Are we finally making progress with suicide and self-harm? An overview of the history, epidemiology and evidence for prevention

Abstract

Ireland’s suicide rate is falling, but suicide and self-harm remain substantial societal problems. It is not possible to predict suicide at the level of the individual but good primary care, good mental health care and good social care all likely reduce risk. In terms of targeted interventions, public health measures, such as paracetamol pack size regulations, have the best evidence base to support them. Despite increased public and professional discussion, much remains to be done to provide effective, coordinated support to those at risk of suicide and those bereaved. In 2016, there were up to 300 different groups providing support. Clearly, a coordinated, effective and compassionate approach is needed, linking community and state resources meaningfully with each other. Approaches rooted outside of core mental health services will be vital: addressing alcohol problems and other addictions, reducing homelessness, reforming the criminal justice system and improving social care.

Suicidal ideation and depressive symptoms in an urban post-partum maternity setting: a retrospective cohort study

“…It is important to note that in general, suicide cannot be predicted on an individual level (Large et al 2016;Chan et al 2016;Kelly, 2018) and the proportion of people with suicidal thoughts who go on to complete suicide is less than 1 in 200 (Gunnell et al 2004;Kelly, 2018). Nevertheless, the emphasis of suicide prevention strategies in Ireland on taking a multi-level, multi-strand approach (Kelly, 2018) should also include consideration of perinatal mental health factors. Jairaj et al, found that 15.8% of antenatal women in an Irish sample screened positive for depression, using an EPDS cut-off score of >12, and that these rates were highest (17.2%) in the third trimester (2019).…”

Care Pathways in a Suicide Crisis Assessment Nurse (SCAN) service

“…People who experience self-harm and emotional crises attend Primary Care (PC) and Emergency Department (ED) services with high frequency in many jurisdictions (Carr et al, 2016;Griffin et al, 2017;Kelly, 2017). Effective assessment and management of these presentations in the ED can be challenging due to limited resources available to meet the high demand.…”

National Clinical Lead for the Assessment and Management of Patients presenting to the Emergency Department following Self-Harm.

“…Professor Brendan Kelly's editorial in IJPM June 2018 (Kelly, 2018) is a welcome historical account of the developments in suicide prevention in Ireland. He identifies the need for a coordinated, effective and compassionate approach to the problem of suicide.…”