Prevention of suicide in Northern Ireland

A Law Centre (NI) response

October 2007

1.  Introduction: About Law Centre (NI)

1.1  Law Centre (NI) is a public interest law non-governmental organisation.  We work to promote social justice and provide specialist legal services to advice organisations and disadvantaged individuals through our advice line and our casework services from our two regional offices in Northern Ireland.  We provide a specialist legal service (advice, representation, training, information and policy comment) in five areas of law: mental health, community care, immigration, social security and employment to almost 500 member agencies.  Members include local Citizen Advice Bureaux, independent advice agencies, local solicitors, trade unions, social services, probation offices, constituency associations of local political parties, libraries and other civic organisations.  

Summary of Main Concerns

	In this submission, we draw the Committee’s attention to our key concerns and recommendations relating to the prevention of suicide in Northern Ireland.  We recommend the Committee give consideration to the following:
	the full implementation of the recommendations of the Bamford Review;
	cohesive planning and implementation of the Bamford Review, the Suicide Prevention Strategy and The Promoting Mental Health Strategy and Action Plan;
	the development and inclusion of specific performance measurement indicators that could monitor the progress of actions in delivering on quantifiable targets;
	commissioning of research on the specific needs of communities within Northern Ireland;
	the use of the European Convention on Human Rights through the Human Rights Act 1998 in the promotion and protection of suicide prevention in Northern Ireland;
	an increase in provision and education on the benefits of ‘talking therapies’ including but not limited to cognitive behavior therapy;
	the introduction of mandatory training for nominated GP’s and other health/social care professionals on depression awareness;
	the inclusion of effective monitoring and follow-up for public campaigns on mental health;
	increased access to effective crisis services, including community services as well as in-patient wards;
	better targeting of high risk groups in the provision of services and support;
	school and/or community programmes to equip young people with effective problem-solving skills.

1. Introduction

1.1 Law Centre (NI) is a public interest law non-governmental organisation.  We work to promote social justice and provide specialist legal services to advice organisations and disadvantaged individuals through our advice line and our casework services from our two regional offices in Northern Ireland.  It provides a specialist legal service (advice, representation, training, information and policy comment) in five areas of law: mental health, immigration, social security, community care, and employment.

1.2  Our services are provided to almost 500 member agencies.  Members include local Citizen Advice Bureaux, independent advice agencies, local solicitors, trade unions, social services, probation offices, constituency associations of local political parties, libraries and other civic organisations. 

1.3  Law Centre (NI)’s mental health legal service provides advice and legal representation in relation to issues around admission to hospital for assessment, capacity, treatment, discharge delay, community services and other mental health related legal issues.  We welcome the opportunity to respond to this inquiry and commend the Committee on its interest and commitment to this important issue.

2. Suicide and Mental Health

2.1 Between 2000 and 2004 there were approximately 150 suicides recorded annually in Northern Ireland, with over forty percent being young men aged under 35 years. In recent years there has been a significant increase in the number of suicides, with 291 suicides recorded in 2006.[1]

2.2 According to the World Health Organisation in the last 45 years suicide rates have increased by sixty percent worldwide.  Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to twenty times more frequent than completed suicide. Suicide worldwide is estimated to represent 1.8 percent of the total global burden of disease in 1998, and 2.4 percent in countries with market and former socialist economies in 2020.[2]  Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries.  Indeed within Northern Ireland’s Suicide Prevention Strategy, ‘Protect Life: A Shared Vision’, males aged between 18 and 34 have been identified as a specific priority target area.

2.3 There is an established link between mental ill health and suicide.  According to the World Health Organisation mental disorders (particularly depression and substance abuse) are associated with more than ninety percent of all cases of suicide.[3]  Research shows that poor mental health is often a contributory factor in many suicides in Northern Ireland.  With one in six people in Northern Ireland suffering from a medically identified mental illness at any one time[4] it is clear that urgent work is required to address the lack of services and support for those with mental ill health to stem the increase of suicides within Northern Ireland. 

2.4  The Bamford Review of Mental Health and Learning Disability provides a comprehensive analysis of mental health and learning disability services, policy and legislation in Northern Ireland.[5]  Suicide and suicide prevention is a major feature across many of the Review’s reports.  The Review makes many detailed recommendations regarding suicide prevention which Law Centre (NI) support and commend.  We would recommend that the Committee as part of this inquiry call for the full implementation of the recommendations of the Bamford Review. 

3.  Reviews and Research

3.1 The inquiry is timely with the release of the final report of the Bamford Review and the current review of the Suicide Prevention Strategy and The Promoting Mental Health Strategy and Action Plan.  It is critical that all of these reviews and reports are taken forward in a cohesive and effective way.  As part of the inquiry we would advocate for the development and inclusion of specific performance measurement indicators that could monitor the progress of actions in delivering on quantifiable targets.

