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Home > First report of the Suicide Support and Information System.

Arensman, Ella and McAuliffe, Carmel and Corcoran, Paul and Williamson, Eileen and O’Shea, Eoin and Perry, Ivan J (2012) First report of the Suicide Support and Information System. Cork: National Suicide Research Foundation.

[img] PDF (First report of the SSIS) - Published Version

The SSIS pilot study was conducted in County Cork over the period September 2008 – March 2011. The SSIS operates according to a stepped approach whereby step 1 involves pro-active facilitation of support for family members bereaved by suicide, followed by step 2: obtaining information from different sources including information from coroners’ records, family informants and health care professionals who had been in contact with the deceased in the year prior to death.

In total 178 cases of suicide and 12 open verdicts (total 190) were ascertained in the Cork region during the pilot phase of the SSIS, with very satisfactory response rates for the three information sources.

Key outcomes include:
• In 39.5% of cases the SSIS pro-actively facilitated bereavement and other support. In 47.5% of cases bereavement support had been obtained prior to contact with the SSIS team. In 8.2% of cases the bereaved did not wish to avail of formal bereavement support from a specific service, but they welcomed further contact with a member of the SSIS team. A small proportion (4.8%) did not wish to receive further contact following the initial letter from the SSIS team.
• Mental health risk factors associated with suicide included mood disorder of the deceased, mental disorder of family members, history of deliberate self harm and lifetime alcohol abuse in the year prior to death.
• Major precipitating factors in the month prior to suicide included significant losses, significant or perceived significant disruption of a primary relationship and significant life changes. Evidence was found for the impact of the economic recession in terms of job loss, increased suicide risk associated with specific occupations, financial problems and loss of possessions, such as house etc.
• Evidence was found for long term adversity in the lives of people who died by suicide, often starting in childhood or early adolescence and continuing in later life, such as mental and physical maltreatment, problems in making contact with others and loneliness over a long period of time.
• The majority of the deceased had been in contact with their GP or a mental health service in the year prior to death, and those who had contacted their GP had done so 4 times or more.
• Challenges exist in the contact with health services including difficulties in accessing health care services, difficulties in adhering to treatment appointments and lack of compliance with instructions related to prescribed medication.
• The SSIS has been able to use official data sooner than the CSO, which has facilitated the identification of emerging suicide clusters.
• Through the multiple sources of information accessed by the SSIS, contagion effects could be identified and direct and indirect relationships among the suicide cluster cases could be established.
• Even though the number of open verdicts was relatively small, comparison with confirmed suicide cases revealed more similarities than differences, such as alcohol consumption at time of death, history of deliberate self harm, a high prevalence of mood disorders and use of psychotropic medication.
• During the SSIS pilot phase, first analyses were performed to link the SSIS data with the data from the National Registry of Deliberate Self Harm (NRDSH). Examination of suicides and deaths classified as open verdicts ascertained by the SSIS between 2008 and 2010 showed that at least 10% of the cases had been medically treated for deliberate self harm in the Cork region over the time period 2007-2009.

Key recommendations:
1. The outcomes of the SSIS pilot study and the independent evaluation by the University of Manchester recommend the maintenance of the SSIS in Cork and expansion to other regions in the country, in particular regions with high rates of suicide and a history of suicide clusters. Recommended options for expansion of the SSIS include: a) Phased implementation in collaboration with the Department of Health and the Department of Justice and Equality;1 b) Phased implementation in collaboration with suicide bereavement support services.1
2. Pro-active facilitation of bereavement support would be the recommended approach for services working with families bereaved by suicide, ensuring that all families bereaved by suicide are offered bereavement support through the services currently in place.
3. It is recommended to increase the awareness of coroners of local bereavement services and materials and to offer these as a matter of course.
4. The association between the impact of the recession (unemployment, financial problems, loss of possessions) and suicide, as identified by the SSIS, underlines the fact that suicide prevention programmes should be prioritised during times of economic recession.
5. Based on the association between alcohol/drug abuse and suicide as identified by the SSIS, it is recommended that:
a) National strategies to increase awareness of the risks involved in the use and misuse of alcohol should be intensified, starting at pre-adolescent age
b) National strategies to reduce access to alcohol and drugs should be intensified
c) Active consultation and collaboration between the mental health services and addiction treatment services be arranged in the best interest of patients who present with dual diagnosis (psychiatric disorder and alcohol/drug abuse)
6. The fact that the majority of people who died by suicide had been in contact with their GP 4 times or more in the year prior to death provides evidence for increased suicide awareness and skills training for GPs.
7. In areas with emerging suicide clusters, it is recommended to encourage involvement of GPs and other primary care professionals in a response plan and in early identification of people at risk of suicidal behaviour.
8. It is recommended to improve access to health care services for people who have engaged in deliberate self harm, people at high risk of suicide and people with multiple mental health and social problems.
9. In areas with emerging suicide clusters, the HSE-NOSP guidelines for responding to suicide clusters should be implemented and supported by additional capacity and specialist expertise as a matter of priority.
10. Comparing the characteristics of confirmed cases of suicide to open verdicts, the SSIS identified more similarities than differences, which underlines the need for further in-depth investigation into cases classified as open verdicts.

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