Dáil Debate in Dáil Éireann introduced by Deputy Dan Neville on 13th February 2013
The relationship Between Alcohol, Suicide and Self-Harming
Deputy Dan Neville
I thank the Ceann Comhairle for allowing me to raise this issue.
While the connection between alcohol abuse, suicide, attempted suicide and self-harm is internationally recognised, it is not highlighted often enough. Alcohol dependence often leads to social decline and isolation, which is a potent cause of suicide. Alcohol dependence leads to loss of self-esteem and, hence, depression. These psychological changes predispose people to suicide. Intoxication produces increased impulsiveness and the weakening of normal restraints against dangerous behaviour. This is very important in the context of suicide. Alcohol abuse may be secondary to and an attempt to cope with recurrent episodes of depression.
Little information is available on the position or role of alcohol in the suicides of non-alcoholics, but some studies indicate that a proportion of these people had been drinking shortly before their deaths, perhaps to bolster their courage. It is well established that people who become dependent on alcohol have a high mortality rate through suicide. We also know that if a person who is mildly depressed, particularly a young person, is involved in heavy binge drinking, a period of severe depression can follow for a period. Long after the effects of the alcohol have waned, depression remains. Some research indicates that this could last for from eight to more than 12 hours after a binge drinking session.
With regard to self-harm, the Minister of State is aware that last year, 2011, there were 12,216 presentations to hospital emergency departments in this regard, involving 983 individuals. These presentations demonstrated repeated acts of self-harm and the impact of alcohol on self-harming. During the period 2006 to 2011, the National Suicide Research Foundation in Cork, which keeps the register on this, identified 45,284 individuals involved in 69,581 self-harming presentations. Some 35% of presentations within this period were due to repeat acts. A total of 374 individuals were involved in ten or more repeated acts of self-harm during that period.
Nationally, overdose involving either prescribed drugs or over-the-counter medication, or both, was the most frequently used method of self-harm across all repeated presentations. However, people who had used alcohol at the time of the indexed self-harm act engaged significantly more often in intentional overdose compared with those who had not. Those who used alcohol had also engaged more often in highly lethal methods when they presented after repeat self-harm incidents. People who had not used alcohol in the indexed self-harm act had engaged in self-cutting significantly more often when they presented for repeat incidences. Therefore, those who used alcohol had more serious and more dangerous attempts at self-harm than those who did not abuse alcohol in the same way.
Deputy Kathleen Lynch (Minister of State at the Department of Health)
I know there is limited time for these issues, but I would like to say that the figures Deputy Neville has given are simply the tip of the iceberg. Presentations to hospital emergency units are simply a reflection of the depth and scale of the difficulty. Deputy Neville will agree that when we talk about self-harm, it is not just about people who cut themselves or people who take deliberate overdoses, but also people who drink heavily on a regular basis. I commend Deputy Neville for having been speaking about this issue at a time when most of us found it uncomfortable to do so. I commend him on his work in this area down through the years.
The misuse of alcohol has long been recognised as a contributing factor in many suicides. Our national strategy for action on suicide prevention, Reach Out, recognises that alcohol and substance misuse are strongly related to deliberate self-harm and suicidal behaviour. The Government recognises that we can no longer be tolerant or ambivalent when it comes to the pattern of alcohol consumption and the problems for which alcohol is responsible. A survey on alcohol consumption and alcohol-related harm in Ireland, which was published last year, found that alcohol-related harm is not restricted to the drinker but has negative consequences for families, friends and the wider community. Approximately 20% of respondents experienced some form of harm as a result of their drinking, with men twice as likely as women to report harm. Harm of others as a result of drinking was experienced by 27% of respondents.
In order to counteract the harm caused by the use and misuse of alcohol, real and tangible proposals are being finalised on foot of the recommendations in the national substance misuse strategy report, which was published last year. These proposals cover all the areas mentioned in the report, including legislation on minimum unit pricing, which is about setting a statutory floor price per gram of alcohol. There are also proposals relating to access to and availability of alcohol, including structural separation in retail units where alcohol is sold, as well as advertising and sponsorship. Following consideration by the Cabinet committee on social policy and liaison with other Departments, my colleague, the Minister of State, Deputy White, intends to introduce specific proposals for consideration by the Government as soon as possible.
