Just a brief note about one 'death by suicide' known to me that has again come to my mind in recent days. In this case a long past, seriously abusive experience may have been an early initiator, a primary generator, a first cause that years later killed a good man long before his time. I say 'may' because there's no way directly and/or conclusively to attribute a 'cause/effect' relationship between this historical abuse and his self-destructive behaviour. And his death was quite unexpected and 'out-of-the-blue'.

Imagine that you, a young 'black' man, aged about 16 years, one of a family of nine, live peacefully, legally and respectfully in a 'white'-dominated lower middle-class UK neighbourhood. You are the youngest of seven siblings, six boys and one girl. Because you are 'black' you, like your siblings, go to a 'faith' school across town wearing your school uniform. Each school-day, you walk 'against the traffic' as it were, to a bus stop 400 metres away while local youths, alighting from a bus, walk from an adjacent bus stop past you en route to a 'state' school nearby. Similarly, you complete your return journey home 'against the traffic' as 'state' school students hurry past you en route to their bus.

Your older brothers and sister have never experienced any difficulty en route to or from their 'faith' school other than the effort to catch a bus to town in time to reach class or to get home in good time. In any case, by this time, all your siblings have 'left home' and you live with your now elderly parents. 

However, one day in the early 1970's without warning, on your way home after stepping off the bus and almost home, you are attacked and seriously assaulted by unidentified person/s. Passers-by help you home. The assailants are not identified but are described as being state school students by way of their distinctive school uniform. For unknown reasons, police are not informed about this crime by the 'Samaritans' nor by your family.

A few years before the incident, a serious, violent, long-lasting (1966-1998) political conflict had erupted in the UK region where you lived . Your family members have never been involved in anything unlawful - indeed several of your relatives have served with honour in local and overseas state police services. Nor are they actively 'political' other than in voting in state elections.

During your remaining school-days and until you acquire a motorcycle and attend university, you are 'escorted' by your father or a sibling or a friendly neighbour to your school bus. On your return journey, you alight from your bus early and stay in a friend's house (the H family) until you are again escorted home.

Although the incident was reported by phone shortly after the event by one of your siblings to a senior school staff member (unidentified, refusing to give his name) this person dismissed the incident, noting that as it allegedly took place away from the school campus, involved unidentified assailants, and was not (yet) reported to police, nothing could or would be done by the school. This was stated defensively and without any expression of sympathy for the injured person.

AFTERMATH

About 15 years later, the victim of this assault died by suicide. It's clear to me, based on my own detailed knowledge of the victim, his family, the local neighbourhood and a then current, poisonous lawlessness feeding off a 'low risk of detection', that this assault was carried out by aggressive, criminal bigots. The assaulted person would have been identified to his bigoted assailants as 'one of them' (a hated minority 'black' outsider) by his school uniform.Since the victim was on his own, these cowards were able to carry out their dirty, unprovoked assault without fear of detection or redress.

I think about this unsolved crime often. I deeply regret that it may well have been an unfair, unjust, illegal 'lighting of a fuse' that created at least a contextual element for the catastrophic, personal explosion that killed an innocent man years later.

I wish that I had been able to do more at the time of the assault and afterwards. Requiesquat in pace (1989).    

             

I wanted to note further thoughts about health, physical health and mental health in particular the boundaries that separate the latter two. Currently these 'Chinese walls' are often noted by politicians and media commentators, some of whom are seeking more UK state funding for 'mental health' as distinct from 'physical health'. It seems everyone knows that a broken leg is a 'physical health' matter with a designated diagnosis, treatment, prognosis. But 'a broken mind'? 

http://www.time-to-change.org.uk/blog/understanding-anxiety-broken-leg-broken-mind

Just to 'check it out' I googled 'healing a broken mind' and found a sad chronicle on the 'time for change' website (see above) by 'Lucy', Oct. 2012, detailing her six year 'battle' with anxiety and panic attacks. Happily Lucy concludes "I'm having psychotherapy,which is really helping, and I plan to take as much time as I need to relax and let my nervous system recover".

