The national strategy for action on suicide prevention, titled Reach Out, was published in September 2005.1 The definition of suicide used by the authors was ‘suicide is a conscious or deliberate act that ends one’s life when an individual is attempting to solve a problem that is perceived as unsolvable by any other means’.

The Central Statistics Office (CSO) compiles mortality data on suicide in Ireland. This is done using the findings of coroners’ inquests and data provided in Form 104 completed by the Garda Síochána. The CSO reported that there was an average of 494 deaths as a result of suicide each year between 2000 and 2002. The annual rate for men rose steadily, from 10 per 100,000 in 1990 to 24 per 100,000 in 1998: the rate dropped to 19 in 2002. The annual rate for women remained stable at around 5 per 100,000 between 1990 and 2002; however, according to the information provided, suicide rates increased among women aged 15 to 24 years. Taking the number of deaths for which the underlying cause is undetermined and expressing it in relation to the number of deaths for which the underlying cause is suicide, it is calculated that, because of doubtful cases, there is on average a 5% possible under-estimate of annual suicide numbers; the under-estimate rose to 18% in 2002.  Given that the under-estimate varies, it is difficult to calculate exact suicide figures over time. Suicide is more common among men than women. The majority of suicides among males occur in those aged between 20 and 34 years, while the majority among women occur in those aged between 45 and 59 years.

The data on deliberate self-harm collected at accident and emergency units throughout Ireland indicate that such harm was more common among women than men in 2003.2  There were over 11,000 cases of deliberate self-harm in 2003; the rate for men was 177 per 100,000 and for women was 241 per 100,000. In 2003, 21% of cases were repeat acts. Drug overdose was a more commonly used method of self-harm by women (80%) than by men (64%), while self-cutting was a more commonly used method by men (23%) than by women (14%). Alcohol was involved in 47% of male episodes and in 39% of female episodes.

Reach Out makes the point that social changes have impacted on the nature and extent of suicidal behaviour in Ireland. Suicide rates doubled during the 1980s and 1990s. This was a time when society experienced considerable transition from an agricultural rural economy to an urban service-orientated one. The church and rural norms were challenged. There have been considerable changes for young adults and older people. Young men in rural areas can no longer assume that they have a livelihood from farming, fathers are isolated with the increasing number of single parent families, teenage girls struggle with media-induced expectations about their physical appearance, and older people no longer have the support of an extended family network. Increasing socio-economic inequalities and social exclusion affecting a variety of groups residing in Ireland also increase suicide rates. It is clear that this is not just a health problem, but a societal one.

This strategy document builds on work by a number of groups since 1995. The four levels of action identified in the strategy were developed through a series of consultations throughout Ireland. The levels of action are: general population approach, targeted approach, responding to suicide, and information and research.

The general population approach will promote positive mental health and bring about a positive attitude towards mental health, problem solving and coping in the general population through 11 major agents who will implement 42 actions.

The targeted approach will reduce the risk of suicidal behaviour among high-risk groups and vulnerable people. These include those who commit deliberate self-harm, those at risk of or abusing alcohol and drugs, marginalised groups, prisoners, unemployed people, people who have experienced physical or sexual abuse, young men and older people. The Garda Síochána will be supported in carrying out their duties in relation to suicidal behaviour. There will be a number of actions to limit access to the means of self-harm.

The response to suicide will minimise distress felt by families, friends and the community following death, and ensure that individuals are not isolated or left vulnerable, so as to reduce the risk of related suicidal behaviour.

Information and research will be used to inform service development and provide information on where and how to get help. It is proposed to link and exchange data between a number of health information systems, including the National Parasuicide Registry, the Hospital In-Patient Enquiry scheme, the National Psychiatric Inpatient Reporting System and the National Drug Treatment Reporting System. It is not clear how the latter will be able to assist in providing information relating to the circumstances of suicide deaths since it does not collect data on clients exiting treatment. The HRB maintains the National Drug-Related Deaths Index, which may be a more useful source of data.

1. Health Service Executive, National Suicide Review Group and Department of Health and Children (2005) Reach Out: National strategy for action on suicide prevention, 2005–2014. Dublin: Health Service Executive.

2. National Parasuicide Registry Ireland (2004) Annual Report 2003. Cork: National Suicide Research Foundation.