By TIFFANY KORSSEN

Twenty-three-year-old Angus MacIntosh loved life. He especially loved the people he shared his life with. A tightly knit group of mates, a supportive family and his soul mate, Melissa Yu, were the people he lived for.

After celebrating New Year in Cambodia with his girlfriend of six years, the couple's Facebook pages were covered – as expected – with happy pictures and hilarious videos of their adventure.

Everyone, including Yu, thought MacIntosh was better than ever.

They were wrong.

On January 13 of this year – days after returning from their Cambodian holiday – Yu found MacIntosh dead. The love of her life had hanged himself in the garage of their Clayton home.

MacIntosh had attempted suicide four times previously; his last attempt – near the end of 2013 – had been almost fatal.

Yu recalls with  bitterness the day he was admitted to ICU at Monash hospital in Clayton.

“We arrived at 3pm and when he sobered up the nurse asked him four short questions. The last one was ‘do you still want to kill yourself’, which of course he replied ‘no’,” says Yu.

“She referred us to a psychologist and made us leave … that was it. We never heard from anyone again.”

Two months after being discharged from care, MacIntosh was dead.

Suffering silently – feeling like a burden and as though he had nowhere to turn – MacIntosh had gone home and hanged himself.

Yu says the image of her partner’s lifeless body hanging in their home – where they shared the happiest moments of their lives together – still haunts her, often leaving her bedridden and unable to go to work.

“So much more could have been done … he saw professionals and they turned us away.

“If they hadn’t, maybe I would still have him … and my life would still be normal. But my life will never be the same again.

“For someone that is so vulnerable [like MacIntosh], to feel neglected by the system like that and to feel as though you’re not cared for by professionals that you’re supposed to be able to trust and rely on, is huge,” says Yu.

MacIntosh is not the only suicidal patient who has been failed by Victoria’s mental health care system.

According to Susan Anderson,  general manager at depression support organisation beyondblue,  50 per cent of people who survive a suicide attempt receive no treatment beyond their hospital stay.

The apparent lack of follow up means current systems need to be drastically improved, or more people will die, she says.

“Twenty per cent  of survivors will reattempt suicide within three months, so it is absolutely crucial that we address this lack of treatment after discharge in order to save lives,” says Anderson.

Suicide is an increasing problem. One Australian attempts suicide every 10 minutes, equaling about 200 attempts every day.

Deaths by suicide have reached a 10-year peak – 2535 in 2012, according to the most recent Australian data. This means nearly twice as many people die from suicide in Australia as from car accidents, with 1298 road deaths nationally in 2012.

Anderson says the Federal Government should enforce proper treatment plans for the growing number of suicide survivors.

Clinical psychologist Dr Fiona Shand agrees Australia’s overburdened and underfunded public mental healthcare system needs a complete and immediate overhaul.

“There needs to be a systems-based approach of how to improve the aftercare of suicide attempt patients,” she says.

“People in positions of power and leadership need to see this as being a priority, because at the moment, it’s really not,” Shand says.

When 32-year-old gym receptionist Sonia Perotta was admitted to the Alfred hospital in 2010 for an attempted suicide, she too, felt let down by the system.

“The staff made me feel like a complete burden,” she says.

“They grumbled about where they could put me and [I] ended up in [a room] with dying 90-year-olds … one nurse came in to see if I was still alive maybe once or twice out of the three days I was there,” says Perotta.

When she was discharged, Perotta was given a referral for a psychologist and told to “book it” herself.

Perotta saw the psychologist once and, like MacIntosh, never heard from anyone again. She had no follow up call from the hospital.

“I was such a complete mess, I was suffering … and I would have really liked to know that someone actually cared, it would have helped,” Perotta says.

Clinical psychologist Dr Wes Johnson works with suicidal patients on a regular basis at the Livingstone St medical clinic in Ivanhoe. Johnson believes although Victoria’s mental health care system has improved over the years, it still has a long way to go.

Aside from psychiatric wards in public hospitals being short of beds, Mr Johnson says that “after care” is simply not in the job description for mental healthcare professionals. But it should be.

“You’ll get people who manage the hospitals telling you that patients receive case managers and follow up calls… but that’s bullshit, they don’t get that at all and the people on the ground know that,” says Johnson.

“They get a referral and a pat on the back and are walked straight out the door.”

