Review of the evidence-base for Review of the evidence-base for Protect LifeProtect Life: : the Northern Ireland Suicide Prevention Strategy the Northern Ireland Suicide Prevention Strategy

(2006-2011) (2006-2011)

Dr Ella ArensmanDr Ella Arensman

National Suicide Research FoundationNational Suicide Research Foundation

22ndnd July 2009 July 2009

ObjectiveObjective

To prepare an update of the 2006 review of the evidence To prepare an update of the 2006 review of the evidence provided for provided for Protect LifeProtect Life, the Northern Ireland Suicide , the Northern Ireland Suicide Prevention Strategy by reviewing the national and Prevention Strategy by reviewing the national and international literature and research evidence published international literature and research evidence published between 2006-2009. between 2006-2009.

Method Literature searchMethod Literature search(2006- June 2009)(2006- June 2009)

- International bibliographic databases including:International bibliographic databases including: PubMed, PsychInfo, ScienceDirect, Cochrane DatabasePubMed, PsychInfo, ScienceDirect, Cochrane Database - Other sources: Books, Reports (published and unpublished)Other sources: Books, Reports (published and unpublished)

- Additional evidence to be obtained through ongoing international research Additional evidence to be obtained through ongoing international research networks:networks:

Network for International Collaboration on Evidence in Suicide Prevention Network for International Collaboration on Evidence in Suicide Prevention (NICE-SP), (NICE-SP),

Child and Adolescent Self Harm in Europe (CASE), Child and Adolescent Self Harm in Europe (CASE), European Alliance Against Depression (EAAD), European Alliance Against Depression (EAAD), Optimising Suicide Prevention and its Implementation in Europe (OSPI-Optimising Suicide Prevention and its Implementation in Europe (OSPI-

Europe)Europe)

Research areas coveredResearch areas covered

Epidemiology of suicide and deliberate self harm in Northern Ireland including international comparison for 2006-2009

Accuracy of suicide and deliberate self harm statistics

Risk and protective factors associated with suicide and deliberate self harm

Efficacy of treatment interventions for deliberate self harm patients

Efficacy of (multifaceted) suicide prevention programmes

Restricting access to means of suicide and deliberate self harm

Programmes promoting positive mental health (incl. school based programmes and programmes focusing on the general public)

Aftercare and follow-up after deliberate self harm

Responding to suicide

Efficacy of media guidelines for reporting on suicide

New at risk groups for suicide and deliberate self harm

Risk factors associated with filicide-suicide and familicide

Results and rating of evidenceResults and rating of evidence

Number of articles: 2006-2009: 89Number of articles: 2006-2009: 89

Number of books / reports: 21Number of books / reports: 21

Rating of available evidenceRating of available evidence

1 – Limited research available1 – Limited research available2 – Some evidence (research outcomes not consistent across studies)2 – Some evidence (research outcomes not consistent across studies)3 - Consistent evidence (research outcomes consistent across across studies)3 - Consistent evidence (research outcomes consistent across across studies)

First findingsFirst findingsAvailable evidence reinforcing actions and their Available evidence reinforcing actions and their

effectiveness in reducing suicidal behaviour (fatal / non-fatal) effectiveness in reducing suicidal behaviour (fatal / non-fatal)

Section A – Population approachSection A – Population approach

Action area: Communities Action area: Communities

1.1. Public information campaign that aims to de-stigmatise mental health, Public information campaign that aims to de-stigmatise mental health, and promote awareness and understanding of issues relating to suicide and promote awareness and understanding of issues relating to suicide and self -harm and self -harm (2)(2) (Hegerl et al, 2006; Wright et al, 2006; Hegerl et al, (Hegerl et al, 2006; Wright et al, 2006; Hegerl et al, 2008; Griffiths et al, 2009)2008; Griffiths et al, 2009)

2.2. To support and encourage the development of community based To support and encourage the development of community based suicide prevention initiatives and support mechanisms suicide prevention initiatives and support mechanisms (2)(2) (Hegerl et al, (Hegerl et al, 2006; Hegerl et al, 2008; Bramesfeld et al, in progress)2006; Hegerl et al, 2008; Bramesfeld et al, in progress)

Section A – Population approachSection A – Population approachAction area: Communities ctd.Action area: Communities ctd.

