STORIES OF SUICIDE:The 'Irish Times' Stories of Suicide series has prompted an extraordinary response from people touched by suicide. Talking openly about the subject is crucial, but suicide prevention must also be a political priority
LAST WEEK Phyllis MacNamara told the harrowing story of her husband’s suicide in these pages. A day or so later she met a woman in the park where she walks her dog each morning. “She stopped me to say her husband had died by suicide 11 years ago, but she had never been able to talk about it,” says Phyllis.
“She just thanked me for saying what she felt unable to say. I also had flowers with a note that just said, ‘Thank you’, hugs, phonecalls, handshakes from strangers who said ‘Well done’ or, more typically, ‘You are very brave.’ ”
It’s a reaction that has been replicated many times. People who told their stories with remarkable dignity and candour in The Irish Times this week have prompted an extraordinary response.
Much of the reaction has come from people who were bereaved by suicide many years ago but felt unable to speak openly about their experiences until now. “My brother took his life almost 10 years ago,” said one reader. “I just wanted to say how important it is that the issue of suicide is being given the daylight and oxygen it so badly needs.”
“This is still an ‘unspoken social phenomenon’ which we must tackle,” said another. “I lost my mother to suicide many years ago, and it is still something family members won’t discuss or admit to.”
Alongside the stigma is a gnawing frustration for many who feel let down by the response of the health services to loved ones in crisis. People expected an intervention that would stabilise a vulnerable family member, but significant numbers said services were disorganised, unresponsive and, in some cases, simply inhumane. “I lost my partner of 10 years to suicide, leaving me with a child to raise alone. I found the support and aid available to be appalling,” said one respondent.
“The services were absolutely atrocious,” said another. “My father was hospitalised after an attempted suicide and released two days later without the family being informed . . . The day he was released was the day he took his life.” Another person who attempted to take their own life commented: “I also encountered a disorganised environment without empathy or pity and devoid of all hope. I survived despite, not because of, the system.”
FOR THOSE CAMPAIGNING to tackle suicide and reduce the numbers taking their own lives, these issues are familiar: they go to the heart of what we need to do if we are to make progress in tackling this most painful aspect of modern society.
Suicide was decriminalised only in 1993, and as recently as the 1970s the Catholic Church barred people deemed to have taken their own lives from being buried in consecrated ground. This stigma has contributed to a failure to plan or invest effectively in prevention measures, resulting in a patchwork of services around the State.
Last year at least 520 people took their own lives, an extraordinary 25 per cent increase in a single year. This, experts agree, is likely to be a significant underestimate of the real number. The economic downturn in particular is placing a strain on middle-aged men and women as never before.
It should be sufficient to spark some kind of national emergency, say many, but all too often it has been met with silence. “The real tragedy about suicide in Ireland today is the lack of action,” says Joan Freeman, who helped establish Pieta House in Dublin as a model to provide emergency counselling for people in crisis. “No one seems to get it. We should be crying from the rooftops about this, but people still don’t want to talk about it.”
Noel Smyth, a solicitor who helped establish the charity Three Ts – Turning the Tide of suicide – says that people who die by suicide are still considered second-class citizens.
“Recently seven people died in road traffic accidents, and there was a major outpouring of grief,” he says. “Yet that same weekend around seven people died of suicide, and no one heard about them. Once again families are left with two questions: what could we have done, and why did they do it?”
For professionals like Prof Kevin Malone much of the frustration lies in the lack of research into why people are taking their lives in such large numbers. Clearly, he says, suicide is not being treated as a political priority. “The truth is that we have done practically zero research,” he told an Oireachtas committee recently. “We are working in a complete knowledge vacuum. How can an action plan be put together when we have a knowledge vacuum?”
THERE DOESN’T SEEM to be a lack of willingness to tackle the issue on the ground. Even a cursory examination of the sector reveals dozens upon dozens of initiatives seeking to tackle suicide. There are many helplines for people in crisis, countless websites, innumerable charities working to address these issues.
But it is the very number of these individual groups, say some, that is part of the problem. We have dozens of organisations working in isolation from each other when they could be sharing resources, experience and expertise. The fragmented nature of these services makes it more difficult to work strategically to tackle suicide. This is something that the National Office for Suicide Prevention, based at the Health Service Executive, is trying to address. Its job is to oversee the implementation of a national strategy on suicide prevention and help to co-ordinate prevention efforts around the country.
