Professor Ella Arensman:

It co-ordinates 22 research projects in the area of suicide, self-harm and related mental health issues, including one on the evaluation of interventions and suicide prevention programmes. One of the major projects is the national registry of deliberate self-harm. It is unique for Ireland to manage such a national system. It is funded by the National Office for Suicide Prevention, NOSP. The NSRF works in partnership with the NOSP and other key stakeholders in implementing evidence-informed actions at regional and national levels, for example, the national implementation of dialectical behaviour therapy for people with frequent patterns of repeated self-harm, guidelines for assessment and management of self-harm in emergency departments, restricting access to lethal means and the implementation of guidelines on media reporting of suicide.

This draft report and the discussion I hope will follow are timely considering that we are this year reviewing the national strategy for action on suicide prevention, Reach Out. In parallel with this, we are working hard - the NOSP is taking the lead - on preparing the next phase of suicide prevention, that is, a new framework to be launched in autumn.

I will make a few comments on the section in the draft report on the accuracy of suicide statistics. It correctly addresses the concerns about the level of accuracy. Therefore, I support the proposal to conduct a nationally representative survey of coroners' records to establish which deaths might be attributable to suicide but do not meet the legal standard of proof required at inquest. It is exactly for this reason that, in recent years, the NSRF has piloted the suicide support and information system, SSIS, in Cork city and county, funded by the NOSP. In the national and international contexts, the SSIS can be considered innovative, as it combines a number of key objectives, for example, facilitation of support for people bereaved by suicide, access to real-time information on the incidence of suicide and associated risk factors and identification of emerging suicide clusters. One of the key outcomes of the SSIS revealed that the characteristics of people who died prematurely and were classified by a coroner as open verdicts were found to be more similar than dissimilar when compared with confirmed cases of suicide, in particular, their psychosocial and psychiatric characteristics.

In recent months, the NSRF has also started a review of all external cause of death verdicts in the Dublin region covering the 2011-12 period in close collaboration with Dr. Brian Farrell, the Dublin area coroner. We are using internationally validated screening criteria to detect probable cases of suicide and are using the review to enhance these criteria further. This approach could be expanded to coroners' services in other regions in the country. In line with recommendations from the World Health Organization, WHO, improving national data systems for surveillance of suicide and access to real-time data is fundamental to national suicide prevention strategies.

I will comment on the report's section on suicide and the economic recession. It correctly describes the increasing trend of suicide and self-harm, particularly between 2007 and 2012, with as many as 560 extra cases of suicide and an increase in the number of cases of deliberate self-harm to 8,862. These numbers are based on analysis recently completed by the NSRF and reflect the worrying impact of the recession. We still do not have a clear indication as to whether the recession is over, if matters have stabilised or so on.

In addition to these statistical outcomes, the SSIS provides supporting evidence that reflects the impact of the recession. For example, of 307 suicide cases that we investigated in great depth, 35.8% were unemployed at the time of death and 41.6% had worked in the construction or production sector until they died. As we know, those work settings were particularly affected by the recession. We must take a balanced view, however, as the SSIS also found that, of the people who died and were unemployed at the time of death, nearly half had a history of alcohol and-or drug abuse and 42% had a history of self-harm. This reflects the importance of the interaction of individual risk factors and external contributing factors.

When we compared Irish trends in suicide with those of neighbouring countries, we found something remarkable. Most of the five nations in question has seen a strong increase in the rates of suicide and self-harm. The exception is Scotland, which has not seen a significant increase during the recession. In fact, it has actually seen a significant decrease in the past 12 years.

Taking this information into account, I propose that we undertake a comparative study involving experts in suicide research and prevention from the five nations to compare suicide trends, the characteristics of the recession and the austerity measures implemented by the different governments, for example, reduced access to mental health and community services, being unable to afford treatment, losing medical cards and having sickness and disability supports restricted.

I wish to comment on another important section in the report, that being, mapping and predicting suicide and self-harm using geospatial analysis, which is an innovative approach to this field. I am pleased to see that the report underlines the importance of using these techniques. A recommended form of analysis is something called SaTScan, which has been used for more than two decades to map infectious diseases but has never been applied to suicide. Last year, the NSRF applied this technique for the first time to suicide data obtained through the SSIS and we identified two significant clusters of suicide in the South. Applying this technique to real-time suicide mortality data from coroners and possibly An Garda Síochána would help us in identifying emerging suicide clusters much sooner than we have been able to do previously.

This approach has a number of important advantages. For example, it improves the early identification of clustering of suicide and self-harm and identifies areas with recurrent suicide and self-harm clustering, something that we have not been able to do so far. We hear about repeated clustering in certain areas through the public and the media, but we have been unable to verify them. The other advantage would be the ability to identify the area level and individual factors associated with clustering of suicide and self-harm, particularly in repeated patterns.

I strongly recommend the use of our national registry of self-harm and this technique, given their possible benefits. In light of the significant and consistent association between trends in non-fatal self-harm and trends in suicide among men in particular, I would also recommend applying the SaTScan to the registry nationally in order to enable the possible prediction of suicide clustering among men in specific areas.

I will make two brief comments on a pair of sections in the report, the first of which is on the establishment of a national registry of organisations that provide services relating to suicide. I agree with the rapporteur on the importance of enhancing co-ordination and collaboration among services working in the field of suicide prevention, ensuring best practice and enhancing quality wherever possible.

In a highly positive development the National Office for Suicide Prevention is compiling a directory of quality assured services in suicide prevention and the Irish Association of Suicidology and representatives from the University of Ulster are developing guidelines for the accreditation of organisations working in suicide prevention. This work has been commissioned by the NOSP.

The final proposal for future action in the report refers to the repositioning and reconfiguring of the National Office for Suicide Prevention at the Department of the Taoiseach and the provision of a dedicated budget for the organisation. While this proposal requires in-depth and lengthy discussion, my current view is that, in light of the growing insight into suicide and the need for multisectoral partnership and collaboration in suicide prevention nationally, there may be benefits in repositioning the NOSP at the Department of the Taoiseach. The Department of Health is, without doubt, the key player and stakeholder and should retain its fundamental role in suicide prevention. Nevertheless, other Departments should take a more prominent role and should be the subject of greater collaboration. I refer specifically to the Departments of Education and Skills, Justice and Equality, Social Protection, Transport, Tourism and Sport and Agriculture, Food and the Marine. A move towards a multisectoral partnership approach would be in line with recommendations issued by the World Health Organisation in the public health area of suicide prevention. Other benefits of repositioning the National Office for Suicide Prevention at the Department of the Taoiseach include greater autonomy and enhanced political prioritisation of suicide prevention.

My written submission includes several practical notes providing clarification on certain matters.