Although a vital suicide indicator, there are no guidelines for the assessment of self-harm, writes Michelle McDonagh
HAVING A history of previous non-fatal deliberate self-harm is one of the most important indicators in terms of those who go on to take their own lives through suicide, the director of research at the National Suicide Research Foundation (NSRF), Dr Ella Arensman, has said.
However, unlike many other European countries, there are no standard guidelines for the assessment of deliberate self-harm patients who present at A&E departments in Ireland, according to Dr Arensman.
"One study we carried out found that 17 per cent of people with non-fatal deliberate self-harm, ie who have taken an overdose or self-cut and survived the act, were not assessed on entering emergency departments in Ireland. I would say it's crucially important that every person who goes into a hospital having been involved in deliberate self-harm is assessed with an emphasis on identification of their risk of further self-harm and, more importantly, of suicide."
Researchers at the NSRF have found that Irish men are more likely to engage in repeated self-cutting than men in other countries where self-cutting is a typically female phenomenon. They are looking at the links between alcohol and self- cutting since men often use alcohol around the time of the deliberate self-harm act.
Last year, Dr Arensman and her team released their findings that most people take their own lives on a Monday in Ireland. Again, this is thought to be linked to the depressive effects of weekend binge drinking.
Dr Arensman said most people engaged in deliberate self-harm between 8pm-4am from Saturday to Monday, when mental health and other services were at their lowest.
"What is particularly important about these findings is that we are not doing research for the sake of research. If we know the incidence of self-harm peaks at night time and over the weekend, we know that's when intervention is required," she said.
"We also know that these people are not receiving the appropriate assessment when they present at emergency departments in this country."
Other NSRF findings reveal that men are more likely than women to end their lives by suicide and the highest risk group is among 15-34 year-old males. Single, widowed or divorced people are also at more risk as are the unemployed. Most suicide attempts are made in the home when others are present.
However, Dr Arensman said the majority of people within these high-risk groups did not go on to take the next fatal step and the big challenge for the researchers was to establish the specific profile of those who do.
"We do know nowadays that depression and alcohol addiction are important risk factors for suicide but, on the other hand, if we look at the entire population of depressive people, only a minority will take their lives.
"The next step we would like to achieve through our research is to find more specific predictors of who in these groups is at most risk of suicide so we can improve our assessment of people at high risk and intervene."
The NSRF is about to start an 18-month pilot study in Cork, funded and commissioned by the National Office of Suicide Prevention to develop a vitally needed suicide support and information system.
The main objective of this system, according to Dr Arensman, is to standardise support for people bereaved by suicide and to ensure that everybody is proactively approached in terms of their need for support. The other aim is to improve the NSR's knowledge of specific risk factors associated with suicide, a need that has already been highlighted by Dr Arensman.
The latest CSO figures on suicide show there were 481 deaths through suicide in Ireland in 2005. Dr Arensman said it was important to note that for over a decade now, there had consistently been more deaths through suicide in the Republic than through road traffic accidents.
"Over the last five years, Irish suicide statistics have remained stable with no indicators of a strong increase or decrease but, having said this, it remains the main cause of death in young men aged between 15-34 years."
Prior to taking up the position of director of research at the NSRF in 2003, Dr Arensman worked in the area of suicide research at the University of Leiden in the Netherlands since 1987.
"All of the research here in the NSRF is carried out under the umbrella of mental health research and public health but it simply doesn't get the attention it deserves. There is definitely a low emphasis on support and funding in the area of mental health and particularly suicide in this country. We are making progress, but very slowly and, in my opinion, too slowly."
•Organisations that help those involved in deliberate self-harm or suicidal behaviour include the Samaritans, tel 1850 60 90 90, Aware ( www.aware.ie) and Mental Health Ireland ( www.mentalhealthireland.ie)