3.3. To encourage all statutory public bodies to carry out health impact To encourage all statutory public bodies to carry out health impact assessments on their policies, in terms of possible adverse effects on assessments on their policies, in terms of possible adverse effects on the mental health and well-being of local communities the mental health and well-being of local communities (1)(1)

4.4. To restrict access to means and methods of suicide, including To restrict access to means and methods of suicide, including identification of “hotspots”, the promotion of safer prescribing, a identification of “hotspots”, the promotion of safer prescribing, a reduction in the accessibility of certain over the counter drugs, and reduction in the accessibility of certain over the counter drugs, and restriction of access to firearms restriction of access to firearms

(3)(3) (Beautrais et al, 2007; Sandilands & Bateman, 2008; Hawton et al, (Beautrais et al, 2007; Sandilands & Bateman, 2008; Hawton et al, 2009; Law et al, 2009; Corcoran et al, submitted 2009)2009; Law et al, 2009; Corcoran et al, submitted 2009)

►►Verifying long term effects and substitution effects remains important Verifying long term effects and substitution effects remains important

1.1. To provide families with the opportunity to avail of non-stigmatising To provide families with the opportunity to avail of non-stigmatising practical interventions to help consolidate parenting, coping and life practical interventions to help consolidate parenting, coping and life skills skills (1)(1)

2.2. To ensure that in times of distress, families have the opportunity to To ensure that in times of distress, families have the opportunity to

access a local emotional health and well-being support network, access a local emotional health and well-being support network, including community/voluntary sector provisionincluding community/voluntary sector provision

(2) (2) (Chang & Horrocks, 2006; Feinberg & Kan, 2008; Ramirez Garcia et (Chang & Horrocks, 2006; Feinberg & Kan, 2008; Ramirez Garcia et al, 2009)al, 2009)

Section A – Population approachSection A – Population approachAction area: FamilyAction area: Family

Section A – Population approachSection A – Population approachAction area: Children and young peopleAction area: Children and young people

1. Promote the inclusion of promoting positive mental health as a key element of the “Healthy Schools” programme and ensure that children and young people are protected from all forms of bullying (2) (Buckner

et al, 2009; Gaffney et al, 2007; Swartz et al, 2007)

2. Raise awareness of and ensure availability and timely access to appropriate intervention services (e.g. Child and Adolescent Mental Health Services, mentoring schemes and other appropriate statutory and voluntary services) (1)

3. To make suicide awareness and positive mental health & well-being training, including how to deal sensitively with disclosure of self-harm or suicidal behaviour, a priority for teachers, youth workers, etc. (2) (Mulvaney-Day et al, 2006; Hegerl et al, 2008; Bramesfeld et al, in progress; Saving Effectively Young Lives in Europe: SEYLE)

Section A – Population approachSection A – Population approachAction area: Children and young peopleAction area: Children and young people

4. Promote a culture of help seeking behaviour, particularly among young

people (2) (Lynch et al, 2006; Gaffney et al, 2007; Ystgaard et al, 2008)

5. Encourage the inclusion of coping and life skills, emotional literacy, and

programmes that promote positive mental health in the school curriculum

(2) (Lynch et al, 2006; Gaffney et al, 2007; Morey et al, 2008; O’Connor et

al, 2009)

6. To develop and implement practices, protocols and referral pathways to

smooth the transition from youth to adult Health and social services (1)

Section A – Population approachSection A – Population approachAction area: Health and social servicesAction area: Health and social services

1.1. Develop enhanced linkages between the Health and Social Services Develop enhanced linkages between the Health and Social Services and the community/voluntary counselling and support network, and the community/voluntary counselling and support network,

particularly in relation to transition services and to bridge gaps in particularly in relation to transition services and to bridge gaps in service provision service provision (1)(1)

2.2. To make depression and suicide awareness/prevention training a To make depression and suicide awareness/prevention training a priority for all frontline staff dealing with people in distress, particularly priority for all frontline staff dealing with people in distress, particularly for GPs, Primary Care and A&E staff in the HSS for GPs, Primary Care and A&E staff in the HSS (2) (2) (Lamb et al, 2006; (Lamb et al, 2006; Berlim et al, 2007; Hegerl et al, 2007) Berlim et al, 2007; Hegerl et al, 2007)

