The recent controversy surrounding the Sunday World’s decision to publish a picture of a man who had apparently committed suicide and the subsequent apology again highlighted the problem of suicide though whether it was an attempt to create a debate or simply sensationalism was of course open to question.

This is an updated version of a blog I did some time ago but now seems a reasonable time to mention it again.
Many years ago I was at a course in Scotland: a respected psychiatrist from Scotland stated that suicide was rare in Northern Ireland and claimed that this low rate was common in societies in conflict. There is certainly some data to back up this suggestion. Historically, however, the only deaths recorded by the coroner as suicide were those where the victim left a note; otherwise the death was recorded as accidental. This was in part (and I would suggest appropriately) to spare the family the trauma and indeed shame and opprobrium attached in the past to such a death; with at times difficulties having a burial in consecrated ground. As such it may be difficult to compare historical figures with current ones.

The reality is that the suicide rate in Northern Ireland is actually quite high, in 2001 it was not quite double that for England and Wales though for the period 2002-2004 the rates in Northern Ireland were lower than Scotland or Wales and little higher than England.

The Investing for Health document showed an increase in suicide rates over the period 1987 to 2003 albeit with significant yearly variation. The variability of suicide rates amongst different groups and different localities is interesting. Suicide rates are highest amongst young men aged 15-34, which is a fairly typical finding word wide. At the risk of being controversial; suicide is more common in predominantly Roman Catholic areas, however, the report stresses that this may not reflect a significant difference due to the number of people living in mixed areas and does not take into account economic deprivation in different areas. It is also modestly more common in urban than rural areas and significantly so amongst those in socially deprived areas. The highest risk employments are own account workers and small employers closely followed by long term unemployed and never worked groups.

Groups at particular risk of suicide include, unsurprisingly, the mentally ill. Those with schizophrenia are notorious amongst psychiatrists for very rarely being a danger to other people (contrary to some popular myths) but a significant danger to themselves. Clearly psychiatric care can help but apart from detaining people indefinitely in mental institutions as we used to there is little way of completely preventing this problem. That of course leaves aside the inappropriateness of making people stay indefinitely in the old “lunatic asylums” and the fact that not infrequently they managed to kill themselves there. Persons with personality disorders also have high suicide rates. Unfortunately such people are extremely difficult to treat and although they may make many attempts before a successful suicide again there is little obvious way to completely prevent this. The provision of increased mental health services in past budgets may have some effect and also highlighting counselling and other services may bring benefits but is unlikely to abolish the problem.

How well those budgets will survive the economic stringencies now being imposed on the public purse is of course unclear. In addition a recent study suggested that during a recession although there is no consistent evidence that a rise in unemployment increased overall death rates across the EU population; there was an association between rising rates of unemployment and a rise in suicide levels among people under the age of 65.

In the relatively recent past there was the disturbing occurrence of spates of suicide amongst teenagers and young people, sometimes in clusters. Concerns have been expressed that sometimes these episodes have a “copy cat” element which is a truly awful concept. However, despite sensationalist claims in the tabloid press over a spate of suicides a couple of years ago in Bridgend, South Wales the police reported no evidence of any link.

An additional previous hysteria drummed up by the media was that many suicides could be explained by a number of social networking internet sites frequented by young people and hence, stopping them would solve the problem. At one stage regulation or even closure of some aspects of these sites, was considered though such strategies seem unlikely to solve much of this problem. Clearly improved mental health services and the provision of counselling have considerable merit and sound like common sense solutions, though acquiring clinical evidence of their efficacy is not especially easy. However, there are other problems related to economic deprivation which is likely to worsen in the short term and loss of social and family cohesion which is prevalent throughout much of the Western world. These problems are vastly more difficult to address but all these issues need to be considered as this is a significant problem within society which merits serious discussion and examination of any possible solutions; incremental as any one of them will undoubtedly be and unfortunate as the circumstances which have again highlighted this issue are.

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