Despite many commentators’ worst fears, and the dire circumstances thrust upon many people by the Covid crisis, suicides have not increased in the past year, figures obtained by The Irish Times indicate.
Charities and mental health experts warn, however, several factors may be protecting people with severe mental health difficulties for now, and fear the fallout post-Covid could be far worse than anticipated.
Definitive suicide data for 2020 will not published by the CSO until 2023 as inquests into suspected suicides will not be completed until later this year or next. Given the backlog in inquests – with coroners’ courts for several months last year – accurate data may not be available until even later.
The Irish Times, however, asked every coroner in the State to indicate how many files on suspected suicides in 2020 they had on hand.
Many declined, given that inquests had yet to be heard, though several provided data on the understanding their location not be published. None show an increase greater than one in 2020 compared with 2019 or 2018, and some indicate a decrease.
In a Leinster county, for example, the coroner recorded 10 suicides in each of 2018 and 2019 and had seven files of suspected suicides for last year. In another (also in Leinster) there were 12 in 2019 with 10 anticipated for last year. A Connacht coroner recorded eight for both 2018 and 2019 and estimates a total of six for last year.
It is a rare, relatively positive note in media coverage of the issue, but important to highlight, says Prof Ella Arensman, chief scientist with the National Suicide Research Foundation at University College Cork.
She says “sensational” headlines – especially in the British press – claiming a “tsunami of suicides” can be harmful.
“Those kinds of headlines could be really harmful for people who are struggling, and who may not be getting their usual, intensive kinds of psychological or psychiatric treatments. If they see again and again the statements about increased suicides on top of so many Covid deaths, it could have a harmful effect on them.”
It underscores the importance of the real-time suicide data being gathered in Cork city and county by the suicide and self-harm observatory, of which she is a member. The pilot project is funded by the Health Research Board.
“Every two weeks we have an update on suspected suicide cases,” says Prof Arensman. “So from March until August, for that period, there was no indication of an increase between 2019 and 2020.” She would like to see this contemporaneous suicide surveillance extended nationally.
GPs – who provide 90 per cent of mental health care – report no increase in suicidality in their practices but they are seeing first-hand the damage of the pandemic on emotional health. "Grief, financial loss, being out of work for the first time and isolation are major events in people's lives. Individuals are presenting with increased levels of stress, irritability, poor sleep and anxiety," says Dr Brian Osborne, assistant medical director with the Irish College of General Practitioners.
Access to supports
And while GPs have continued operating many report difficulties accessing mental health services for their patients. “Access for children and their families to CAMHS [Child and Adolescent Mental Health Services] can be problematic. A recent report showed that over 2,000 children are awaiting their first appointment,” said Dr Osborne. “Access to psychology in primary care is haphazard and again has long waiting times. At present in Galway there is an 18-month wait for this service.”
Those who have spoken to The Irish Times report mixed experiences. Ann’s daughter, aged 17, was taken to the emergency department by ambulance in October 2020. She had collapsed in school after an overdose.
Though she had “come round” by the time Ann got to the school, the paramedic advised her to let them bring her daughter to hospital “as the best way to get fast-tracked into CAMHS”.
“Within three days we had an appointment. We had a psychologist and a psychiatrist and the psychiatrist scared the pants off us. We just had not realised just how passively she did not want to be in this world. Your heart just breaks for them. We were so lucky. We got in quickly to services. Somebody was looking after us.
“Right now she has a job, she’s writing music and in some ways it was the best thing that ever happened to us. It brought everything to the fore. We didn’t realise how much one particular teacher was making her life a misery – that’s very insidious.”
Frank, however, feels cut off from his mental health supports since last year. He is diagnosed with borderline personality disorder, anxiety, depression and work-related post-traumatic stress, and has made a number of serious suicide attempts since 2016. He has been hospitalised several times and has just started a community programme in dialectical behavioural therapy, online.
