IN THE same week it was announced that Donal Walsh, the courageous teenager from Kerry who pleaded with those considering suicide to think again, was to be awarded person of the year, the National Research Suicide Foundation published two reports, one into deliberate self-harm and the other, a preliminary one, into suicide in Ireland.
The report into self-harm showed that there were just over 12,000 presentations to our hospitals nationally for the treatment of self-injury and that this involved over 9,400 individuals.
In themselves, these figures show that a large number of such episodes are carried out by those repeating the behaviour.
The overall numbers are showing a downward trend for the second successive year, although the number is still 12pc higher than in 2007, the year before the recession started.
These figures amount to a national rate of self-harm of 195/100,000 for men and 228/100,000 for women. This pattern of higher rates among women is a consistent feature worldwide.
As with many other social problems, Limerick has the most serious problem of self-harm also, with a male rate of 469/100,000 and a female rate of 528/100,000, figures that are much higher than the national rates detailed above.
Another interesting feature is that these behaviours are highest at weekends, around midnight and on some bank holidays.
Overdosing was the most common method (69pc) especially with benzodiazepine tranquillisers (eg Valium, Xanax, etc), followed by cutting (23pc), while hanging, clinically the most dangerous method, was used by 7pc of those seen.
These figures are clearly an underestimate since many never present themselves to hospital in these circumstances, choosing instead to stay at home or attend their general practitioners.
It is obvious that these actions point to enormous levels of distress and suffering, not to mention the risk of suicide. It has been recognised for decades that for most, thankfully, this behaviour is not a failed attempt to take one's life. Instead there are many motivations although international figures show that for around 1pc, suicide is the outcome after one year.
This means that if we could follow up the 12,000 who have self-harmed last year and reassess them one year later, that 120 would now be dead. This is not an insubstantial number.
What prevents us psychiatrists from identifying those who are likely to take their own lives?
Everybody who presents with an episode of self-harm is supposed to have a full psychosocial assessment in the Emergency Department by a psychiatrist or a psychiatric nurse trained in suicide risk assessment.
Regrettably, not everybody receives this and the report shows that between 6pc and 19pc leave before they are seen.
The second reason for failure to identify those at high risk is that the factors associated with suicide are common – for example, being male, having a mental illness, misusing alcohol – and are present in thousands of people in the general population.
In other words, the risk factors are not specific enough to be of use in prediction.
In addition, some refuse treatment while for others, most in fact, the self-harm may have been an impulsive act driven by the depressant and disinhibiting effects of alcohol, a feature that is also alluded to in this report. For others, the level of suicide intent is low and the action is a physical way of showing distress in those who are unable to articulate this.
The most pressing reason for the detailed psychosocial assessment is to identify those who are currently suicidal and whose current motivation is the ending of their life.
When those with this high level of intent receive help, even a short period in hospital that allows them time to reflect, many are no longer so desperate. Those whose suicidal desire is driven by mental illness need active treatment of their illness so as to prevent death.
The Government recently announced a shortfall in the budget to fund the essential services needed to identify those who are suicidal and consequently the implementation of best practice has been delayed. Donal Walsh showed tremendous insight and forthrightness in pleading with people to think twice before ending their lives.
In his eloquent letter, he gave suicide a perspective that acted as a jolt to many.
"As a 16-year-old who has no say in his death sentence, who has no choice in the pain he is about to cause and who would take any chance at even a few more months on this planet, appreciate what you have, know that there are always other options and help is always there." Too bad that the Government doesn't show the same concern for those a risk of suicide as this exemplary teenager.