Transcriber: Leonardo Silva Reviewer: Claudia Sander
From 2007 to 2012,
it's estimated that 476 men and 85 women died by suicide in Ireland
as a result of the economic recession and subsequent austerity measures.
Those figures were put out in a journal article
in the International Journal of Epidemiology
in June, this year.
And the findings went largely unreported,
even though that's the equivalent of 20 or more bombings.
And the reason for that, I believe,
is that we still as a society have this idea
that somehow suicide is a choice,
it's a decision people make, it's a rational decision,
or alternatively, that people who die by suicide are so mentally ill
that there's nothing we can do to save them.
I believe that that's not the case.
I'm going to show you today why that's not the case
and what we can do as a society to drive those suicide rates down.
Epidemiology is a really powerful research tool.
When we look at the figures,
we look at the population rates of suicide from year to year,
we can see that social factors make a massive difference.
Yes, most people who die by suicide do have a mental illness,
and suicide and mental illness are very much related,
but the really interesting thing is that most people with mental illnesses
are not suicidal.
They don't die by suicide.
Suicidal thoughts and ideation are very common,
but very few people go on to act on those thoughts,
and social factors are what makes the difference
between thinking about the purpose and meaning of your life
and acting on those thoughts.
There's a wealth of evidence showing us
that people who attempt suicide and think about suicide
don't necessarily actually want to die.
When we analyse the tweets, the social media posts
of people who are suicidal, who are thinking about suicide,
the most common word that they use is not 'death,' it's not 'suicide;'
it's actually 'life.'
And when we do qualitative interviews
and ask people about their thoughts of suicide,
they tell us about the characteristics of that life
that they want to get away from.
They tell us about a life that's characterised
by unending pain.
In fact, 'unbearable, unending pain' is not adequate to describe it.
It's more like an unending torture.
It's an anguish.
People feel trapped - there's no alternative.
There's often a lot of ambivalence around suicide.
Conversations about life and death aren't really relevant sometimes.
People are just doing something
to address the unbearable pain that they find themselves in.
Kevin Hines so eloquently speaks about his thoughts
just after he made a suicide attempt from the Golden Gate Bridge
in San Francisco.
Very few people survive suicide attempts from that bridge.
And as Kevin Hines was falling,
he tells us about the thoughts that were going through his head.
'What have I done?
I don't want to die.
God, please, save me.'
So, suicidal behaviour is a response to unbearable pain,
to hopelessness for the future,
to feelings of failure and entrapment.
And there's a lot of that about in Northern Ireland.
In 2008, myself along with colleagues,
Professor Brendon Bunting and Dr. Sam Murphy,
conducted the Northern Ireland study of health and stress.
And that was a study that was conducted in 30 countries,
and we led the Northern Ireland study.
We looked at over 4,000 people, a representative sample of the population,
and we asked them about their suicidal thoughts
and their mental health conditions.
In that study, we found
that Northern Ireland ranked in the top three of all of those countries
for most of the mental health disorders.
So we're right up there.
And for post-traumatic stress disorder, we topped the table -
we were number one.
Post-traumatic stress disorder
is a really, really interesting mental health condition.
It's always associated with a trauma, there's a traumatic event,
and the symptoms of PTSD are what follows that traumatic event,
if things go wrong with the memory-encoding processes.
So PTSD is characterised by nightmares, flashbacks,
like hallucinations,
that bring the person right back as if they were in that experience.
There's avoidance behaviour ...
There's emotional numbing -
people numb their emotions to try and manage that ...
And there's hyper-vigilance and arisal.
It's an incredibly debilitating condition.
And we found that at any one point in time,
around 5% of the population are suffering from PTSD,
and around 8% of people here have had PTSD at one stage or other in their lives.
Going back to the Northern Ireland study of health and stress,
we also asked people about traumatic events
that they'd experienced,
and we found that 39%, almost 4 in 10 people here,
had experienced or witnessed a traumatic event
related to the Northern Ireland troubles.
We're talking here about shootings, bombings,
seeing somebody dead or seriously injured or being involved in riots.
That's a hell of a lot of people in a small population
like Northern Ireland.
When I was growing up,
every evening the news in Northern Ireland was a litany of deaths,
numbers of people who had been killed or injured in bombs and shooting.
And Thomas Joiner argues that when a society like ourselves
has been exposed to that level of pain and violence,
we become numb, we become anaesthetised,
both literally and metaphorically,
to the effects of pain and violence.
And whenever we ourselves experience pain,
whenever we have existential feelings when we wonder about our own future,
our automatic response then is to turn to pain and violence.
It's what we do -
we've practised it.
Delving a little deeper into that 42% of people
who've been most affected by the troubles,
we find that there's another subpopulation in Northern Ireland,
and recent work that we've conducted with the victims commissioner
has shown us that that's about 15%.
And those 15% of the population have been exposed to multiple traumas,
multiple adversities
and multiple hardships,
and they're really, really, really at risk of suicide.
When we analyse that group,
we find that they've had hard childhoods,
there's a lot of exposure to pain and violence,
but they're continuing to be affected by the economic and social legacy
of the Northern Ireland troubles.
There's lots of deprivation, there's poverty,
there's low levels of educational achievement,
high levels of substance use and medication
for mental health conditions,
and sadly, high risk of suicide.
So we can see how in particular areas there's a real breeding ground
for suicidal behaviour.
And we have suicide clusters -
we suicidal behaviour that spreads in particular areas.
The problem is psychological pain,
and our response is violence because that's what we do here -
we've practised it.
So what can we do about this?
At the minute, the suicide rates in Northern Ireland are way too high.
We have almost 300 deaths every year.
And when we talk to people who think about suicide
but don't act on those thoughts,
and ask them, 'What was it that stopped you
from doing anything about that?'
they tell us that there's social connectedness,
their relationships with others.
They think about their friends and their family,
and that's what stops them from acting on their suicidal thoughts.
We conducted a study a couple of years ago
where we looked at the Coroner's data on suicides,
looked at those case histories in over 1,400 suicides,
and the largest category of life events prior to death by suicide
was interpersonal difficulties and relationship difficulties.
And there's so much we can do as a society to increase connectedness
and to help each other find that support
and find a way through emotional problems and mental health difficulties.
We need to protect the disadvantaged.
We need to look very closely at that 15%
and consider the effects of the economic recession
and the subsequent austerity measures here in Northern Ireland
that are being introduced right now,
and how that's going to impact on the most vulnerable.
Because what we don't want is in several years
to be having our own interrupted time series -
statistical analysis -
showing 210 extra deaths in Northern Ireland,
because that's the equivalent proportion that we'll be seeing
if we don't do something about this.
It's absolutely staggering to me
that a quarter of gay and lesbian people in Northern Ireland
have attempted suicide.
That's shocking, and it's wrong.
And there's a very simple thing that we can do:
we can introduce marriage equality
to send out a very powerful message to gays and lesbians in Northern Ireland
that they're part of our community,
that they're a welcome and valued part of society,
that they're absolutely equal.
For me,
the only morally acceptable target for suicide is zero.
Suicide deaths are preventable,
and we should all be working as a society
to drive those death rates right down to zero.
And how do we do that?
We provide evidence-based treatments
for trauma-related mental illnesses specifically
and for mental illnesses in general.
And we also look at inequality and social justice
until we make sure that everybody in our society
feels equal, valued and respected.
Thank you.
(Applause)