About 500 people die by suicide every year in Ireland. Those working on the coalface of the problem say it’s closer to 10 deaths a week – eight of which are men. Today, on World Suicide Prevention Day, these people and others who have attempted suicide will be remembered.
In Ireland, we are no longer afraid to talk about suicide and there are now many charities supporting people through periods of extreme psychological distress who might otherwise have taken their own lives.
There is also more help for families and friends trying to understand and cope with the loss of a loved one through suicide.
But, do we really know what best helps people in acute emotional crisis? And do we have the psychological maturity to give people the support they need to prevent them from taking their own lives?
Caroline McGuigan is a psychotherapist with Suicide or Survive (SoS) and a former user of the psychiatric services.
She firmly believes that the keys to suicide prevention are within the community. “There isn’t one answer or one organisation. What works for you won’t work for me but if we invest in community, it can heal itself,” says McGuigan.
Struggles and vulnerabilities
She says that while we are talking more about suicide, we don't talk about our own vulnerabilities and struggles.
“Part of life is struggle and we need to challenge the idea that if you feel low or anxious that you are a lesser person because of it and that it’s something to feel ashamed or embarrassed about.
“I’ve learned time and time again that listening is the key and asking questions like, have you experienced this before? What did you do to help you through then? Don’t decide you know what’s best for the person. Don’t judge them. A paternalistic approach doesn’t work.”
According to McGuigan, what’s really important is to hold hope.
“The stressful thoughts and emotions do pass. It’s also very important to use the word ‘we’ when talking about getting support and remind the person that he/she is a valued and capable human being.
“Even in distress, a person can tap into the resources that got him/her through so far.”
The standard advice for anyone who is suicidal is to seek help from their GP, at their nearest A&E department or to phone a helpline.
Joan Freeman from Pieta House, the suicide and self-harm crisis centres, points out that if someone in acute distress arrives at their GP or A&E department, he/she needs to be seen "quickly, compassionately and efficiently".
“People can be waiting for hours among people who are physically ill and [when A&E departments are busy] many of those in acute emotional distress will leave the hospital without being seen,” she says.
She acknowledges, however, current HSE plans to put in place emergency care nurses who will fast-track individuals in acute emotional distress and/or with a history of self-harming.
Freeman says organisations such as Pieta House are an alternative to primary or secondary care with extended weekend opening hours and on-call therapists.
“Nine out of 10 people who come to Pieta House have no psychiatric history and their acute emotional distress is a reaction to a life event.”
Like McGuigan, Freeman says that family, friends, colleagues and neighbours are the most important component in suicide prevention. “More people are saved by their families and friends than organisations like ours. The problem is that most people don’t believe suicide will come to their door. They don’t believe something so tragic will happen because they have seen their loved one cope with distress before.”
For these reasons, Pieta House continues its awareness-raising campaigns – the most recent of which is the Mind Our Men campaign (mindourmen.ie) which aims to educate people about the signs of suicide – isolation, sleep disturbances, no interest in anything, seeing no future.
“The two main tipping points for men are the loss or lack of a significant relationship and uncertainty around work,” says Freeman.
Consultant psychiatrist Prof Kevin Malone, Department of Psychiatry, University College Dublin and at St Vincent's University Hospital, Dublin, says the main problem with suicide prevention in Ireland is that we dip in and out of it and "don't have a durational engagement with the problem."
He also believes that it’s time to pull all the “fragmented voices [within the charity sector] together in an integrated way”.
“There is a lot of duplication, work and energy put into keeping all these projects, associations and charities going. It would be more efficient to move to another level to make services more streamlined and sustainable,” he says.
According to Malone, 60 per cent of those who die by suicide have had a significant mental illness and the vast majority of people with suicidal thoughts are seen by the mental health services.
No uniformity of response
"The problem is it is still hit and miss as to whether you can get help, particularly in rural areas. We don't have the uniformity of high-quality response that is available in the cancer centres of excellence."
He commends the UK health strategy whose catch line is “no health without mental health” which has been incorporated into staff training, health information and services. And, the efforts there to follow up patients after discharge from hospital which has reduced suicide numbers.
“I think the best end game in Ireland would be statutory services working with the voluntary sector but you’ve got to have leadership from the very top of the political system for that to happen.”
The National Office for Suicide Prevention – nosp.ie – has a comprehensive list of organisations offering support to people who self harm and/or are in acute psychological distress.
suicideorsurvive.ie, tel; 1890 577577