Evidence Brief

Why did we start?

Most people who complete suicide are in contact with their family doctors or other services in the months prior to death. A better understanding of the nature of these contacts and the various pathways experienced by suicidal people should reveal the gaps and barriers to effective service provision. We also need better information about the difficulties experienced by family carers, both prior to the death and afterwards. Of particular interest to policy makers in Northern Ireland was a concern that people from rural areas may be at increasing risk of suicide. We were commissioned by the Health and Social Care R&D Division of the Northern Ireland Public Health Agency to address the gaps in our understanding of suicide in NI.

What did we do?

We undertook a mixed methods study in which we examined the records of 403 people who took their own lives over a two-year period between March 2007 and February 2009. We linked these data to GP records and then examined help-seeking pathways of people and their contacts with services. We did in-depth face-to-face interviews with 72 bereaved relatives and friends who discussed their understanding of the events and circumstances surrounding the death, the experience of seeking help for the family member, the personal impact of the suicide, and use of support services. Additionally, we interviewed 19 General Practitioners about their experiences of managing people who died by suicide.

What answer did we get?

We found no evidence that suicide rates in urban and rural areas differ. However, we noted relatively high rates for people living in large towns and significantly higher levels of contact with primary care services, especially among women in such areas. As in similar studies, we found that mental health problems may have been undetected for many people. Families report the distress of trying to get appropriate help but felt impeded by a combination of stigma and service failures. The burden of care was exacerbated by lack of professional communication. In addition, GPs highlight the problems of limited time for consultations and fragmented care.