Suicide researcher calls for intervention before crisis point

“The help needs to be more up-stream and to be there earlier before someone develops a severe clinical depression or anxiety disorder,” she said.

“There is a need for early interventions and awareness.” Having real-time data to inform health professionals about risks is part of this, she said.

When the pandemic hit, she was already part of a team creating a real-time suicide surveillance system for Cork and this now includes Kerry, in collaboration with local coroners.

“Hopefully this can be implemented more widely in Ireland,” she said.

“With the Central Statistics Office we don’t have real-time data on suicides — the latest figures are for 2020. These represent 465 suicide cases, with a significantly higher rate of 14.2 per 100,000 among men compared to women, 5.2 per 100,000.” 

The Cork-Kerry system has already helped with briefings requested from the CMO and Nphet, and informed timely responses to suicide contagion.

“What our data has already helped with is preventing the spread of misinformation,” she explained.

“It’s too early to say if this is really a trend; there are some indications for a possible increase in suicides among older people in Cork and Kerry. But we are talking in absolute terms about relatively small numbers so then it’s difficult to determine trends.

"Having this access to real-time data helps us to be vigilant, and to intensify responses where needed. So GPs in remote areas could be more aware of a possible increase in depression or anxiety among people who are older.” 

She was working with European agencies who did compile live data during 2020 and this can inform Irish discussions, she said.

“In the first six months of covid, there were sometimes unsubstantiated reports in the media saying something like ‘it is likely the covid pandemic will be paralleled by a suicide epidemic’,” she said.

“Certainly for the first year of covid in 2020 in Western countries, there was no indication of a significant increase in suicides.” 

Another concern for campaigners, including Elaine Clear whose son died by suicide, is how mental health crises are treated in busy hospitals. Ms Clear has called for dedicated mental health emergency departments.

Prof Arensman said there have been “many improvements” in emergency access, but obstacles remain.

“The stigma relating to challenges that I discovered as a young researcher in the mid-80s are still present but less prevalent,” she said.

“A nurse now would have greater confidence in openly engaging with somebody who has self-harmed, because of enhanced training.” 

She added, however, that “very big challenges” remain around people with physical injuries being prioritised over mental health patients.

“In terms of capacity and having immediate access to expertise, it could be helpful to have a mental health emergency department, however we really have to look at where it would be best to focus that expertise,” she said.

In the general emergency department where many people who self-harm are coming through, if there is still a lack of expertise or understanding there then people may not feel very well understood — and that is at the first step of care.

A system of ‘train the trainer’, where senior hospital staff are shown how to help patients in crisis and can in turn teach their team, could be a sustainable solution, she suggested.

“There is a lot of rotation of staff in the emergency department, so if you have a train-the-trainer approach, everyone is aware," she said. 

Prof Arensman was speaking to mark World Health Day on Friday.

“I am optimistic the increased awareness of the importance of public health and public mental health during covid-19 will strengthen capacity-building at national and global level,” she said.

If you have been affected by issues in this article, you can contact: Text HELLO to 50808 or contact the Samaritans: free phone 116 123/ email jo@samaritans.ie; Childline: 1800 66 66 66; www.aware.ie; www.yourmentalhealth.ie ; www.spunout.ie