Suicide Statistics - IrelandAverage deaths by suicide in Ireland is 495.The highest number of deaths by suicide(519) occurred in 2001.Figures fell significantly from 2003- 2008however;Figures are expected to rise.(Central Statistics Office data for 2000 – 2008 ‘year of occurrence of death’ data)
Suicide Statistics - Ireland 424 suicides in 2008; (332 (78 %) male, while 92 (22 %)female); a reduction of 36 compared with 460 in 2007and 460 in 2006. However the first quarter of 2009 saw an increase insuicides- 9.6 per 100,000 population compared to 6.8 per100,000-same period in 2008. Suicide prevention expertssay job losses and the recession may be linked to theincrease. There is growing concern re the increases in“undetermined” deaths - 119 in 2007 and 181 in 2008 (notincluded in suicide statistics).HSEs National Office for Suicide Prevention (Sept 2009)
Suicide Statistics - IrelandSuicideDeliberate selfharmSuicidal thoughts, hopelessnesspoor mental healthN = 500 (approx)A+E presentations =11,000DSH in the community =estimated 70,000N = 1 million(estimated)
Suicide Statistics - Ireland Ireland - fourth highest rate of youth suicide in the EUbehind Lithuania, Finland and Estonia. The highest rates -Men aged-20 and 24 years. 10% of adolescents aged 13-19 in Ireland have a depressivedisorder. (NOSP 2009) Suicide is a 4 times more common in men than women. Men under 35 years account for 40% of all Irish suicides. Approx 8 suicides/week and 100 suicide attempts. Medical and farming professions are most at risk ofdepression and suicide (CSO). Males represent 78% of suicides. Females 22%. 11,000 + cases of deliberate self-harm are seen in Irishhospitals every year. In the community-DSH- estimated70,000+. (NRDSH)HSEs National Office for Suicide Prevention (Sept 2009)
Statistics-Suicide/Para-suicide Ireland Suicide Most common methods ofsuicide -hanging, drowning. (2001- 2005) suicide by hangingwas the most common usedmethod by males in all agegroups and females in theyounger age groups (CSO). Poisoning and drowning wereother methods used byfemales.(CSO) A consistent trend has been thatmales are more likely to useviolent methods while femalesuse less lethal/ violent methods(HSE 2006) Para-suicide Two main methods of para-suicide nationally are overdoseand cutting. More lethal methods such ashanging, drowning and firearmsare rarely used in para-suicide. In 2006 74% of all episodes ofpara-suicide involved overdose,with 41% of all cases involvingalcohol. Cutting accounted for 25% ofmen and 18% of females.(HSE 2006)
Global Statistics Significant worldwide public health problem; 1 suicide/ minute 1 attempt /3 seconds 1,000,000 +/suicides worldwide /year. Estimated - 10 to 20 million non-fatal attempts/year. Global suicide rate is 16 : 100,000. 1.8% of worldwide deaths are suicides. Global suicide rates -increased -60% in the past 45 years. More people die from suicide than armed conflict.www.who.org (2010)
Causative factors of Suicide(HSE 2006)Sociological Psychological BiologicalChanging family structure Mental well-being GeneticsMarital breakdown Personality Neurotransmitters-example- serotoninChanging cultural values andreligious practicesPsychosocial Psychiatric illnessUnemployment/employmentPhysical illnessAlcohol and substancemisuseIncreased availability ofmethods of suicide
Risk Factors (HSE 2006)Long termFactorsShort term/precipitatingfactorsSocio-demographicFactorsPsychiatric illness Interpersonal problems Gender/ sexAlcohol and substancemisuseRejection AgePrevious suicide attempt Loss events Marital statusFamily history of suicide Work Problems OccupationPhysical illness A humiliating life event UnemploymentLoss Access to means
