Unexpected, tragic events with adverse outcomes present a huge challenge to individuals, health services, families and communities who are striving to do their best in stressful circumstances. In order to progress towards better mental wellbeing for all, we must question how we can help vulnerable people. This research has examined in depth and in detail those tragic circumstances that no one personally or professionally ever wishes to face.

To do this objectively, openly and with a fierce intent to use the findings to improve the identification of people at risk to sudden unexpected deaths in mental health services, examining the factors that contribute to risk and the consequences for families in the aftermath were key objectives of the research team. The findings revealed that no single factor dominated the cases examined. Each case had a complexity which underlined that any recommendations made needed a multifaceted, collaborative approach.

It is hoped that the research tools described, the recommendations made and the contributions of all the families who gave their time so unreservedly will help all mental health services in Ireland. This data set of consecutive untimely sudden deaths will contribute to suicide research internationally, but most importantly it helps cast light onto what must be done to provide effective suicide prevention in Ireland. When a series of unexpected deaths occurred in Donegal, local mental health services began to search for answers.

P.8 The clinical files of all 34 cases were examined with regard to cause of death. Overdose of medication or drugs accounted for the largest loss of life (n=15, 44%) followed by hanging (n=14, 41%) and drowning (n=5, 14.7%). Almost half of the cases being examined were known to abuse both drugs and alcohol prior to death (n=16, 47%), six had abusive or dependent issues with a single substance while more than one third were reported to abuse neither drugs nor alcohol.