Geoff Day, who heads the office, says steady progress was being made in tackling suicide until last year: the numbers had stabilised and were even beginning to go down. Since the economic downturn that progress has been wiped out. “The increase in suicide last year was alarming and has been a bit of a kick in the teeth to all of us working to tackle suicide, but it also reinforces the message that we have to keep plugging away at this.”
The office spent €9 million last year on anti-stigma initiatives, such as TV adverts, and has ploughed money into training and awareness
programmes on suicide for close to 20,000 gardaí, teachers and other members of the community.
It is also piloting new and more effective ways of intervening with people in crisis, such as using outreach nurses to visit vulnerable people in their homes.
“Availability of resources will always be key,” says Geoff Day. “We’re operating in a tough climate, but we’ve protected most of our budget and we’re always looking for new sources of funding to help roll out the national strategy.”
But there are limits to what the office can do. Much of the progress in this area hinges on the modernisation of our mental-health services: closing down the Victorian-era mental hospitals and replacing them with modern, community-based services focused on the needs of the patient.
Yet the national plan, A Vision for Change, has been starved of funding and the timescale for change has been pushed back. An independent monitoring group established to oversee the implementation of the plan concluded earlier this year that “little substantial progress” had been made and pointed to the absence of “determination, leadership and understanding” to ensure that a recovery ethos underpins all aspects of mental-healthcare services.
The personal commitment and energy of the Minister with responsibility for mental health, John Moloney, is not in doubt. He has spoken bravely about his own experiences with depression, and he helped to spearhead a national anti-stigma campaign in recent months. But there are limits to what a junior minister can do when the issue is not at the top of the Government’s list of priorities.
SO WHERE DO we go from here? All the evidence points to simple steps that can reduce suicide rates. They include restricting the access to means of suicide, such as drugs; establishing community-based prevention programmes; introducing guidelines for the media on reporting suicide; and training front-line professionals to deal more effectively with suicide.
We are taking steps in all these directions and making good progress that does not make newspaper headlines, although there are still gaps. For example, we still do not have specially trained nurses in every AE department to follow-up on people who self-harm, even though this category of people is among those most at risk of suicide.
Prof Malone says we need to go much further and follow the example of countries such as Finland, which shed its bleak record as one of world’s suicide capitals after the issue became a political priority. The numbers taking their own lives there have dropped by about 40 per cent over the past 15 years.
Much of this progress, according to Finland’s national public health institute, has been down to a major effort from the top of the Government to provide better research, more education and improved supports.
“Depression is more often properly recognised, prevented and treated,” the institute’s head, Jouko Loennqvist, said recently. “We have had special projects and campaigns about depression, which is now better recognised and treated. Psychological support and social support are nowadays in better condition.”
Joan Freeman agrees that education and awareness are the key to tackling the problem, as well as better and more responsive services for those in crisis. “If we had 100 Pieta Houses I’m not sure that it would reduce suicide. But if everyone knew what the signs and symptoms are, they could refer people on or ensure they get help,” she says.
Battling the stigma that persists around suicide and mental-health issues in general will also be key to any progress we make. This, says Phyllis MacNamara, means opening up the topics of anxiety or depression and making it okay to talk about them.
“Michael [her husband] had a breakdown. He felt going to a doctor about a mental-health problem was the greatest disgrace. He actually couldn’t live with it, so he took his own life. He shouldn’t have felt like that. It’s our society and environment which make people feel like that. A mental-health problem should be no different to an illness affecting any other organ of the body,” she says. “We need to create a space where people can talk openly about their feelings and look for help. There is lots of work to be done. We need to make it okay for people, especially men, to talk about negative feelings about themselves and know they won’t be judged.”
Console holds its Christmas service of light tomorrow week at 4pm at St Patrick’s College, Maynooth. The event, to remember lives lost through suicide, features Frances Black, Niamh Kavanagh, Jack L and Eleanor Shanley. Tickets: 01-6102638 or console.ie
If you or someone you know is in crisis and needs someone to talk to, the following organisations can help:
* 1Life (1life.ie): call 1800-247100 or text HELP to 51444 for one-to-one text support
* Samaritans (samaritans.org): 1850-609090 in the Republic or 08457-909090 in the North, or e-mail jo@samaritans.org
* Pieta House (pieta.ie): call 01-601 0000 or email mary@pieta.ie
* Console: this charity for people bereaved by suicide has a free helpline at 1800-201890, or see console.ie
* Aware, which helps people with depression, has a helpline at 1890-303302, or see aware.ie
* National Office for Suicide Prevention, part of the HSE, also offers advice and information on efforts to tackle suicide. See nosp.ie
