A tale of two cities?

Two years ago, John and Lynne Neale faced the devastating loss of their youngest son, 30-year-old Chris, and Knowle West lost another young man to suicide.

“The incidence of suicide and undetermined death is highest amongst people in the most deprived areas”, states Bristol City Council’s 2016/17 Joint Strategic Needs Assessment (JSNA), a vast document profiling health and wellbeing data across the city. Within its pages are some alarming warnings about divisions in the city’s richest and poorest areas across many aspects of health, from smoking and obesity to cancer, but particularly for mental health.

Chris’ battle with depression began with the breakdown of the relationship with his children’s mother. “He loved life. He was a laugh. Everybody knew him as this bubbly character, but we were the only ones who could see the change. The photos of him from the end, he’s not smiling like usual. He’s looking into space,” recalls Chris’ father, John. “If it was a physical battle, he’d stand up in front of six blokes. But mentally he couldn’t cope with not being able to see his kids.”

Chris Neale took his own life in 2016 under the care of Bristol Mental Health’s Crisis Service

A suicide attempt put Chris in the BRI and put the family in contact with Bristol Mental Health’s Crisis Service, who visited them at home. “The initial meeting was brilliant,” John says. “Chris was buzzing. He went and did what they suggested – getting involved in things that he wouldn’t usually do – and he was positive.

“But the next time somebody turned up, they were totally new. It was different people every time so we had to go over the same things, and there was no rapport. He couldn’t get that bond. He was just answering questions with ‘yeah, yeah, yeah’ and saying he was fine. It was what they wanted to hear.

“With a suicide, you can’t do it by the book. Everybody is different. The situations are different. The personalities are different. People haven’t all got the same background or upbringing or abilities and you can’t tar everyone in Knowle with the same brush – the first thing they seemed to think was that Chris was a druggy or an alcoholic, or that he didn’t have a job. I do believe that if we were in Clifton, it wouldn’t have happened.”

Community mental health service Positive Minds runs from Hartcliffe’s Gatehouse Centre

According to the JSNA, healthy life expectancy for both men and women is in the lowest five per cent in England in Withywood, Hartcliffe and Barton Hill. There are many complex factors that exacerbate the issue of poor mental health in areas of multiple deprivation, from money worries to food poverty, domestic abuse and cramped housing, and it’s something that Helen Gunson, manager of Positive Minds, based at the Gatehouse Centre in Hartcliffe, is familiar with.

“People come here with complex needs,” Helen says. “There are lots of issues in this community, and poverty is just one. Seeking help to tackle personal issues can be scary, so I work really hard to engage and build trust with people. Whilst I can be flexible, unfortunately some statutory services can’t be, so if you miss two appointments, you’re out.”

The service has had around 100 referrals per year and more than 880 in total since Helen started it in 2009, with the aim of tackling social isolation in Hartcliffe and Withywood, by involving people in their community, thus creating networks of social support that can plug holes in provision.

“There is a massive gap between primary and secondary care in Bristol,” Helen says. “The primary care is very good: you see your GP and they will assess you and perhaps refer you to Bristol Wellbeing Therapies, who offer a range of psychological support. But if issues are more complex or more acute, lots of people fall through the gap between that and secondary care services – the community mental health team, crisis care and hospitalisation at Callington Road Hospital.

“It can be difficult to respond to people’s needs quickly, and unfortunately that can mean people who are struggling to cope can’t access help and can spiral into not coping. It’s not until crisis point or when people become high risk that secondary care services kick in.”

Helen Gunson set up Positive Minds in 2009 and in that time has seen 880 people from Hartcliffe and Withywood

However, Helen sees these issues being citywide, and not limited to the south of the river, something that Heather Williams, chief executive of Knowle West Health Park, also echoes. “It’s sad that Chris’ family feel they would have had better services elsewhere. It’s a lack of investment in the whole city that has failed them,” Heather says.

“It’s too easy to say that there’s a north-south divide; it’s too complex. It’s all individual and mental health resources are stretched citywide. Treatment here is the same as anywhere else in Bristol. It’s the community’s resources that create divides: in deprived areas, some people’s networks have too much to hold because everyone is suffering. Poor mental health becomes a norm when everyone’s lives are chaotic and then the threshold for accessing services becomes really high.”

One issue that undoubtedly affects south Bristol is physical isolation. Bus routes run into the centre from Hartcliffe but don’t connect laterally as they do in the north. “There are lots of resources in Knowle West but they are all inundated,” Heather says. “There are barriers of transport and money for accessing services in central Bristol like Cruse bereavement counselling, so fractured families are not getting support because it’s not local. Issues like that need to be recognised and unpicked.”

Heather Williams is chief executive of Knowle West Health Park

South Bristol certainly has its struggles with mental health but the picture its issues paint over Bristol as a whole are more concerning still, and do nothing to alleviate the fears of the Neale family.

“Chris isn’t the only person to have killed himself over the kids; loads of blokes have done it,” says John. “I don’t want it to happen again to somebody down the road, because it’s the worst thing in the world.”

This article is part of an ongoing series, looking into mental health across Bristol. For advice and local mental health services, visit www.bristolmentalhealth.org or for immediate support contact the Samaritans on 116 123.

Main image: Illustration by Tanja Tjong

Read more about Chris Neale’s story: ‘With a suicide, you can’t do it by the book’