One can only wonder, with regret, about the up to six years of pain and discomfort seemingly endured by Lucy between onset and access to help. I mean: what is it that stops the Lucys of this world from seeking help, wherever it may be found, as soon as or perhaps well before the pain becomes unbearable. Just like they do when they 'break a leg'. It's not as if counselling and psychotherapy is not widely available via NHS, GPs, EAPs, community and voluntary organisations and private practitioners. The available quality may range from less than poor to quite excellent but we know beyond a doubt that the client/therapist relationship determines outcomes. Don't we all know that by now?

A final comment: when we use the term 'physical illness' we know it's meaningless without stating its locus, its  effect on 'normal' functioning and/or behaviour, etc. Not so for 'mental illness'. Four portmanteau terms mental health, mental illness, mental disease, and mental disorder are widely deployed by those who should know better, often without any descriptors or further explanation. Consumers of these bare, vague, non-specific terms, viz. students, readers, electors, voters, audiences, and ultimately the general public are left to apply their own frequently threadbare, factually deficient definitions: why? Could it be those old, cob-webbed, hackneyed silencers and stultifiers of meaning, knowledge and wisdom viz. stigma, taboo and fear of ridicule. 

Ideally our health and well-being, individually and collectively should be capable of being regarded, understood, maintained and where necessary enhanced in a holistic manner. For now that's some way off. 


It is indeed time for change.   

Regrettably I was diverted from updating this blog by ridiculous events, during June 2014-Mar 2015, that were outside my immediate control but which I had to grasp by the throat, address and dispose of, with the sterling support of friends/comrades, particularly M. This took up far too much of my time and energy. Also recently (Feb-April 2015) I suffered two sudden bereavements - one human, one canine. Each death had a crunching effect upon me, initially lowering my mood and leaving me numb for several weeks. Indeed, I remain somewhat altered and reduced although I'm learning to live as well as I can with these serious detachments.One does not 'recover' from loss, one adjusts to a diminished present and to a related, attenuated future.

For a couple of months past I have begun (tentatively and humbly) but with a view to eventual publication on this website or by way of a commercial publisher, to document my personal perspectives (1982-2015) on suicide and suicidology. Coincidentally subtle changes in my physical health have signalled memento mori. I'm not afraid to acknowledge the truth, the unavoidable reality of the human life-cycle: beginning, growth, maturity, decline, end. Rather I know that each day lived has reduced my 'allotted span' by one and this, hopefully encourages me to 'get the finger out' and to reach out towards my goal/s. Dag Hammarskjold's 'Markings'(1964) include his insightful, helpful aspiration: "Tomorrow we shall meet, death and I - and he shall thrust his sword into one who is wide awake'. Deo volente. 

I am still pondering a further (second) meeting of the Belfast Centre for Study of Suicide (BCSS) - the initial gathering was in Aug 2013, and related documents are available on site. And perhaps another (third) local tv-online interview with my friend Rowan Hand in Newry, Co Down. But echoing in my head are the gently challenging remarks of my good friend and long-term adviser W - 'Maybe it's not the right time for you' - in other words the BCSS is either premature or misdirected or both. In the meantime I have enquired about legal protocols,if any, regarding using the name SuicidologyNI as a more convenient, portmanteau title for the Centre that encapsulates the principal objective of our work - the study of suicide, including suicide prevention, in Northern Ireland.

I try to respond albeit selectively to online discussions about suicide especially when I am able to refute as robustly as possible the facile, misleading and scaremongering mantra 'mental disease and suicide are cause and effect' that underpins much published suicidology research. I recently (May 2015) wrote to a local print newspaper, that had published some of my earlier articles/letters, about a speculative 'opinion' piece about suicide that I considered misleading. My letter was not published and so I plan to upload it to this site shortly. This is yet another reason for writing about, and publishing as widely as possible, my personal perspectives in order not to 'hide my light under a bushel'.

More later.    


          

Since my last entry in Feb 2014 there have been several developments that are worth noting here. I advised DHSSPS about some of these on 21 March 2014, as follows: [Note: Belfast Centre for Study of Suicide is referred to as BCSS.]

