Kings HospitalPalmerstown

25th February 2010Presented by

Brid Carroll

Suicide is death resulting from a intentional, self-inflicted act

Suicidal behaviour comprises both suicide and acts of self-harm that do not have a fatal outcome. ◦ Described as attempted suicide◦ Suicide attempt (deliberate)◦ Self-harm◦ Para-suicide

Behaviour intended to result in death carries (high suicidal intent)

Denial of burial (Christian churches) No honour bestowed (Jewish tradition) Grave crime )Islam) Decriminalised in UK and Wales in 1961 In Ireland in 1993 Never a felony in Scotland – less stigma Seen as: heroic, honorable and a duty, an

act of patriotism, punished as a mortal sin, crime or sign of madness

Today we see it as a multi-caused condition

Suicide figures by Year and GenderYear Male Female Total2003 386 111 4972004 406 87 4932005 382 99 4812006 379 81 4602007* 378 82 4602008* 332 92 424*2007 and 2008 figures are subject to revision as some undetermined deaths maybe recorded as suicide following a coroner’s inquest.

Change in religious beliefs Breakdown in family life Media influence Multiple losses Adolescence as a time of change Celtic tiger existence- consumer-driven, ‘status’

is all important ‘Role status’ Males: absence of romantic interpersonal

relationships, change in status with job loss, lack of money

Females: hopelessness, depression and low self-esteem, isolation

Gender Mental disorders

Alcohol and substance abuse Hopelessness

Impulsive and/or aggressive tendencies History of trauma or abuse

Bullying Some physical illnesses Family history of suicide Previous suicide attempt

Shame

Job or financial loss Relational or social loss

Easy access to lethal means Local suicide clusters

Lack of social supports Stigma associated with seeking help

Glamorising of suicide in media Internet addiction

Marital status Recent bereavement Poverty- social status

Sexual orientation

Strong family connections Good problem-solving skills Good coping skills Employment Positive life attitude Supportive schools/communities Effective clinical care Support for seeking help Restricted access to lethal means of suicide Cultural and religious beliefs

Strive for closeness but fear intimacy Rebel against control but want direction and

structure Push the limits but see limits as a sign of caring Not given autonomy but expected to act maturely Highly self centred, self-conscious and

preoccupied with their world but society puts huge demands on them

Asked to face and accept reality but are tempted by many avenues of escape

Have to think of the future but there is a strong urge to live for the moment and enjoy life

Searching for identity Developing values for life They can be extremely lonely Struggle between dependence and

independence is central Time of decision making Sexual conflicts Pressure to succeed Peer group pressure is great

Mask fears with rebellion Cover their dependency by exaggerating their

new autonomy Moody, negative and rebellious Use drugs and drink Blame instead of taking responsibility Drop out or strive to reform society Try to find meaning over sense of uselessness Prepare for a future that is uncertain

To experience success to build confidence To recognise and accept feelings Need to communicate their thoughts, feelings

and beliefs to significant others Need approval Need trust to make decisions Need faith and support of caring adults Need guidelines and limits Need to develop identity over role confusion

Good communication Acknowledgement Respect Information Inclusion Security Safe space to express feelings Explore choices

Being present to them Listen to them Hear what they are not saying Give them time to unfold their struggles Perhaps they will communicate to another

adult who can support Be proactive rather than reactive Listen to the silence Avoid aggression

Loss of interest in the daily activities Loss of appetite and the ability to sleep Regressive behaviour In bereavement:

Imitation of the person who died Constant statements of wanting to be with the dead

Withdrawal from friends Difficulties in school Persistent self blame Over activity Risk taking behaviour Suicidal thoughts Self harming

