This document summarizes a medical study day program on suicide in Ireland. It discusses facts about suicide rates globally and in Ireland, as well as risk factors like mental illness, substance abuse, and previous attempts of deliberate self-harm. It notes that predicting suicide is difficult as models generate many false positives. The presentation recommends population-level measures and improved treatment of mental illness to help address suicide, as well as asking direct questions of those at risk and providing containment. The key message is that care providers can help prevent suicide despite the difficulty of prediction, and lists resources for further information.

1. Medical Study Day Programme
Saturday 14th November, 2015
Suicide in Ireland:
Fact, Fiction and What Can We Actually Do?
Professor Brendan Kelly
People caring for people….

2. There is but one truly serious philosophical problem
and that is suicide
Camus

3. Suicide and deliberate self-harm
Prediction
What to do?

4. Suicide and deliberate self-harm
Prediction
What to do?

5. Suicide
Intentional killing of oneself
Deliberate self-harm
Apparent attempted suicide without the
actual intention of killing oneself
Includes a range of behaviours:
Self-cutting
Self-burning
Ingesting overdoses
...without an intent to die

6. Suicide
Globally 2013 842,000
Ireland 2013 475 (65 undetermined)
2014 459 (62 undetermined)
80% male

9. NOSP, 2013

11. General population data
2.9% have attempted suicide in the past
2.3% have had suicidal thoughts in the past
year
...fewer than 1/200 go on to die by suicide
Young people: 19% have had suicidal thoughts
in the past year

20. Suicide and deliberate self-harm
Prediction
What to do?

21. Risk factors
Suicide Deliberate self-harm
Male Female
Substance misuse Substance misuse
Mental illness Mental illness
Deliberate self-harm Deliberate self-harm

22. Prediction using mental illness
Major depression
Bipolar disorder
Schizophrenia
Alcohol dependence

23. Prediction using mental illness
Major depression 15%
Bipolar disorder 15%
Schizophrenia 10%
Alcohol dependence 10%
Individuals who engage in deliberate self-harm
have a 30-fold increased risk of suicide

24. Prediction using risk-factors
One study followed-up 5,000 psychiatric
inpatients after discharge, using a combination of
known risk factors to predict suicide
They predicted 35 out of 67 suicides
Model also generated over 1,000 ‘false positives’
(i.e. predicted suicide in over 1,000
individuals who did not die by suicide)

25. Suicide and deliberate self-harm
Prediction
What to do?

28. If suicide is allowed then everything is allowed
Wittgenstein

31. (a) Population health measures
(b) Better treatment of mental illness
Generic mental health services
Intervention in primary care

32. (a) Population health measures
(b) Better treatment of mental illness
Generic mental health services
Intervention in primary care

35. Irish Journal of Medical Science 2002; 171: 148-50
Irish Journal of Medical Science 2006; 175: 40-2

37. (a) Population health measures
(b) Better treatment of mental illness
Generic mental health services
Intervention in primary care

39. What can you do?

40. Risk factors
Suicide Deliberate self-harm
Male Female
Substance misuse Substance misuse
Mental illness Mental illness
Deliberate self-harm Deliberate self-harm

41. A Ask, ask, ask
B Be direct, open and honest
“But this has never happened to you...”
“Have you ever felt like this?”
“Why did this happen to me?”
C Contain

42. What to do?
Remember deliberate self-harm
Bear in mind known risk-factors
Provide normal care in a steady fashion
Provide containment
You will fail
You will succeed
You will never know what you prevented

43. Suicide and deliberate self-harm
Prediction
What to do?

45. National Office for Suicide Prevention
www.nosp.ie
National Suicide Research Foundation
www.nsrf.ie
Console: Living With Suicide
www.console.ie

46. Suicide in Ireland:
Fact, Fiction and
What Can We Actually Do?
Brendan Kelly
brendankelly35@gmail.com