In February 2002 the organisation of Economic Co-operation and Development (OECD) published a report, which placed Ireland second in a league table of people under 25 year olds who take their own lives. New Zealand was top of the league. Ireland scored a rate of 10.3 per 100,000, which compares to an average of 5.6 per 100,000 in other OECD countries. The UK has a rate of 3.3 (see appendix) The World Health Organisation places Ireland 4th highest in Europe after Latvia, Lithuania, Estonia and Finland.

One of the areas where everybody experiences is attendance at school and therefore every child in the country is in contact with teachers, 5 days a week for 40 or more weeks of the year. This has led to intervention, in other countries, within the school system with a view to preventing suicide and parasuicide.

There is division, however, as to how this might best be done. There are approaches that involve teachers and approaches that involve students. The greatest controversy affects the latter.

Should students participate in Suicide Awareness Programmes?

If so, should they occur in primary, secondary and third level institutions? Some researchers are against this, believing that such programmes may induce the very thing they are trying to prevent.

There is no doubt, however, that the formal education of our young people should be widened to encompass the needs of their social and emotional development. The Leaving and Junior Certificate examination, essential though they are, may have a constraining influence on such matters. The measures of success in later life has more to do with the ability to create and sustain relationships and less to do with points and position at a particular moment in time.

In the final analysis, personality has a greater determining effect upon achievement than does intelligence. There is both room and a need to prepare our young for those wider dimensions of life. The physiological and counselling services within our schools need development. The National Task Force on Suicide recommended that teachers, at all levels, be supported in respect of the psychological and social dimension of their work, through undergraduate and continued professional educational courses; that programmes should be initiated aimed at teaching children about positive health issues, including coping strategies and basic information about positive mental health at an early stage as a natural part of their health care curriculum and that psychological services delivered to schools by the Department of Education and Science be extended so that the needs of all students can be met without undue delay.

The voluntary sector may contribute to this. Members of the Irish Association of Suicidology have contributed through active collaboration, both in the school system and with organisations such as the National Youth Council and St Vincent de Paul, which endeavours to better the life circumstances of people.

On a more positive note it should be emphasised, that research has shown that remaining within the school system between the ages of 16 and 18 may have a protective affect against young suicides or put differently, leaving school early is a vulnerability or disposing factor. The rate of suicide among those who leave school between the ages of 16 and 18 in Ireland is higher than among those who stay on.

It should be emphasised however that those who leave school early may be of a more deprived social background; may come from more disturbed homes; may be more likely to experience the harmful affects of alcohol and drugs; may be more likely to suffer illness and physiological disability; or, leaving school may have reflected a lack of purpose in terms of meaningful attainable goals in their lives. Whatever the association, every encouragement should be given to youngsters to stay at school.

Examinations themselves do not appear to be as directly linked to suicide as had been previously suggested. Every case of suicide occurring in a young person of school-going age was examined over an 18-year period between 1976 and 1993 in Ireland. The exact date of death was determined in each case.

It was hypothesised that if the state examinations were important in young suicides, then the timing of these deaths should be related to the sitting of the examinations and the issuing of the results. The students sit Leaving and Junior Certificates in June and the results of the former come out in August and the latter in September. For young people in general there is no variation in the monthly rate of suicide that would suggest that neither the sitting of the examinations nor the issuing of the results is an important cause.

Examinations contributed to little more than a handful of suicides over this 18-year period. Such research should act as a corrective to the very occasional outlandish newspaper reports, which blame examinations for the rise in young peoples suicides.

Suicide rates are declining in a number of Western and non-Western countries. Particularly in youth (below 25 years of age) these decreases are remarkable. Since 1997, Australia has witnessed a 32% decline in this age group. Other important declines have been recorded in New Zealand, USA, Canada, Scotland, England and Wales. Parallel decreases have not been noticed in the 25–34, nor in the 34–44, which have not declined at all in Australia. This fact has raised speculations about the possible presence of a cohort effect, but it is unclear which components of these supposed cohorts can actually make a difference. Professor Diego de Leo the President of the International Association of Suicide Prevention has pointed out in December 2002

It is also unclear why suicide rates are declining. We formulated reasonably convincing hypotheses about the motives for past increasing rates in youth suicide, but now we face perplexing questions about the possible role that increased antidepressant treatments, increased number of mental health operators (with better training), and the increased number of psychotherapy opportunities may play. Can the current decline be attributed to these factors?

The recently released WHO World Report on Violence and Health (Brussels, 3rd October 2002) estimated that the global number of suicides was 815,000. While still an enormous issue, compared to the previous Health Report, 20,000 less cases were reported.

Parasuicide

In 2010, 11,966 presented to hospital involving 9,630 individuals due to attempted suicide and self harming. This was an increase of 5% from 2008, 45% ubder 30 years of age.

The male rate of deliberate self harm was 205 per 100,000, 4% higher than 2009. The more pronounced increase in the male self harm rate was the 10% increase in men aged 20–24 years. The female rate for 2010 was 231 per 100,000, 4% higher than 2009.

