James Wentworth-Stanley’s descent into suicidal thoughts was so rapid it is breathtaking. There were just 11 days between the catalyst – the operation on 4 December – and his death. In this time, exacerbated by the geographical distance between the farm and his student life at Newcastle University, he plummeted downwards, out of reach.
As Clare now knows, his journey illustrates how quickly young men with no history of depression can deteriorate: ‘Suicide is often the result of a crisis in your life, rather than a history of mental illness. We know that the top trigger is relationship breakdown but there are others, like debt and family issues. For James, it was his own crisis [about his health].’
After his death, she discovered from his computer records that he had become obsessed with the idea that the operation had gone wrong, that he would not be able to be a father and that he had become impotent. In fact, there was no reason for concern – his surgeon had confirmed that the operation had been a complete success. But beforehand he had been told there was a tiny risk of impotency and it was on this that he had become fixated.
After the operation he had gone home for a weekend. He went for a walk with his mother and asked her, ‘Do you think I can have this reversed?’ Clare recalls: ‘I kept saying, “Let it all settle down.”’
He was studying business and Spanish at university, and when he returned home for the Christmas holidays a week later, he seemed full of anxiety and had lost weight. ‘I rang my GP and said, “I’m really worried about James. He doesn’t seem right since the operation. I think he might be depressed. Can we see the surgeon, just to make sure everything is OK?” The GP said he would make an appointment the following day.’
But James delayed it as family were arriving. On the day of his death, the entire family – all five children and Clare’s husband – had travelled to James’s father’s house in Worcestershire. Before they left, he had asked to shower in Clare’s bathroom and had come out in a towel and asked, ‘Do I look different? Have I lost weight?’
‘And I remember saying, “No, darling, you look wonderful,” but I did think it was odd. I didn’t want to overreact.’
What adds to Clare’s loss is the possibility that James’s death could have been prevented. In the subsequent inquiry, it emerged that, post-operation, he had asked for help in Newcastle. He had gone to a walk-in centre and confessed he was suicidal. He was referred to A&E and went, but left without being seen. Clare says, ‘I don’t think he would have been up to the wait.’ A letter was sent to his GP by second-class post. By the time it arrived, James was gone.
‘I had no knowledge of mental health issues or anxiety or depression. I wish I’d asked him directly, “James, do you feel suicidal?” God, I wish I’d known. That is what I have to live with, but I had no idea he was asking for help. I didn’t know and I feel guilty. He’s my son. I wish I’d saved him.’
At the walk-in centre, he had been assessed as a ‘low-priority’ risk, despite him telling them he had felt suicidal. Nobody had rung his GP. ‘I was completely unaware of any of this. When my GP finally received the letter, he was in tears,’ says Clare. ‘I now know that a man of James’s age presenting as having suicidal thoughts is the highest risk. It’s the biggest killer of men of his age.’
A goodbye note was found in his room in Newcastle, crumpled up and thrown in the bin. ‘I really believe he didn’t want to die. I don’t believe he wanted to kill himself but he couldn’t get the help he needed. He hadn’t told me he felt suicidal because I don’t think he wanted to scare me.’
Everything in the next decade of Clare’s life stemmed from one question: What mental health service would have saved James? And with that in mind, what service could she help to create that would save other men like him?
Among the many polo trophies in Clare Milford Haven’s office, there is another prize sitting in pride of place: the Merseyside 2019 Woman Making a Difference Award. It is in recognition of 10 years of dedication to improving mental health services for men in crisis. ‘The award meant a huge amount to me,’ she says.
Two years after losing James, Clare and her ex-husband set up a memorial trust in his name. She was still deep in her grief, as well as battling other feelings of rejection, vulnerability, guilt and rage: ‘It felt unfair, and I was angry with James for doing this to the family. But that anger disappears and you feel something else.’ Counselling continued to help with these feelings, as did meeting other parents who had lost children in similar circumstances.
‘When Nick suggested we set up a trust, I had thought to myself, “Am I really able to withstand working in this area?” But it was the most brilliant idea.’
The trust gave her purpose. It raised half a million pounds through fundraisers, which they donated to charities working in mental health. More and more of her own research showed, however, that there was a need to create a centre – with its own clinical model – specifically for men. ‘For 10 years, I worked on researching what we could provide,’ she explains. ‘I set up an alliance with different charities and met with them all. It was a full-time job, looking at what existed, looking at what could have saved James.’
In 2018, the Duke of Cambridge, a family friend, officially opened James’ Place in Liverpool, a house in the city’s Georgian quarter designed to provide a calming and friendly environment for anyone who comes through its doors, via GP, A&E, student counselling services referral or self referral. ‘Thank you for bringing suicide out of the shadows,’ Clare told the Prince. The centre’s opening was largely made possible by James’s younger brother Harry Wentworth Stanley, who raised £650,000 by completing a 3,000-mile row from the Canary Islands to Antigua.
At James’ Place in Liverpool (a second centre will open soon near Old Street in London), each man is seen swiftly after they are referred. This is crucial. It is a rapid response that saves lives. The men are offered a brief, intensive, therapeutic intervention in a place that has been created so they feel safe and valued: ‘The atmosphere was really important to me,’ says Clare.
The man is given a consultation, his GP informed, and a supporter (such as a friend or family member) nominated to help him through the intervention and be a point of contact for staff. The model consists of five components: environment (Clare’s sister, garden designer Louise del Balzo, created the Liverpool garden, with water features, seating areas and green space), suicide prevention therapists, clinical referral pathways, rapid access to the service itself and a ‘Lay Your Cards on the Table’ session involving a set of cards that help men to verbalise their feelings.
The centre, Clare explains, is meticulously thought through: a ground-floor reception and waiting area, and two floors of therapy rooms with plenty of light. The furniture and art have been chosen to create a sense of safety and relaxation.
The premise is to catch men – aged 18 and upwards – where they might once have fallen through the cracks. If James’ Place had existed for James, for example, he would have been welcomed into the clinic soon after turning up at the walk-in centre. Clinicians would have intervened, ‘and I would have been informed’, says Clare. ‘We’d have supported him from then on.’
By 2025, James’ Place hopes to have become a national charity with three more centres opening across the country, pending raising a further £10 million, reliant as it is on independent donations (with some Government funding). The success of the clinic is independently evaluated by Liverpool John Moores University using the ‘core outcome’ model (where distress is measured on a numerical scale out of 100). ‘On average, the men we work with drop 54 points on the scale from severe distress to mild,’ explains Clare. ‘We’ve saved the lives of more than 1,000 men so far.’
One such man is Dan, who was referred to the centre in 2019, a year after it opened, by a concerned third party after a bereavement had made him increasingly depressed and reclusive.
Now 33, he was evaluated by one of the therapists using the core outcome scoring method, which identified both his risk and the cause. After the Lay Your Cards on the Table intervention, eight sessions followed with a therapist, working on long and short-term aims. Risks were removed, healthier daily routines established, and while long-term counselling was needed elsewhere, James’ Place had stepped in at a crucial point to provide hope. It had saved Dan’s life.
Dan contacts me after I meet Clare to tell me: ‘Finding James’ Place at the point I did was fundamental to my survival. I was at a point of crisis in life that I was increasingly feeling like I couldn’t get out of. I felt like every door around me was closing. James’ Place swung open a door and gave me the help I needed.’
‘I have come to realise that there is meaning and purpose in even the most tragic circumstances,’ Clare says.
To make a donation to James’ Place, go to jamesplace.org.uk/get-involved/donate. The Magic Sandcastle (Serenity Press) is published on 28 April