Suicide in NI: Where are we
This article will attempt to look at suicide in Northern Ireland. First, we will establish the problem which faces us. Then we will look at how the issue has been treated up to this point and then, finally, we will look at the possible methods for addressing the issue. I will not try to establish a detailed pathway to deal with suicide in Northern Ireland, as I feel like that would require a significantly larger bit of writing. However, I will try to make some observations on the issue of suicide in Northern Ireland and hopefully find some clarity in the information I have gathered.
-Establish the problem
There is a sizable amount of research completed on suicide and the issues surrounding the problem (however, more research could be done on treatment). The most obvious place to start is the suicide rate over the years in Northern Ireland: recently, we found out from a report on suicide that a third of reported suicides in the past five years were actually accidental drug overdoses (https://www.bbc.co.uk/news/uk-northern-ireland-54436324). Yet it should not be forgotten that over the past forty years, even when we discount the misreported suicides, we see suicides nearly triple in NI (1970 saw 73 and 2019 saw 197). From this, we can deduce that the NI suicide problem is not dissimilar to the suicide problem which can be found in the surrounding countries, meaning we are not suffering from a unique suicide rate. It should be noted that we may be on the precipice of a massive increase in the suicide rate following the pandemic. Many have pointed to the fact that early reports suggest a drop in suicide rates over 2020 but this is not due to an improved response to suicide. The rate will not increase during a crisis, the rate will increase in the emotional hangover following the crisis.
Knowing that the suicide rate is substantial and probably going to rise, we should build a profile as to who is likely to commit suicide. It has been well reported that the majority of those committing suicide are male, with more than two men committing suicide for every female suicide victim. Age is also a factor, as those aged between 25 and 34 appear to be the age group worst effected by suicide while the age groups surrounding them suffer from a much lower suicide rate, this rate then further reduces the old the group. (This could be inaccurate due to the misreported drug overdoses but the corrected 2019 figures generally follow the same pattern)
We can get even more specific, but this comes with the drawback of having to use research from 2009. This research found that one of the most vulnerable groups were divorced men between the ages of 20-34 (Corcoran, D and Nagar, A. 2009). Divorce in general (for women as well) would result in an increased chance of suicide. Interestingly, being married acted as a protection against suicide with the rate dropping significantly amongst married people.
Some other characteristics of NI suicide victims (according to an Ulster University report from 2016):
80% chance of have some form of prescription
40% chance of being on antidepressants
Men more likely to be drunk when committing suicide
Relationship difficulties are a leading cause of suicide
A third of victims had visited the health service within two months of their suicide (probably through primary care)
More likely to commit suicide if in a low to medium skilled job
More likely to commit suicide if living in an urban area
High likelyhood of self harm before a suicide attempt
-How NI has attempted to deal with it
There have been four attempts by the Executive to tackle the issue of suicide in the past two decades. The first came in 2006 where they sought to reduce the suicide rate by 15%, the second came in 2012 where they created a similar objective but highlighted the need to tackle the especially high suicide rate in less affluent areas. The third attempt in 2016 attempted to do the same as the previous two strategies and the most recent attempt in 2019 has stated its goals are the exact same.
All of these strategies, as things stand, have failed to create any noticeable dent in the suicide rate in Northern Ireland. Each report had the same criticism aimed in its direction: the plan had too many separate actions which were necessary to see its success and lacked a realistic and clear vision about how it would achieve its goals. By the end of the strategies, more than half of the goals were usually left unachieved and had failed to impact its main targets. Each new strategy has come back with slightly cleaned up intentions and a more obvious path way to success but each got caught up in the extremely complex and difficult multi-departmental and all encompassing issue that is suicide prevention.
We know that overly complex and intricate changes to multiple departments in the space of a few years is difficult. Additionally, part of the answer has to be cultural which can take even longer to change and has no obvious or easy framework to predictably work from. Large reform is needed, but our current political institutions have shown they are either unwilling to make significant changes or they are simply unable to reorganise themselves without getting tangled up in ways which only further complicate the existing issues. It feels like suicide prevention may be effectively asking the impossible of modern Northern Irish policy making.
-How to confront the problem?
