New programme tackling self-harm and suicide to be rolled out across the country

A treatment programme that has dramatically reduced suicide and self-harm rates in other countries is to be rolled out across Ireland.

The evidence-based treatment known as dialectical behaviour treatment (DBT) has cut suicide rates in half in some countries and reduced inpatient admissions by as much as 73%.

The developer of the programme, Marsha Linehan, professor of psychology at the University of Washington, also said elements of the programme, such as mindfulness and coping skills, should be taught as part of school curricula to try and prevent kids from starting to self-harm.

DBT has been running in Cork since 2010 and a study of 12 participants on its pilot programme showed a dramatic fall in emergency department (ED) visits, admissions to psychiatric units, and bed days used — with associated falls in cost to the health system.

The programme has now begun in areas such as Meath, Dublin, and Waterford, with other areas such as Kerry also in line for a DBT programme.

The Cork programme, the first to be run by the HSE in Ireland, has been operating in Cork North Lee and one patient said it had transformed her life.

Yesterday, Prof Linehan, said aspects of it should be introduced into school curricula, and that parents should also receive aspects of the training.

“There is no doubt in my mind — we have to get this into school systems,” she said.

The programme, which lasts a year, involves group and individual therapy sessions.

The HSE’s national lead in implementing the DBT programme, Daniel Flynn, said Cork had been chosen for the pilot due to the high rate of self harm.

According to the National Registry of Deliberate Self-Harm, in 2012 there were 12,010 ED admissions involving 9,483 people around the country.

The highest rates for deliberate self-harm were in Cork, Limerick, and Waterford cities and Cork City’s rate among men was twice the national average.

“The focus needs to be on long-term patient outcomes,” said Mr Flynn. The National Office for Suicide Prevention has provided funding for 17 teams around the country.

He said the focus would initially be on “people who need it most” before moving from “intervention to prevention”. He said aspects of the programme could be included in school programmes “in the next number of years”.

Taking a 12-person sample who underwent the programme in Cork, ED visits fell from 49 in the year before DBT to six during the sessions and none in the six weeks afterwards.

The number of admissions to a psychiatric unit fell from 12 in the 12 months before the programme to three during the treatment and one in the six weeks afterwards. Similarly, the number of bed days went from 207 ahead of the DBT programme to 45 during it — and only for one person — and just one in the six weeks after the programme finished.

The estimated cost to the health service for the dozen patients before the DBT programme was €144,900; in the six weeks afterwards it was €700.

Training is open to psychologists, social workers, nurses, and other mental health professionals, and four child and adolescent teams have been trained already alongside adult teams.

Prof Linehan said that while DBT was not primarily a suicide prevention programme, “if you give a group of people DBT you will reduce the probability that they will kill themselves”.

Case study

Sewing can be therapeutic but, for Mary, the needlework was not the product of a happy soul. After all, she had just run a needle and thread through her own hand.

Mary [not her real name] was just 11 when she first self-harmed. “It would hurt but it’s better to have a physical hurt than an emotional hurt — it’s easier to deal with,” she says.

Now a few decades older, she recalls how she had feelings of anxiety and inadequacy “from a young age — not fitting in, not getting along with others and I found making friends difficult”.

She says her parents never seemed to notice her injuries. She kept them well hidden. “Maybe they just thought I was odd,” she says now.

In her early teens, she began stealing sleeping tablets and drinking her father’s whiskey. However, on only one occasion did she intend to take her own life with a combination of both. She slept for hours and hours and then just woke up.

As she got older, the self-harm continued — not weekly, but “every now and then”. It escalated to “putting cleaning stuff in my eyes” — in other words, fluids in bottles with Xs on them. Her behaviour also began to involve illegal drugs.

“Drugs and drink and all that stuff, and still self-harming the whole time,” she says. “Serious depression — ‘you don’t want to live’ kind of depression. Feeling pathetic, stupid, useless, worthless...”

Mary got a job, and occasionally self-harmed in the toilets. It was only ever momentary relief, “just to start again”, but as an escape valve, it wasn’t working. It was only a few years ago, when the chance to undertake the HSE’s Dialectical behaviour therapy Endeavour programme emerged, that she finally began to feel better about herself. It came just after a diagnosis — finally — of her problems: Borderline personality disorder.

The programme lasted six months, with group and individual therapy, and then the whole programme is repeated again. It allowed Mary to look “outside of myself”, to be non-judgemental and to deal with negatives as they occurred, in isolation, “to regulate how you feel”.

It is a serious undertaking. You must attend preliminary sessions, and sign a contract committing to reducing self-harm. Not long into the course, Mary started to feel better.

“I learned how to see things separately — just because one thing isn’t working out doesn’t mean everything isn’t working out. Decisions become easier,” she says.

Since finishing the course she has had one episode of self-harm, and nothing now for close to a year. “The skills that you use become normal and more natural,” she says. “You notice levels of recovery that you reach, and then there’s another one, and another one.”