Dr. John Sheehan:

I will begin with the first question on the absence of a clinical marker in head 4. There is no specific clinical marker to assess suicidal risk. A risk assessment will include whether a person has a current mental disorder, such as depression or a depressive illness. It will also examine alcohol or drug use and then it will look specifically at a whole range of risk factors. We also take other factors into consideration such as gender because suicide is four times more common in men than in women; the peak in suicide depending on age with a peak in young men and in older people. There is a range of factors to be taken into consideration. However, there is not a scientific formula. There are different scales, for example, the use of what is called a hopelessness scale. These scales are helpful.

However, I think all we could actually say it that these are helpful as opposed to being definitive. Therefore, there is not a definitive clinical marker in that regard.

The second question raises an interesting issue concerning a person who is suicidal and has a mental illness. The bread and butter of psychiatry is seeing people with mental illness or mental disorder who, for example, may be suicidal. Good standard medical practice comes into play there - that is, everything from evidence-based treatment, such as cognitive therapies, day hospital care and admission to hospital. There is a wide range and medication may be used. In those situations, dealing with a person who is suicidal with mental illness, the principles are to target the mental illness and keeping the person safe.

It gets more difficult when a person does not have a mental illness. Anybody who works in an emergency department, particularly in the inner city, regularly sees homeless individuals who essentially want a bed for the night. They will come in and say they are suicidal and I need to be admitted. When one delves down to what is going on, they need a bed for the night and that is what they are looking for. They know that by asking the question in that way, that is how they can access a bed. It becomes much more complex when one is dealing with issues that do not relate to mental illness or mental disorder as such.

The liaison psychiatry faculty, of which I am a member, represents doctors who largely work in emergency departments and see people who have attempted suicide. They would question the validity of an assessment of an individual who does not have a mental illness but who, for example, is requesting or demanding something. It can be quite difficult to be certain and accurate in an assessment when a person does not have a mental illness or mental disorder.

I also wish to allude to some other points. If a psychiatric assessment is done by a psychiatrist or a member of a multi-disciplinary team, in certain services members of the multi-disciplinary team have conducted assessments of people presenting after self harm. Nationally, it tends to be a psychiatric assessment but there are services that have involved people from the multi-disciplinary team concerning people who have done self harm.

We warmly welcome the clinical care pathway programme which is coming down the tracks. It will involve having specialist nurses doing assessments of people post-self harm. We welcome that but it is not a psychiatrist doing the assessment there.

Finally, I will deal with the issue of infanticide, which is extremely rare. Resnick divided infanticide into two types: early and late. Early infanticide was where a mother killed her little baby within 24 hours after delivery. In that situation, the woman was often usually very young, completely unsupported and immature. She felt she had no other option but to do what she did, but certainly did not have a mental illness.

Infanticide that occurs later is related to major psychiatric illness and usually what we call psychosis. This is very rare and clearly very tragic when it happens. That is the issue concerning infanticide.