Socio-Cultural Factors Gender: Four times as many womenattempt suicide as men: however, four timesas many men actually succeed in theirattempt. Age: The over 65’s and 15-30 age groups areat increased risk of suicide. Males under theage of 35 are most at risk. Among olderpeople, suicide can occur as a consequenceof increasing disability; 44% of one samplestudied committed suicide to prevent beingplaced in a nursing home. Marital Status: highest among divorcees,widowed and single people. Substance abuse: About 60% of attemptedsuicides involve alcohol/ substance abuse. Occupation: Highestrates among medical andfarming professions Unemployment (strongassociation betweenunemployment andsuicide) Access to means(example firearms)(Bennett 2005)(HSE 2006)
Socio-Cultural Factors Sexuality: 28% of homosexual or bisexual males but only 4%of heterosexual male adolescents- considered or attemptedsuicide. For females the corresponding figures are 21% and15% Suicide among those who have recently been bereaved is alsofrequent. Research also indicates that abuse in childhood isstrongly linked with suicide.(Bennett 2005)
Socio-cultural- Alcohol Estimated that 1: 10 Irish people are alcoholics. Alcoholism in one person, directly affects the lives of at least 4-5others. Alcohol was involved in 46% of males and 39% of female episodesof suicide in 2008. Consumption of alcohol in the Irish population has increased by18% over the past 13 years, from 11.5 litres per adult in 1995 to 14.4litres in 2008. The recent national accounts from the Central Statistics Officeshow that expenditure on alcohol in Ireland is almost 10% per centof total personal expenditure, The recent EU-funded report claims that Ireland spends threetimes more than any other country on alcohol.www.rutlandcentre.ie/alcohol(2010)
Suicide and Mental Illness Over 90 percent of peoplewho die by suicide have apsychological illness at thetime of their death. Untreated mental illness(including depression,bipolar disorder,schizophrenia, and others)is the cause for the vastmajority of suicides. Untreated depression isthe number one cause forsuicide.(www.suicide.org 2010) 400,000+ Irish peoplecurrently experiencedepression (approx 1 in 10 ofthe population) 40,000+ Irish people currentlyexperience Bi-Polar. Severely depressed individualsusually lack thevolition/energy to act on theirfeelings. As depression begins to lift,individuals are more at risk/inclined to commit suicide.www. aware.ie (2009)
A Vision For Change (2006)Report of The Expert Group onMental health PolicyReach OutNational Strategy forAction on Suicide Prevention2005 - 2014
NOSP Annual Report 2009 The National Office for SuicidePrevention 2009 Annual Reportsets out progress against each ofthe Actions in Reach Out, theNational Strategy for Action onSuicide Prevention, for the year2009 and reflects the significantamount of work undertaken atlocal, regional and national levelby community groups, voluntaryorganizations and statutorybodies in this sensitive andimportant Review this document athttp://www.nosp.ie/html/reports.html
Reach OutNational Strategy for Action on Suicide Prevention2005 - 2014 Reach Out makes the point that social changes have impacted on thenature and extent of suicidal behaviour in Ireland. Suicide rates doubled during the 1980s and 1990s. This was a time when society experienced considerable transition from anagricultural rural economy to an urban service-orientated one. The church and rural norms were challenged. There have been considerable changes for young adults and olderpeople. Young men in rural areas can no longer assume that they have alivelihood from farming. Fathers are isolated with the increasing number of single parentfamilies. Teenage girls struggle with media-induced expectations about theirphysical appearance, and older people no longer have the support of anextended family network. Increasing socio-economic inequalities and social exclusion affecting avariety of groups residing in Ireland also increase suicide rates. It is clear that this is not just a health problem, but a societal one.
