Professor Ella Arensman:

I very much appreciate the comments of Deputy Byrne, particularly her emphasis on mental health promotion for young people in schools. Under the umbrella of ReachOut, a lot of initiatives have taken place in recent years. An important document was implemented and launched last year on guidelines for schools on how to take on issues around mental health and how to respond when a suicide occurs. It is great when those documents exist but the next step is appropriate implementation.

Even though I am very optimistic that it is feasible to implement the work, we are still dealing with very strong stigma around mental health. If I see that among health professionals then it is certainly still there in schools. I am a strong supporter of implementation in terms of not only explaining to school principals what the guidelines are about but offering them a training package as well or lunch time sessions where they can also talk about their experiences with young people who have engaged in self-harm or who have died by suicide.

My final comment is in response to the very good contribution of Deputy Fitzpatrick. That is an issue of great concern. Through the very in-depth approach we have established with the suicide support and information system we have seen a relatively large number of groups of teenage friends but also families with multiple cases of suicide or self-harm in a short space of time. It is one of the priorities that we have put in place – a lot of work has been done by Console and the National Office for Suicide Prevention, NOSP – but we still need to have a greater capacity of counsellors who can liaise with families after a suicide in particular where they can also address the needs of the people who are left behind. That is particularly a priority when one sees multiple cases of suicide and self-harm in one family.

In terms of risk factors it must be clear that there is a great variety of risk factors but reference has already been made to behaviour change and changes in mood. Increases in alcohol and substance abuse are often indicators of possible risk of self-harm and suicide. Interestingly, a pattern that we have seen through the suicide support and information system among men is that when men who may have been depressed or abusing alcohol or drugs over a long period come closer to a plan and have higher ideation of suicide their depression or substance abuse sometimes apparently improves. That is all information that is apparent in hindsight, unfortunately, but it seems that up to two weeks prior to a suicide family members who otherwise might have been quite severely depressed or suffering from addictions suddenly seem to do better, but that pattern of improving may be part of their plan or decision or even a ritual such as organising events to get distance from family members. To refer to that in a more clinical way, people become more disconnected from their loved ones.