Reaching OutReaching Out

Garreth PhelanGarreth PhelanResource OfficerResource Officer

Suicide Prevention & Mental Health Suicide Prevention & Mental Health PromotionPromotion

HSE Dublin NEHSE Dublin NE

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‘‘Reducing suicide rates requires a collective, Reducing suicide rates requires a collective, concerted effort from all groups in society; health, concerted effort from all groups in society; health, social services, other professionals, communities social services, other professionals, communities and community leaders, voluntary and statutory and community leaders, voluntary and statutory agencies and organisations, parents, friends, agencies and organisations, parents, friends, neighbours and individuals. It also requires the neighbours and individuals. It also requires the careful nurturing of a culture in which people in careful nurturing of a culture in which people in psychological distress don’t hesitate to seek help’psychological distress don’t hesitate to seek help’

Remarks by President Mary McAleeseRemarks by President Mary McAleeseat the World Congress of Suicide Prevention - Killarney in August at the World Congress of Suicide Prevention - Killarney in August

20072007

Purpose Of PostPurpose Of Post Co-ordinate and implement national suicide

prevention strategy

To enhance resilience across all population groups around mental health with a specific focus on vulnerable and at risk sectors.

Consultation with statutory and non statutory organisations working in the area of suicide prevention, bereavement support and deliberate self harm.

Support and co-ordinate high quality research in relation to suicide and to translate research findings into action

Purpose Of PostPurpose Of Post Support stigma reduction Advocate for the development of and

access to mental health services within primary care, crisis intervention services and bereavement services

Support, co-ordinate, and develop appropriate training in mental health promotion and suicide prevention.

To draw strategic guidance from the range of policies/strategic documents.

A Vision For ChangeA Vision For ChangeReport of The Expert Group on Report of The Expert Group on Mental health PolicyMental health Policy

Reach OutNational Strategy for National Strategy for

Action on Suicide PreventionAction on Suicide Prevention

2005 - 20142005 - 2014

Principal Duties and Responsibilities

To develop a population health approach whereby mental health is improved

over the entire lifecycle encompassing both individuals and communities.

To develop coping mechanisms to address challenging life events e.g.

bereavements, loss, family issues.

This is done within:This is done within: Health PromotionHealth Promotion Community SettingCommunity Setting Health Care SettingHealth Care Setting ResearchResearch Health LiteracyHealth Literacy Education &TrainingEducation &Training

Mental Health PromotionMental Health Promotion

Develop and progress mental health promotion by developing evidence based programmes and interventions aimed at strengthening individuals, strengthening communities and reducing structural barriers to mental health

Community SettingCommunity Setting Establish, distribute and maintain a directory

of appropriate community & voluntary groups who are providing services in relation to mental health, suicide and parasuicide.

Liaise with and establish networks between the HSE, community and voluntary groups which are currently providing services and supports in mental health, suicide and parasuicide, whilst respecting the specific ethos of each group.

Enhance the capacity of all groups working in this area through training, support, establishment of best practice procedures/methodologies

Health Care SettingHealth Care Setting

Cooperate with all other health and social services on the issue of suicide to promote the prevention of suicide and re-orientate the service to reduce the risk of suicidal behaviour amongst high risk groups and vulnerable people.

Act as a resource person and catalyst to enable others to work effectively in reducing suicide in line with standardised evidence based practice.

Health LiteracyHealth Literacy

To enhance health literacy across all sup-population groups around positive mental health and suicide prevention and the development of appropriate resources.

ResearchResearch

To promote research and local needs assessment relating to suicidal behaviour in line with the NOSP National research strategy.

To develop appropriate evaluation tools by which outcome/impact effectiveness of initiatives can be measured.

To create a dynamic whereby intervention’s and programmes are re-aligned with research/needs assessment findings.

Education & TrainingEducation & Training

SafeTALK is half day training for community groups, to enable participants identify the signs of a person with thoughts of suicide and know how to support them.

ASIST is a two-day skills based course which trains participants to recognise and respond to a suicidal risk. The course provides opportunities to learn what a person at risk needs from others in order to keep safe and get further help.

