Professor Ella Arensman, Director of Research at the National Suicide Research foundation recently presented in University College Cork at a lecture centred on Dialectical Behavioural Therapy (DBT). The Founder of DBT, Dr. Marsha Linehan also presented at the event, to mark the end of her week in Ireland training mental health professionals in the delivery of DBT.
The Experience of Reintegration for Military Families and Implications for DoDAnita Harris Hering
Over 2.6 million members of the United States military have deployed in support of the wars in Iraq and Afghanistan since 2001. Although most Service members are resilient and do not develop long-term difficulties, some face traumatic events and experience mental and/or physical health problems upon homecoming. Further, military deployments affect not only the Service members, but their families as well. This webinar will outline the current research, existing and emerging topics military families face during reintegration. In addition the Office of Family Policy will provide a brief interpretation of how these findings may impact programs and policies.
The median IDU population for Coast is
26,667 with Mombasa accounting for over 5,000.
A third of all IDUs have shared injecting equipment with their close friends or primary sex partners.
Common reasons for sharing injection equipment include lack of personal needles when needed (23%), difficulty in accessing new needles or cost (17%), pressure from other users (14%), or being in prison (2%).
Most IDUs cleaned injecting equipment previously used by other IDUs with water, and only 1% of respondents cleaned with bleach.
More than 50,000 youth have being affected by drugs at Kenya coast (NACADA) and several have died due to scarcity of drugs after GoK efforts to curtail supply were effected.
Most IDU met while on high will always be looking down. There is a joke that the sky is so bright that stitching the leakages will perhaps make it nice to look up and give hope to IDUs in Mombasa to enable them look up with courage
The results are from GFR7 Activities through care Kenya
Substance abuse treatment is tailored to help with recovery from drug and alcohol addiction. Comprehensive services are the key to success. Learn more about substance abuse treatment at FindRehabCenters.org and get help finding the appropriate treatment center for you. (877) 322-2450
The National Suicide Research Foundation recently held an Information Evening in the River Lee Hotel, Cork, entitled; "What's New in Suicide and Self-harm Research in Ireland?".
Professor Ella Arensman, Director of Research at the NSRF, discussed some new findings in suicide research in Ireland, with a focus on the impact of the recession and unemployment on rates of suicide.
For more information, contact:
e.arensman@ucc.ie
+353 (0)21 420 5551
www.nsrf.ie
It is important that individuals directly response for making people’s lives hell through bad legislation be held to account.
http://www.publicwhip.org.uk/mp.php?mpn=Andrew_Dismore&mpc=Hendon&house=commons&dmp=989&display=motions
Affordable Care Act Briefing, Joanne Grossi, LWVMCVAcalindstrom
Presentation made to LWV of Montgomery County, VA and friends on Aug. 7, 2012. Speaker, Joanne Grossi, Director Region U.S. Dept. of Health and Human Services. (Shared with her permission)
An introduction to the Kia Piki o te Ora programme, which aims to prevent suicide rates amongst Māori and promote Whānau Ora throughout Aotearoa. Experience through wānanga how the KPOTO teams work to achieve our 7 goals.
Presentation by Kia Piki National Coordinators at the 2009 SPINZ National Symposium: Culture and Suicide Prevention in Aotearoa: http://www.spinz.org.nz/page/108-events-archive+spinz-national-symposium-2009+symposium-coverage
Evaluation of the NZGG Self-Harm & Suicide Prevention Collaborative MHF Suicide Prevention
The evaluation describes the collaborative methodology, reviews quality of project implementation, impacts achieved, and stakeholder satisfaction of the New Zealand Guidelines Group Self-Harm and Suicide Prevention Collaborative. The collaborative was designed to improve crisis care in emergency departments and mental health services while recognising local situations, people and resources. Presented by Julian King and Michelle Moss. View this presentation from the 2010 SPINZ World Suicide Prevention Day Forum on YouTube: http://www.youtube.com/watch?v=FbY1QpBubtk
The first part of the presentations from the ground-breaking Reducing Suicide Summit 2011, hosted by CALM and focusing on the Cheshire & Merseyside regions of the UK. More info at http://www.thecalmzone.net
The Impact of Alcohol on Self-harm and Suicide in Ireland - New Insights.AlcoholActionIreland
Prof Ella Arensman's presentation about the impact of alcohol on self-harm and suicide in Ireland, providing new insights from recently collected data. Prof Arensman is Director of Research with the National Suicide Research Foundation and Adjunct Professor with the Department of Epidemiology and Public Health, University College Cork.
