Bereavement

I wish to deal with the bereaved (referred to in literature as survivors) of the suicide death of a loved one. These form a neglected group with individual and collective problems. The psychological situation is distinct from the bereavement following natural death. Complicated grief is a newly defined and distinctive psychiatric disorder that occurs in response to a significant loss through death.

One of the first clinicians to call attention to the problem of suicide bereavement suggested that “the person who commits suicide puts his psychological skeleton in the survivors emotional closet, he sentences the survivor to a complex of negative feelings and, most importantly, to obsessing about the reasons for the suicide death”.

The usual response to a natural death is loneliness related to the loss of the relationship, helplessness, a feeling of being deserted. One has often an opportunity to work through ones feelings if the death was anticipated. Society encourages grieving and we lend support to the mourners. Help is offered during the mourning period. One learns to adjust and finally to recover. Survivors of loss by suicide have special problems. They are often subject to investigation by the Gardai, Coroners and Insurance Agents. The societal stigma associated with suicide often results in a lack of support for the bereaved when the support is most urgently needed. The suddenness of the loss precludes prior working through of feelings. The most prominent reaction of a person who suffers a loss by suicide is that of guilt.

Frequently there is no external cause to diminish guilt. In normal grief guilt diminishes and the inevitability of the death can be accepted. In suicidal death, the tendency to blame oneself, especially if there was conflict, is maximised. Another common reaction is anger. With natural death, there is anger at the desertion or with God for taking the person away. The deliberateness of suicide focuses anger on the deceased for his or her wilful desertion (she had no right to leave me). There can be a feeling that the deceased had the last word in a quarrel.

The adult survivor searches for meaning. With natural death, meaning may be dealt with spiritually (his time had come, he led a good life). Suicidal death, however raises many questions. Was the victim in his right mind? Will my children be likely to be suicide victims because of his suicidal death? Was the suicidal death a sin?

The suicide survivor often reaches for a scapegoat. If the victim had been in psychotherapy, the therapist is the obvious choice. If he was under doctor’s care, the doctor may be blamed. If he was an alcoholic this was to blame. There is need for a provision of special counselling for the bereaved. The survivor needs to reach an understanding of the suicidal death that preserves his own self-worth and satisfied his search for meaning.

He needs an opportunity to express his feelings in a non-rejecting atmosphere. He must be encouraged to mourn the loss and to consider life without the deceased in addition to dealing with suicidal nature of the death. It is important that we have in place assistance to those people made patients by no actions of their own.

Politics

I wish to outline the role which the political process played in bringing suicide out from the hidden Ireland and facilitated political debate in this serious public health issue.

In June of 1991, I researched a bill to decriminalise suicide. The front bench of Fine Gael sanctioned the Suicide Bill, which was published on the 10th June 1991. I introduced this bill, at Second Stage in Fine Gael Private Members Time on 27th and 28th November 1991.

This was the first comprehensive debate in the Oireachtas on suicide. The Bill decriminalising suicide finally passed both houses on the 3rd June 1993 and signed into law by President Robinson on 1st July 1993.

The decriminalisation of suicide has helped to reduce the stigma surrounding the area and has removed the added stress that a loved one who suffered death by suicide or those who attempt suicide are treated under the law as criminals. It has also implications for legal and insurance purposes.

In 1995, following discussions which the late Dr. Michael J Kelleher and I had with the then Minister for Health, Mr. Michael Noonan TD, he established the National Task Force on Suicide

The Report of the Task Force was published in January of 1998. Action must be taken to ensure that comprehensive suicide prevention programmes are introduced. It is not acceptable the recommendations of the National Task Force are not being comprehensively introduced.

It is not acceptable that the state has failed to set up an extensive network of community bases psychiatric services, bringing specialised, multi-disciplinary psychiatric services within easy reach and assessable to all citizens and referral agencies to that psychiatric services are readily available and acceptable to all.

The Department of Health must immediately introduce relevant training for the relevant health care personnel and give continuing education in matters relating to suicidal behaviour.

It is not acceptable that the Department of Justice, Equality & Law Reform has failed to ensure that coroner’s receive special training in psychological management of highly sensitive issues with particular reference to adjudicating on matters such as suicide.

It is not acceptable that the Department of Education & Science has failed to support teachers in respect of psychological and social dimension of their work through undergraduate and continued professional educational courses.

