Suicide is Suicide is everybody’s everybody’s business- Why?business- Why?Dr Vincent RussellDr Vincent Russell

Living Links Conference 18/9/10Living Links Conference 18/9/10

OverviewOverview

Introduction & BackgroundIntroduction & Background The problem of isolation and stigmaThe problem of isolation and stigma De-mystifying what can help De-mystifying what can help Why is suicide everybody’s business?Why is suicide everybody’s business?

The problem of wordsThe problem of words

Suicidal thoughts- common- up to 13% of Suicidal thoughts- common- up to 13% of population population

Only 1 in 200 people with suicidal thoughts die Only 1 in 200 people with suicidal thoughts die by suicide by suicide

Suicidal behaviour occurs with widely varying Suicidal behaviour occurs with widely varying orientation towards deathorientation towards death

Suicide attempts are 20 times commoner than Suicide attempts are 20 times commoner than completed suicidecompleted suicide

Suicide attempters and completers- largely Suicide attempters and completers- largely separate groups with a small overlapseparate groups with a small overlap

Suicide Prevention – what Suicide Prevention – what works? works?

Suicide usually results from the interplay of Suicide usually results from the interplay of multidimensional factorsmultidimensional factors

Prevention should be aimed at high risk Prevention should be aimed at high risk groups and at the population as a wholegroups and at the population as a whole

Socio-economic events have historically Socio-economic events have historically produced major fluctuations in suicide ratesproduced major fluctuations in suicide rates

Interventions with high risk groups will be Interventions with high risk groups will be less likely to reduce suicide rates than less likely to reduce suicide rates than changes affecting the whole populationchanges affecting the whole population

Suicide and AlcoholSuicide and Alcohol

Estimated 8-fold increase in suicide risk in Estimated 8-fold increase in suicide risk in the presence of current alcohol misusethe presence of current alcohol misuse

Per capita consumption of alcohol in Ireland Per capita consumption of alcohol in Ireland increased by 41% between 1989 and 1999increased by 41% between 1989 and 1999

Study in East Cavan- alcohol reported by Study in East Cavan- alcohol reported by young men themselves as their biggest young men themselves as their biggest problemproblem

Effects of alcohol may be more significant Effects of alcohol may be more significant on the male brainon the male brain

Suicide and Mental Suicide and Mental IllnessIllness

Virtually every mental disorder increases Virtually every mental disorder increases suicide risk suicide risk

Therefore- widely available effective treatments Therefore- widely available effective treatments are essentialare essential

Greatly increased risk in Mood Disorders, Greatly increased risk in Mood Disorders, Alcohol/ Drug Abuse, Schizophrenia, Alcohol/ Drug Abuse, Schizophrenia,

Suicide and Young MenSuicide and Young Men

Definite High Risk Group in IrelandDefinite High Risk Group in Ireland Strong association with alcohol Strong association with alcohol Less likely to attend professional services Less likely to attend professional services

before deathbefore death Often significant life event (usually break-up in Often significant life event (usually break-up in

relationship) before deathrelationship) before death More likely to be in unskilled jobs or not to More likely to be in unskilled jobs or not to

have completed secondary schoolhave completed secondary school

Key Issues in Suicide Key Issues in Suicide Prevention in IrelandPrevention in Ireland

Alcohol PolicyAlcohol Policy The position of young men The position of young men Social/Mental Health Services Social/Mental Health Services Primary Care ServicesPrimary Care Services The economic situationThe economic situation The need for active partnerships within The need for active partnerships within

communities to reflect on the problem communities to reflect on the problem and generate potential solutions and generate potential solutions

The challengeThe challenge

““Suicide prevention remains a land of Suicide prevention remains a land of hopes and promises but not of hopes and promises but not of certainties. This should not induce certainties. This should not induce discouragement, but must be interpreted discouragement, but must be interpreted as a stimulus to do more and do it better as a stimulus to do more and do it better while avoiding past mistakes”while avoiding past mistakes”

No man is an island?No man is an island?