This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
The Experience of Reintegration for Military Families and Implications for DoDAnita Harris Hering
Over 2.6 million members of the United States military have deployed in support of the wars in Iraq and Afghanistan since 2001. Although most Service members are resilient and do not develop long-term difficulties, some face traumatic events and experience mental and/or physical health problems upon homecoming. Further, military deployments affect not only the Service members, but their families as well. This webinar will outline the current research, existing and emerging topics military families face during reintegration. In addition the Office of Family Policy will provide a brief interpretation of how these findings may impact programs and policies.
The median IDU population for Coast is
26,667 with Mombasa accounting for over 5,000.
A third of all IDUs have shared injecting equipment with their close friends or primary sex partners.
Common reasons for sharing injection equipment include lack of personal needles when needed (23%), difficulty in accessing new needles or cost (17%), pressure from other users (14%), or being in prison (2%).
Most IDUs cleaned injecting equipment previously used by other IDUs with water, and only 1% of respondents cleaned with bleach.
More than 50,000 youth have being affected by drugs at Kenya coast (NACADA) and several have died due to scarcity of drugs after GoK efforts to curtail supply were effected.
Most IDU met while on high will always be looking down. There is a joke that the sky is so bright that stitching the leakages will perhaps make it nice to look up and give hope to IDUs in Mombasa to enable them look up with courage
The results are from GFR7 Activities through care Kenya
Substance abuse treatment is tailored to help with recovery from drug and alcohol addiction. Comprehensive services are the key to success. Learn more about substance abuse treatment at FindRehabCenters.org and get help finding the appropriate treatment center for you. (877) 322-2450
The National Suicide Research Foundation recently held an Information Evening in the River Lee Hotel, Cork, entitled; "What's New in Suicide and Self-harm Research in Ireland?".
Professor Ella Arensman, Director of Research at the NSRF, discussed some new findings in suicide research in Ireland, with a focus on the impact of the recession and unemployment on rates of suicide.
For more information, contact:
e.arensman@ucc.ie
+353 (0)21 420 5551
www.nsrf.ie
It is important that individuals directly response for making people’s lives hell through bad legislation be held to account.
http://www.publicwhip.org.uk/mp.php?mpn=Andrew_Dismore&mpc=Hendon&house=commons&dmp=989&display=motions
Affordable Care Act Briefing, Joanne Grossi, LWVMCVAcalindstrom
Presentation made to LWV of Montgomery County, VA and friends on Aug. 7, 2012. Speaker, Joanne Grossi, Director Region U.S. Dept. of Health and Human Services. (Shared with her permission)
An introduction to the Kia Piki o te Ora programme, which aims to prevent suicide rates amongst Māori and promote Whānau Ora throughout Aotearoa. Experience through wānanga how the KPOTO teams work to achieve our 7 goals.
Presentation by Kia Piki National Coordinators at the 2009 SPINZ National Symposium: Culture and Suicide Prevention in Aotearoa: http://www.spinz.org.nz/page/108-events-archive+spinz-national-symposium-2009+symposium-coverage
Evaluation of the NZGG Self-Harm & Suicide Prevention Collaborative MHF Suicide Prevention
The evaluation describes the collaborative methodology, reviews quality of project implementation, impacts achieved, and stakeholder satisfaction of the New Zealand Guidelines Group Self-Harm and Suicide Prevention Collaborative. The collaborative was designed to improve crisis care in emergency departments and mental health services while recognising local situations, people and resources. Presented by Julian King and Michelle Moss. View this presentation from the 2010 SPINZ World Suicide Prevention Day Forum on YouTube: http://www.youtube.com/watch?v=FbY1QpBubtk
The first part of the presentations from the ground-breaking Reducing Suicide Summit 2011, hosted by CALM and focusing on the Cheshire & Merseyside regions of the UK. More info at http://www.thecalmzone.net
The Impact of Alcohol on Self-harm and Suicide in Ireland - New Insights.AlcoholActionIreland
Prof Ella Arensman's presentation about the impact of alcohol on self-harm and suicide in Ireland, providing new insights from recently collected data. Prof Arensman is Director of Research with the National Suicide Research Foundation and Adjunct Professor with the Department of Epidemiology and Public Health, University College Cork.