3.3. Develop clinical guidelines for all HSS staff to use when dealing with Develop clinical guidelines for all HSS staff to use when dealing with people who are at risk of suicide/self harm people who are at risk of suicide/self harm (3)(3) Cooper et al, 2006; Cooper et al, 2006; Cooper et al, 2007; Holi et al, 2008; Cooper et al, 2008; Patel et al, Cooper et al, 2007; Holi et al, 2008; Cooper et al, 2008; Patel et al, 2009)2009)

Section A – Population approachSection A – Population approachAction area: WorkplacesAction area: Workplaces

1.1. To implement a targeted information campaign aimed at enhancing the To implement a targeted information campaign aimed at enhancing the mental health and well-being of all members of the workforce mental health and well-being of all members of the workforce (2)(2) (Nishiuchi et al, 2007; Martin et al, 2009; Zimber et al, 2009)(Nishiuchi et al, 2007; Martin et al, 2009; Zimber et al, 2009)

► ► Need for long-term follow-up studies to verify sustainability of positive Need for long-term follow-up studies to verify sustainability of positive effectseffects

2.2. To ensure that positive mental health training is available to relevantTo ensure that positive mental health training is available to relevant

members of the workforce including small/medium enterprise members of the workforce including small/medium enterprise employers employers (1)(1)

Section A – Population approachSection A – Population approachAction area: Police and Emergency ServicesAction area: Police and Emergency Services

1.1. To ensure that suicide prevention is included in all Emergency Services To ensure that suicide prevention is included in all Emergency Services Public Service Agreements, and reflected in individual services annual Public Service Agreements, and reflected in individual services annual priorities priorities (1) (1)

2.2. To make suicide awareness/intervention training a priority for all To make suicide awareness/intervention training a priority for all frontline emergency services staff [See also Action 2 under frontline emergency services staff [See also Action 2 under Health and Health and social servicessocial services] ] (2) (2) (Lamb et al, 2006; Berlim et al, 2007; Hegerl et al, (Lamb et al, 2006; Berlim et al, 2007; Hegerl et al, 2007) 2007)

Section A – Population approachSection A – Population approachAction area: Churches and religious bodiesAction area: Churches and religious bodies

1.1. To support the development of enhanced links between To support the development of enhanced links between churches/religious bodies and the local community support networks churches/religious bodies and the local community support networks (1)(1)

2.2. To make suicide/depression awareness type training available for all To make suicide/depression awareness type training available for all church/religious leaders church/religious leaders (1) (1)

► ► This is a structural element of the European Alliance Against This is a structural element of the European Alliance Against Depression (EAAD) and Optimising Suicide Prevention Programmes Depression (EAAD) and Optimising Suicide Prevention Programmes and their Implementation in Europe (OSPI-Europe)and their Implementation in Europe (OSPI-Europe)

Section A – Population approachSection A – Population approachAction area: MediaAction area: Media

1.1. To work with the National Union of Journalists, and the Association of Editors, in To work with the National Union of Journalists, and the Association of Editors, in relation to implementation of effective media guidelines in relation to the reporting of relation to implementation of effective media guidelines in relation to the reporting of suicide and self-harm issues suicide and self-harm issues (1)(1)

► ► This is a structural element of EAAD and OSPI-EuropeThis is a structural element of EAAD and OSPI-Europe

2.2. To pro-actively work with the media to promote positive mental health and raise To pro-actively work with the media to promote positive mental health and raise awareness of sources of support for individuals or families experiencing mental awareness of sources of support for individuals or families experiencing mental health problems health problems (1)(1)

► ► This is a structural element of EAAD and OSPI-EuropeThis is a structural element of EAAD and OSPI-Europe

3.3. To develop and implement appropriate media monitoring mechanisms To develop and implement appropriate media monitoring mechanisms (2) (2) (Sch(Schääfer fer et al, 2006; Niederkrotenthaler & Sonneck, 2007; Niederkrotenthaler et al, 2007; Fu et al, 2006; Niederkrotenthaler & Sonneck, 2007; Niederkrotenthaler et al, 2007; Fu & Yip, 2008)& Yip, 2008)

► ► Recommend process evaluation in addition to outcome evaluationRecommend process evaluation in addition to outcome evaluation

4.4. To provide media volunteer training for nominated bereaved families To provide media volunteer training for nominated bereaved families representatives (clarification)representatives (clarification)

► ► Preventing suicide: a resource for media professionals (WHO, IASP, 2008) Preventing suicide: a resource for media professionals (WHO, IASP, 2008)

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: Self-harmAction Area: Self-harm

