Suicides in NI: causes and prevention
Northern Ireland has the highest suicide rate in the UK. There were 307 in 2018 – that’s 18.5 suicides per 100,000 people, double the rate for England and equates to around five deaths per week.
A huge number of us – several hundred thousand - will have been affected through bereavement. The consequences are devastating.
Yet suicide is preventable: which raises the question of why suicide rates here remain so high. This raises uncomfortable questions for government in unexpected ways.
Earlier this week SDLP Deputy Leader Nichola Mallon said that Northern Ireland needed a Mental Health Action Plan driven by a junior minister to help people struggling with mental health or addiction issues. She added: “This has been a harrowing week for too many families with so many young lives lost. Condolences and words of comfort aren’t enough.”
Mallon is correct to highlight the under-investment in mental health in Northern Ireland and to campaign for a greater focus on it. However we already have a suicide strategy – Protect Life 2 2019-2024 which was published in September of last year. And although there are linkages between mental illness and suicide they are not synonymous. As Pat McGreevy, Secretary of the Suicide Down to Zero charity told Scope: “mental illness doesn’t kill people but suicide does.”
The reason why this is important is that tackling suicide takes us far beyond the remit of mental health and into virtually every aspect of government and policy-making.
There has been considerable research on the factors that can contribute to people having suicidal thought. There has been a great deal of research about this which is well summarised by the Scottish government as:
- risks and pressures within society, including poverty and inequalities, access to methods of suicide, prevalence of alcohol problems and substance misuse, and changing trends in society such as marital breakdown;
- risks and pressures within communities, including neighbourhood deprivation, social exclusion, isolation, and inadequate access to local services;
- risks and pressures for individuals, including sociodemographic characteristics, previous deliberate self-harm, lack of care, treatment and support towards recovery from serious mental illness, loss (e.g. bereavement or divorce), and experience of abuse;
- quality of response from services, including insufficient identification of those at risk.
In Northern Ireland we can add to that the traumatic impact of the conflict, whether experienced directly or inter-generationally.
Many of these factors relate to deprivation. Suicide rates in the most deprived areas of Northern Ireland are over 3.5 times the rate in the least deprived areas; self-harm admissions rates are also 3.5 times higher than in the least deprived areas.
Experts have isolated risk factors for individuals as including feelings of hopelessness; being unemployed, having unmanageable debt and being in poverty.
It is hard to escape the conclusion that if we are really serious about tackling suicide, concentrating suicide prevention resources in areas of deprivation is only part of the answer. We also have to tackle deprivation itself.
Protect Life 2 defines the circumstances that can lead to suicide as follows: “The belief is that suicide results from the frustration of psychological needs leading to psychological pain culminating in an overwhelming sense of burdensomeness, hopelessness, entrapment, and lack of belonging.”
This also clearly shows that having suicidal thoughts is a result of deep unhappiness, not necessarily mental illness.
So who is most at risk?
The suicides that attract most newspaper headlines are the most emotive ones – often involving young people. And whilst there is evidence to suggest that young people are increasingly vulnerable, they are not those most at risk.
Men are more than three times more likely to die by suicide than women. Other groups known to be vulnerable include the LGBT population, ethnic minorities, migrants, and those in contact with criminal justice.
Men are vulnerable because for many their perception of masculinity deters them from asking for help. The report states: “Psychological distress is perceived by many men as a weakness and as representing a loss of control, whilst seeking support equates to an acknowledgement of vulnerability.”
That’s why men in their late teens to mid-50s are the most at risk group in society and the risks increase further for men who are single, unemployed, and living in socio-economic disadvantage.
It also helps to explain why more than 70% of suicides involve people who have not been under the care of statutory mental health services in the 12 months prior to death.
Therefore helping to tackle suicide will have to involve a massive campaign to increase awareness about suicide prevention; to reduce stigma which is associated with suicidal behaviour and mental illness, and promoting the notion that people, especially men, should seek help when they need it.
Many experts say that there used to be a notion that there was somehow an “acceptable level of suicide” and that people determined to take their lives would do so anyway.
This is dangerously irresponsible. The World Health Organisation states: “Heightened suicide risk is often short-term and situation-specific” meaning that interventions can and do work.
And given that suicide is preventable it is tempting to conclude that the Protect Life’s aim to reduce it by 10% by 2014 lacks ambition. A number of health organisations have embraced the Down to Zero movement which seeks to eliminate suicide altogether. In this context it is difficult to see how government can sign up to ending road traffic deaths but not suicides.
But then perhaps the Department of Health is being realistic.
After all once you drill down into the risks you start to understand the scale of the challenge.
Protect Life 2 provides a useful summary of some of the actions that will be required.
Much of this will be addressing the individual problems that people face: family factors, childhood abuse, bullying, physical health, social isolation, mental ill-health, and substance misuse to give just some examples.
But they also need to include much broader issues, way beyond the scope of the Department of Health. These include: “strategies designed to reduce poverty and unemployment, improve family support and enhance child development, restrict harmful use of alcohol, improve educational attainment, reduce crime and antisocial behaviour, promote social inclusion, reduce domestic and sexual violence, address the legacy of “the troubles”, and improve mental health. Successful outcomes in these areas are vital for achieving a sustained reduction in suicide prevalence.”
That will not just involve a whole government approach, it will also require the halting and reversal of austerity measures, the active promotion of greater social mobility and the successful resolution of the seemingly intractable matter of dealing with the past.
Research from Africa shows that replacing a sense of hopelessness with one of optimism is critical to reversing suicidation. If we are to be more successful in achieving that then surely we need to create more reasons for people to be optimistic, and that has to involve tackling deprivation.
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