This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
suicide - a public health problem
history, global scenario, Indian scenario, etiology, risk factors. protective factors, suicide in adolescents, treatment, prevention, recommendations
De las intervenciones breves a los farmacos. malaga 2015 Antoni Gual
Conferencia sobre los problemas derivados del alcoholismo y su tratamiento, impartida el 6 de marzo del 2015 en la reunión de la Red de Trastornos Adictivos, realizada el Hospital Universitario de Málaga
Overview of tackling non-communicable diseases in EnglandDr Justin Varney
A presentation I gave in 2014 to a senior delegation of officials from Iraq on our approach in England to addressing the challenge of non-communicable disease
Risk profiling, multiple long term conditions & complex patients, integrated ...Dr Bruce Pollington
Dr Bruce Pollington web-ex presentation to LTC QIPP programme
Utilising risk profiling, and risk stratification to identify patients with multiple long term conditions requiring complex care through integrated care teams.
Presentation Overview
• Introduction to self-harm
• Hospital-treated self-harm in Ireland
• Treatment of self-harm
• Challenges and recommendations
• Actions from the Registry
Anne Webster, -Clinical Lead Winterbourne Projects, NHS England,
Joanne McDonnell - Senior Nurse for Mental Health and Learning Disabilities, NHS England
Neil Hoskin - Expert by Experience, NHS England
Presentation from the Winterbourne Medicines Programme Launch held in London on 10 September 2014
Ensuring safe, appropriate and optimised use of medication for people with learning disabilities who demonstrate behaviour that can challenge
Paul Gill: The value of psychiatric liaison servicesThe King's Fund
Dr Paul Gill, Consultant Psychiatrist at Sheffield Liaison Psychiatry Service, explains what liaison psychiatry is and how it can help provide better outcomes across secondary and acute points of care.
Bristol - building a truly healthy city, pop up uni, 12.00, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Improving the Health of Adults with Limited Literacy: What's the Evidence?Health Evidence™
Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health (NCCDH), hosted a 60 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on interventions to improve the health of adults with limited literacy, presenting key messages, and implications for practice on Wednesday October 31, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Karen Fish, Knowledge Translation Specialist, and Connie Clement, Scientific Director, both from the NCCDH.
This webinar focused on interpreting the evidence in the following review:
Clement, S., Ibrahim, S., Crichton, N., Wolf, M., Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.
Similar to Self-Harm in Ireland: Trends, risk factors and implications for intervention and prevention (20)
Overview
*The extent of suicide in Ireland
*Attitudes towards suicidal behaviour
*The Suicide Support and Information System
*Risk factors associated with suicide
*Engaging with people at risk of suicide: Listening, Understanding, Responding
12,010 presentations by 9,483 individuals in 2012
• 2,527 (21%) were repeat acts
• 1,374 individuals (14.5%) repeated in 2012
• Risk of repetition is greatest in the short-term
• Risk of repetition varies by:
• Age
• Recommended next-care
• Method of self-harm
• Number of previous self-harm presentations
Presentation Overview:
The extent of suicide in Ireland
Attitudes towards suicidal behaviour
The Suicide Support and Information System
Risk factors associated with suicide
Engaging with people at risk of suicide: Listening - Understanding -Responding
If you have any questions regarding this presentation, please contact e.cusack@ucc.ie
The National Suicide Research Foundation recently held an Information Evening in the River Lee Hotel, Cork, entitled; "What's New in Suicide and Self-harm Research in Ireland?"
Dr. Celine Larkin, Research Psychologist and Project Co-ordinator with the NSRF, discussed an exciting new internet-based guided self-management tool for mild to moderate depression. This is a part of the overall aims of the PREDI-NU Project. Visit: www.predi-nu.eu/
For more information, contact:
c.larkin@ucc.ie
+353 (0)21 420 5551
www.nsrf.ie
More from National Suicide Research Foundation (10)
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Self-Harm in Ireland: Trends, risk factors and implications for intervention and prevention
1. Self-harm in Ireland:
Trends, risk factors and implications for
intervention and prevention
Prof. Ella Arensman
National Suicide Research Foundation
Department of Epidemiology and Public Health, UCC
2. Systematic Review of the Efficacy of Psychosocial and pharmacological
Treatments in Preventing Repetition. British Medical Journal.