1.1. To ensure that responsive self-harm support services, including mentoring To ensure that responsive self-harm support services, including mentoring support, are in place in all Health and Social Service Trusts support, are in place in all Health and Social Service Trusts (1)(1)

► ► This is a structural element of EAAD and OSPI-EuropeThis is a structural element of EAAD and OSPI-Europe

2.2. To implement programmes that enhance the coping and problem solving skills To implement programmes that enhance the coping and problem solving skills of those who self-harm, and which reduce the risk of repeat self-harm of those who self-harm, and which reduce the risk of repeat self-harm (3) (3) Systematic review including in total 41 studies (RCTs) by Hawton et al Systematic review including in total 41 studies (RCTs) by Hawton et al (submitted, 2009)(submitted, 2009)

3.3. To improve detection of, and access to, support services for people who engageTo improve detection of, and access to, support services for people who engage in less serious forms of self-harm in less serious forms of self-harm (1)(1) ► ► This is a structural element of EAAD and OSPI-EuropeThis is a structural element of EAAD and OSPI-Europe

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: Mental IllnessAction Area: Mental Illness

1.1. To ensure that those in contact with mental health services are followed up at To ensure that those in contact with mental health services are followed up at appropriate intervals, with assertive outreach where necessary, to assess appropriate intervals, with assertive outreach where necessary, to assess suicide and self-harm risk suicide and self-harm risk (1)(1)

2.2. To ensure that all Health & Social Service Trusts, and other relevant bodies, To ensure that all Health & Social Service Trusts, and other relevant bodies, have pro-active suicide awareness/intervention programmes in place for staff have pro-active suicide awareness/intervention programmes in place for staff who work with people who have mental health difficulties who work with people who have mental health difficulties (2) (2) (McCann et al, (McCann et al, 2007; Berlim et al, 2007; Brunero et al, 2008)2007; Berlim et al, 2007; Brunero et al, 2008)

3.3. To provide appropriate support and information to promote awareness of suicide To provide appropriate support and information to promote awareness of suicide risk among people caring for someone with mental illness risk among people caring for someone with mental illness (2) (2) (Nosek, 2008; (Nosek, 2008; Jorm et al, 2008)Jorm et al, 2008)

4.4. To provide timely and appropriate support and follow-up for patients discharged To provide timely and appropriate support and follow-up for patients discharged from psychiatric units from psychiatric units (1)(1)

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: Drug and Alcohol MisuseAction Area: Drug and Alcohol Misuse

To ensure that appropriate suicide awareness/intervention training is available To ensure that appropriate suicide awareness/intervention training is available for all frontline health service staff, police officers, and other relevant for all frontline health service staff, police officers, and other relevant professional who come into contact with people with alcohol and drug problems professional who come into contact with people with alcohol and drug problems (1)(1)

2.2. To develop agreed protocols concerning the assessment and management of To develop agreed protocols concerning the assessment and management of

patients at risk while under the influence of drugs and/or alcohol patients at risk while under the influence of drugs and/or alcohol (1) (1)

► ► NICE guidelines for the management of self harmNICE guidelines for the management of self harm

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: Young MalesAction Area: Young Males

1.1. To ensure that targeted outreach programmes for young males, who may be at To ensure that targeted outreach programmes for young males, who may be at risk of suicide and self-harm, are available in local communities and in all Health risk of suicide and self-harm, are available in local communities and in all Health & Social Services Trusts & Social Services Trusts (1)(1)

2.2. To implement a targeted information and awareness campaign for young males, To implement a targeted information and awareness campaign for young males, aimed at breaking down the current male culture of not discussing their aimed at breaking down the current male culture of not discussing their problems openly problems openly (1)(1)

3.3. To enhance the role of the community/voluntary sector concerning the provision To enhance the role of the community/voluntary sector concerning the provision of mentoring support for young people at the risk of suicide and self-harmof mentoring support for young people at the risk of suicide and self-harm

► ► This is a structural element of EAAD and OSPI-EuropeThis is a structural element of EAAD and OSPI-Europe

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: Survivors of Sexual, Physical and Action Area: Survivors of Sexual, Physical and

Emotional AbuseEmotional Abuse

1.1. To provide an accessible support network in local communities for all survivors To provide an accessible support network in local communities for all survivors of abuse of abuse (2)(2) (Draper et al, 2008; Postmus et al, 2009; Wekerle et al, 2009)(Draper et al, 2008; Postmus et al, 2009; Wekerle et al, 2009)