“I hate online. It’s horrible. I get a call from my mental health doctor every few months. You feel they’re ticking boxes. If they call on a good day I’m good. If they call on a bad day the world is crashing in around me and I just try to get them off the phone. When I’m like that I don’t want to talk to anyone, just want to curl up on the bed and just die.”
He feels vulnerable, he says, and “not supported at all”.
Mental health organisations all report increased demand, with many reporting increased suicidality among clients, callers and texters.
Leigh Kenny, Dublin region manager with Pieta House, says: "We have been seeing an increase in demand for services for sure. We had a 25 per cent increase in calls and texts between December 2019 and December 2020, so had to double the size of our helpline team to manage that."
At spunout.ie, which has run a 24/7 crisis text line aimed at those under 35 since last summer, said there was a 10 per cent increase between December 2020 and January 2021 in the number of conversations mentioning suicide. The ISPCC, which also provides a 24/7 text line, has had an average of 35 children a week talk about suicide, since early December. "We are definitely seeing an increase in anxiety, stress and sadness," says John Church, the society's chief executive. While at the start of the crisis children feared Covid and loved ones getting ill, now they feel isolation and loss, and worry about the pandemic never ending.
“It’s about the impact on their sense of selves, anxious about the future and being happy again.”
Thomas McCann, co-ordinator of the Traveller counselling service, reports: “We have a lot more clients in the past year and a lot more suicidal ideation – about 25 per cent of calls include suicidal thoughts.
“There’s increased inter-family tension, overcrowding, greater demand on addiction services, and of course accessing supports is more difficult when they are online.” He repeats his call for an ethnic identifier in suicide statistics.
Suicide prevention strategies
The question is: Why is all this not translating into increased suicide rates?
Prof Arensman says rates have remained steady throughout the pandemic in higher-income countries such as Ireland. Striking too, she says, is that most have completed at least one national suicide prevention strategy. “We have had years of investment in awareness raising, reducing the stigma about mental health. I do not think we would have kept the figures as low if we had entered Covid-19 with very high levels of stigma. There has been some buffering as a result of a lot of hard work, by an enormous amount of people, over the past 15 years.”
Rory Fitzgerald Ireland director for the Samaritans agrees greater awareness of mental health means "services like ours, like Alone, Pieta House are widely publicised".
Several speakers caution, however, there may be a protective factor in the universality of the current crisis – that people are “hunkering down” and “getting through it” – but a profound level of post-traumatic stress after the pandemic, compounded in many cases by job losses, long-Covid, evictions and other challenges, may loom.
For many, warns Fiona Coyle, chief executive of Mental Health Reform, "the worst may be yet to come" given the wearing impact the pandemic will have had on people's emotional resilience. If anything good can come, she hopes it will be that the importance of strong mental health services is firmly established. "We need investment. Never before have we as a nation been so united on that.
“The other good thing is that for years mental health has been focused on the individual. There hasn’t been a widespread acknowledgment of the role social circumstances and inequality have in mental health. I think people are becoming more aware of that due to Covid.”
Echoing her, Martire says: “Mental health is a social justice issue. People experience disparities in their mental well-being in social inequalities, and disparities accessing services.
“Homelessness, poverty, abuse in the home, financial insecurity. A lot of these are related to things the State could do to improve conditions and outcomes. These have tangible mental health outcomes and Covid has exposed these.”
– Pieta House, 1800 247 247, text HELP to 51444.
– Samaritans, 116 123, email@example.com.
– Suicide Or Survive, 1890 577 577, firstname.lastname@example.org.
– Aware, 1800 80 48 48, email@example.com.
– Childline, 1800 666 666, text 5101.
– HSE Drugs and Alcohol helpline, 1800 459 459, firstname.lastname@example.org.
– Traveller Counselling Service, (01) 868 5761, 086 308 1476, email@example.com.
– HSE Crisis Text Service, Text 50808.
– St Patrick's Mental Health Services, (01) 249 3333, firstname.lastname@example.org.
– Alone, 0818 222 024, email@example.com