Suicide is a tragedy that we are constantly working to prevent. We are also working to give more support to families affected by suicide. Reach Out makes a number of recommendations with regard to fast-track referrals to community-based mental health services, effective responses to incidents of deliberate self-harm, training and stigma reduction, etc. As a consequence, the HSE’s National Office for Suicide Prevention has developed a range of initiatives to support people who are suicidal. The office is also working to help the families, friends and peers of such people to recognise and respond appropriately to signs of emotional distress and suicidal thoughts. In 2012, the office made progress with a number of key initiatives, including the provision of a wide range of awareness and training programmes, the continuation of the national awareness campaigns, the funding of partner agencies and projects and the development of the recently launched guidance for post-primary schools on mental health and suicide prevention, which were developed with the Department of Education and Skills.
The annual budget for suicide prevention increased this year to over €13 million, with €8.1 million available to the National Office for Suicide Prevention to fund voluntary and statutory agencies’ delivery of services in the areas of prevention, intervention, post-intervention and research. The remaining €5 million is available regionally to fund resource officers for suicide prevention, self-harm liaison nurses in hospital emergency departments and local suicide prevention initiatives. The office is working to integrate current programmes within the sector and to provide a strategic framework for co-ordination of the extensive range of actions in this area.
Deputy Dan Neville
I thank the Minister of State for her reply. I recognise the work she has done to develop the National Office for Suicide Prevention over the past two years. The office’s budget has doubled from €4.1 million in 2012 to €8.1 million in 2013. Our ambition is to see the level of funding increase to €10 million. I am sure we are on the way to doing that. The Minister of State referred to those who do not attend accident and emergency departments after attempting suicide or self-harming. Research conducted in the UK by Professor Keith Hawton, who is a great friend of the Irish Association of Suicidology, shows that for every one person who presents at an accident and emergency department in these circumstances, eight people do not present. They might go to their general practitioner, or they might not inform anybody of what has happened because of the stigma surrounding these matters. Dr. Ella Arensman, the director of research at the National Suicide Research Foundation, has confirmed that international research corroborates Professor Hawton’s figure. If international research by such distinguished scholars and suicidologists is indicating that between 60,000 and 80,000 people deliberately self-harm in Ireland every year, it is clear that we have a serious problem in this regard. I would like the Minister of State to respond to some of the recommendations that have been made by the National Suicide Research Foundation on foot of its work in this area. The foundation recommends that starting at pre-adolescent age, national strategies should be intensified to increase awareness of the risks involved in the use and misuse of alcohol. It also recommends that we should escalate our efforts to reduce access to alcohol and arrange active consultation and collaboration between mental health services and addiction treatment services in the best interests of patients who present with dual diagnoses, such as psychiatric disorder and alcohol abuse. Finally, it recommends that assessment of alcohol misuse and abuse should be a structural part of the work that is done when the risk of repeated self-harm and suicide attempts is being determined.
Deputy Kathleen Lynch
I thank the Deputy for his work in this area. I fully agree with the final point the Deputy made about the need to include excessive alcohol consumption and abuse of alcohol in our consideration of the definition of self-harm. When people who have engaged in self-harm present themselves at accident and emergency departments or general practitioners’ surgeries, or contact the health services in some other way, we should take that as an early warning and ensure not only that they are referred to the appropriate services but also that their cases are followed up. That is why, in conjunction with the National Office for Suicide Prevention, we are putting specifically trained nurses into our accident and emergency departments. In the immediate aftermath of incidents of self-harm, the people in question might be traumatised because of the harm they have inflicted on themselves or might be quite drunk and therefore incapable of responding. The following morning, when they have been stabilised, these specially trained nurses will bring them through a follow-on process to ensure they keep the appointments that are made for them with more appropriate services.
I will take on board everything the Deputy has said. Everyone in the country is determined to come to grips with this problem, and any input is very welcome. I thank the Deputy.