after the piano playing stopped, it became clear Edward was not well. Mallen remembers his son withdrawing. He became pale and looked unwell. He told his mother, Suzanne, that he was down, but never revealed to his parents he felt suicidal. Two weeks before his death, Edward saw his family’s GP, who immediately referred him to an NHS crisis intervention team, recommending he be assessed within 24 hours. But when a triage mental health nurse with limited experience spoke to Edward, he downgraded the risk and recommended a five-day wait. Moreover, while Edward had turned 18 less than two months before his death, he had given permission for his parents to be told about his suicidal thoughts. They never were.
After an inquest in June last year, Cambridgeshire and Peterborough NHS Foundation Trust said in a statement that “while there are elements in what occurred that may well not have been foreseeable there were also things the Trust could have done better. The Trust has held an internal enquiry and also commissioned an independent report and it is implementing [their] recommendations.”
Mallen describes in an email his son’s case as “a haphazard fiasco of confused process, unclear responsibilities and tortuous post-tragedy contention which greatly deepened a family’s distress,” adding: “The real concern here is that this was not an isolated incident.”
The Zero Suicide approach started as an attempt to reduce deaths in mental health systems. At a meeting in 2001 at the Henry Ford Health System, which manages hospitals, clinics and emergency rooms across Detroit, Ed Coffey, then the CEO of its Behavioural Health Services, remembers discussing Crossing the Quality Chasm, a report published that year by the US Institute of Medicine that called for sweeping healthcare reforms. The report had triggered a debate about the idea of “perfect care,” and Coffey wondered what that might mean for mental health. “I remember a nurse raising her hand and saying, ‘Well, perhaps if we were providing perfect depression care, none of our patients would commit suicide,’” Coffey has said. (Coffey, who is now president and CEO of the Menninger Clinic, a psychiatric hospital in Houston, Texas, did not respond to requests for interview.)
Coffey took that as a challenge and set about reforming the Henry Ford Health System’s own approach with a new, Zero Suicide goal in mind. The initiative involved improvements in access to care and restrictions in access to the means of suicide. Any patient with a mental illness was treated as a suicide risk and asked two questions at every visit: “How often have you felt down in the past two weeks?” and “How often have you felt little pleasure in doing things?” High scores triggered new questions about sleep deprivation, appetite loss and thoughts about self-harm. Screenings would create personal care and safety plans and involve a patient’s family. Every death would be studied as a “learning opportunity.”
What caught global attention were the results that the Henry Ford system reported. In 1999, its annual suicide rate for mental health patients stood at 110 per 100,000. In the following 11 years, there were 160 suicides, but the average rate fell to 36 per 100,000. And in 2009, for the first time, there were zero suicides among patients. The stats were startling. But the strategy also faced criticism, partly in the way staff felt it made medical professionals hostages to fortune, with many already operating in a culture of blame. Louis Appleby also points out a lack of hard evidence to back up the strategy. But he does believe in its power to raise the profile of suicide prevention and compel mental health authorities to consider their own practices. At Magellan Health Services in Arizona, where Covington was an early adopter of Zero Suicide before moving to RI International, the network has reported a 50 per cent fall in the suicide rate in the past 10 years. “We had an enormous pushback in our community and healthcare providers to get started,” he admits. “But as soon as the resistance gave way, ‘zero’ goes into the brain ... Once that seed plants, people get really excited.”
* * *
In 2013, Ed Coffey visited Mersey Care—which employs more than 5,000 people and serves more than 10 million across the Northwest—to talk about suicide prevention. In 2015, the trust, which sees more than 40,000 patients a year, became the first in the U.K. to adopt a Zero Suicide policy, which it ratified last year, committing to eliminating suicide from within its care by 2020. In a nondescript office at the trust’s headquarters at a business park in east Liverpool, I meet Jane Boland, a health administrator and Mersey Care’s suicide prevention clinical lead. When she started as a mental health clinician 18 years ago, she says suicide training did not exist. “We weren’t taught how to speak to someone who is suicidal,” she recalls. “It was talked about as an occupational hazard, an inevitability.” As part of Mersey Care’s new policy, Boland is responsible for delivering training to all the trust’s staff, from senior clinicians to receptionists and cleaners. “And these 5,000 people don’t exist in isolation,” she says. “They’re out in the city, on trains, noticing when people aren’t feeling great.”
