Parasuicidal Tendencies

A new report shows a frightening level of suicidal behaviour among our population, writes Catherine Shanahan.

IT is the tip of an iceberg of mental distress, a potent symptom of the mental health of our population. That is how the authors of a study due for launch next Monday by Health Minister Micheál Martin describe its grim findings.

It is the National Parasuicide Registry's annual report 2002 and it outlines a frightening level of suicidal behaviour among our population.

Starkest among its harsh statistics is the fact that teenage girls are most likely to deliberately harm themselves and the most popular way to do this is by way of either drug overdose or self-cutting.

Seventeen-year-olds are particularly vulnerable and for every 140 girls of this age who attended hospitals in 2002, one had deliberately tried to harm herself. A second pilot study, part of the Child and Adolescent Self Harm in Europe (CASE) study, threw up an even higher statistic one in eight or 13% of girls aged 15-18 said they had self-harmed and 6% had inflicted injury on themselves more than once. The study included 12 schools in Cork and Kerry and interviewed 1,022 students, male and female.

The Registry report gives a national picture. Women across all age groups are far more likely to attempt suicide, with a parasuicide rate 42% higher than men. For men the figure was 167 per 100,000, for women 237 per 100,000. For men the peak rate was among 20 to 24-year-olds, at 407 per 100,000. The rate of parasuicide gradually decreased with increasing age with men. However, there was a secondary peak in the parasuicide rate in middle-aged women.

The report is based primarily on data collected for the year 2002 on presentations to acute hospitals as a result of parasuicide. Parasuicide data was collected from each health board region in the country. There was complete coverage of the Midland, Mid-Western, North Eastern, North Western, South Eastern, Southern and Western Health Boards and partial coverage of the Eastern Regional Health Authority.

Based on the near-complete coverage of acute hospitals, an estimated 8,400 individuals inflicted deliberate self harm in 2002.

The authors of the report say there is preliminary evidence that parasuicide is an increasing problem in Ireland. The four health boards for which a full year's data were collected in 2001, the Midland, Mid-Western, South Eastern and Southern Health Boards experienced increases of 6%, 12%, 9% and 13%, respectively, in the rate of individuals presenting to hospital due to parasuicide. The report points out that repeated acts of self harm "represent a significant problem" and it calls for action to tackle this problem.

"One in five of all parasuicide presentations in 2002 were due to repeat acts. The development and delivery of interventions for this difficult to reach patient group must be prioritised."

Rates were particularly high in the young with 90% of all presentations involving individuals aged under 50 years. Again, the high risk of self harm among adolescent girls, prompted the report's authors to issue a warning.

"The high rate of deliberate self-harm in adolescent girls poses a particular challenge for our health system as individuals in this age group may fall between child and adult mental health services," they said.

Commenting on the report, consultant child and adolescent psychiatrist Dr Helen Keeley, said the figures showed an urgent need for greater investment in child and adolescent psychiatric services.

"You are really talking about a puberty thing, in girls the deliberate self harming starts at about 12 and builds up to age 17, then it drops off a bit, so what we need is early intervention.

"We need people in schools, counsellors, someone who projects themselves as independent of the school hierarchy that they can trust and confide in."

A big problem, according to Dr Keeley, is the shortage of child and adolescent psychiatrists, and the fact that over the age of 16, a teenager does not have access to these services.

The shortage of psychiatric in-patient beds for children and adolescents is another much-publicised problem, with youngsters frequently ending up in adult wards.

"There are just 20 beds nationally when there should be 144, 12 in Galway and eight in Dublin, so adolescents end up in inappropriate adult wards. These services need to be prioritised," said Dr Keeley.

So what prompts a young person to attempt to take his or her own life?

Paul Corcoran examined the causes. A feeling of hopelessness, a background of social deprivation, high generational unemployment, a family background of alcohol and substance abuse, emotional neglect.

The manner in which males and females attempt suicide was also examined. Drug overdose was the most common method, followed by self-cutting. Cutting was significantly more common in men (24%) than in women (15%). This is in sharp contrast to findings in international literature that women are more likely to cut.

Dr Keeley said from talking to her young patients, cutting seemed to be a kind of release.

"They tell me they have a kind of frustration, an internal tension and that cutting is a release and they tell me it doesn't hurt at the time they do it."

While men cut themselves more, they do not self-harm as frequently as women. Dr Keeley said people who self-harm are more likely to be "the worrying kind".

"Over half of those who self-harm tell me that they are worried, mainly about relationships. It could be fighting with their parents, or somebody dying. Others worry about pressures such as work and study, but our research shows that those with work and study worries are less likely to repeat self harm because they are engaged in something productive."

Adolescents are particularly vulnerable to self harm.

"It is a trying time anyway, people are forming an identity, it's a time when we are supposed to take risks, it is part of the natural process."

The statistics in the National Parasuicide Registry report make for bleak reading. As it authors point out, the report "highlights the challenge that deliberate self-harm poses for our health system and our society as a whole ..... The challenge we face is to better understand the fundamental family, social, cultural, economic, educational and other determinants of poor mental health and suicidal behaviour in our population."

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