To oversee the implementation & monitoring of a regional To oversee the implementation & monitoring of a regional training strategy on suicide prevention and mental training strategy on suicide prevention and mental

health promotion in line with National training strategyhealth promotion in line with National training strategy

a whole population approach a more targeted approach aimed at those

individuals who have particular vulnerabilities

support to individuals and communities bereaved by suicide

Evidence suggests that community based programmes are effective in reducing suicidal behaviour.

The approach taken to suicide prevention is based on

recommendations by the WHO and combines

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Reach Out Reach Out strategystrategy

Targeted suicide prevention

Whole population prevention

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What does the What does the research tell us research tell us

about suicide and about suicide and suicidal behaviour suicidal behaviour

in Ireland?in Ireland?

Total suicide rate per 100,000 population in the EU

30.426.0

21.520.3

19.918.8

18.217.0

15.415.2

13.313.2

13.012.6

11.911.9

11.511.3

10.910.6

8.37.8

6.46.46.3

3.5

Lithuania

HungarySlovenia

Estonia

Latvia

Finland

BelgiumFrance

Austria

Poland

Czech RepublicSweden

Bulgaria

Slovakia

DenmarkGermany

Portugal

Romania

Luxembourg

IrelandNetherlands

Spain

United Kingdom

MaltaItaly

Greece

Based on W.H.O. Data accessed in Dec 2009

Youth suicide rate (15-24yr olds) per 100,000 population in the EU

20.8

18.2

15.2

13.4

11.3

11.2

10.9

10.8

10.7

10.6

8.7

8.5

7.5

7.4

6.7

5.9

5.4

5.0

4.9

4.7

4.6

3.9

3.7

3.4

3.1

1.9

Lithuania

Finland

Estonia

Ireland

Luxembourg

Belgium

Poland

Sweden

Latvia

Austria

Slovenia

Czech Republic

Slovakia

Hungary

France

Germany

Denmark

Romania

Bulgaria

Netherlands

United Kingdom

Spain

Portugal

Malta

Italy

Greece

Based on W.H.O. Data accessed in Dec 2009

Figure 2: Figure 2: Rate of suicide per Rate of suicide per 100,000 population by gender, 100,000 population by gender,

1980-20061980-2006

Figure 4:Figure 4: Suicide compared with road traffic Suicide compared with road traffic accident fatalities – rates per 100,000 accident fatalities – rates per 100,000

population, 1980-2006population, 1980-2006

Average annual suicide rate by age Average annual suicide rate by age and gender, 2002-2006and gender, 2002-2006

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Biopsychosocial Biopsychosocial model of suicidal model of suicidal

behaviourbehaviour

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High risk

Biopsychosocial model of Biopsychosocial model of suicidal behavioursuicidal behaviour

Protective FactorsProtective Factors

EmploymentEmployment Social ValuesSocial Values Health TreatmentHealth Treatment Coping SkillsCoping Skills Reasons for LivingReasons for Living Physical activity & healthPhysical activity & health Family ConnectednessFamily Connectedness Supportive SchoolsSupportive Schools Social SupportSocial Support Religious ParticipationReligious Participation

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How can I support individuals How can I support individuals identified at risk of suicidal identified at risk of suicidal

behaviour?behaviour?

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Warning SignsWarning Signs Some of these warning signs and risk factors can be Some of these warning signs and risk factors can be

associated with everyday behaviourassociated with everyday behaviour

You should look at the overall picture for the person You should look at the overall picture for the person you are concerned aboutyou are concerned about

However, the more warning signs and risk factors, However, the more warning signs and risk factors, the higher the possible riskthe higher the possible risk

Some people show their warning signs in very Some people show their warning signs in very subtle ways and they can be missed but seen only in subtle ways and they can be missed but seen only in hindsighthindsight

It is important to treat each person and their case It is important to treat each person and their case as individual and unique.as individual and unique.