Inadequate progress has been made in initiating programmes aimed at teaching children about positive health issues including coping strategies and basic information about positive mental health at an early age as a natural part of their health education.

No move has been made whatsoever to cater for the young people in the out-of-school sector. The Department of Health and Children has made no effort to work with Youth Services, develop a social and personal health education programme, which should include modules on depression awareness and anger control skills.

Dialogue should be immediately entered into by the Department of Health with the Press regarding reporting of individual suicides to limit the reporting to particular cases where it is thought to be in the public interest to do so. Issues should be raised in this forum would be the exclusion of specific details as to the mode of suicide. Nothing should be written or said that might encourage others to end their lives.

No approach has been made to the television and radio stations to deal with suicide issues and related issues, sometime very effectively, to obtain agreement that programmes be accompanied by Help Line numbers and referral information. A detailed programme of research must be introduced regarding young suicides, those under 24 years, with a view to identifying and understanding the reasons why they occurred so that society may respond appropriately.

The state must provide access to children and young people at the time of crisis to appropriate support services and a comprehensive range of psychological and counselling services.

No consideration has been made by the Department of Health & Children regarding the psychological needs of older people whether due, for example to isolation or bereavement, and have them separately addressed by counselling and social intervention and the provision of specialised psychiatric services for older people which needs expansion.

No research or examination has been done with regard to the removing of the means, which are used to die by suicide. A strong programme of teaching all children to swim should be introduced as part of their general education there must be a programme of life-saving apparatus being made available at all appropriate places where there is easy access to water and all applications for firearms should be more carefully scrutinised.

The state must revisit the sale of paracetamol products. These should be restricted for sale through pharmaceutical outlets only. Special programmes must be introduced to respond to those who engage in acts of parasuicide. Professional help must be available as soon as possible after the event and that appropriate help professional contact is immediately made following the act of parasuicide and this should include the involvement of the person’s General Practitioner.

Special support must be introduced to general practitioners in looking after both the immediate and long terms needs of the parasuicidal patient

Ministers for Health and the Government as a whole must give prevention calls for an innovative comprehensive multi-sectional approach comprising both the leadership and provide the resources. Government must respond to all the needs of its citizens. This must include the unexpressed needs. The political system will respond to the expressed needs as it will gain votes. Political leadership must also respond to the unexpressed needs where the rewards at the polls are less obvious or absent. Suicide is as yet an unexpressed political need. I believe that to ignore it is not only politically irresponsible but bordering on the politically immoral.

The report entitled ‘A Vision For Change’ published in January 2006 outlined a new national mental health policy framework and was subsequently adopted by Government. This explicitly stated that a minimum of an additional €25 million was required annually for a six-year period to allow for the implementation of the mental health services expansion and improvement as outlined in the policy. This allocation was made in 2006 and 2007.

However we now know that of the €25 million allocated on 2006 only €17 million went towards developing the priorities set out in a Vision for Change. In 2007 only €10 million of the €25 million was allocated to the programme. The remainder was hived off by the HSE to cater for deficits elsewhere.

The programme for the Fine Gael/Labour Parties Programme for Government includes

We will ring fence €35m annually from within the health budget to develop community mental health teams and services as outlined in A Vision for Change to ensure early access to more appropriate services for adults and children and improved integration with primary care services. Part of the ring-fenced funding will be used to implement Reach Out, the National Suicide Prevention Strategy, to reduce the high levels of suicide.

Suicide is a human tragedy that has devastating impact upon not only the victims but also their families, friends, and colleagues. In this context, it may seem insensitive to attempt to place a monetary value on the costs of suicide mortality. The Department of Economics, NUI Galway has calculated the total cost of suicides in Ireland in 2001 at €906,662,836 and in 2002 at €835,662,917.

Research

Adolescence, the period between childhood and adulthood has gradually been extended during the 20th century. For many it stretches from puberty to the early or mid twenties. The pace of social and cultural change has never been faster. The life expectancy of most jobs is now less than 5 years and skills can fast become redundant. Individuals must become more and more adaptable. What is an opportunity for some is a threat to others.

Stresses affect both young men and young women although males are currently proving less adaptable to change in their status.

Education, which is a protection against suicide and attempted suicide must be broadened, particularly in the case of boys to encompass the various modern, social and domestic conditions.