3.2 Research helps determine which factors can be modified to help prevent suicide and which interventions are appropriate for specific groups of people.  Further specific research needs to occur within Northern Ireland to ensure that appropriate and effective services and support systems are put in place to deal with the specific needs of communities.  Before being put into practice, prevention programs should be tested through research to determine their safety and effectiveness. For example, because research has shown that mental and substance-abuse disorders are major risk factors for suicide, many programs also focus on treating these disorders.  Consideration therefore needs to be given to the collation of Northern Ireland specific data and the creation of programmes aimed at the particular needs of Northern Ireland communities. 

3.3 Consideration should also be given to the use of the European Convention on Human Rights through the Human Rights Act 1998 in the promotion and protection of suicide prevention in Northern Ireland.  Article 2 is particularly relevant as it places a positive duty on governments to protect life.[6]  There is a growing body of case law on the use of Article 2 in suicide related cases, many of which relate to investigations into suicide or attempted suicide in prison.[7] 

4. Training and Public Awareness

4.1 We are aware that the Protect Life strategy includes a commitment to the provision of training in depression awareness for General Practitioners and other primary care professionals and staff.  We understand that the take up of this training across Northern Ireland has been limited and would welcome further information as part of the inquiry regarding the reasons for this and action plans to encourage the take up of this vital training.  We recommend that consideration be given to the introduction of mandatory training of this nature with the requirement that each GP practice nominate at least one staff member to undertake the training to ensure that each practice has at least one ‘specialist’ in this field. 

4.2 We welcome the development and roll out of the “Minding Your Head” campaign by the Department of Health, Social Services and Public Safety, though the Health Promotion Agency for Northern Ireland, as part of the ongoing implementation of the Protect Life strategy.  We note that the campaign highlights how mental illness can affect anyone and the need for individuals to take control of their own mental health.  Mental health promotion and prevention is closely linked with suicide prevention and campaigns need to integrate both issues.

4.3 Stigma and discrimination against people with mental health problems is rife through all areas of society and its impact is far reaching and goes beyond just the impact on an individual to society as a whole.  Sixty-three percent of people surveyed in Northern Ireland underestimated the proportion of people who might have a mental health problem at some point in their lives while over half said that if they were experiencing mental health problems they wouldn’t want people knowing about it. [8]

4.4 Northern Ireland has seen two other campaigns this year by BBC Northern Ireland and Rethink, to address the stigma and discrimination associated with mental health.   The success of these campaigns is yet to be determined but we are encouraged by the positive work undertaken by agencies in Northern Ireland to address this issue.  Further work, however, needs to be done to ensure organisations working in the field of mental health and learning disability are sufficiently resourced to enable them to work on campaigns to create long-term positive impact. 

4.5 The inquiry should consider ensure that any such campaigns are closely monitored in order to determine effectiveness.  High profile media campaigns can be expensive and there is often a lack of follow through at the conclusion of such campaigns.  While the issues may be highlighted if there are insufficient support services on the ground to assist people who respond to public campaigns the success will always be limited. 

5. Services and Support

5.1  Studies in the United States showed that cognitive behaviour therapy (CBT) reduced the rate of repeated suicide attempts by 50 percent during a year of follow-up. A previous suicide attempt is among the strongest predictors of subsequent suicide, and cognitive therapy helps suicide attempters consider alternative actions when thoughts of self-harm arise.[9]  As highlighted in the Bamford Review further resources are required to provide adequate psychological therapies for the treatment of mental ill health.  We are encouraged by the increase in availability of CBT in Northern Ireland through the Northern Ireland Centre for Trauma and Transformation but more needs to be done.  Further consideration needs to be given to other ‘talking therapies’ including dialectical behavioural therapy which can have extremely positive results in the management and prevention of mental ill health. 

5.2 There is a clear need for increased access to effective crisis services, including community services as well as in-patient wards to meet the needs of those at risk of suicide or self-harm.  As part of the provision of effective services consideration must be given to better targeting of high risk groups as highlighted within the Protect Life strategy but which in reality has seen little action on the ground. 

5.3 While we welcome the increased awareness of the needs of children and young people within the Bamford Review and the recent increase in provision of facilities for Child and Adolescent Mental Health Services.  Consideration must also be given to prevention and the provision of school or community programmes to equip children and young people with effective problem-solving skills to develop coping skills and awareness of mental health which will aid the prevention of suicide. 

4. Conclusion

4.1 Law Centre (NI) welcomes the opportunity to provide a submission to the Committee.  We trust you will find our comments helpful.  If there is any further way in which we could contribute to this process we would welcome the opportunity to do so.