Medical Assistance in Dying

After 6 deaths, 6 years ago, on November 17, two days ago, the New Zealand Herald featured an article reporting on an inquest into these deaths. The original with photos of the 6 children is linked. The text is below the link. The action in this post happens right at the bottom of the NZH article and beyond.

Fluoxetine use in teenager scrutinised in youth suicide inquest

A coroner’s inquest into the deaths of six Northland young people, including Martin Loeffen-Romagnoli, has revealed systemic failures.

The inquiry is also examining the role of antidepressants, including fluoxetine, and seeks solutions for suicide prevention.

• Hamuera Ellis-Erihe, 16, of Raumanga died in 2018. He loved dancing, rapping and singing.
• Summer Mills-Metcalf, 14, of Kaipara, died in 2018. She was described as a happy, smiling girl who enjoyed pulling pranks on family members.
• Ataria Heta, 16, of Moerewa died in 2020. She was a stand-out kapa haka performer with a kind nature.
• Maaia Reremoana Marshall, 13, of Kaitāia died in 2018 after being under the care of Oranga Tamariki.
• James Patira Murray, 12, of Ruakākā died in 2018. He loved rugby and was a Northland representative.
• Martin Loeffen-Romagnoli, 15, of Kaipara died in 2018. He was a talented hockey player described as friendly and loveable.

When Paula Mills took her 14-year-old daughter Summer to get help for depression she had no idea the common antidepressant they were given could have deadly risks.

Four weeks after doctors doubled Summer’s dosage of fluoxetine, commonly known as Prozac, Mills’ world shattered when her daughter took her own life.

Now, Mills is demanding better warning be given about the suicidal ideation effects of the drug, and a leading psychiatrist agrees with her.

Coroner Tania Tetitaha has been leading a Northland coroner’s inquest into the deaths of six youths who died by suicide in 2018 and 2019.

The teenagers were aged between 12 and 16 and the court has heard two of the girls involved – Summer Mills-Metcalf and Ataria Heta – were on prescription medication for depression and anxiety leading up to their deaths.

The four-week hearing involving Te Whatu Ora, Oranga Tamariki, ACC and the Ministry of Education has brought a range of professionals in to look at where possible failings occurred and seek solutions to impediments to suicide prevention, specifically in Te Tai Tokerau.

Coroner Tetitaha indicated early in the hearing there would be a finding the youths died by suicide.

Several witnesses have given evidence in relation to Summer’s death including her mother, a school principal and a leading child psychiatrist.

Her mother said earlier in the hearing her daughter had a short history of being prescribed Fluoxetine, a serotonin selective reuptake inhibitor (SSRI).

A happy, bubbly and outgoing girl, Summer’s mood dramatically turned after she was plagued by bullying at school and on social media throughout 2017.

Her mother was actively involved in seeking help for Summer and took her to the doctor on February 14, 2018, where the teenager was prescribed fluoxetine at 10mg with a note to increase to 20mg per day as tolerated.

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Mills rang doctors twice in March and April requesting a review around upping her meds and over that time, increased her dosage to 20mg per day.

On May 1, after consultation with her doctors, Summer’s dosage was upped to 40mg a day with a note for a scheduled review in four to six weeks.

But Summer never made it to the review date. She ended her life on June 3, 2018.

‘Doubling her dose was a huge error’

Fluoxetine is a commonly used drug in New Zealand to treat depression, obsessive-compulsive disorder (OCD) or eating disorders.

When dispensed, the package comes with a six-page pamphlet inside with a warning on page four that if thoughts of suicide begin to occur, seek medical help.

In America, the drug comes with a black label warning on the box that the drug may increase the risk of suicidality.

Mills gave evidence that she had noticed Summer becoming more agitated but never thought her daughter would end her life. She said they were not advised about the risks of suicidal ideation by any health professional, a side effect she only discovered from her own research after Summer’s death.

