Novelist Marian Keyes reveals fight against constant "suicidal impulses"

The novelist Marian Keyes has revealed how she battled constant suicidal urges at the height of her mental illness.

The Irish writer opened up to Kirsty Young about her struggle with alcoholism and depression on BBC Radio 4’s Desert Island Discs on Sunday.

At her worst – an 18-month period beginning in 2009 – Keyes said she struggled not to harm herself.

She had stopped being able to eat, sleep and interact with others, and was eventually hospitalised.

“Then the suicidal impulses started and it was very hard to physically to stop myself from going through with it,” she said. “For months and months, every day was an enormous effort not to do the acts of wounding myself.”

Her recovery was “really speedy”, but the experience altered her perception of what it meant to be depressed.

“Nothing worked but the passage of time … It’s an illness and it ran its course.

“I had always described myself as melancholy or depressive but I hadn’t a clue. Anything I had before was a blue day by comparison. This was altered perceptions, a mental illness.”

She wrote her novel The Mercy of Mystery Close in that period. She told the Guardian in 2013 that a scene in which the heroine planned to kill herself in a hotel room was inspired by her own experience.

“I had two goes going out assembling the whole kit and buying paper and Sellotape to write the note,” she said. “The conversation Helen has with the man in the shop, I actually had that, with him asking: ‘What is it you’re proposing to cut?’

“It was so bizarre to be standing in a DIY shop, buying a knife to open my veins with. I was absolutely going through who would find me, leaving money for her to apologise … I wasn’t in my right mind.”

Keyes, 53, also told Young about her experience of alcoholism while living in London in her 20s.

“Alcohol was the love of my life. It was my best friend and, in the end, my only friend … I had stopped eating, stopped hoping, I was constantly suicidal. There was only one way it would go. I couldn’t stop drinking and was preparing to go under.”

Writing was her “rope across the abyss”: she wrote her first short story, then a few months later began a rehabilitation program for alcoholism. She has now been sober for more than 20 years.

“It was that primal urge in all of us to stay alive, saying ‘I can give you this, will you live for this?’ It didn’t get me sober but gave me something to hope for.”

Keyes’ debut novel, Watermelon, was published in 1995.

Her 12 novels to date have sold 35m copies worldwide and been published in 33 languages.

Her 13th book, The Break, will be released in the UK and Ireland on 7 September.

• In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. Hotlines in other countries can be found here

Novelist Marian Keyes reveals fight against constant "suicidal impulses"

The suicidal patient who taught me the value of time

The ambulance pulled in but unusually the crew came into the hospital alone. They informed us that a high risk mental health patient was on their way to the department, and was being accompanied by the police. This set alarm bells in my head.

I qualified as a staff nurse a few years previously. We received no mental health training, but we do look after people in real crisis. In my experience patients with severe mental health problems do not usually want to be in A&E.

I have been spat at, verbally abused and threatened. Though this was normally due to drugs, alcohol and fear, it wears you down. The environment is busy, loud and fast and even with my lack of mental health training, I know this is not conducive to calm.

When I started working in A&E I was in my early 20s and had a very naïve view of the world. A&E taught me that some people have very hard lives, they’ve experienced things no one ever should and it’s taught me everyone has a story, even if they hide it.

The police arrived and when they stepped aside I saw this child-like figure; she had closed body language, her hair was strewn across her face, and mascara ran down her cheeks. She was terrified. She sat down and stared at the floor while the ambulance crew and police handed over.

Knowing what to say is hard. You want to take the pain away but mental torture isn’t cured by painkillers.

She was in her late teens. She was having hallucinations and suicidal thoughts. Her parents had phoned the police because they were scared of her behaviour. She was screaming and shouting. She had arrived without any family. I remember a wave of sadness washing over me as I listened. How had this young, beautiful girl got to this point? How had she got to point of thinking she would be better off dead?

The patient was still visibly agitated but was no longer shouting. The crew and police left, telling us to phone if we needed them. I sat next to her, but she remained closed.

Knowing what to say in this situation is hard. You want to take the pain away but mental torture isn’t cured by painkillers. She didn’t reply to anything I said until I realised that if I was in her situation, I would want to know I was safe. I put my arm on her shoulder and told her she was safe. She fell into my chest sobbing. She stayed there for what felt like hours, holding me so tight as her make-up ran down my uniform.

I was grateful the department wasn’t overflowing that day. My manager looked over to me and mouthed: “Stay with her.” The patient told me how her parents didn’t care, how she hated herself and just wanted to be normal. I just listened, not saying anything. I thought that her parents probably did care, but just didn’t know how to help. Many people’s fear is expressed as frustration.

As her sobbing stopped the exhaustion set in. She was assessed by our psychiatric team and only then did I see how much she needed help. She thought doctors were trying to kill her. Sorrow filled me, knowing her mind was causing her to have these terrible thoughts.

The patient was sectioned. I went home and cried because I couldn’t make her better. She was only a few years younger than me and I could understand what was happening to her. This was not the first or the last time I would cry about a patient.

Weeks later, I arrived at work to find a letter addressed to me. The letter thanked me and told me that if all nurses were like me, everyone would be sane. I welled up reading it. It was my first note from a patient and I treasure it to this day.