"Since launch of the BCSS in August 2013 the following progress has been made including:
i) Live interview on 3 December 2013 with Rowan Hand on Destination Newry, a local online tv station in Newry
ii) Creation of website in October 2013 at www.philipokeeffe.com to make educational materials about human suicidal behaviour more widely available [incl my doctoral study (2010) on aftermath of suicide for clinicians bereaved by client/patient suicide and an occasional blog] and to report BCSS progress 
iii) Short course in October 2013 on 'Insights into Suicide' at QUB School of Education - Open Learning Programme (for info re next course in May/June 2014 contact - QUB website or Senior Teaching Fellow - Dr Tess McGuiness)
iv) Interview in November 2013 with Naomi Long MP and Chris Lyttle MLA
v) Publication of several short articles on suicide-related themes in 'Mind Matters' column of "The Irish News" - archived hereon
vi) Interview in March 2014 with Prof S O'Neill, Bamford Centre, Ulster University, Derry
vii) Interview in March 2014 with Fr M Magill PP Sacred Heart Parish Belfast
viii) Renewal of registration/accreditation with British Association of Counselling and Psychotherapy (BACP) in Feb 2014
ix) Participation in several seminars incl a) on 27 February 2014 'Man Matters' (Dr Iain Banks; Dr Barry Goldman; at Crum Road Gaol) and b) SPRC online webinar in March 2014 on 'men in the middle years and suicide' - Dr Eric D Caine presented an alternative suicide prevention paradigm at this event that recognises, but goes well beyond ASIST and the like
x) Attendance at NCB/NAIMH/NIPHA seminar in October 2013 'Down but not out - youth depression and suicide' (Dr Ian Mannion, Canada) at Skainos Centre, Belfast
xi) Completion in November 2013 of 2-day course in Belfast for counsellors/psychotherapists in gay affirmative therapy training 
xii) Completion in Nov 2013 of application by Belfast Centre for Study of Suicide seeking status as a 'company limited by guarantee', preliminary to registration as charitable institution with Inland Revenue.

I received DHSSPS's response on 24 March 2014. This referred me to the websites for DHSSPS, Public Health Agency and the Assembly Health Committee. 

On 25 March 2014, I sent a preparatory note to Kieran McCarthy MLA, setting out discussion points for a proposed meeting. Dr W Farry asked me for "your views on the ... study of suicide". I replied as follows:


"Dr Farry asks about "my views on . . . the study of suicide". My views are clear: it would be very good if opportunities to 'study suicide' existed via colleges/universities here. I do not know regarding curricula what the universities offer in relation to suicidology. I suspect (but do not know for certain) that short occupational modules are available for some medical/legal specialisms. (I exclude my short courses at QUB School of Education Open Learning Pgm. as these sessions amount to 'tasters' only.) I know from personal contacts that a number of discrete postgraduate research studies in suicidology are likely to be in progress at any time in both universities. However I am not aware of an agreed suicidology research agenda for either N Ireland or Ireland.  

"Complex barriers to progress (i.e. reduction in incidence of suicidal behaviour in N Ireland/Ireland) include:
a) absence of courses of study at 'A' level (college) or undergraduate (university) level 
b) relative silence from our coroners 
c) unhelpful sensationalist reporting by print / broadcast media, caused in part by lack of access to relevant knowledge base, and that often contravenes IAS/Samaritans' Media Guidelines for Reporting Suicide (2013), 
d) bureaucratic 'shambles' [i.e. labyrinth] involving DHSSPS Health Improvement Policy Unit, Public Health Agency, Health and Social Care Board, HSC Trusts, Suicide Prevention Strategy 'Protect Life' Implementation Group(s), publicly funded support groups/charities, and professionals across several occupational disciplines.
e) unaccredited training courses offered by support groups/charities, that produce an under-qualified volunteer resource
f) gross imbalance between 'economic costs of suicide' and 'level of planned public investment in suicidology' 
g) linked to d) above, efficacy of an internal 'suicide prevention programme' delivered by HSC in liaison with the DHSSPS; and
h) excessive dependence by DHSSPS upon 'internationally recognised expert academics' in preference to indigenous expertise ('prophet in his own land' syndrome)

"There are many more.