““No man is an island, entire of itself; every man is No man is an island, entire of itself; every man is a piece of the continent, a part of the main…a piece of the continent, a part of the main…Any man’s death diminishes me, because I am Any man’s death diminishes me, because I am involved in mankind; and therefore therefore involved in mankind; and therefore therefore never send to know for whom the bell tolls; it never send to know for whom the bell tolls; it tolls for thee” tolls for thee”

(John Donne 1624)(John Donne 1624)

ImpactImpact

““On average, every suicide intimately On average, every suicide intimately affects six other people and the impact affects six other people and the impact can be on hundreds when it occurs in a can be on hundreds when it occurs in a school or workplace” (WHO, 2000)school or workplace” (WHO, 2000)

StigmaStigma

Any attribute, trait or disorder that marks Any attribute, trait or disorder that marks an individual as being unacceptably an individual as being unacceptably different from the ‘normal’ people with different from the ‘normal’ people with whom he/she routinely interactswhom he/she routinely interacts

Reinforces denialReinforces denial Reinforces delay in getting helpReinforces delay in getting help Increases isolationIncreases isolation

Isolation vs “Living Isolation vs “Living Links”Links”

The individualThe individual

The bereaved familyThe bereaved family

The caregiverThe caregiver

What clinicians do?- not a What clinicians do?- not a mysterymystery

Good patient-centred clinical care is Good patient-centred clinical care is always the best risk managementalways the best risk management

The aim is to systematically identify The aim is to systematically identify modifiable suicide risk and protective modifiable suicide risk and protective factors and to treat these factors factors and to treat these factors aggressivelyaggressively

The Standard of CareThe Standard of Care

Suicide itself cannot be predicted- only Suicide itself cannot be predicted- only the risk of suicide can be predictedthe risk of suicide can be predicted

Pressures on care givers can lead to Pressures on care givers can lead to defensive practices not all of which defensive practices not all of which support good caresupport good care

Suicide risk assessment is like weather Suicide risk assessment is like weather forecasting- more accurate in the very forecasting- more accurate in the very short termshort term

Wounded HealersWounded Healers

We are human variants- some of us have We are human variants- some of us have gilded genes and squaky clean families gilded genes and squaky clean families of origin- most of us are not so fortunateof origin- most of us are not so fortunate

We are made more vulnerable yet We are made more vulnerable yet stronger by these sticks and stonesstronger by these sticks and stones

Overcoming stigma in ourselves is a life-Overcoming stigma in ourselves is a life-long challengelong challenge

Risk/Protective FactorsRisk/Protective Factors

A. A. Actuarial or FixedActuarial or Fixed AgeAge GenderGender Socio-economic GroupSocio-economic Group RaceRace Sexual orientationSexual orientation OccupationOccupation Family historyFamily history Past history- psychiatric, medical, self, harm, Past history- psychiatric, medical, self, harm,

impulsivity etcimpulsivity etc

Risk/Protective Factors Risk/Protective Factors contd.contd.

B- B- ModifiableModifiable- factors you or others are in a - factors you or others are in a position to do something aboutposition to do something about

Access to MeansAccess to Means Mental disordersMental disorders Alcohol/Drug AbuseAlcohol/Drug Abuse Medical IllnessMedical Illness Reasons for living Reasons for living Quality of relationshipsQuality of relationships Financial/Employment StatusFinancial/Employment Status Stress- especially lossesStress- especially losses

Human UnderstandingHuman Understanding

Why is suicide everybody’s Why is suicide everybody’s business?business?

Because suicide prevention Because suicide prevention is everybody’s opportunityis everybody’s opportunity

Final Words-Final Words-Information vs Information vs KnowledgeKnowledge

““Information only becomes knowledge Information only becomes knowledge when it is used and practised”when it is used and practised”