Considering that Ireland was the last country in Europe to decriminalise suicide in 1993, the ‘catch-up’ on national and regional suicide prevention programmes with other countries has been significant, up to a level where Irish researchers currently advise international suicide prevention and research policy in WHO via the National Suicide Research Foundation’s WHO Collaborating Centre on Surveillance and Research in Suicide Prevention.

The second National Suicide Reduction Strategy, Connecting for Life, 2015-2024, co-ordinated by the HSE National Office for Suicide Prevention (NOSP), has provided a template for suicide prevention policy in other countries. 

Unique elements of the Connecting for Life Strategy are the cross-sectoral approach, involving 22 government departments and agencies leading or co-leading on the strategy’s 69 actions and regional implementation plans, co-ordinated at county level by Resource Officers for Suicide Prevention.

Having spent more than three decades working in the field of suicide prevention research and public mental health, currently, the demand for evidence-based public mental health policy has never been greater, especially in light of the challenges posed by the covid-19 pandemic. 

The UCC School of Public Health and National Suicide Research Foundation have seen a significant increase in requests for policy briefings, research collaborations, requests for real-time suicide and self-harm surveillance data to inform mental health promotion and suicide prevention programmes.

Requests for mental health expertise related to other public health emergencies have also increased over the past three years.

We have come a long way. Twenty years ago, the stigma associated with suicide was tangible, and we came across professionals and people in the community who would not feel comfortable using the word ‘suicide’, and sometimes they referred to the ‘S-word’. Fortunately, this has changed. 

How can we even make a first step in preventing suicide, if we are not able to openly listen to and communicate with people who are experiencing suicidal thoughts? Despite the progress, it may take generations before people who are experiencing ‘emotional pain’ are approached with the same openness as those experiencing ‘physical pain’.

Ongoing challenges 

Compared to other countries, the overall suicide rates in Ireland are average. However, in relation to young people aged 15-19 years, Ireland ranks 9th in Europe, after Baltic and Scandinavian countries, which is a worrying development. 

In addition, the National Self-Harm Registry Ireland, funded by the NOSP, has identified a sustained increase in hospital-presenting self-harm by children and adolescents. For example, the rate of self-harm presentations to hospital Emergency Departments by 10-to 14-year-olds doubled during the 10 years before the covid-19 pandemic.

Complete data on suicide deaths in Ireland are not available for several years and the pandemic has compounded this problem. For last year’s World Suicide Prevention Day, the Central Statistics Office (CSO) published a release on suicide statistics up to 2019. 

Among persons under 25 years of age, suicide was the leading cause of male deaths and the third-leading cause of female deaths. However, there was some evidence of a decrease in suicide over the period 2011-2019. For every 100,000 persons in the country, there were 12.5 suicides in 2011 compared to 11 suicides in 2019, a 12% reduction.

In order to have access to timely data, researchers in the School of Public Health and National Suicide Research Foundation, have established a real-time suicide surveillance system in collaboration with coroners in Cork and Kerry, known as the Suicide Observatory, which we aim to implement more widely in Ireland. 

Having access to timely and accurate suicide mortality data is critical in order to provide a timely response and supports in situations of suicide contagion and clustering, which is an ongoing worrying phenomenon, especially among young people. 

Also, the increasing challenges related to ‘misinformation’, including statements about apparent suicide clusters, rapidly and widely disseminated via social media, and not substantiated by real-time suicide data, have had harmful impacts on people who are vulnerable and who are currently at risk of suicide. 

People who are experiencing a severe depression will selectively focus on negative news, such as a media headline referring to ‘suicide epidemic’, without questioning whether this is based on real facts. 

Improved accuracy of suicide mortality data will also be critical in determining whether Ireland will be able to meet the UN Sustainable Development Goal, in particular target 3.4: to reduce by one third premature mortality from non-communicable diseases, including suicide by 2030.

Supporting people who have experienced the loss of a family member, friend or colleague through suicide is another priority. 

A recent national survey among people bereaved by suicide identified that one in five participants (21%) reported some degree of suicidal ideation in the previous two weeks, which was higher among men than women. 

This underlines the need for structural and specialised supports for people bereaved by suicide, to meet their needs and to reduce suicide risk.

Evidence-based interventions and prevention programmes 

People who present to hospital Emergency Departments following one or more episodes of non-fatal self-harm are at high risk of suicide. 

Therefore, the introduction of the National Clinical Programme for Self-Harm and Suicide Related Education, in 2014, has been a major improvement in capacity building and quality improvement of the assessment and management of self-harm via the allocation of 49 Mental Health Clinical Nurse Specialists across Irish hospital Emergency Departments.

From the broader Public Mental Health perspective, and specifically the prevention of suicide and self-harm, we need to prioritise evidence-based intervention and prevention programmes at population level, to work more ‘upstream’. 

Too often we are walking behind the facts, and it is critical that we become more effective in preventing mild depressive symptoms developing into a severe depressive disorder and suicidal behaviour. This is a key priority considering the increasing rates of self-harm under the age of 12. 

How do we reach people at risk in the population, before they develop suicidal thoughts and before a first act of self-harm? Via schools (both primary and secondary), workplace settings, primary care services and community-based services.

A number of school-based mental health promotion programmes have shown to reduce self-harm and suicidal ideation, with one evidence-based approach: the Youth Aware of Mental Health Programme, implemented and evaluated in secondary schools in Cork and Kerry, reaching publication in The Lancet.

In recent years, the School of Public Health and the National Suicide Research Foundation, have worked intensively with colleagues in other European countries and Australia to implement and evaluate the impact of an online workplace mental health promotion and intervention programme, the MENTUPP-Hub, among both management and employees in the health, construction and information and communication technology sector. 

The first outcome evaluation of implementing the MENTUPP-Hub in nine countries, including Ireland, has demonstrated the potential to strengthen employees’ wellbeing, reduce anxiety symptoms and improve stigmatising attitudes towards depression and anxiety.

Within National Public Health Policy, it would be important to consider a National Suicide Prevention Act, which can legislate clear priorities, accountability, focus and sustainability. In Ireland, the second National Suicide Reduction Strategy, Connecting for Life, which commenced in 2015, is currently being implemented until 2024. 

However, time-limited suicide prevention programmes may pose the risk that valuable and effective interventions may be discontinued, and changes in Government priorities may pose challenges and cause delays in initiating the next suicide prevention programme. 

Internationally, we have seen that national suicide prevention legislation in other countries, such as Japan, can have a significant impact on reducing suicides.

In working with people with lived of experience of suicidal behaviour over the past decades, an observation that has remained stable over time is that ‘people who attempt suicide don’t want to die, what they want is a different life’.

Support services:

• The Samaritans - 116 123 or text: 087 2 60 90 90 
• Text about it: 50808 
• For information on mental health support services please visit: yourmentalhealth.ie

• Professor Ella Arensman is Head of School of Public Health & Professor of Public Mental Health & Chief Scientist, National Suicide Research Foundation, University College Cork 
• Dr Paul Corcoran Head of Research, National Suicide Research Foundation & Senior Lecturer, National Perinatal Epidemiology Centre & School of Public Health University College Cork