Professor Ella Arensman:

We also analysed so-called three year average rates of suicide over a ten year period. The period included the years of the recession. This model is usually recommended when one is dealing with a relatively small population - even 4 million is considered small - and a correspondingly small number of suicides. Even in the context of this analysis, we still discovered a significant - 4.5% - increase in the number of suicides from 2007 to 2011. I apologise for extrapolating, but we also have available to us the national registry of self-harm which allowed us to identify the fact that between 2007 and 2011 there was a 30% increase in the level of male self-harm in Ireland. In the 25 years I have been working in this area I have never come across such an increase in the level of male self-harm. There is sufficient international evidence available to allow us to stand over our approach and use changes in trends in male self-harm as a proxy for changes in trends in suicide. I very much appreciate, however, that we are not fully up to speed in knowing all of the details of people's histories and additional factors, particularly over a long period.

The first question to which I wish to respond came from Deputy Caoimhghín Ó Caoláin and relates to whether we might be able to consider baseline figures for the period prior to the recession. If they were available, we would have examined them already. The Deputy also inquired about what we had identified by means of the suicide support and information system. It is a new system that we can use to access full data from coroners' records, including post-mortem records. We also invite family members who have been bereaved as a result of suicide to participate in interviews with well-trained specialist psychologists. In addition to the interview, we also seek permission from the family member involved to contact a health care professional who was in contact with the deceased prior to death. These are three sources from which we have been able to collect very in-depth information. Given that we only began collecting the information in question in 2008, it is very difficult to carry out a baseline study. If we consider the comprehensive psychological autopsy study compiled by Dr. Tom Foster in Northern Ireland some years ago, we find similar prevalence rates in respect of previous self-harm and mental health issues, particularly depression, but significantly lower levels of unemployment and much lower numbers of people working in the construction and production sectors. Even though they do not provide a direct baseline, the high levels of unemployment and the large numbers of people working in the construction and productions sectors which we identified give an indication of the contributing impact of the recession in Ireland.

I was also asked about the potential value of comparing the position here with that in neighbouring countries. I have just proposed this to a colleague in Scotland. It is certainly something we could consider, particularly in the context of potential differences. One of the differences I have already encountered relates to the fact that at the beginning of the recession the government in Scotland decided to increase alcohol prices and introduce even more stringent rules in the advertising of alcohol at sports and other events. During the same period alcohol prices in Ireland were reduced. Regardless of whether there is a recession, we know that alcohol has an important impact in the context of suicide and self-harm. I hope that by the time the committee moves forward with its report, we will have begun our comparison with neighbouring countries.

Deputy Dan Neville inquired about the international experience with regard to other external causes of death which might include or capture probable cases of suicide. In the United States, Australia and the United Kingdom comprehensive research has been conducted into possible other categories of external causes of death which may capture probable cases of suicide, including single vehicle road traffic accidents and accidental drownings and poisonings. Unfortunately, there has been an increase in the number of such poisonings in Ireland in recent times. Before the recession began, there were indications of a reducing trend in the number of suicides in the United Kingdom. At the same time, however, there had also been an increasing trend across that jurisdiction for so-called narrative verdicts. Such verdicts refer to descriptions of particular situations in the context of the methods used, the circumstances in which a person died and the sequence of events, but they do not involve specific findings on whether the death was intentional or accidental. On the basis of this work, the Centre for Disease Control and Prevention in the United States developed screening criteria. They were first introduced in the 1980s, but they have been updated in the interim and there is always scope to update them further. There is a tool available to facilitate screening for external causes of death in respect of the probability of whether they capture probable cases of suicide.

I was delighted when Deputy Billy Kelleher asked whether accident and emergency departments offered an appropriate setting for dealing with people - even if they have not engaged in self-harm - expressing suicidal ideation. On the basis of the current setting and also the capacity of staff in accident and emergency departments to deal with such individuals, I would be concerned. I am particularly concerned about whether staff are adequately equipped to deal with this very challenging group of individuals. One of my concerns is based on the outcomes of an evaluation of accident and emergency department staff, particularly nurses, in terms of the extent to which they had received training in the area of suicide and self-harm awareness. We recently finalised this evaluation in Cork and discovered that fewer than 10% of the relevant staff had received such training. I do not have a clear-cut alternative to offer, but we must give further consideration to this matter.