“She was taking her medication but it wasn’t working. When they doubled her dose we asked if it was safe and the doctor said it wasn’t well-researched.

“I now believe doubling her dose was a huge error and more inquiries should have been done. I couldn’t understand why Summer hadn’t fought to live.”

Written information needed

Doctor Andrew Craig Immelman, a member of the New Zealand Medical Council with multiple accreditations in child youth psychiatry, gave evidence in the third week of the hearing about his opinions relating to the clinical engagement with Summer.

Notes on the medical file said adverse reactions were discussed with Mills, however, Immelman said there was no evidence any handouts were given, something he believes is lacking in medical practice.

“The issue is retention.

“I refer to a study where junior doctors were involved in simulated handovers with or without printed handouts and reiterate only 2.5% of the information was retained after five verbal-only cycles as opposed to printed handouts.

“I see it as a reflection of the memory of people involved, it points very clearly to written information being a prerequisite,” he said.

“It’s quite hard on whānau and a human characteristic is to not register information at stressful times of appointments.”

Immelman suggested providing patients with pamphlets at doctor’s clinics should be standard practice. These pamphlets should be concise – about two pages with about 1000 words – and available in multiple languages, ensuring information is clear and accessible to all.

“It would be best if we had a New Zealand formula, a handout that was less wordy and able to be used more easily by young people and anyone who requires medication.

“Putting myself in the position of a parent, it is information that I would want to receive.”

Changes are needed

Mills also made similar recommendations to the coroner and said if they had known the risks, they would have perhaps chosen a different path.

“There needs to be changes in our mental health system when handing out medications. These psych drugs can and do cause suicidal ideation, Medsafe states professionals should discuss clearly the adverse effects with their patients.”

Immelman was also critical of the six-week follow-up Summer had been given and said a check-in with her should have been done the following week.

Immelman also believed the possibility of a thorough treatment plan being dictated and written in front of the patient would help with engagement and therapeutic alliance.

“We need to change our practice and I’m sorry to be so forceful about it.

“There are things outside our control like workforce shortages … I believe we need more people out there, we need more boots on the ground and we don’t have that so we tend to cut corners and often it works out okay but it’s not the best practice.”

Coroner Tetitaha will release her findings on the inquest into Ataria, Summer, Maaia Marshall, Martin Loeffen-Romagnoli, Hamuera Ellis-Erihe and James Murray in early 2025.

SUICIDE AND DEPRESSION

Where to get help:
• Lifeline: Call 0800 543 354 or text 4357 (HELP) (24/7)
• Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO) (24/7)
• Youth services: (06) 3555 906
• Youthline: Call 0800 376 633 or text 234
• What’s Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
• Depression helpline: Call 0800 111 757 or text 4202 (24/7)
• Helpline: Need to talk? Call or text 1737
• Aoake te Rā (Bereaved by Suicide Service): Call 0800 000 053
If it is an emergency and you feel like you or someone else is at risk, call 111

Have you been effected by Fluoxetine?

Katinka’s Petition

Earlier this year Katinka Newman got the idea of a petition aimed at getting Suicide Helplines to find a way to help those receiving calls to be able to put the possibility that the caller’s meds, if recently changed, might be making them feel worse.

Helplines like the ones you see obligatorily listed at the end of this NZH article. Helplines which the Daily Mail wanted to feature at the bottom of Katinka’s article about a petition saying they were not doing their job.

See – Is Your Treatment Making you Suicidal

And – Drug Dysregulation of Iatrogenic Insanity 

And – Truth is Stranger than Fiction

We face an increasingly bizarre situation, that could almost be described as psychotic.  On one side, especially in suicide prevention programs, we have experts stressing the need to listen to the patient’s voice. But this mostly means giving them space to describe their social and related situations – everything except their experience of the medicines they are on.

We have suicide prevention helplines like Papyrus figuring the best thing that can be done is to get people on antidepressants.

