The midnight calls keep coming: rabbis are on the last line of the suicide crisis

After a long day at the synagogue you return home and prepare for bed. Your final task is to set the alarm on your phone. As you do, the device buzzes with a “goodbye” message from a female congregant with a history of poor mental health.

The professional in you knows that calling 999 is essential. You don’t hesitate, but whilst dialling you reflect on your vocation; good work boundaries mean that you shouldn’t have been reading a late-night message, let alone needing to react to it. At the same time, you know that doing nothing may result in the heartbreaking task of arranging your congregant’s funeral.

Your next call is to the congregant – knowing that this is another suicide attempt – you pray that you’re not too late. Increasingly, our vocation requires life-saving interventions. Fortunately, the congregant answers. It becomes clear that she feels badly let down by everyone else: her GP, her NHS-assigned therapist, the local crisis team, even the wonderful but overstretched Samaritans, who left her on hold.

Get The Jewish News Daily Edition by email and never miss our top stories Free Sign Up

In her despair, she attempted to take her own life. Yet, because the method was not instantaneous, she messaged the one person she believed still cared enough to notice — her rabbi.

That farewell message saved her life, this time.

Judaism has long used the language of gateways and doors to speak about moral responsibility. We strive to build welcoming communities and to support our members, especially those in distress. Unsurprisingly, even at the lowest points in Jewish history, our tradition insists that human pain requires an emotional outlet: “Since the day the Temple was destroyed, the gates of prayer were locked… but even though the gates of prayer were locked, the gates of tears remained open” (Babylonian Talmud, Berakhot 32b).

We are two rabbis who have been shaken by deaths by suicide, as well as suicide attempts and suicidal ideation, and not just in our professional lives, but within our wider families. We have sat with people in hospital beds recovering from attempts to die. We have visited those who have been sectioned and confined to mental health institutions. Worst of all, we have stood in cemeteries carrying the shock, anger, heartache, and regret of mourners. We have walked into homes where sudden loss has frozen families in grief. We have seen scars that never fully heal.

We have also seen people at their lowest points who then go on to live full and meaningful lives. This has taught us that timely support can transform outcomes. It is why the British Government’s Suicide Prevention Strategy (2023) was right to argue for a “no wrong door” approach; offering help wherever people first seek it.

And yet, the reality conveyed by that late-night text is clear. At all times of the day, but especially out-of-hours, we have seen people turned away or left waiting until a crisis escalates. Lives that could be saved are lost. The Jewish teaching, “Whoever saves a life, it is as if they have saved the whole world” (Babylonian Talmud, Sanhedrin 37a), demands better.

Inspired by the Listening Project of South London Citizens – which has led to tangible improvements in mental health recovery – we have conducted our own Listening Project to educate ourselves about NHS services for adults suffering from acute mental illness. We have interviewed people across every level of care: patients, carers, GPs, psychiatrists, senior managers, nurses, and national policymakers.

It was reassuring to hear about some improvements, including wider access to talking therapies and increased suicide-prevention training across London. However, we were repeatedly distressed by stories of unsafe provision. The most consistent theme was a severe workforce crisis.

One psychiatric nurse-educator told us, “It is all fire-fighting… the system is overloaded.” Administrative demands are unrealistic and leave staff exhausted and demoralised. Psychiatrists described shortages of care co-ordinators and ward staff as the single biggest pressure in inpatient services.

We were told, again and again, that NHS computer systems fail to communicate with one another, doubling workloads and fragmenting care. Communication between GPs and crisis teams was described as particularly poor. One GP said that the loss of having a named doctor, combined with routine referrals to crisis teams, has created a system in which no one feels responsible. Many patients and carers echoed this. One mother even told us that her son had been assigned seven different care co-ordinators in a single year.

Psychiatrists criticised “meaningless targets” and a “tick-box culture” aimed at measuring speed rather than quality. Getting to know patients, they said, was simply not valued. Likewise, carers described conversations that felt rushed and impersonal, not least because overwhelmed staff made assumptions instead of asking questions. Patients and families also reported disturbing instances of clinical negligence. One parent spoke of “sloppiness on an industrial scale” in the monitoring of clozapine for her son. It took nine months — and a formal complaint — for the correct dosage to be recorded. When she requested an urgent GP visit, she was told: “I will only come out for a suicide attempt.”

Returning to the promise of “no wrong door”, we heard that severely ill people cannot access the provision they need, even from the emergency services, because no one takes ownership. One patient’s friend put it starkly: “entry into care should never lead to a dead end.”

The dedication of professionals and volunteers within the NHS is extraordinary, but they are constantly undermined by systemic failure. What struck us most was that patients, carers and staff all know where the system is broken; which is why tragedies may be shocking but are rarely surprising. This raises a troubling question: if the fault lines are so clear, why is meaningful reform so slow?

We are profoundly concerned about the state of mental health care in England. Services are under-resourced; staff feel overstretched and burnt out; care has become increasingly anonymous. Some patients survive only because family members advocate relentlessly — at immense emotional cost. Those without such support are at even greater risk. And yet, we have not lost hope, for we have discovered beacons of best practice and postcodes with excellent provision. However, too rarely do other NHS Trusts seek out and emulate these pockets of best practice.

We are rabbis who are determined but limited in what we can do alone. If you would want to help us, or if what we have described resonates with you, please write to rabbim@gmail.com.

People in acute mental distress should not have to rely on chance messages to be heard. Access to care must be reliable, humane and immediate — because all doors should remain open when lives are at stake.

Rabbi David Mitchell, West London synagogue and Rabbi Dr. Michael Hilton, Emeritus Rabbi, Hatch End Reform synagogue

• If you have been affected by anything in this article please contact the Jewish community’s Helpline: info@thehelpline.org.uk; phone: +443301273333