Suicide prevention operates at different levels. Methods of primary prevention tend to have a short-term benefit unless they are combined with secondary and tertiary programmes aimed at those known to be at high risk of suicide.
Examples of primary prevention which have been shown to work include fencing off access to high bridges and the removal of firearms from the home. Limiting the number of paracetemol tablets in a packet reduced the lethality of suicide as measured by the need for subsequent liver transplantation.
A 1994 British Medical Journal study estimated that a change of car exhaust design and the widespread use of catalytic converters would produce a 7 per cent reduction in suicide.
However, removing access to ready methods of suicide may only reduce the number of deaths from these means rather than impacting on the overall suicide rate.
Dr John Connolly, Secretary of the Irish Association of Suicidology, emphasises the importance of educating the public on issues such as the warning signs of impending suicide, an improved awareness of depression and an understanding of the risk factors for suicide.
The Social, Personal and Health Education Programme in schools is an important vehicle for suicide prevention. Mr Matt Crehan, the co-ordinator of the Western Health Board Strategy Group on Suicide Prevention provides support to schools and teachers in delivering the suicide component of this programme, which is run in the junior cycle of post-primary schools.
Last October the WHB launched a Personal Service Guide for people in distress and copies were distributed to all post-primary schools, as well as to GPs, accident and emergency departments and gardai.
Ms Teresa Mason, a Resource Officer for Suicide Prevention with one of the area health boards of the Eastern Regional Health Authority, has met with Dr Michael Boland, Director of the Postgraduate Resource Centre of the Irish College of General Practitioners to discuss piloting a training package in the eastern region.
Ms Mason emphasises that the aim of the initiative is for GPs to define their own training needs in the area of suicide prevention, to run an educational programme and then to evaluate its effectiveness.
Funding is available from the ERHA and the National Suicide Resource Group for a GP to undertake a one- year fellowship aimed at designing an appropriate educational model. This will then be disseminated nationally.
According to Dr Boland, this is likely to include enhancing GP skills in suicide prevention and increasing the clinical awareness of suicide during a consultation. There is also the issue of providing support to GPs who are themselves bereaved by suicide of a patient, he added.
While suicide prevention has been a regular topic in the GP Continuing Education Programme run by the College, Ms Mason and Dr Boland envisage that the proposed training programme would include modules on recognising those at risk, the appropriate treatment of conditions which heighten suicidal risk, the support needs of GPs and how to provide support to families who have been bereaved by suicide.
The ERHA has already completed a pilot three-day training course for a crosssection of staff, including those working in community care and accident and emergency departments. One of the key issues to emerge in the feedback is the need to tighten up communication between accident and emergency, general practice and community psychiatry.
Dr John Connolly echoes this point. In his experience there can be a gap between someone presenting to an accident and emergency department with a failed suicide attempt and the subsequent follow-up and referral for psychiatric intervention.
The key to suicide prevention is a multi-layered approach, with interwoven primary and secondary prevention initiatives based on reliable research.
The groundwork is already underway; we should begin to see positive results in the near future.