"What's beyond criticism of course is the sincerity, commitment and compassion of volunteers, professionals, public servants, educationalists and the political class involved in suicidology, in N Ireland/Ireland. Unfortunately this is clearly not sufficient to contend with suicide's attrition which continues to kill someone every day in N Ireland and twice as many in Ireland (RoI), in total probably in excess of 1,000 N Irish/ Irish souls every year."


At the above-mentioned subsequent meeting with Kieran McCarthy, MLA on 27 March 2014, I asked Dr W Farry for information about the reporting/accountability relationships that linked these three organisations with the Health Minister specifically in relation to suicide prevention /  practice / operations but have had no response over two weeks later.

On a positive note, DHSSPS's response (24 March 2014) advised me that "20 workshops ... led by 'Protect Life' Implement Groups ... between Dec 2013 and Feb 2014" were held. These were (apparently) advertised in 'local press'. Unfortunately I missed these advts and was therefore unable to participate. However, DHSSPS have promised to let me have 'a summary report' of the workshops' responses. I've not yet received this. DHSSPS plan to engage with 'a small group (unnamed) of internationally recognised expert academics' (but see h) above) before issuing the new 'Protect Life' strategy for consultation.

Final note for now. I submitted a 1,200 word article to the Irish Association of Suicidology on 28 Feb 2014 for their newsletter. This attempted to summarise Dr Eric D Caine's hypothesis for suicide prevention that he introduced during an SPRC webinar (11 March 2014) - see ix) above. I plan to upload this work to this site's archive shortly, along with a related draft article prepared for 'Mind Matters' ("The Irish News") column.

All best til next time. Feel free to send your comments via the Contact section of the website.    

     

Yesterday (17 Feb 2014) I paid for and collected, from QUB's excellent print shop, my downloaded 'print/bind' copy of "Prioritized Research Agenda for Suicide Prevention - An Action Plan to Save Lives" (2014: Action Alliance for Suicide Prevention-USA: www.suicide-research-agenda.org). On the back cover of this 172 page publication, the publisher states: "The Action Alliance envisions a nation free from the tragic experience of suicide." One cannot but share this ambitious - if unrealistic - goal for all nations: but read on for an alternative Northern Ireland view. 

I am not fully au fait with up-to-date results of the NI-DHSSPS's efforts in strategy formulation and policy implementation since their Suicide Prevention Workshop held at King's Hall, Belfast on 30 May 2013. On 16 July 2013 the relevant policy branch issued to workshop attendees (including the writer) a 'summary' of that event's conclusions. This 16 page A4 document resembles something like a tidied up version of inevitably jumbled-up outputs of small-group brainstorming sessions, summarised in two parts:
a) Visioning the future (4 questions); and
b) Realising the vision (3 questions).

Unsurprisingly (since we are living in Northern Ireland / North-East Ulster), participants could not agree about whether or not to establish a "suicide reduction target" for measuring the "success of ... a future suicide prevention strategy". Amazingly, it was suggested that a specific target (i.e. percentage-wise / numerical) for reducing the incidence of deaths by suicide among our fellow citizens 'may set the strategy up to fail given the huge range of social and environmental factors that influence suicide and which would be outside the scope of the strategy. 

One wonders what these mysterious factors might be!

PS I almost forgot. Research is mentioned at page 6 of the 16 page document - in response to:
"Q2(a) What gaps need to be addressed through the new strategy . . . (b) what else do we need to do/do differently . . . " 
under the sub-head "Information, evidence, and assessment" but not under the sub-head "Specific areas for action": 
Research to determine if the risk (sic) is associated with the areas in which people live or with the group they belong to or a combination of both.

I've just checked: the above research topic was investigated in 2008. Read all about it in "Area Factors & Suicide: 5 year follow up of the NI population" (2008, O'Reilly et al., Brit J Psychiatry,192, 106-111.  

More later. (Writer: Philip O'Keeffe PhD Registered MBACP (Accred) 

This is the initial entry in my blog. The Belfast Centre for Study of Suicide invites anyone interested in understanding more about the subject to make contact. The idea of the Centre is to organise, develop and offer learning opportunities.

In time, the Centre plans to develop a knowledge base devoted to the study of suicide in Belfast, and further afield.

Your ideas about how this might be achieved are invited and welcomed. In later blog entries, I shall explain some of mine.