Time for real action on suicide

MIND MOVES: Death by suicide is a disturbing reality that continues to impact directly on the lives of many people in this State.

As we face into 2006, it is worth considering whether there are grounds for feeling any more hopeful that we can reduce suicidal behaviour and the suffering it causes to so many in its wake.

The past year was a particularly active one for raising public awareness, establishing many important community initiatives and publishing comprehensive Government strategies pointing to how we can engage effectively with this problem.

As a society, there is no doubt that we have a much greater awareness now of the extent of suicidal behaviour. When a community sample of young men (aged 18-34 years) was asked if they knew someone who had died by suicide, 78 per cent said "yes", 42 per cent knew "more than one person", while almost one in five knew a "close friend" who had died by suicide.

Clusters of death by suicide have affected whole communities, leaving friends and families devastated and frightened. In one community alone, Clondalkin, 20 young men have died by suicide in the past year.

We have repeatedly heard the outcry of those bereaved by suicide to do more to prevent this needless loss of life from continuing.

The figures for suicide are staggering and, while statistics can seem cold, they do serve to identify the extent of this problem. Over the period 2000-2004, some 2,216 deaths by suicide were registered in the Republic. Men accounted for 1,784 (80.5 per cent) and women 432 (19.5 per cent) of these deaths.

This indicates a male/female suicide ratio of four to one. The greatest numbers of deaths were among males in the 20-29 year age group.

A closely-related problem concerns the numbers of people engaging in deliberate self-harm. In 2004, there were 11,100 presentations to hospital of individuals who had deliberately harmed themselves. The majority were girls and women aged 10-19 years.

Engaging in deliberate self-harm is a serious concern for all of us, because it is the strongest predictor of future suicidal behaviour. While there is evidence of growing expertise in place in A&E services to respond to this problem in a timely and expert way, there are still hospital settings where the required expertise is unavailable. This requires our immediate attention.

No single cause has been identified to explain suicidal behaviour. The reasons for suicide are complex and involve an interaction of psychological, biological, social and environmental factors that cause protracted pain over the course of a person's life. Very often, these individuals reach a breaking point when some particular personal difficulty is experienced. The perception that there is no way out and no possibility of rescue, coupled with the ready availability of lethal means to do harm to themselves, can lead to a heightened risk of suicidal behaviour.

I believe we are better equipped now to make a real impact on this major public health problem than ever before.

The publication of Reach Out - A National Strategy for Action on Suicide Prevention was launched in September 2005 and details a series of actions to be taken over the next five to 10 years to effect real change.

The imminent publication of a national policy on mental health for Ireland will detail the means by which mental health services can improve their response to people known to be at high risk for suicide.

In addition, a National Office for Suicide Prevention has been established within the HSE to implement and to co-ordinate the recommended actions in Reach Out. This development offers the possibility for firm leadership in this endeavour, to co-ordinate what have hitherto been important but fragmented initiatives, and the building of strong partnerships between statutory, voluntary and community groups and individuals; something that has been sorely lacking up to now.

Funding of this endeavour on a reliable, continuous basis must be given the priority it deserves in Government if we are to achieve the goals we are now setting for ourselves. As we go forward into a new year, effective suicide prevention will only succeed if the proposed strategies are established on a long-term basis, rather than being given injections of short-term funding in the wake of specific tragedies that are widely publicised.

Last March, President McAleese convened a forum in Áras an Uachtaráin of representatives from all areas of Government and the community to express her personal commitment to the area of suicide prevention and to encourage partnership among all the parties involved.

This event proved to be an important turning point in fostering a more co-ordinated response to suicide prevention in Ireland. Part of the strategy of the National Office of Suicide Prevention will be to continue this forum on an annual basis and to ensure that we are all aware of what is being done and how we can support each other in more effective ways, and to respond to the challenge that suicidal behaviour poses to everyone.

• Dr Tony Bates is principal clinical psychologist at St James's hospital, Dublin.