"Not a day goes by but I think about suicide, about killing myself. When I tried before, I really wanted to do it. It's hard to explain, it's just this incredible feeling of depression, of feeling so low it's hard to describe, of really, really, not wanting to live anymore."
Martin (name changed on request) is over 30 years of age. He has tried to kill himself on four occasions. He lives alone and is separated from his wife. He is undergoing vocational training and is attending a psychiatrist who is aware that Martin believes he will eventually take his own life. Martin's interview with The Irish Times was arranged by the Southern Health Board.
At a relatively early age, he found his depression was eased when he inflicted severe wounds on his own body. The effect, he says, was almost cathartic.
"Looking back, I figure I've had this feeling since I was about 12. When I was about 16, I used to go to clubs or discos and then afterwards, I would cut myself . . . it made me feel better. I used to feel relieved. People wouldn't understand that but it was like an enormous build-up of tension and I felt better after I did that," he said.
The board has recently launched a strategy - Targeting Suicidal Behaviour - and a range of services designed to offer help and intervention at an early stage.
According to the latest figures released by the SHB, there were 67 suicides in Cork and Kerry last year, while nationally, the figure was more than 400. The figures could be higher because the statistics given here reflect only the number of suicides registered by the Central Statistics Office.
In Cork, the number of suicides last year was 48, the Kerry figure was 19. The SHB says the highest risk category is men between the ages of 20 and 24. The latest SHB study also shows that 40 per cent of those who attempted to take their own lives were under 25 and that Cork had one of the highest rates of male-attempted suicide in Europe.
The new strategy includes four initiatives. They include a suicide helpline, 1800 742745, which is open daily, seven days a week between 6 p.m. and 10 p.m., for people who may be feeling suicidal or for family members and friends who may be concerned about someone.
The board has also appointed two crisis intervention nurses who will work in the A&E departments of hospitals in Cork with people who have tried to take their own lives. Support teams, drawn from 51 trained personnel, working in twos, will liaise with families and people in a community affected by suicide.
The board has also established a parasuicide intervention study for people who have attempted suicide, and have been admitted to A&E departments.
Its aim is to help patients develop problem-solving skills and equip them to deal with problems in everyday living. Previous research at Cork University Hospital shows that attempted suicide is related to difficulties in coping with inter-personal problems, conflict or rejection.
The introduction of the A&E nurses is part of a one-year pilot programme which is likely to be extended to Kerry next year.
"Too many lives are affected by suicide," Mr Pat Madden, the SHB's programme manager said. "We have looked at the most appropriate and sensitive way to address this problem. As a board, we are very serious about helping people affected by suicide. Staff involved in these projects have been specially trained and are ready to help people in whatever capacity they can," he said.
Despite all the help now being made available in the southern region, it is difficult to listen to Martin's story without feeling a deep sense of unease. He is articulate and even analytical about his condition, and about the persistent feeling that some day he will take his own life. He is on medication to help him cope with those feelings.
He offers the chilling view that he expects to die by suicide while at the same time accepting help for his condition. He acknowledges the contradiction but says, for him, that is the reality.
His life, he says, has been shrouded by a pall of depression which medical intervention has relieved intermittently. During the suicide attempts, Martin was also drinking heavily but he has now become an occasional drinker only. "I feel better now, I have changed my medication and I'm not on anti-depressants at present. My doctor knows the way I feel and at times would like me to go back into hospital for treatment. I suppose I'm happy enough with my life but that feeling is always there that I will sink into total depression again and do it this time.
"I'm living alone now. I don't mind that because I'm a kind of loner at heart. Sometimes, I do crave company, though. I try to be in bed before 11 each night because the end of the night can be a bad time for me. I can feel very low towards the end of the night," he said.