Listening and learning: dealing with the threat of suicide

Brendan McManus was at a conference of the Console Suicide Bereavement Group in Dublin on September 22. He was impressed by the concern and good sense of the speakers. The constant refrain of the day was that people must listen well to those who are at risk.

As one whose family has been touched by suicide, I could relate to broadcaster Gareth O’Callaghan’s opening question about finding answers to ‘this awful blight’ that affects contemporary Irish society. Suicide seems to be a particularly contemporary phenomenon with the breakdown in tradition family structures, a more pressurised lifestyle and reduced levels of support. The thing that is common, though, is that it can strike anyone, is very hard to spot beforehand and yet the levels of subsequent personal, familial and societal devastation are considerable.

Mary Harney, the Minister for Health, opened the conference, acknowledging suicide as a very difficult area. She referred to the new Console facility in Clondalkin, an area which has seen an upsurge in suicides recently, 40% of those being young males under 35. She outlined the government’s new Suicide Prevention Office, a counselling referral system that would be based around A&E departments when people displayed evidence of self harm. Suicide is a complex issue involving biological, familial, and social factors- for example 30% of suicides are unemployed. However, those prone to suicide can often not be reached through the mainstream media, so some careful targeting of high-risk groups is needed. Most of the burden falls back on families, self-help groups, and personal counselling. The challenge is to develop a mental health strategy whereby people are not stigmatised; mental institutions need to move to more community-based services. She also underlined the need to listen to the experience of the families involved.

Dr. Tony Bates, a clinical psychologist who has written widely on depression and suicide, spoke on what young people are saying to us through self harm. Concerned with suicide prevention, he asked for ‘a more compassionate society’ outlining the struggle for mental health and well-being in the light of a lot of breakdown of traditional support structures. He quoted the Columbine example where youth felt they were not being listened to, whereas the internet has created new possibilities for youth discussion forums, e.g. Bebo.com or TheIcarusProject.net. He reviewed a number of depression/suicide websites that quoted verbatim young people’s struggle with life and the core human problems of finding safety, meaning, and identity. He commented on the “mental health gap for mid-teens”; that they find it very difficult to talk about distress and inner conflict, the lack of real listening from parents and peers, and the despair that often results. The personal problems resulting from this distress often resulted in hopelessness, alcohol/drug abuse; abusive sexual activity; with suicide always lurking behind. Finally he reiterated the need for young people to be heard, and to create a safe place of acceptance, where they could regain self-trust. He suggested a youth “drop-in service”, which would be confidential and convenient, a one stop shop with no further referring.

Carol Fitzpatrick, a child and adolescent Psychiatrist, spoke on “depression and suicidal behaviour in young people: how can families help?” Ironically, the young people that she meets are the lucky ones- the group most at risk and unlikely to present are young men who find it difficult to talk about their problems. Depressive disorders are a significant factor in suicide, but this is exacerbated in the intensity of adolescence and the difficulty of recognising depression within it. She outlined the typical symptoms of low mood, withdrawal, poor energy/concentration, suicidal thoughts or acts, problems sleeping, appetite loss, irritability and increased anger levels.

What was interesting though, was the complexity of predisposing factors. These included: genetics; personality (e.g. self confidence); life experience (especially involving loss, abuse, or bullying); family factors (e.g. internal conflict); and drugs/alcohol abuse (e.g. alcohol played a role in one third of suicides). In a recent DVD project in the Mater, a group of 14-18 year olds highlighted the need for coping skills, or ‘getting it all out’ and not staying isolated in one’s room. Obviously these skills get better with age, though recovery from depression in adolescents is slow (normally takes around 2 years). She related that up to 60% recover totally but severe disorders need more complex treatment. Cognitive behaviour therapy (CBT) was better for mild or moderate depression while Fluoxetine medication plus CBT was needed to treat severe depression. In all cases family support was critical, as was finding the right words to dialogue with teens.

A lot of delicacy was needed, Carol Fitzpatrick said, in terms of offering help; schools and teachers could be useful on an informal level, while using GPs and formal counselling and mental health services was more difficult. She underlined the importance of family support and the importance of not reacting. Rather, active listening and encouragement was preferred, finding a balance between addressing the problem and support.

Ruairi McKiernan from Community Creations based in Donegal outlined www.spunout.ie, a national youth website created by youth for youth. Young adults have contributed over 2000 pages on the positives of youth culture. The site is “youth friendly” with music and images while promoting mental health and how to access relevant services. With all the contemporary pressure for success and the stigma of seeking help, the website was seen as ‘a lifeline’ for expression and prevention. The website allows young people to talk anonymously with others without judgement, to provide support and “normalisation” for those who feel ’emotionally challenged’. It offers very practical help, allowing youth to actively participate though the Internet. The advantages are that it avoids the use of jargon, can reach even isolated rural areas, it is not intimidating, and it deals well with sexual issues.

Dr. Justin Brophy, a consultant psychiatrist from Newcastle spoke on “Disarming the enemy within’, underlining the issue of substance abuse, mainly alcohol, in the under 25s. Quoting the evidence from A&E departments, he has seen a huge increase in alcohol abuse which is a huge risk factor for depression. Many adolescents drink for respect or escape from anxiety and depression, especially those with self-esteem problems and those on the margins of society. It is widely known that alcohol acts as a depressant, impairs decision making, brings out aggression, sharpens pain, and messes with brain chemistry. Essentially it multiplies the problems, dividing one’s supports at the most vulnerable times. Suicide and alcohol abuse rates are strongly correlated. Again, he pointed to the importance of coping mechanisms, “wait, relate, communicate”, though the ‘macho’ culture made this difficult for males in particular. There is a need to make services more accessible, especially in poor areas, and tackle the stigma and denial around this issue.