plenary session gp medical study day programme

Medical Study Day ProgrammeSaturday 14th November, 2015

Suicide in Ireland:

Fact, Fiction and What Can We Actually Do?

Professor Brendan Kelly

People caring for people….

There is but one truly serious philosophical problem

and that is suicide

Camus

Suicide and deliberate self-harm

Prediction

What to do?

Suicide and deliberate self-harm

Prediction

What to do?

Suicide

Intentional killing of oneself

Deliberate self-harm

Apparent attempted suicide without the

actual intention of killing oneself

Includes a range of behaviours:

Self-cutting

Self-burning

Ingesting overdoses

...without an intent to die

Suicide

Globally 2013 842,000

Ireland 2013 475 (65 undetermined)

2014 459 (62 undetermined)

80% male

NOSP, 2013

General population data

2.9% have attempted suicide in the past

2.3% have had suicidal thoughts in the past

year

...fewer than 1/200 go on to die by suicide

Young people: 19% have had suicidal thoughts

in the past year

Suicide and deliberate self-harm

Prediction

What to do?

Risk factors

Suicide Deliberate self-harm

Male Female

Substance misuse Substance misuse

Mental illness Mental illness

Deliberate self-harm Deliberate self-harm

Prediction using mental illness

Major depression

Bipolar disorder

Schizophrenia

Alcohol dependence

Prediction using mental illness

Major depression 15%

Bipolar disorder 15%

Schizophrenia 10%

Alcohol dependence 10%

Individuals who engage in deliberate self-harm

have a 30-fold increased risk of suicide

Prediction using risk-factors

One study followed-up 5,000 psychiatric

inpatients after discharge, using a combination of

known risk factors to predict suicide

They predicted 35 out of 67 suicides

Model also generated over 1,000 ‘false positives’

(i.e. predicted suicide in over 1,000

individuals who did not die by suicide)

Suicide and deliberate self-harm

Prediction

What to do?

If suicide is allowed then everything is allowed

Wittgenstein

(a) Population health measures

(b) Better treatment of mental illness

Generic mental health services

Intervention in primary care

(a) Population health measures

(b) Better treatment of mental illness

Generic mental health services

Intervention in primary care

Irish Journal of Medical Science 2002; 171: 148-50

Irish Journal of Medical Science 2006; 175: 40-2

(a) Population health measures

(b) Better treatment of mental illness

Generic mental health services

Intervention in primary care

What can you do?

Risk factors

Suicide Deliberate self-harm

Male Female

Substance misuse Substance misuse

Mental illness Mental illness

Deliberate self-harm Deliberate self-harm

A Ask, ask, ask

B Be direct, open and honest

“But this has never happened to you...”

“Have you ever felt like this?”

“Why did this happen to me?”

C Contain

What to do?

Remember deliberate self-harm

Bear in mind known risk-factors

Provide normal care in a steady fashion

Provide containment

You will fail

You will succeed

You will never know what you prevented

Suicide and deliberate self-harm

Prediction

What to do?

National Office for Suicide Prevention

www.nosp.ie

National Suicide Research Foundation

www.nsrf.ie

Console: Living With Suicide

www.console.ie

Suicide in Ireland:

Fact, Fiction and

What Can We Actually Do?

Brendan Kelly

brendankelly35@gmail.com