Time to step up action on suicide

Sharon Grace's tragic death again brings into focus a key failing in health provision, writes Carl O'Brien, Social Affairs Correspondent

It was a last, desperate, plea for help. Late last Saturday evening, Sharon Grace arrived with her two young daughters at the reception of Ely Hospital, just outside Wexford town, looking for a social worker. The receptionist couldn't help. It was Saturday evening. There was an out-of-hours GP service, but no social worker would be available at the hospital until Monday.

Hours later, at 10am on Sunday, the bodies of Sharon (28), Mikahla (four) and Abby (three) were spotted by part-time fishermen in the Kaats Strand area of the River Slaney, a short distance from the hospital.

It was a pitiful end to a tragic story. Sharon, described by family members as a devoted mother who doted on her children, had lived apart from her husband for the previous 18 months. Fearful of losing access to her children, she had become consumed by worry. She had kept this hidden from those closest to her, although in the final weeks of her life she was increasingly tearful and upset.

The day before she died she had met a social worker for the first time. They discussed a number of issues, including her emotional state and access to the children. By the Saturday she seemed okay, her sister says.

"The last time I saw her was at 3.30pm on Saturday," says Lillian Reddy, her voice strained with grief. "We were planning to have a few drinks that night and she asked me to bring home a bag of coal and a packet of fags. I never saw her again after that."

For professionals working in the field of mental health, the steps leading to Sharon's death ring depressingly familiar and put into sharp focus an underfunded but vital arm of the health service.

There are no guarantees that a last-minute intervention last weekend, or any intervention for that matter, would have saved her life. These are imponderable questions. But health professionals say a better resourced and more comprehensive system of suicide awareness would help to prevent some of the hundreds of other such tragedies that occur each year.

Suicide was decriminalised in the State in 1993. While the stigma of illegality has been addressed, there has been a failure to plan or invest in services at a national level to reduce the number of unnecessary deaths and put in place appropriate supports for bereaved and grieving families and friends.

The proportion of funding that goes towards mental health as a proportion of the overall health budget has been falling over the last decade or so. Mental health services received only 6.8 per cent of the health budget last year, down from 10.6 per cent in 1990.

"We are light years behind places such as Scotland and New Zealand in terms of recognising the problem and investing in solutions," says Prof Kevin Malone, of St Vincent's University Hospital, Dublin. "It's a tragedy. As a physician you're trained to look after life and protect life. It's deeply frustrating not being able to deliver the services on our doorstep which are there in other countries. We've lost a lot of lives as a result."

While the scale of suicide - which claimed 444 lives in 2003, almost 100 more than died in traffic accidents - is relatively low by European standards, we are catching up fast. Suicide among young men is accelerating in the Republic at a pace unmatched by any other EU country. Suicide is now the most common cause of death among people aged between 15 and 24 in this country and, according to the National Suicide Review Group, the highest rate of suicide over the past five years has been among men aged between 20 and 29.

ONE OF THE barriers to progress in dealing with suicide prevention has been the lack of a single State agency to take responsibility for the area. This, say professionals, has led to a patchwork of services that vary widely from health board area to health board area.

In the absence of significant progress at national level, communities alarmed by high suicide rates have made their own response. Tallaght in Dublin, Midleton in Co Cork and Rosbrien in Co Limerick have, in conjunction with local health authorities, developed schemes to train people in listening skills, in aspects of counselling and in when to refer those at risk to professionals.

"Many communities feel shattered and helpless and let down by services when suicide occurs, " says Dr Tony Bates, a clinical psychologist. "There's not a one-size-fits-all solution. It's only people living locally that can really assess the impact of suicide and identify those most vulnerable."

Despite the decriminalisation of suicide, much of the work in the field of prevention still involves chipping away at the walls of stigma surrounding suicide and mental health.

"Many people in severe emotional distress see suicide as the only option," says Bates. "This is tremendously sad. We need to create a society where there is more awareness that we're all prone to emotional distress and where people are encouraged to access counselling and support. We need, if you like, to improve the mental health literacy of the community, so we can talk about mental illness in the same way as we talk about physical illness."

As well as prevention, there also needs to be greater focus on the level of protection available for those considered to be at risk, Bates says.

"We sometimes see risks in simplistic terms, such as how bad someone is feeling," he says. "But risk is also related to the kind of protection they have - for example, do they live on their own, are they in a relationship, do they have enough credit for their mobile phone, are they a single mother with two or three kids? Some of the people who kill themselves within a short time of leaving hospital are often in these kinds of situations."

Health professionals and experts are currently drawing up a 10-year national suicide prevention strategy, due to be published in the summer, which is likely to focus heavily on mental health promotion. There is growing hope that, with increased focus on the area through initiatives such as President Mary McAleese's recent suicide forum at Áras an Uachtaráin, there may be greater political commitment given to investment in mental health services.

Mental health experts point to places such as Scotland [ see panel] as an example of how progress can be made with a combination of investment and good planning. A national strategy for Scotland, published three years ago, already seems to be having an impact. For the first time in 30 years, suicide rates have dropped - by 12 per cent.

IN THE MEANTIME, says Bates, simple steps - such as better awareness of existing services on the ground, talking, listening, and offering emotional support - can make all the difference. "I'm very hopeful that in five to 10 years' time we'll have better responses, identifying people in crisis in the community and offering the services they need. At the moment we're trying to get the thinking right and to join minds together. I do feel optimistic, even in the wake of a tragedy like this which really hit me in the belly."

Yet the possibility that simple steps and greater awareness could have averted the deaths of Sharon Grace and hundreds of others like her is among the most difficult things bereaved families and friends have to deal with.

At the heartbreaking Requiem Mass at Barntown, Co Wexford, where the three coffins of Sharon, Mikahla and Abby were decorated with soft toys and floral tributes, Fr Sean Gorman touched on questions that must have been running through the minds of family members and friends in recent days.

"We can have feelings of guilt, we can ask questions like did we let Sharon down, could we have said or done something that could have prevented this tragedy . . . And also we can have feelings of anger, that Sharon chose to leave us so suddenly. We also today could have feelings of despair - has a day ever been this dark before, will the sun ever shine again?

"Nobody really knows what is in our hearts, only God Himself knows. He understands us better than we understand ourselves. That is why he has reserved for Himself, and Himself alone, the right to judge."