I have never forgotten this young woman or how she changed my perception of mental health patients. She taught me so much. Most importantly that spending enough time with someone at the right moment can achieve so much. This situation taught me to take my time whenever I can, and to fight for safe staffing. This story could have been so different if the department was busy.

Years later, when I saw the patient in the local media advocating for mental health patients, I was amazed. For the first time, I felt hope and joy when seeing her; hope for her and for the NHS, joy that she had recovered so well, and that maybe I touched her life in a similar way to how she touched mine.

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The suicidal patient who taught me the value of time

When I leave someone suicidal I"m scared they won"t be there the next day

Leaving a suicidal man in the hands of colleagues was hard

During my eight years in social care, I have struggled, like everyone in support roles, with the dreaded fear. It’s a fear that finds you not just at work but on your lunch break, during the commute, in the bath … everywhere. I recently supported a young man in his early twenties who has a long history of mental health problems and was alcohol dependent. It was the anniversary of a bereavement, and he was intoxicated, self-harming and suicidal so I spent hours with him calming him down and putting plans in place. I stayed late – you do in this role, it’s not 9 to 5 – but the time came when I needed to hand over to my colleague.

You have to trust your team when you leave someone like that. But then you leave after having been in an intense crisis situation and you close the door behind you and you’re in the street with people just walking their dogs, doing normal things. You go home thinking over everything you did and wondering what you’ll be told when you go back the next morning.

Senior support worker, Sussex

Related: Silence your phone and let go of guilt: 10 tips to improve your wellbeing at work

I worry when people with mental health problems are in crisis and have no support

Time constraints and a demanding caseload mean that at times I feel I’m just putting a sticking plaster on situations as we’re expected to work fast from assessment until discharge. I worry about the individuals that fall through the net. IAPT services appear to cherry pick those with low level support needs that will provide them with the best outcomes This leaves those with more substantial needs who have suicidal thoughts, or dual diagnosis unable to access counselling or cognitive behavioural therapy. I worry that genuine care for people seems to be missing from the service; my colleagues have judgmental attitudes and a lack of empathy. When I’m not there, I fear that people won’t be visited unless they hit a crisis. Even then, I worry about the lack of support from the crisis team. We’re meant to take people to A&E, which is a waste of NHS money. They often refuse to help so the police are called, who can’t help. All they need is some additional daily home treatment to get them through it.

Mental health social worker, Lancashire

Who looks after older people with advanced dementia?

In the past I’ve worried about the people we’ve looked after who were incapable of being alone because they had advanced dementia. One would walk around outside in the middle of the night, claiming they had been kidnapped and needed to get home. The police wanted to detain another under the Mental Health Act but the doctor refused. We have also reported numerous instances of service users being abused physically, emotionally, financially and sexually, only to be told by the relevant authorities they were private matters between husband and wife. Not enough is done to protect people. That is until it is the carers at fault and then people are up in arms about it.

Community team leader for a home care agency, North Devon

I was held at knife point by a five-year-old, but being taken off the case just made me worry about the family more

I worry about not having sufficient time to spend with families to really make a difference. My time is so thinly spread that I’m having a mediocre impact at best. I fear for families that are offered support but, due to caseloads and lack of funds, this doesn’t come to fruition.

One family sticks out in my memory. The dad was disabled, the mum was attending IT courses to help her get back to work and they had three children under seven, the oldest of whom had significant behavioural problems. The family felt like they had been passed from pillar to post and that the health team, school and social care were letting them down.

I have been held at knife point on two occasions while working and one of the incidents was in this family’s home. It was the normally well behaved middle child, aged five, who held the knife to my head while I was trying to help the older one. The parents were devastated and called the police themselves but no further intervention was offered. I was pulled out of working with them and it was stepped up to a social worker who didn’t know their history. The family had to retell the story, which must have been frustrating considering that the eldest child took a good year to put her trust in me.

Family support worker, east Midlands

Related: Social work is a high-stress job – support from peers is invaluable

We are humans, making human decisions. What if that decision is wrong?

You can’t always be there to make sure everyone is OK. Leaving work when someone is sick, substance affected or suicidal makes you fearful. I worked with a young woman who had experienced a lot of trauma and struggled with mental health issues. One afternoon she said she was having hallucinations and was concerned she may harm someone as a result. I took her to A&E and stayed three hours late with her. You try to make a difference in the social care sector, but there are always worries, especially given that we are humans, making human decisions. What if that decision is wrong? You often second guess yourself and wonder: “What if I had done that differently?”

Resident support worker, east Sussex

I hate not being able to make a difference when it really matters

I worry about children getting stuck in one part of the system and missing out on support that would make a difference. I was working with a 13-year-old girl last year at risk of child sexual exploitation who was recommended a different care plan to what she needed. Within a few months it was discovered that the girl had been groomed by an adult offender on the internet and he was arrested. Only then was she moved to the appropriate child protection plan.

Senior family support worker, Surrey

If you are experiencing suicidal thoughts, the Samaritans can be contacted on 116 123 in the UK. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

Join the Social Care Network to read more pieces like this. Follow us on Twitter (@GdnSocialCare) and like us on Facebook to keep up with the latest social care news and views.

When I leave someone suicidal I"m scared they won"t be there the next day