Behind the figures


Last week, a new report found that the Republic's suicide rate is 47 per cent higher than in the North, but is it really that black and white? Tony Bateslooks behind the figures

SUICIDE MAY not be an easy topic to discuss in polite company, but it's impossible to ignore. The frequency of suicide across the lifespan and across every social class disturbs and challenges us. We look to Government and non-government agencies to reduce the number of lives lost in this way, especially among our young.

A report published last Wednesday by the Institute of Public Health (IPH) has once again brought the subject into our collective consciousness. A unique feature of this report is that it presents statistics on a county-by-county basis for Ireland's 32 counties. It presents evidence of apparently dramatic variations in the occurrence of suicide north and south of the Border, and between the 26 counties themselves.

Glancing at the headlines that followed the launch - eg "Suicide rate is 47 per cent higher here than in the North" - one could be forgiven for believing that some locations in Ireland are perhaps less depressing than others. In fact, the statistics show that for every 100,000 people of the population, 12.4 died by suicide in the Republic (2001-2004), whereas 8.4 people died this way in the North.

There is a strange comfort in statistics; they limit our anxiety by defining the extent of a problem and they give us something solid against which we can measure progress - or the lack of progress - over time.

In the case of suicide, they allow us to contemplate the problem dispassionately, without ever having to imagine ordinary people whose pain was so crushing that suicide seemed to offer the only escape.

Reports like this IPH publication undoubtedly contribute to increasing awareness of suicide and garner support for public health strategies that have been proven to work if they are appropriately funded. But comparing rates of suicide north and south of the Border, without some clear discussion for the disparity in the statistics, runs the risk of adding to our confusion rather than enabling us to see the problem more clearly.

In fairness, the IPH report did caution that disparities in rates of suicide across the 32 counties may reflect differences in how suicide is recorded locally. What it neglected to mention is that the number of deaths, recorded as "undetermined", was significantly elevated in Northern Ireland between 2001 and 2004 (the time period covered in its report).

Conservative estimates would put the ratio of death by suicide to undetermined death at 5:3 in the North, compared with 5:1 in the Republic. It has become policy in the UK to factor in undetermined deaths when computing annual suicide statistics, but this practice has been slow to be implemented in Northern Ireland.

This means that for every death given the verdict of suicide in the South, there is another that may well have been due to suicide, but declared "undetermined", while in NI there are three deaths to every five deaths by suicide that may well have been a result of suicide.

If the rates of suicide reported by the IPH had factored in undetermined deaths in the North, the overall disparity between the two regions would have been halved.

Another shortcoming of the IPH report was that it gave no consideration to the historical context within which the statistics were computed. The period of 2001-2004 was prior to the implementation of the peace treaty. It brought to a close a period where suicide rates in the North were significantly lowered.

Whatever horrors were visited on that community during the Troubles, it was a time when death by suicide was reduced. Perhaps this was because communities on both sides of the divide were bonded together in an effort to survive against a common "enemy".

With the cessation of violence, however, there has been a dramatic upsurge in deaths by suicide. Anecdotal evidence from coroners in the North would suggest anything up to a 100 per cent rise in suicide rates.

Only time will confirm this impression, but it will be interesting to compare North-South suicides rates for the period 2005-2008 when those statistics become available.

In terms of the 26 counties, it is worth noting that 2001-2004 was a time prior to the publication and implementation of Reach Out, the comprehensive suicide-prevention strategy published in 2005.

Since then, the Republic has seen the establishment of the National Office for Suicide Prevention and an investment of just over €12 million over the past four years in suicide prevention. International evidence would suggest that it takes about 10 years to demonstrate the benefits of such a strategy, but already there is evidence that the rate of death by suicide in the South has steadied, if not declined slightly.

It is vital that we continue to invest in the Reach Outstrategy, because it can only achieve its full impact if its action plan is implemented as a whole and not in some piecemeal fashion.

Reports of suicide are much more to the fore of media coverage these days. This openness has a number of benefits: it has made mental health a social priority for the first time in our history and it has given rise to a number of national initiatives determined to respond effectively to those known to be at risk of self-harm and suicide.

Young people in particular have become a focus of concern. One statistic we have in common with Northern Ireland is that death by suicide is higher in the 15- to 24-year age group in this country than in any other western European country.

But our increased awareness of suicide tragedies can also bring with it a feeling of despondency and helplessness. There is a real danger that as a society we can feel like giving up, perhaps in the same way that people who are vulnerable to suicide feel like giving up.

We need to look to the evidence that we can make a difference. Australia is an example of a country that made a significant investment in mental health promotion and suicide prevention from 1995.

Studies have begun to appear which have evaluated the impact of this investment over the decade from 1995 to 2005 and to analyse the key factors that made a difference. And their findings are quite dramatic.

The graph above compares suicide trends in Australia and Ireland during those years. It shows a 50 per cent reduction in suicide rates across Australia in the 15- to 24-year age group, compared with minimal change in Ireland.

Analysis of what made the difference in Australia highlighted two factors: there was an increase in help-seeking among younger people and increased confidence right across the community to engage with young people in distress.

As a result, the incidence of depression and self-harm presentations to service providers increased significantly during that decade.

It seems clear that if we are serious about suicide prevention, we have to be open to acknowledging and responding to psychological distress rather than trying to make it go away.

The Australian experience suggests we cannot stop the pain that young people experience, but we can create networks of support right across the community that enable us to respond more effectively to their needs.

This means that every person concerned with the welfare of young people needs a greater awareness of what their world is really like and of the many different kinds of support they need in their journey to adulthood.

Sometimes they will need the practical help of a friend or family member to solve problems they face. Sometimes they will need the experience of a professional to help them become emotionally unstuck.

Above all, we need to believe in ourselves and to communicate to our young that the pain and heartache that comes our way does not in itself have the power to destroy us; that we have in us far greater power to heal and be made whole. And that it is precisely those times when we confront suffering that we discover an unbelievable resilience in ourselves. And we need to know that we are not alone and that there is no reason to feel ashamed when darkness falls.

Tony Bates is founding director of Headstrong - the National Centre for Youth Mental Health. See