What we know:◦ There is no typical suicide victim◦ No absolute reasons for suicide◦ No predictive warning signs◦ Always multi dimensional◦ Prevention must involve many approaches◦ Most people do not want to die◦ Ambivalence exists until the moment of death◦ If you reduce the risk factors you reduce the

risk◦ If you enhance the protective factors, you

reduce the risk factors

One or more risk factors most strongly associated with suicidal behaviour, such as:◦ A prior suicide attempt◦ History of self-harming◦ Suicidal ideation and threats of suicide◦ Exposure to suicide or suicide of a friend or family

member◦ Detailed plan for a suicide attempt (when, where,

how)◦ Access to lethal means, especially firearms

Depression lasting longer than two weeks School performance problems; learning

problems; dropping out of school Serious family fights and conflict,

outrageous, abusive, or unpredictable behaviour by parents

Loss of interest in personal appearance Alcohol and other drug use and abuse Isolation, alienation from family, peers High number of serious stressful events,

transitions and losses Involvement in risky behaviour

To seek help To escape from an impossible situation To get relief from a terrible state of mind To try to influence some particular person To show how much they loved someone To make things easier for others To make people sorry To frighten someone or to get their own way To make people understand how desperate they were

feeling To find out whether they were really loved To do something in an unbearable situation Loss of control Desire to die

Copyright Brid Carroll 2008

Risk taking thoughts and behaviours

Suicidal ideationsSuicidal threats

Suicide attempt

Suicide

Suicide-related behaviours

Suicide acts

• Panic- feeling inadequate• Fear – what if it happens anyway?

• Frustration – don’t need this right now• Anger – how dare you do this to me

• Resentment – I’m feeling manipulated• Helpless – How can I help?

• Hopeless – I don’t see any other choice• Conflicted – I don’t have the right to stop

them• Troubled – my personal values make it

impossible to help

Education Education of partners Discussing death and suicide as part of

school curriculum Community awareness programs Awareness of intervention programmes Awareness of gatekeeper programmes Where do we refer? Know what our local resources are

Deal with your feelings – name accept express

Adjust your attitude – optomist/pessimist Discover your choices – what can change? Accept imperfection – we all make mistakes Give yourself a break – promote self care Take one step at a time - prioritise Be kind to yourself – be positive Plan ahead – time, energy and tools Ask for help – support helps

Adolescents who talk about suicide do not attempt or complete suicide

Talking about suicide can plant the idea in the minds of at-risk teens

The only one who can help a suicidal adolescent is a counsellor or mental health professional

If an adolescent wants to complete suicide there is nothing anyone can do to prevent it.

Hopeless: “Things will never get better”. “There is no point in trying.”

Helpless: “There is nothing I can do about it.” “ I can’t do anything right.”

Worthless: “Everyone would be better off without me”. “I’m not worth your effort”.

Guilt, shame, self hatred: “What I did was unforgivable”

Pervasive sadness Persistent anxiety

Explore the signs Ask about suicide Listen to the reasons for dying and living Review the risk Contract a safe-plan Follow-up on commitments

Suicidal thoughts keep safe, safety contacts, no use of substances, link to resources

Prepared Disable the plan Desperate ease the pain Alone Link to resources Familiar Protect against

danger, (past attempt) support past survival skills

Vulnerable link to health worker

Don’t glamorise the death Treat like another death Support the bereaved network Use it as a teaching moment Observe those who are bereaved - as

coping can be more difficult at milestone events or anniversary time

Bereaved families of suicide should be linked to professional services for support

Mindfulness refers to a particular way of paying attention to our experience in any given moment. It is a capacity within each of us for moment-to-moment, non judgemental awareness that can be very liberating.

It does not seek to change what we are feeling and thinking as much as to become curious about it and to hold it in awareness rather than running from it, or acting on it.

National Office of Suicide prevention IAS Irish Association of Suicidology Suicide Resource offices Console Turning the Tide on Suicide You are not Alone booklet “Echoes of Suicide” Edited Siobhan Foster-

Ryan and Luke Monahan, Veritas “Cultivating Suicide” Caroline Smyth, Malcolm

Mac Lachlan and Anthony Clare, Liffey Press.