Hawton K, Arensman E, Townsend E, Bremner S, Feldman E, Goldney R, et al.(1998).
Dialectical Behaviour Therapy was
the only psychotherapeutic
treatment showing a significant
reduction in self-harm.
Target group: People with a history
of multiple acts of self-harm who
met the diagnostic criteria for
Borderline Personality Disorder
3. Consistency of positive outcomes in applying Dialectical
Behaviour Therapy in different countries and settings
4. Overview
The National Registry of Deliberate Self-Harm
Trends in self-harm in Ireland and associated risk factors
Evidence based interventions for self-harm
Evidence informed implementation of DBT in Ireland
5. Suicide and medically treated deliberate
self harm in Ireland: the tip of the iceberg
Suicide
Approx.
550 p.a.
Medically treated DSH
Approx. 12,000 p.a
“Hidden” cases of self-harm
Approx. 60,000 p.a.
6. National Registry of Deliberate
Self-Harm
Identification of deliberate self harm presentations
in accordance with an internationally recognised
definition (Schmidtke et al, 1996)
- Non-fatal outcome
- Deliberately initiated self-harming behaviour
- Varying behaviours (e.g. self cutting, overdose
etc.)
- Varying intentions (e.g. wish to die, selfpunishment, relief from state of mind)
In 2012, there were 12,010 presentations made by 9,483 individuals:
Since 2003 there have been 111,682 presentations
of self-harm recorded by the Registry
A Northern Ireland
registry operates
across the 5 trusts in
NI, with full coverage
obtained as of 2012
7.
8.
9. Methods of self-harm by gender
Men
Women
2%
4%
12%
3%
2%
7%
Drug overdose only
7%
Self-cutting only
16%
5%
54%
Overdose & self-cutting
Attempted hanging only
19%
69%
Attempted drowning
only
Alcohol was involved in 38% of all cases (42% in men, 36% in women)
10. Consistent peaks of self-harm during
the year and week
Average number of self-harm
presentations to hospital per
day: n=33
1100
Men
1000
Number of presentations
Dates in the year on which 50
or more self-harm
presentations occurred were
mostly public holidays or
the day after, e.g in 2012:
- January 1st
- March 17th and 18th
- June 5th
Self-harm by day of the week and gender
Women
900
800
700
600
500
400
300
200
100
0
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
12. Repetition by number of
self-harm presentations
Repetition of self-harm by
recommended next care
13. The extent of repeated self-harm presentations
Persons
Number of DSH acts
in 2003-2011
Presentations
Number
(%)
Number
(%)
One
48,066
77.1%
48,066
48.2%
Two
7,899
12.7%
1,5798
15.8%
Three
2,709
4.3%
8,127
8.2%
Four
1,297
2.1%
5,188
5.2%
Five - Nine
1,713
2.8%
11,010
11%
10 or more
635
1.0%
11,483
11.5%
14.
15. Recommended aftercare among those
who repeat 10 times or more
60
% of presentations
50
40
30
Male
Female
20
All patients
10
0
Admission ward
Admission
psychiatry
Patient refused
to be admitted
Left without
being seen /
without decision
Not admitted
16. Evidence based interventions taking into account
differences among people who self-harm
Dialectical Behaviour Therapy –
Individuals with a history of multiple self-harm acts, often associated with
Borderline Personality Disorder and co-morbid mental health problems
Cognitive Behaviour Therapy, Mindfulness based Cognitive Therapy -
Individuals with single/infrequent self-harm acts, often associated with
mood, anxiety disorders, and alcohol/drug abuse
Problem-solving interventions –
Individuals with single self-harm acts, not primarily associated with mental
health problems
17. National Clinical Programme for Mental Health
A programme for the management of self-harm among people presenting to
hospital emergency departments
Key objectives:
Enhance assessment and management of self-harm for people presenting to
EDs at national level and ensure continuity of care, e.g. referral to indicated
treatment, and follow-up
Standardisation of evidence based treatment options nationally for people
who have engaged in self-harm based on best available evidence
19. Outcomes initial DBT programme implemented in the North