Whereas the physical health of young people might be better in comparison with years ago the same cannot be said with regard to the social and psychological pressures to which young people are exposed. This is partly due to the increasing instability of family life and the changing sense of personal and family relationships.

I have since May of 1999 called for an establishment of a Task Force or Group to examine the pressures on young people, to determine the range and size of problems facing modern society and to determine the best methods of addressing them from a social, recreational and educational prospects.

I have raised this on many occasions in Dail Eireann, yet, little interest has been shown by either the politicians or the media on the need to examine such pressures.

I call again for the investigation and examination of, the pressures on young people to ensure that our services are competent and available to respond to their needs in a society that is changing so rapidly and placing materialistic pressures in which people look at a society that equates happiness with instant gratification, wanting it all and wanting it fast, where the favourite TV programmes are soap operas, where the world should be filled with the same good looking people dressed in the latest fashions with lots of money and prestige without having to work hard.

The volume of such unrealistic and unfulfilled expectations, appear to cause a measure of despair amongst young people.

IAS

Over the years Dr. Kelleher spoke about his intention to establish a National Association dealing with suicide. On the 14th September 1995 he wrote to me and confirmed his intention to establish an association and invited me to be the founding President.

The Irish Association of Suicidology had its inaugural meeting at Adare on the 26th October 1996. I was honoured to be elected President, Dr. Kelleher was appointed Chairman and Dr. John Connolly, Chief Psychiatrist, St. Mary’s Hospital, Castlebar was elected Secretary.

The present Chairman of the Irish Association of Suicidology is Professor Michael Fitzgerald, Professor of Child and Adolescent Psychiatry. The Secretary/treasurer is Dr. John Connolly Chief Psychiatrist, St. Mary’s Hospital, Castlebar, Co. Mayo.

The idea of setting up an Irish Association of Suicidology had been germinating for a considerable time before its birth. Perhaps the work of the National Task Force on Suicide was the final spur.

We felt there was no doubt of the need for an organisation such as this to act as a forum for a meeting point for all those interested in suicidology. For too long the many Groups, professional, voluntary and self-help involved in this field had ploughed a lonely furrow in isolation. No one Group has an answer to the tragic, multi faceted problem of suicide. It is only by the concerted effort of all of us acting in unison that it will be possible to achieve the objectives of the Irish Association of Suicidology, which are:

  • To facilitate communication between clinicians, volunteers, survivors and researchers in all matters relating to suicide and suicide behaviour.
  • To promote awareness of the problems of suicide and suicidal behaviour in the general public by holding Conferences and Workshops and by the communication of relevant material through the media.
  • To ensure that the public is better informed about suicide prevention.
  • To support and encourage relevant research.
  • To encourage and support the formation of Groups who help those bereaved by suicide.

The Association is affiliated to the International Association for Suicide Prevention, which helps to protect it from parochialism and will allow its members to influence developments in a larger stage while benefiting from innovative work done in other jurisdictions.

The International Association for Suicide Prevention (IASP), was established in Austria in 1960 and Dr. Kelleher was elected as Vice Chairman of this in 1996.

Through its public meetings and its publications and the publications of its members The Irish Association of Suicidology intends to influence the media in its reporting of suicide, so that the Irish community at large will benefit from the endeavours of those who, in their diverse ways, are tackling suicide and its aftermath.

Our Association and its individual members have played a leading role in highlighting this sad and tragic issue and focused attention on the need to introduce suicide prevention programmes based on comprehensive research and responding to the cultural and societal circumstances. In 2007, the Irish Association of Suicidology hosted the the International Association of Suicide Prevention World Suicide Conference which took place in Killarney, Co. Kerry.

In 1998, the Association of Suicidology has become a 32 county organisation with the co-option of 4 Directors from Northern Ireland to bring our numbers to 12. We are at a very early stage of tackling the suicide epidemic. Much taboo and stigma must be removed.

I will continue my work as President of the Association of Suicidology to promote the need for research and to carry out the aims of our association and in Dáil Éireann to ensure that the political system responds to the full implementation of the National Task Force on Suicide.

We must never forget that suicide is a terrible act against nature, causes desperate trauma to the bereaved family and community and must never be considered as a solution to any problem in any circumstances.