The training begins with an online course designed to help staff look out for signs of distress. It also challenges the inevitability and selfishness myths around suicide. Boland gives talks too, and invites people who have been affected by suicide to share their experiences. She has even persuaded her own husband to talk about the death by suicide of his sister when he was 16 and she was 21. “He’d talked to me about it, but I hadn’t realized I was one of about four people he’d ever told,” Boland says. “Now he tells hundreds of people that there’s not a day goes by that he doesn’t think about this sister, and you can hear a pin drop.”
Anthony Gerace / Mosaic Science
Mersey Care’s plan also includes easier access to crisis care, better safety plans for each patient and swifter investigations after deaths or suicide attempts, with a focus on learning rather than blame. Joe Rafferty, the trust’s chief executive, told me in May this year that it is too soon for the policy to have shown an effect on its suicide rates, which are 5.5 per 100,000 patient contacts (Rafferty says this equates to a death per fortnight on average, and places Mersey Care in the lowest 20 per cent of mental health trusts).
“But the big win has been around culture and attitude,” he says. “Even two years ago I’d talk to senior colleagues about suicide and the conversation would finish with, ‘Don’t worry, we’re in the lowest quintile’ or ‘We benchmark very favourably’ ... The biggest change has been moving to an absolute view that the benchmark should be zero.”
Rafferty sees the Zero Suicide foundation he has discussed with Steve Mallen as a way to spread this thinking to other trusts, and to any organization that might be willing to change. Mersey Care is already trying to reach some of the 70 per cent of suicide victims who do not have contact with mental health services in the year before they die. Boland works with local authorities and has delivered suicide training to Job Centre staff in Liverpool. The trust is in talks about delivering training to taxi drivers and barbers.
Versions of a Zero Suicide strategy have also been adopted by NHS clinical networks covering large areas of the south-west and the east of England. The spread of the approach coincides with belated political focus on suicide. In January 2015, Nick Clegg, then the deputy prime minister, launched a new mental health initiative and called on the NHS to adopt a Zero Suicide campaign. Earlier this year, the health select committee welcomed the Zero Suicide pilots, but noted that the strategy had not been more widely adopted, while outcomes were still to be evaluated. The most recent Conservative manifesto made no mention of suicide, but reaffirmed government commitment to improving mental health care. The current government target, set by the independent Mental Health Taskforce, is a modest reduction of 10 per cent by 2020. Meanwhile, mental health advocates are pushing hard for better funding for mental health research, which remains a fraction of that devoted to physical health conditions such as cancer.
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As a businessman, Steve Mallen finds it hard to understand why, if not the moral case for suicide prevention alone, the economic case has not brought about more rapid change.
“We’re losing so many people who would have gone on to contribute to society,” Mallen says. He wants a new focus on earlier intervention, in schools and homes and GP surgeries, to identify problems before they lead to crisis, and improvements in mental health literacy. “Edward existed in a family, in a friendship group, at a sixth-form college and nobody picked up what was happening to him,” he says. “Yet in retrospect when I think back, the signs were there.”
Edward’s death devastated his family. “He was empathetic, sharing, nurturing,” Mallen says, preferring not to name his other two children, who are themselves now approaching adulthood. “We never had a lot of squabbling. He also kept me and Suzanne in check. He was wise beyond his years. Losing any member of a family is difficult, but it’s like the heart has been ripped out of the middle of ours and that has made it practically impossible.”
Mallen, in common with the mental health experts I speak to, does not believe total eradication is possible. Suicide will always be more complicated than polio. But no one doubts that huge reductions can—and must—be made, and there is a growing body of evidence to show how. If there is one thing he could change first, it would be continuing shifts in attitudes.
“Why didn’t my son ask for help?” he says as he heads to the station for the train home to Cambridge. “If my son had been taught about mental health in the same way he was taught about diet, citizenship, physical health, he would have understood that it’s OK to feel shit. But despite his brilliance, he didn’t have the education to help him come forward. At the start of that eight-week period when he stopped playing the piano, he would have said, ‘Dad, I think I might need some help.’ And we’d have got him help.”
This post appears courtesy of Mosaic.
from Health News And Updates https://www.theatlantic.com/health/archive/2017/08/zero-suicide-strategy/535587/?utm_source=feed
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