2.2. To initiate an information campaign that seeks to sensitively raise awareness of To initiate an information campaign that seeks to sensitively raise awareness of

the increased risk of suicide among all survivors of abuse, and encourage the increased risk of suicide among all survivors of abuse, and encourage survivors of abuse to seek help in times of crisis survivors of abuse to seek help in times of crisis (1)(1)

3.3. To make training available to support those working with survivors of abuse To make training available to support those working with survivors of abuse (2)(2)

(Read et al, 2006; Aksan & Aksu, 2007, O’Riordan & Arensman, 2007)(Read et al, 2006; Aksan & Aksu, 2007, O’Riordan & Arensman, 2007)

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: Marginalised and Disadvantaged GroupsAction Area: Marginalised and Disadvantaged Groups

1.1. To ensure that appropriate support services reach out to all marginalised and To ensure that appropriate support services reach out to all marginalised and disadvantaged groups, in particular lesbian, gay, bi-sexual, and transgender disadvantaged groups, in particular lesbian, gay, bi-sexual, and transgender groups, rural communities, ethnic minorities, and those people who are groups, rural communities, ethnic minorities, and those people who are economically deprived economically deprived (3) (3) (Brotman et al, 2007; Turell & Herrman, 2008; (Brotman et al, 2007; Turell & Herrman, 2008; Gerrisen & DevillGerrisen & Devillé, 2009; Fuller et al, 2009)é, 2009; Fuller et al, 2009)

2.2. To initiate a targeted information campaign that seeks to sensitively raise To initiate a targeted information campaign that seeks to sensitively raise

awareness if the increased risk of suicide among those groups identified as awareness if the increased risk of suicide among those groups identified as marginalised and disadvantaged, and encourages them to seek help at times of marginalised and disadvantaged, and encourages them to seek help at times of crisis crisis (1)(1)

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: High Risk OccupationsAction Area: High Risk Occupations

1.1. To raise awareness of high risk occupations and develop a culture of help To raise awareness of high risk occupations and develop a culture of help seeking among people in occupations that have a high risk of suicide and self-seeking among people in occupations that have a high risk of suicide and self-harm harm (2) (2) (Garelick et al, 2007; Fridner et al, 2009; McLaren & Challis, 2009)(Garelick et al, 2007; Fridner et al, 2009; McLaren & Challis, 2009)

2.2. To develop a crisis plan for targeting people in high risk occupations, as and To develop a crisis plan for targeting people in high risk occupations, as and when emergency situations arise when emergency situations arise (1)(1)

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: PrisonersAction Area: Prisoners

1.1. To make appropriate mental health and suicide awareness, prevention and To make appropriate mental health and suicide awareness, prevention and

intervention training a priority for all frontline prison and police custody staff, and intervention training a priority for all frontline prison and police custody staff, and where possible identified “listener” inmates where possible identified “listener” inmates (2) (2) (Hayes et al, 2008; Konrad et al, 2007)(Hayes et al, 2008; Konrad et al, 2007)

2.2. To ensure that the environment for those held in custody, in both prison and To ensure that the environment for those held in custody, in both prison and

police stations, has been adapted to reduce the possibility of suicide police stations, has been adapted to reduce the possibility of suicide (2) (2) (Camillerie & (Camillerie & McArthur, 2008; Patterson& Hughes, 2008; Daniel, 2009)McArthur, 2008; Patterson& Hughes, 2008; Daniel, 2009)

3.3. To work with the Prison Service to provide access to appropriate services for all To work with the Prison Service to provide access to appropriate services for all

prisoners with mental health difficulties, including the development of appropriate prisoners with mental health difficulties, including the development of appropriate “listener” groups “listener” groups (2)(2) (Fazell et al, 2008; Fox & Whitt, 2008; Fox et al, 2008; Watson et (Fazell et al, 2008; Fox & Whitt, 2008; Fox et al, 2008; Watson et al, 2008)al, 2008)

► ► Recommendations International Association for Suicide PreventionRecommendations International Association for Suicide Prevention

Task Force on Suicide in Prisons. Task Force on Suicide in Prisons.