Lee Adult Mental Health Services – Endeavour Programme
(Flynn and Kells, 2013)
• Following 12 month DBT, reductions in most outcomes:
- Self-harm repetition rates
- Symptoms of Borderline Personality Disorder
- Depression
- Hopelessness
• Cost-effectiveness – Comparing use of service in the
12 months prior to DBT and in the 3 months after
completion of the programme:
Significant reductions in:
- ED visits (from 49 to 0)
- In-patient admissions (from 12 to 1)
- Bed days (from 207 to 1)
20. Wider implementation of DBT in Ireland
After the initial project, DBT was expanded to 3 other adult mental health
sites in Cork, funded by the National Office for Suicide Prevention (NOSP)
Additional funding has been provided by NOSP to further implement DBT in
Ireland over the period 2013-2015 – Key objectives:
- Establishment of National DBT Project Office in Cork, June 2013
- Support the administration of the national roll out of DBT and allied
interventions
- Ensure continued independent evaluation focussing on effectiveness and
cost/benefit of training
- Ensure meaningful involvement in DBT and allied intervention programmes
21. Action plan National DBT project
• Training 16 teams nationwide over a period of 2 years
• Teams selected on the basis of their area’s incidence of
repeated self-harm and local commitment to the
implementation of DBT
• Teams selected in year 1:
- 4 adult (AMHS) and 4 adolescent (CAMHS)
- Teams trained in December 2013
- Delivery of DBT to start in March 2014
- Training of further 8 teams in September 2014
22. Consideration of variation in self-harm repetition rates
when implementing DBT at national level
Males
Leitrim
Galway City
Waterford County
Dublin City
Cork City
Limerick City
Kilkenny
Tipperary South
Donegal
Tipperary North
Dun-Rathdown
Waterford City
Kerry
Monaghan
South Dublin
Louth
Limerick County
Galway County
Laois
Cavan
Meath
Cork County
Westmeath
Sligo
Kildare
Mayo
Wexford
Wicklow
Fingal
Clare
Longford
Carlow
Offaly
Roscommon
Average rate of
repetition
0
5
10
15
20
25
Females
Leitrim
Limerick City
Cork City
Donegal
Sligo
Limerick County
Clare
Dun-Rathdown
Waterford County
Mayo
Dublin City
Kildare
Tipperary South
Kerry
Louth
Roscommon
Fingal
South Dublin
Wexford
Cork County
Waterford City
Galway County
Kilkenny
Galway City
Wicklow
Cavan
Carlow
Tipperary North
Meath
Laois
Offaly
Westmeath
Longford
Monaghan
Average rate of
repetition
0
5
10
15
20
25
23. DBT recommended as part of a comprehensive treatment
programme for persons with Borderline Personality Disorder
24. Challenges
• The high levels of self-cutting and repeated self-harm among
Irish men may pose challenges for the implementation of DBT
as most DBT trials included women
•
• How can DBT be sustained in the long term, and integrated in
the mental health services as one of the options of a menu of
evidence based treatments offered to people with multiple
self-harm acts
• Linking the implementation of guidelines of the national
clinical programme to the national roll out of DBT
25. “People who attempt suicide never want
“
to die, what they want is a different life”
(R. Wieg, 2003)
26. Acknowledgements
• NSRF: Ivan Perry, Margaret Kelleher, Eileen Williamson, Paul Corcoran, Eve
Griffin, Amanda Wall, Helen Keeley, Caroline Daly, Celine Larkin
Data Registration Officers: Liisa Aula, Agnieszka Biedrycka, Grace Boon, Kate
Brennan, James Buckley, Ursula Burke, Lisa Byrne, Laura Cosgrove, Rita Cullivan, Breda
Heavey, Ailish Melia, Catherine Murphy, Mary Nix, Diarmuid O’Connor, Kathleen
O’Donnell, Eileen Quinn, Karen Twomey, Una Walsh
The late Dr Michael Kelleher, founder of the NSRF
• Health Service Executive – South: Daniel Flynn, Mary Kells, Mary Joyce, Catalina
Suares, Louise Dunne
• Health Service Executive: National Office for Suicide Prevention, Suicide Prevention
Resource Officers, Hospital staff, HSE departments/units
• Department of Health
27. Thank you!
Prof. Ella Arensman
National Suicide Research Foundation
Department of Epidemiology and Public Health
University College Cork
Ireland
T: 00353 214205551
E-mail: earensman@ucc.ie
www.nsrf.ie