Reach OutNational Strategy for Action on Suicide Prevention2005 - 2014 Reach Out – 4 main approaches The general population approach will promote positive mental healthand bring about a positive attitude towards mental health, problemsolving and coping in the general population The targeted approach will reduce the risk of suicidal behaviouramong high-risk groups and vulnerable people. These include those whocommit deliberate self-harm, those at risk of or abusing alcohol anddrugs, marginalised groups, prisoners, unemployed people, people whohave experienced physical or sexual abuse, young men and older people. The response to suicide will minimise distress felt by families, friendsand the community following death, and ensure that individuals are notisolated or left vulnerable, so as to reduce the risk of related suicidalbehaviour. Information and research will be used to inform service developmentand provide information on where and how to get help.
(Begley et al. 2006)Reasons why young men are more likely to commit suicide Social change- different types ofpressure (mentally tougher) thanin the past Increased pressure to provide andsucceed in education/work etc Changes in the family- Divorce/separation/ decrease in extendedfamily/ Family life more stressful Negative sense of community andover reliance on self. Changing attitudes to religion Over reliance –alcohol / drugs Stigma attached to mental illhealth Attitude to seeking help(Anonymity/confidentiality) Lack of knowledge/ accessibility /lack of knowledge of services-unsure -where to go to seek help. Reluctance to see GP (Cost/ overreliance on medication/confidentiality) Difficulty in admitting problem. Distrust of existing services. Males choose more violentmethods for taking their own life.(Begley et al. 2006)
How society can make an effective response Society needs to consider changes that have occurred inculture and society- family/ community / work andimplement new procedures accordingly. From a young age – boys should be encouraged to accesssupport – family/ friends/ community services. GP settings to incorporate mental health professionals. Mental health nurse- in schools. Youth focused services- such as Clockwork in Australia-service run by GP’s, nurses, psychologists, youth workers etc.Begley et al. 2006
How society can make an effective response User friendly- one stop shop-which provides healthinformation (especially for men) Parenting courses Skills based educationprogramme for parents- how tocope in a crisis. Consideration should be given toyoung men’s opinions andpreferences when developingsuicide/ bereavement services.Many have a strong religious/pastoral element which may notbe appropriate for many men. Support for fathers who do notget to see their children. Housing incentives Awareness- leaflets/programmes/ad’s. Media- need to acknowledge-Impact of drugs and alcohol onmental health- highlightingpositive coping strategies anddamaging effects of negativebehaviour (anger/ alcohol etc).Begley et al. 2006
How society can make an effective response Education (PHSE) in schools- integrate mental health issues. There are over 900 Gun clubs in the country- need toimplement suicide prevention strategies. Need to implement tighter restrictions to possessing a gun. Gun safes- guns and ammunition kept separate. Independent Dr’s as opposed to individuals own GP’s todetermine medical (mental) fitness of applicants to hold agun license.Begley et al. 2006
“A Vision For Change” (2006) A Vision for Change (2006) detailsa comprehensive model of mentalhealth service provision forIreland. It proposes a holistic view ofmental illness and recommendsan integrated multidisciplinaryapproach to addressing thebiological, psychological andsocial factors that contribute tomental health problems. However the absence ofmeaningful progress in theimplementation of Vision forChange remained an ongoingconcern for the Mental HealthCommission during 2008 andAmnesty International.(MHC 2008 Annual report). Since 2006-Government planned to raisesome €700 million through the sale of landsused by psychiatric hospitals that are due forclosure. By Feb 2010 this had notmaterialised and the implementation of‘Vision for Change’ remained an ongoingconcern. March 2010- plans being implemented toclose 14 Mental health institutions over thenext 3 yrs. Monies from the sale to be usedto treat patients in the community. Too littletoo late? (Value of lands/ property hasgreatly declined since 2008) At the annual forum organised by theNOSP(Sept 2009), Minister of State forMental Health John Maloney insistedfunding for suicide prevention wouldcontinue. However in 2008 Gov. funds forsuicide prevention were halved from8,000,000 to 4,000,000 € per annum.