The methods of suicide prevention are not always well researched and they are not always field tested however they do still offer some hope that suicide can be dealt with through policy. Some of the methods which are most commonly talked about are (Zalsman, G. 2016):
Emotional education for young people: this should prevent rash actions and helps people understand why they feel the way they do and how to cope with those emotions. School based mental health programmes have shown to help.
Media coverage: it must avoid propagating suicide techniques and avoid sensationalising suicides, even amongst celebrities, to avoid making it seem attractive. Instead, the media can help by presenting the alternatives to suicide and having respectful coverage of the suicide victims.
Pharmacotherapy (medication): has been successful but not as successful in countries associated with high levels of alcohol consumption which would suggest it may not be a complete solution for NI.
Primary care physicians and nurses training: Physicians and nurses can be trained to better identify those who might be depressed or exhibiting suicidal behaviour. Shows to generally be more helpful for women. Orlaithi Flynn currently has a private member’s bill in consultation phase which would effectively see this method enacted in NI.
Means restriction: this method focuses on restricting access to tools which are usually used in suicide. For example, the simple act of selling paracetamol in smaller doses and changing the packaging from a pot to blister packs saw a marked reduction in suicides from paracetamol overdose in Australia and the UK. This helpful but only works on certain kinds of suicide methods. However, it has been proven to work in the UK in the past.
Psychotherapy: has worked but needs further research to fully understand its full capabilities and where it can be productive.
Gatekeepers education: This methods involves educating local gatekeepers (teachers,community leaders, religious leaders) to appreciate the risks of suicide and better communicate the alternatives to those in their community. This does not help on a micro-level but does help normalise the feelings surrounding suicide. AA groups have particularly shown to help men.
When it comes to devising a perfect approach for Northern Ireland, the profile can be used to create a more NI specific model. The Private Member’s Bill for physicians and nurses (from Órlaithí Flynn MLA) would help but probably will not do much to tackle the male suicide rate. That is why media coverage and gatekeepers education (along with anonymous groups and phone services) should be used to hopefully tackle a stigma that does not just inhabit suicidal thoughts but inhabits the culture of NI which prevents men from opening up on emotional issues.
Additionally, education of the youth should be seen as paramount to preventing suicide as early as possible. Too often are young people left to figure these issues out on their own when emotional support could be started at an early age that would guide them towards alternative methods of dealing with negative emotions. By doing this, we would hopefully see early alternatives to damaging behaviour being presented to young people who, in their near future, would be the most likely to consider suicide as an option.
I would be wary of relying too heavily on the use of pharmacotherapy or means restriction methods. Both serve as brilliant short term solutions but completely neglect the fact that there are clearly underlying issues which have to be addressed and little will be solved for the next generation through restricted access to paracetamol or excessive prescriptions of antidepressants. At the same time, the people who have attempted suicide or those who suggest a high chance of suicide, whether that be a divorce, antidepressants or a recent traumatic even, should receive the adequate support which appears to have been lacking in some cases. This could even be something as simple as counciling being offered after someone experiences a divorce to ensure that they are in a sound mental state. Robbie Butler’s proposed Private Member’s bill on PTSD in emergency responders would likely be a brilliant starting point on this issue.
(some of these ideas have been somewhat addressed in the propsed 10 year Mental Health plan: https://www.health-ni.gov.uk/sites/default/files/publications/health/carers-ni-q3-20-21.pdf . But this plan also appears to have some possible planning difficulties.)
Conclusion
So how do we address the situation. I would hope that a single government minister would be tasked with instituting the changes needed as, so far, the multi-departmental approach has been lacking. The most obvious minister would be the health minister but the communities minister would be in a similarly advantageous position to tackle the societal issues which need to be addressed on this issue. That minister would create a 5 year plan that would not focus on reducing the suicide rate but focus on cultural phenomenons and institutional changes that would have a ripple effect of tackling suicide in Northern Ireland. Before all that is done, there needs to be an immediate look at how the pandemic has affected the people most at risk of suicide in Northern Ireland. Hopefully with that knowledge, a plan can be built that has a solid set of information to draw from. This plan would need mechanisms that allow for periodic self-reflection on how well the five year plan has done. However, that would need to be viewed as a starting point that allows for a continued governmental and cultural presence of mind when it comes to the ways in which our culture affects the humans that have to live in it.
