BREAKING THE SILENCE: This year has seen a watershed in terms of how Irish society has become more willing to face up to death by suicide, writes Sylvia Thompson
For far too long, if someone died by suicide, there was a silence and lack of support for those bereaved that made grieving the loss of the loved one even harder.
This silence was cloaked in respect - a respect that even the media held onto in the way a suicide was often reported as "a death in tragic circumstances".
This was a euphemism that served only to stigmatise and isolate those bereaved families more, and left everyone else paralysed by the fear of suicide as a growing reality in our midst.
Those who had attempted suicide but failed got a clear message - there were few people ready to understand the level of despair that made them try to take their own lives.
But, in 2004, things began to change.
As part of the preparation for the National Suicide Prevention Strategy, meetings were held in five locations around Ireland so that people could talk about suicide.
Called "Open Space", these meetings gave both those bereaved by suicide and those working in suicide prevention, opportunities to discuss what mattered.
Overall, the National Suicide Prevention Strategy, which will be published in draft form in March 2005, will have three main strands.
The first is to improve public awareness of suicide.
The second is to establish mental health promotion programmes in schools, workplaces and in primary care settings.
The third is to target vulnerable people suffering from mental illness and those who engage repeatedly in deliberate self-harm, and to monitor training programmes and ongoing research into suicide.
Another important development in advancing public awareness of suicide this year has been the number of high-profile conferences organised by the Irish Association of Suicidology and the newer charity, Turning the Tide of Suicide (known as the "3Ts").
The commemoration of World Suicide Prevention Day on December 10th in College Green, Dublin and the Celebration of Light remembrance service at All Hallows College, Drumcondra, Dublin on December 12th also served to give faces and voices to those grieving the loss of loved ones who died by suicide.
"We are interested in moving from ignorance to awareness to knowledge, and this year we achieved better public awareness of suicide," says Prof Kevin Malone, co-founder of the 3Ts, who is attached to the Department of Psychiatry and Mental Health Research at St Vincent's University Hospital, Dublin.
"Only when you start holding up examples of what other countries are doing do people realise how bad things are here.
"In Scotland, they have put €30 million into suicide intervention and prevention whereas, in Ireland, the spend on mental health services has dropped from 9 per cent of the health budget to 6 per cent of the health budget in the last five years.
"There is no centre of expertise for suicide in this country and no fast-track approach to care.
"You can't call a society a success when you have the blemish of suicide figures that we have in Ireland.
"A country has got to be a social success too, but this country is a health and social disaster," Prof Malone adds.
Crowded A&E departments or busy GP surgeries are often the only port of call to those seriously depressed or distressed individuals who have attempted to take their own lives.
Speaking at a conference organised by the 3Ts earlier this year, Prof John Mann, professor of psychiatry at Columbia University, New York, said that more than 90 per cent of people who died by suicide had suffered from an undiagnosed or untreated psychiatric disorder.
"There is an urgent need to educate health professionals, the public and patients about the link between psychiatric problems and suicide as part of wider suicide prevention programmes," he says.
A recent large study of the mental health of young people in Ireland found that serious personal, emotional, behavioural or mental health problems were experienced by 27 per cent of Irish teenagers.
Of these, less than 20 per cent received professional help.
This study was carried out by the National Suicide Research Foundation and presented to the National Symposium on Young People's Mental Health in October.
It also found 9 per cent of teenagers showed "a lifetime history of deliberate self-harm" and only a minority had been in contact with a health service.
"The study findings clearly indicate that there is a hidden population of adolescents with serious mental health problems, who do not come to the attention of the healthcare services.
"Healthcare professionals need to invest more time to trying to motivate people to seek help," says Dr Ella Arensman, who is research director of the National Suicide Research Foundation.
Another report on youth suicide, from Northern Ireland, identified a history of depression, substance misuse and poor family circumstances as key risk factors in youth suicide.
Schools can play a critical role in preventing suicide among young people, according to Maureen Underwood, a clinical social worker from New Jersey, US.
She spoke on this topic at the Association of Suicidology's annual conference in Galway earlier this year.
Putting suicide prevention programmes in place, training up specific staff members and establishing liaison procedures with local mental health agencies are some of the suggestions on ways forward.
Speaking at the same conference, Prof Brian Mishara of the University of Quebec, Canada, said it was important for parents to correct misinterpretations of suicide (for example, glorification of male heroes who died by suicide).
They must acknowledge and talk to children about their grief when there has been a suicide in the family.
We must put suicide prevention programmes in schools and workplaces.
Along with these programmes, we have to provide comprehensive accessible countrywide mental health services for vulnerable individuals, and provide adequate bereavement counselling services for those bereaved by suicide.
It is vital that we give everyone the understanding that keeping yourself in good mental health is just as important as eating a good, healthy diet and exercising adequately, he says.
Only then will we really begin to tackle the spiralling rates of suicide in this country.