Section B- Targeted ApproachSection B- Targeted ApproachAction Area: Prisoners (continued)Action Area: Prisoners (continued)

4.4. To ensure that all remand and sentenced prisoners continue to receive initial To ensure that all remand and sentenced prisoners continue to receive initial and ongoing monitoring of their mental health, and assessment of their risk of and ongoing monitoring of their mental health, and assessment of their risk of suicide suicide (2)(2) (Harrison & Rogers, 2007; Easton et al, 2008)(Harrison & Rogers, 2007; Easton et al, 2008)

5.5. To liaise with the prison and probation service about the provision of follow-up To liaise with the prison and probation service about the provision of follow-up support for those who have been recently released from custody support for those who have been recently released from custody (2) (2) (Binswanger et al, 2007)(Binswanger et al, 2007)

6.6. To provide appropriate support in relation to the removal of stigma from those To provide appropriate support in relation to the removal of stigma from those who have been released from custody without charge who have been released from custody without charge (1)(1)

► ► Recommendations International Association for Suicide Prevention Recommendations International Association for Suicide Prevention Task Force on Suicide in PrisonsTask Force on Suicide in Prisons

New priorities for suicide research and preventionNew priorities for suicide research and prevention

Interventions Interventions Investigate the effectiveness of psychological interventions for Investigate the effectiveness of psychological interventions for malemale DSH patients DSH patients Investigate the effectiveness of interventions to reduce alcohol misuse and abuse Investigate the effectiveness of interventions to reduce alcohol misuse and abuse

Risk factors associated with suicide and DSH Risk factors associated with suicide and DSH Risk factors associated with clusters (copycat) of suicide and DSHRisk factors associated with clusters (copycat) of suicide and DSH Risk factors associated with extended suicide (e.g. filicide-suicide / familicide)Risk factors associated with extended suicide (e.g. filicide-suicide / familicide)

Restricting access to means Restricting access to means Investigate the feasibility of further restricted availability of paracetamol and its Investigate the feasibility of further restricted availability of paracetamol and its

impact on intentional drug overdosesimpact on intentional drug overdoses

Prioritise Suicide bereavement support for relatives (adults and Prioritise Suicide bereavement support for relatives (adults and children/adolescents) children/adolescents)

Section C- Overarching ActionsSection C- Overarching Actions

Need to verify implementation of actions 1, 2, 4-8Need to verify implementation of actions 1, 2, 4-8

Action 3:Action 3: To develop and pilot a self-harm register in local A&E departments To develop and pilot a self-harm register in local A&E departments

Has been implemented in the WHSSBHas been implemented in the WHSSB

0

100

200

300

400

500

600

700

800

900

1000

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Age group (yrs)

Annual

per

son-b

ased

rat

e per

100

,000 Males

Females

Incidence of Deliberate Self Harm age 2008 - Incidence of Deliberate Self Harm age 2008 - WHSSBWHSSB

Methods involved in DSHMethods involved in DSH

WHSSBWHSSB

77.5

16.8

4.5 4.1 2.6

0

10

20

30

40

50

60

70

80

Drugoverdose

Cutting Drowning Hanging Other

%

2007

2008

64% involved alcohol2007 – 59%2008 – 69%

AlcoholAlcohol

Alcohol involvement by Alcohol involvement by Gender & Age-Group - WHSSBGender & Age-Group - WHSSB

33

54

67

77

69

80

74

70

79

54

35

45

25

38

57

52

65

71 71

61

74 74

27

48

0

10

20

30

40

50

60

70

80

90

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Age Group

Perc

enta

ge involv

ing a

lcohol

Males

Females

Issues to consider in evaluating Protect LifeIssues to consider in evaluating Protect Life

• Accuracy of suicide statistics (inclusion of undetermined Accuracy of suicide statistics (inclusion of undetermined deaths)deaths)

• Only rely on suicide ‘year of occurrence’ dataOnly rely on suicide ‘year of occurrence’ data

• Consider changes in suicide rates over a period of min. 5 Consider changes in suicide rates over a period of min. 5 yearsyears

• Consider both outcome and process evaluationConsider both outcome and process evaluation

Contact detailsContact details

Dr Ella ArensmanDr Ella ArensmanNational Suicide Research FoundationNational Suicide Research Foundation

1 Perrott Avenue1 Perrott AvenueCollege RoadCollege Road

CorkCorkIrelandIreland

T: 021 4277499T: 021 4277499E-mail: ella.nsrf@iol.ieE-mail: ella.nsrf@iol.ie