Doctors can’t see a problem because if they ask they hear that helplines can ask people if they are taking any meds. In some countries helpline volunteers can ask if someone is on meds – in order to suggest going to a doctor if they are not yet on meds.  But they cannot ask about anyone’s experience on those medicines or hint the medicine might be the problem.

Of course, if they could ask common sense questions about the effect of your medicines, and suggest going to your doctor, the result is likely to be a doubling of the dose of the antidepressant.

As Dexter Johnson found out.  See

The History of a Medical Psychosis

In Memory of Dexter Johnson

and Romain Schmitt – See

Quil’s Mangent Des Médicaments

Clinical Details confuse Expert Doctors

Romain’s father Vincent suggesting closing these helplines down. This sounds counter-intuitive until you think about it. Rather than doing the job they were set up to do, they have their hands tied behind their back and can pretty well only make things worse.

Helplines are a show, a token. Having them makes people think something is being done about a problem.

A Silencing

It is not just the voices of the children and the rest of us being put on these medicines that are being silenced.

A colleague mentioned in an email a week ago that her two daughters, in two different schools, came home the previous week both reporting that someone in their school had committed suicide.  These days schools are programmed to pull in therapists to help students recover from a trauma like this – programmed to put in place a gateway to get more students put on drugs.

Until recently students rarely committed suicide. But in the last decade they have had to face a rising tide of suicides of their friends.

There is no mention in school assemblies or from therapists or anyone that some of these suicides might be linked to meds. If anything is blamed it is likely to be social media.  Experts of all sorts are piling in to claim that bullying on social media is causing suicides. This might be possible occasionally in sextortion or catfishing cases but bullying is more likely to lead to antidepressants which lead to suicide.

Are Old Media or New Media to Blame?

Damsels Dying from Distress or Dysphoria?

No one, however, seems willing to face up to the role of the meds.  Not the old media – nor the medical media.

Silencing Doctors Silencing Safety

Medical journals should be full of articles outlining the adverse effects of drugs – in order to better help a doctor ask about a patient’s experience on the medicines s/he has put them on.  That is exactly what medical journals were full of till about 30 years ago – but no longer. There is not a trace of an iota of a hint that medicines could possibly cause problems – other than mentions of hazards in order to dismiss ridiculous misinformation.

Where Does the Misinformation Come From

Loss of Humanity

We have lost our humanity.  Just as with actors, or mask wearers, who can say anything because it is not them who is talking – they are just the mouthpiece for a script from elsewhere – so too with our doctors and politicians and educators.

This is a chilling instance of education aimed at conforming – brick in the walling – students. Rather than tackle the awkward job of educating teens or their parents and others in desperate need of education on matters of life and death like this, our educators are being political – speaking with forked tongues. How much of this do their listeners detect?  How much squares with their experience?

Actors always have smooth lines. No need to struggle to articulate or fumble for the right word. Life is easier in acting mode.

When in the room with our doctors and educators, the presence of others controlling what can be said is palpable.

HAKA

Things are getting worse. There is an increasing turn to telehealth, which industry are rapidly colonizing as a means to get us on more and more drugs.  Not just telehealth but soon to be ChatGPT delivered consults with your meds delivered by Amazon.

For convenience we can package your meds to help you to remember what to take when.  Packaged this way they come with no information sheets that despite being designed to mislead you might possibly give you a hint of the problems your meds can cause – not just suicide but for instance the living death that is PSSD.

These days legislators get lobbied about Medical Assistance in Dying. But almost no-one, apart from those who have been bereaved, are lobbying for efforts to reduce a rising tide of preventable Medically Assisted Death (MAD) in youngsters who, for the most part, whatever else is desperate about their situation, desperately do not want to die.

Is it time to move beyond Petitions? Time to take the HAKA or an equivalent to Departments of Health or Congresses?

Or perhaps Irish Hunger Strikes, which are not an act –

To the Last Breath.