The Suicide Crisis Assessment Nurse(SCAN) (Dublin & Wexford) The Suicide Crisis Assessment Nurse (SCAN) –launched-March 2007 by the Cluain Mhuire Service in Blackrock, Co.Dublin, provides a fast-track priority referral system from primarycare for people experiencing a suicidal crisis. It is operated by onenurse five days a week from 9a.m. to 5p.m. In August (2009) the Wexford service, (consists of threenursing posts), was rolled out across the county. Referrals to the service are made by the GP who calls the nurse,and the patient needing help will be seen within hours, or thesame day. ‘Minding the gap’ – SCAN nurse link role in maintainingcontact with patients until they engage with ‘next care’services. Next care’ pathway[Mental Health Services; Counselling:Social Networks/Vol Groups]www.hse.ie (2010)
Suicide Crisis Assessment Nurse (SCAN)Wex: GP’s = circa 45 practices Dublin: GP’s = circa 67 practicesPopulation = circa 132,000 Population = 183,000- New Ross - Blackrock- Wexford Town - Dunlaoighre- Rosslare - Shankill- Enniscorthy - Dundrum- Gorey - Kilmacud-Arklow - Mt Merrion Network & partnership approach with 90% oflocality GP’s. Ongoing analysis and evaluation of the service –consulting GP’s, Mental Health Colleagues &Service Users.
crisis referrals in the 65 days pre and post implimentationResponseAuditNo. Cases(65 days)AssessedSame dayDelayedassessmentNot seen DocumentedassessmentPre SCAN 13 8 5(mean > 2days)1 60%SCAN 16 11 2(mean < 1 day)3 100%Period Pre-SCAN 65 Days SCAN first 65 daysAdverse event(requiring medical adm.)2 0Number of bed days resultingfrom admissions followingassessments172 16Cost to CMHT budget 60,185 Euro 5,599 EuroProjected annual cost 337,030 Euro 31,354 EuroEffect of introduction of SCAN serviceOn patient care and CMHT
Mainstreaming SCAN: The ChallengeDublin: Training 3 CommunityPsychiatric Nurses todeliver the Primary CareSuicide Crisis AssessmentNurse modelWexford: Provision of a 7 dayWexford General Hospitalliaison nursing service anda 5 day County widePrimary Care Suicide CrisisAssessment Nurse Service. Nationally: Sharing know-how with othercommunity psychiatric services Incorporating SCAN skills intoadvanced nurse practitionertraining Informing service planners ofbenefits to patients and costsavings However both Chluain Mhuire andthe Wexford service only have enoughfunding from the NOSP until March2010
Wexford SHIPSelf Harm Intervention Programme Commenced -June 2004- a joint initiative between theHSE South East Area’s Adult Counselling Service and itsSuicide Resource Office. Individuals at risk of suicide or self harm are eligible toself refer or be referred by a health professional Weekday office hours (Tel 053 74050) Provides short term counselling contracts up to 12sessions duration Lower age threshold : 16 years
HSE –South Regional Suicide Resource OfficeBereavement Counselling Service for SuddenTraumatic DeathCounselling Hrs per CountyWexford68%Waterford17%Tipperary3%Carlow8% Kilkenny4%WexfordWaterfordTipperaryCarlowKilkenny280.5137.55429.5 28050100150200250300Wexford Waterford SouthTipperaryCarlow Kilkenny
Role of Triage - Suicide Often-Point of first contact If the triage clinician suspects risk of suicide, or deliberate self harm-regardlessof chief complaint- Ask questions—save a life. Ask patient direct questions and/or get information from familymembers/friend if present How the questions are asked affects the likelihood of getting a truthful response.Use a tactful, non-judgmental, non-condescending approach. Example; 1. Do you feel you are at risk/threat to yourself or somebody else? 2. Are you currently thinking about ending your life? 3. Have you ever thought that life was not worth living? 4. Have you ever thought about ending your life? 5. Have you ever attempted suicide? When suicidal ideation is present the triage clinician must ask about: 1) Frequency, intensity, and duration of thoughts; 2) Existence of a plan and whether preparatory steps have been taken; and 3) Intent(Suicide Risk: A Guide for Evaluation and Triage-at /www.sprc.org/library/SuicideRiskGuide8.pdf)