Kevin Freele, the executive director of mental health, drugs and alcohol from Geelong public hospital Barwon Health, says: “All suicide attempt patients are given a casemanager and a follow up treatment plan…and have been for at least the last 10 years.”

But suicide survivor Emmylou McCarthy has a different story.

In late 2006, 35-year-old McCarthy attempted suicide for the first time and was admitted to Barwon Health hospital.

“After I was physically well, they booked me in with a psychologist and I went for one session,” she says.

“He never followed me up … it was completely left up to me to organise my own recovery.

“I definitely wasn’t assigned a case manager, no … and I still feel as though I’m not fully over it even now,” McCarthy says.

Psychiatric nurse Sally Desmond (not her real name), who has worked for Northwestern Mental Health in Melbourne for more than 20 years, knows this to be true.

“Follow up all depends on how the patient has been assessed,” she says.

“If they are assessed to be high risk for a repeated suicide attempt, we will book them in with a psychologist and call once in the first week of discharge, but there’s really nothing further after that.

“There definitely is nothing in place to ensure that these discharged patients have care after their hospital stay, especially those who are low risk,” she says.

Beyondblue is  undertaking a trial of The Way Back Support Service in the Northern Territory. The program provides a non-clinical support network that links discharged suicide survivors with professional services and ensures each case is continually followed up so adequate care can be provided.

Beyondblue’s Ms Anderson says the trial is intended to prove the service's efficiency.

“[We want] to prove that it can make a difference in the lives of people who have attempted to commit suicide and to prove that it can save lives so we can eventually have it [enforced] and funded by the Federal Government for a national program,” she says.

However, it could be another three years before there is the funding to trial a similar program in a metropolitan area like Melbourne, according to Anderson.

Desmond says three years is too long to wait for a much-needed aftercare program like this one.

Austin hospital psychiatric nurse Tom Smith (not his real name) agrees.

“There is no capacity for the public mental healthcare system to follow up with patients, it really struggles to work with people who are past the crisis or acute phase of their attempt,” he says.

“If they are no longer experiencing disability they are passed on to others for follow up,” Smith says.

The issue is that “the psychologist is paid to do treatment, not to do the follow up”, says Anderson.

The reality is, this vital service could be in the job descriptions of both psychologists and hospital workers if federal funding for mental healthcare was redirected.

According to the chief executive officer of Suicide Prevention Australia, Susan Murray, the Government spends $380 million every year on mental healthcare.

“Roughly $24 million is dedicated to suicide alone … which is very limited and piecemeal,” says Murray. Additionally, nearly all suicide recovery programs are privatised and outsourced by the Government.

Clinical psychologist Johnson says this means services are splintered, hard for patients to locate and are extremely ad hoc. It also means there are no co-ordinated recovery or treatment plans for suicide survivors after hospitalisation.

“It would be wonderful if funding was redirected so there could be a coordinated plan for [discharged] survivors … these are people’s lives we could be saving and we absolutely know that this type of service will save lives,” says Johnson.

Suicide Prevention Australia’s Murray says her organisation wants both to protect the funding that is already available and to make sure that money is used more effectively.

Without this redirection of funding, hundreds of Victorians will continue to slip through the cracks of the system every year, receiving minimal or no follow up treatment at all.

According to the Black Dog Institute, the research is clear about what the most effective methods of follow up should be. Still, millions of dollars continue to be poured into other areas of the mental healthcare sector.

MacIntosh’s still-devoted partner, Melissa Yu, is frustrated.

“Gus [Angus MacIntosh] was in hospital … he saw someone … but nobody cared enough to give him a phone call or to build any rapport," she says.

“People need to feel as though society cares about them and that they have a safe place to turn to outside of their family and friends.

“I really believe the only way to [provide this] is through reform and a federally funded, nationwide program,” she says.

Johnson says: “Sometimes all people need is guidance and to feel they are accepted without judgment.

“Believe me, it doesn’t have to end with death.”

This is an issue close to Yu’s heart.

“After a suicide attempt they are so vulnerable and they can’t be expected to make decisions on their own.

“There needs to be something in place to make sure they’re taken care of and it’s just ridiculous that there isn’t.

“I don’t want anyone to have their lives cut short because of this lack of service ever again … because I know I didn’t have Gus for long enough, but maybe I could have had him for longer.

“No amount of time is ever enough with the one you love,” says Yu.

If you or anyone you know is experiencing difficulties or contemplating suicide contact Lifeline for 24-hour support on 13 11 14.