In 2010 there were a number of notable changes in the age-specific deliberate self harm rate between 2009 and 2010 but the most striking by far was among 20–24 year-olds. The rate among men in this age group increased by 19% and among women increased by 30%. See NSRF.

Media

I wish to deal with the effect of the media. The media is only one factor involved in some suicides. Suicide is a complex phenomenon and the paths to suicide are varied and many. There is no single cause for suicide but many interweaving influences and factors that come together to shape that final horrific act.

Concern over how individual suicides are reported in the media has arisen from studies that have indicated a risk of copycat suicides, particularly amongst adolescents and young adults. There is a general agreement that reporting suicide is important and can be beneficial. There is more dissent over the nature of the coverage.

Suicide by imitation has long been recognised. In the US, well-publicised clusters of youth suicide appear to have occurred following sensationalised, insensitive, and inappropriate coverage of suicide.

There is a fine line between sensitive, intelligent reporting by the media and sensationalising the issue. The focus should be on educating and informing the public rather than trying to shock, present graphic details or worse, titillating.

Perhaps the most important guiding principle is to consider the reader, listener or viewer, who might be in crisis when they read, hear or see the report.. Will this piece make it more likely that they will attempt suicide or more likely that they will seek help?

Is the report likely to cause extra, unnecessary pain for relatives and friends of the deceased person?

The media obviously can play a very important positive role in the efforts needed to provide accurate information and greater understanding of suicide. But the reporting of incidents of suicide and self-harm raises some difficult issues. Suicide is generally newsworthy, and it is right that it should be reported. The public has a right to be informed of tragic events in their midst. But the ethical and professional standards that should govern the reporting of human tragedy have never been easy to determine. The rights of the media to inform and of the public to know should not extend to a level of detail or intrusiveness into the lives of the bereaved which only caters to morbid curiosity and aggravates the burdens of a grieving family. The Code of Practice of the Press Council of Ireland requires that sympathy and discretion must be shown in seeking information in situations of grief and shock, and that in publishing such information, account should be taken of the feelings of grieving families. In the case of suicide there is an added reason for discretion and restraint in that research shows that explicit descriptions or pictures can provoke imitative behaviour and lead to so-called copycat suicides.

The media therefore has a heavy responsibility in the manner in which it reports incidents of suicide and self-harm. I know that they are anxious to meet that responsibility. The guidelines which have been assembled by the IAS and Samaritans are of great help in this regard. They are informative, comprehensive and based on solid data and research. Click here for details of IAS/Samaritans media guidelines.

Copycat

Suicide clusters represent a dramatic increase in observed over expected number of suicides in a community. Copycat suicides and cluster suicides may occur following direct exposure to the suicide of a friend or acquaintance and in cases where the victims were known to each other or through indirect exposure where the victims knew of the initial suicide in the cluster through accounts in the media or by word of mouth. Research shows that persons attempting suicide had an unusually large number of suicidal friends.

Clusters are compared to an epidemic or outbreak of a disease, which will end when all those susceptible to the disease will have contracted it or in this case have committed suicide. The precise nature of the imitative process is not understood.

Individuals are more likely to imitate a model’s suicide if they identify with the characteristics they attribute to the model. During a cluster of suicides and potential suicides they may identify more closely with those who die violently if their own past includes similar violent experiences such as suicide attempts or threats of inter-personal violence.

In research completed in the UK the groups most at risk of suicide, were identified. The estimated magnitude of increased risk in the following groups was identified.

High Risk Group Estimated magnitude of increased risk
Current or psychiatric patients x10
4 weeks following discharge from a psychiatric hospital x100/200
History of self harm x10/30
Alcoholics x20
Drug mis-users x20
Prisoners x5
Doctors x2
Farmers x2
Unemployed x2
Samaritan clients x20

Signs

People often show their suicide feelings by

  • Being withdrawn and are unable to relate
  • Having definite ideas of how to commit suicide, and maybe speaking of tidying up affairs, or giving others indications of planning suicide.
  • Talking about feeling isolated and lonely.
  • Constantly dwelling on problems for which there seems to be no solutions.
  • Expressing the lack of supporting philosophy of life, such as a religious belief.

Myths

There are some myths, which should be dispelled with regard to the general view of people who are suicidal. It is generally felt that people who talk about it don’t commit suicide. This is not so. Most people who kill themselves have given definite warnings of their intentions.

It is believed that suicidal people are absolutely intent upon dying, this is not so. Most suicidal people are ambivalent about living and dying. They gamble with death but may retain their desire to live.

People feel suicide happens without warning. This is not so. Suicidal people often give indications of thoughts (sometimes before the thought becomes intentions) by words and actions.

It is believed that once a person becomes suicidal, he or she is suicidal forever. This is not so. Suicidal thoughts may return but they are not permanent and in some people they may never return.

It is believed that after a crisis, improvement means that the suicide risk is over. This is not true. Many suicides occur in a period of improvement when the person has the energy and the will to turn despairing thoughts into self-destructive actions. Suicidal behaviour is often felt to be a sign of mental illness. This is not fully true. Suicide behaviour indicates deep unhappiness but not necessarily mental illness.

It is felt you are either the suicidal type or you are not. In fact suicide could happen to anybody.