High risk patients/ Interventions Include those who have: Made a serious or nearly lethalsuicide attempt Persistent suicide ideation orintermittent ideation withintent and/or planning Psychosis, includingcommand hallucinations Recent onset of majorpsychiatric illnesses, especiallyMDD (Clinical Depression) Been recently discharged froma psychiatric unit History of acts/threats ofaggression or impulsivity(Suicide Risk: A Guide for Evaluation and Triage-at/www.sprc.org/library/SuicideRiskGuide8.pdf) Emergency services(Ambulance/ Gardai) Emergency evaluation byDr. Psychiatric/psychologicalevaluation ASAP Ensure family/friend tomonitor while waitingprofessional review Maintain contact with thepatient until help arrives.(Suicide Risk: A Guide for Evaluation and Triage-at/www.sprc.org/library/SuicideRiskGuide8.pdf)
Resources Samaritans4-5 Ushers CourtUshers QuayDublin 8Office:24 Hour Telephone Helpline: firstname.lastname@example.org(24 Hour Email Helpline) 01-67100711850 609090 Text-phones (For the deaf and hard of hearing) 1850 60 90 91 BarnardosChristchurch SquareDublin 8.Office:Callsave: email@example.com or1850 222 300 Aware 72, Lower Leeson StreetDublin 2.Office: 01-6617211Helpline: 1890 303 302(7 days from 10am - 10pm) firstname.lastname@example.org Living Links- National Committee Office5 Lower Sarsfield Street,Nenagh, Co. Tipperary.Phone: 067 43999 or087 4122052Email; email@example.comWeb:; www.livinglinks.ie Mental Health IrelandMensana House6 Adelaide StreetDun LaoighreCo. Dublin.Office: firstname.lastname@example.orgTel;01-2841166 ConsoleAll Hallows CollegeDrumcondraDublin 9Office:Helpline: email@example.com 201 890 Providing support to those bereaved by suicide Grow Ormonde HomeBarrack StreetKilkenny firstname.lastname@example.org 474 474.
Documents/ Government Publications A Vision for Change (2006); Report of the expert group on mentalhealth policy, Government publication office, Dublin. Begley et al (2006) ‘The Male Perspective: Young men’s outlook onlife’, Bord Slainte, Suicide prevention Office, Midwestern Healthboard. HSE (2006) Towards Understanding; A suicide InformationBooklet, Regional Suicide Resource Office, Waterford. Mental Health Commission (2008), Annual report; including thereport of the Inspector of Mental Health Services, Governmentpublication office, Dublin. National office for suicide prevention (2008) Annual Report Reach Out (2005-2014) National Strategy for Action on SuicidePrevention, Government publication office, Dublin. The Quality Framework (2007) Mental Health Services in Ireland,Government publication office, Dublin.
‘Human understandingis the most effectiveweapon against suicide’Dr Edwin Shneidman
References A Vision for Change (2006); Report of the expert group on mental health policy,Government publication office, Dublin. Bennett, P (2005) Abnormal Clinical Psychology; An Introductory Textbook (Second edition).Maidenhead: Open University Press HSE (2006) Towards Understanding; A suicide Information Booklet, Regional SuicideResource Office, Waterford. National Centre for Health Statistics; (CSO)Deaths: Injuries (2002-2008), Governmentpublication office, Dublin. National office for suicide prevention (2009) Annual Report, Government publicationoffice, Dublin. Reach Out (2005-2014) National Strategy for Action on Suicide Prevention,Government publication office, Dublin. Suicide Risk: A Guide for Evaluation and Triage-at /www.sprc.org/library/SuicideRiskGuide8.pdf www.aware.ie www.hse.ie www.rutlandcentre.ie www.suicideireland.com www.suicide.org www.who.org