Hate the act, but love those driven to it

Members of a youth club had the excellent idea of establishing an ongoing fund that could be drawn upon as a quick response to…

Members of a youth club had the excellent idea of establishing an ongoing fund that could be drawn upon as a quick response to events such as the tsunami, writes Breda O'Brien.

Rather disturbingly, they decided to name the fund in honour of a young person who had recently died by suicide.

Their motivation is easy to understand. They obviously cared for and missed their friend, and wanted to honour her memory. Yet I wonder what effect this might have on other vulnerable young people in the area?

Have we come perilously close to not just honouring the person who died by suicide, but also the act of suicide? Previous generations stigmatised not just suicide, but the person who died by his own hand, a condemnation that rippled out to those left behind and added to their grief.

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Have we gone too far in the other direction, and managed to destigma-

tise the act of suicide itself, so that for some people it has moved from being unthinkable to being an option if life seems unbearable?

There are no easy answers to the problem. However, concerning depression and suicide in the young, there are obvious problems that need to be remedied. Suicide is notoriously difficult to predict. Yet some young people do give clear signals.

Even when such distressed young people are identified, unless they are actively suicidal and at immediate risk, they may have to go on a waiting list for a year, and perhaps even two. The overstretched and underfunded public child and adolescent psychiatric health services will be unable to attend to them any sooner. In the meantime, that young person's difficulties may have escalated to the point of crisis.

For young people who need hospitalisation, there are only 16 public sector beds available in the entire country. Seven further planned units will not become available until 2007.

According to Dr David McNamara, a consultant child and adolescent psychiatrist, speaking at a joint Celtic meeting of psychiatrists this month, at least eight adolescents are being funded by health boards to receive inpatient treatment abroad, at a cost of between €300,000 and €500,000 each a year.

Shockingly, in 2003 some 24 young people under the age of 16, and more than 680 between the ages of 16 and 19, were in adult psychiatric facilities.

In some cases, that is fine, but some young people in locked wards with seriously ill adults may begin to believe that repeated hospitalisation is all that is ahead for them, too. That bleak vision may lead to some avoidable suicides. That is tragic.

Why is there so little will to tackle the obvious need for funding and resources? As one doctor said to me, mental health is not sexy, and there are no votes in it.

If a parent has a child with a chronic illness, or is in need of organ donation, it is much easier for them to demand action publicly. However, because stigma still attaches to mental health problems, parents are much more reticent about drawing attention to a child who has mental health difficulties.

There has been much talk of introducing suicide programmes into school. Such a suggestion makes me deeply nervous. There is the very real problem of suicide contagion, or so-called copycat suicide.

Kay Redfield Jamison, herself a professor of psychiatry who has battled mental illness and suicidal tendencies, writes clearly and eloquently about this danger in her book, Night Falls Fast.

Quoting studies of school-based programmes, she says there are grave dangers, for example, in using case histories of people to help students identify friends who are at risk. Paradoxically, young people may identify with the case histories and "may come to see suicide as the logical solution to their own problems". She also warns that destigmatising suicide may normalise it, and remove protective taboos.

Similarly, here in Ireland it is one thing to train teachers to notice behaviour that signals risk, but that will be useless unless there is a well-funded, easily accessed service to which students can be referred for prompt help.

Teachers who are anxious to be of service to distressed students live constantly with the fear that they may do more harm than good. Employing far more guidance counsellors, linked to a substantial network of healthcare professionals, might be a better place to begin.

One school-based intervention that appears to be very successful is called Teenscreen. Pioneered by Prof David Shaffer of Columbia University, it offers every second-level student a voluntary computer-based screening to identify the presence of potential risk factors.

There are no lectures about suicide. At-risk students are identified, and given a personal interview by a clinician. If necessary, parents are contacted, and the student is referred for treatment.

Identifying and helping young people who are at risk is vital, but it does raise one central question. Why has there been such an explosion in suicide, especially among young males?

Nobody can give a definitive answer, but many people feel that the complexity of modern life, coupled with a collective crisis of confidence by adults in the values they once held, makes life difficult for young people.

Unlike the case with older adults, there may be no history of depression or mental illness in young people who die by suicide. For some of them at least, suicide was an impulsive act, often connected with abuse of alcohol. That is why we need to be so careful to avoid suggesting to susceptible people that society is honouring the suicidal behaviour of someone who is dead, rather than mourning that person's death.

Society needs to show clearly that it values those who are suicidal, or who have died at their own hands, but hates the act of suicide. It needs to send a clear message that it is always a tragedy; that it leaves swathes of devastation in its wake among friends and family.

There is always a better way. Sadly, such a cultural message might be more believable if we backed it with adequate services for all, and in particular for vulnerable young people.