Individual Warning Signs- Individual Warning Signs- BehaviourBehaviour

Difficulties in school/workDifficulties in school/work Dropping out of activitiesDropping out of activities Sleeping/eating disturbancesSleeping/eating disturbances Isolating self from friends/familyIsolating self from friends/family Drug/alcohol abuseDrug/alcohol abuse Disinterest in usual activitiesDisinterest in usual activities High risk behavioursHigh risk behaviours

Warning signs - PhysicalWarning signs - Physical Neglect of appearanceNeglect of appearance

Personal hygiene/dress neglectedPersonal hygiene/dress neglected

Persistent physical complaintsPersistent physical complaints

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Warning signs - thoughtsWarning signs - thoughts PessimisticPessimistic

Inability to find solutions to problemsInability to find solutions to problems

Preoccupation with a known suicidePreoccupation with a known suicide

Overly self-criticalOverly self-critical

Difficulty in concentratingDifficulty in concentrating

Expressing suicidal thoughtsExpressing suicidal thoughts

Individual Warning Signs – Individual Warning Signs – Suicide SpecificSuicide Specific

Writing about suicide.Writing about suicide.

Talking about suicide.Talking about suicide.

Listening to songs with a suicidal theme.Listening to songs with a suicidal theme.

Threats and statements of intent.Threats and statements of intent.

Giving away treasured possessions .Giving away treasured possessions .

Tidying up affairs.Tidying up affairs.

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Risk situations (1)Risk situations (1)

Death of a loved one or significant other Death of a loved one or significant other

Break up of a relationshipBreak up of a relationship

Bullying or victimisationBullying or victimisation

Disappointment with resultsDisappointment with results

Unemployment & poor financesUnemployment & poor finances

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Risk situations (2)Risk situations (2)

Access to a method of suicide e.g. medication, Access to a method of suicide e.g. medication, firearmsfirearms

Serious illnessSerious illness

Interpersonal conflicts or lossesInterpersonal conflicts or losses

Legal or disciplinary problemsLegal or disciplinary problems

Peer group pressurePeer group pressure

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Taking action: Taking action: Responding at an Responding at an individual levelindividual level

Key steps in taking actionKey steps in taking action

Skills to enable taking action Skills to enable taking action

Show you careShow you care ListenListen Ask the questionAsk the question Call for helpCall for help

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Active listeningActive listening

Show interestShow interest Be warm and Be warm and

supportivesupportive Pay attentionPay attention Ask for clarificationAsk for clarification Allow timeAllow time Be silentBe silent Be empatheticBe empathetic

ArgueArgue InterruptInterrupt Make value Make value

judgementsjudgements Give adviceGive advice Find the solutionFind the solution Burden the personBurden the person Give out platitudesGive out platitudes

Do’s Don’ts

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Encouraging the person to Encouraging the person to get helpget help

Focus on the person’s positive strengths – how have Focus on the person’s positive strengths – how have earlier problems been resolved?earlier problems been resolved?

Who could the person rely on in bad times? Is there Who could the person rely on in bad times? Is there anyone who might help?anyone who might help?

Explore alternatives to suicide :Explore alternatives to suicide :

“ “Let’s talk to someone who can help”Let’s talk to someone who can help”

“ “I will stay with you until you get help” I will stay with you until you get help”

“ “You’re not alone and help is available”You’re not alone and help is available”

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Eight key steps for Eight key steps for helpinghelping

1.1. Take all threats seriously.Take all threats seriously.

2.2. Ask the person to tell you what is wrong.Ask the person to tell you what is wrong.

3.3. Listen and offer support.Listen and offer support.

4.4. Remove anything that could be lethal.Remove anything that could be lethal.

5.5. Don’t leave the suicidal person alone.Don’t leave the suicidal person alone.

6.6. Be positive and emphasise choices.Be positive and emphasise choices.

7.7. Don’t promise confidentiality.Don’t promise confidentiality.

8.8. Get professional help.Get professional help.

‘‘Human understanding Human understanding is the most effective is the most effective weapon against suicide’weapon against suicide’

Dr Edwin ShneidmanDr Edwin Shneidman

Thank YouThank You