DRAFT

Life is full of emotional peaks and valleys. Many people find their way through with little difficulty but a considerable number of people reach rock bottom or near to it. It is our opinion that most people can be helped through these dark times with appropriate treatment.

It is widely accepted that the people most at risk of suicide are young people in the mid teens to mid twenties bracket. This is a time of life when the pressures of life bear heavily, the time in life which is most challenging to one’s self-esteem. It is a time when they are unsure of the future. There are major pressures like exams the point’s system etc. as if the worries associated with growing into adulthood were not enough. It is a time when they think that major decisions have to be made (What career will I pursue, will be able to buy a house when I settle down, will I be able to afford to buy a car etc). Young adults often experience many other major pressures such as subtle peer group pressure to consume excessive amounts of alcohol.

When an adult reaches a low in their life they may have experienced it before and this can be a help but when a young person reaches a low it is more than likely that it is for the first time and it terrifies them. This can and does lead to suicide. Currently, if one of these young people presents them selves to the existing services the will receive little attention and more than likely will be prescribed medication which will make them feel better.

They will have arrived at the mental health services with their mind in a state of crises needing some one to guide them through their crises so that the can handle life better and go on to lead a normal life. But what they are given is little time or understanding but medication which may sometimes make them feel better but does not deal with the issues which were troubling them. Our experience is that after a short time these problems surface again and medication is increased leading to a cycle of seemingly unending medical treatment. And worse still, when they try to live without the medication, they are often faced with the problem of dependency on the medication.

The vast majority of the people we have described need someone to who can give them time and guide them through a crises which could have led them to take their own life.

The services need to become far more attuned to the public they serve. A lot of young people using the psychiatric services do not need to see a psychiatrist but require psychotherapy or counseling, psychiatry being the branch of medicine concerned with the diagnosis and treatment of mental disorders, often with prescribed medication. In contrast, counselling or psychotherapy can be described as a process whereby the client, through a confidential relationship with the therapist, is helped to explore, understand and alleviate concerns and difficulties.

The control of existing services is with the Psychiatrists and they decide on the services required and utilised. It is our experience that most Psychiatrists will not refer patients to or embrace alternative treatments such as psychotherapy and counselling.

If the Pilot were set up under the existing Day Hospitals it would likely be psychiatry driven. For this reason it is essential that a professional psychotherapy service run to a high standard be set up separate from the existing psychiatric service but part of the MWHB mental health structure, connecting with the current mental health services when appropriate. This will also allow the pilot to be properly monitored and evaluated.

We would see the Day Care Centre catering for the following: -

The pilot could also cater for other groups of people at risk of suicide by providing specialist services on arranged visits. One such group who we have contact with are people with Eating Disorders who have expressed similar concerns regarding current mental health services. A number of members of the Rosbrien Suicide Awareness Group are involved in this area.

The pilot should consist of the following: -

At the A & E Department

A procedure to deal with all parasuicide cases, this procedure to also apply to people who present themselves at A & E at a time of crises.

It is important that we differentiate between people who have an identifiable mental illness, who may require psychiatric treatment and those who are going through crises in their lives who may only require cuonselling or psychotherapy. (It is the later who are most at risk of suicide in our opinion).

Day Care Centre

The provision of a specialised multi-disciplinary counselling and non-medication service at a Day Care Centre, out side of the present Day Hospital structures but part of the MWHB mental health services, connecting with the current mental health services when appropriate.

It is acknowledged within the medical profession that current approaches to the prevention of suicide are not proven to be effective. This point was conceded in the Aware document, Suicide in Ireland: A Global Perspective and A National Strategy, 1998); ‘A review conceded that the evidence of individual psychiatric and psychotherapeutic effectiveness remains unproven for suicide prevention’.

For decades, medication has been by far the most predominant form of treatment provided for mental and emotional distress. However, the effectiveness of antidepressant medication in the prevention of suicide is unproven, as the following comment by a leading Irish psychiatrist illustrates; ‘No clinical trials have been conducted to indicate treatment efficacy of pharmacotherapy’. It is a failure of modern psychiatry that we still cannot say to patients with suicidal depression: ‘treatment X has been scientifically proven to significantly reduce your risk for suicide’ (Dr. Kevin Malone, Mater Hospital, Irish Medical News, 27/9/99).

Yet, with little scientific evidence to back up the practice, antidepressant medication has been the mainstay of the mental health services approach to suicide prevention. Indeed, in one of his recent reports, the Inspector of Mental Hospitals has acknowledged and validated the frequently expressed complaint by mental health service users that medication is usually the only form of treatment offered by the mental health services.

From a scientific point of view, since there is little evidence that antidepressants prevent suicide and since there is little evidence that any of the current approaches to suicide prevention are working. There is nothing to be lost by making this proposed pilot service available, provided it is done professionally and to a high standard. Indeed there may be much to be gained. Service users and service groups have for years been calling for more humane, less intimidating treatment options and treatment centres.

As a group, young people are particularly at risk of suicide, young men in particular. Yet it is well known within medicine that young people, particularly young men do not access the mental health services. And many people who do access the services do not continue contact, do not keep their ongoing appointments. A commonly mooted explanation for this has been young peoples’ failure to seek help and support when the need it. There may of course be some truth in this explanation.

However, there is an additional explanation, one which is regularly mentioned both by users of the mental health services, and young people who do not use these services; the mental health services, and psychiatry in particular, is a terrifying prospect for many young people. Given that many young people who reach the point of suicide are already very anxious and fearful, it is not too surprising that they will not engage with a system which they perceive as terrifying, fuelling rather than reducing their sense of terror, distress and alienation. While the above is particularly true with regard to admission to psychiatric hospitals, it is also true with regard to attendance at psychiatric day hospitals. In our experience, young people are intimidated and frightened off by the current mental health services, a situation that is alarming and counter-productive.

It is within this context that we propose the establishment of a counselling service for those who are suicidal. For the reasons outlined in the paragraphs above, we recommend that the proposed counselling centre be physically detached from the psychiatric services. We believe that by doing so, the centre will far less intimidating to young people, and consequently far more acceptable to young people who are suicidal. We believe that the premises in the Krups Complex, as mentioned at our last meeting, has considerable promise in this regard.

We believe that the proposed centre should be primarily a counselling centre, properly managed, staffed by a small number of trained therapists and a secretary. The centre should begin ‘small’.

Another gap in the present Services is the lack of contact between the voluntary oerganisations and the psychiatric service and the involvement of these organisations in the treatment of those at risk of suicide.
The pilot could also address this issue.
The following groups and organisations have come together to form the

Limerick Support Services Network

They meet regularly at the Pastoral Centre in Denmark St.

All these groups support the setting up of this Day Care Centre.

A number of these Groups have expressed an interest in having a direct involvement at the centre by providing back up to a professional service.

Their roll would be in areas such as: -

Facilitators

Listening service

Ongoing contact with clients

Helping to create a welcoming and warm atmosphere at the Centre

Provide information on wide range of voluntary services etc.

As well as providing a professional counselling service, the Centre could also provide community support for those attending the Centre and their families.