​SUICIDE IS NO ACCIDENT
Suicide is no accident. Think about it. The implication becomes clear: that a cause/effect relationship within the human mind links unbearable psychological pain (Shneidman, 1993) to irreversibly lethal behaviour that kills the pain but that tragically and coincidentally destroys the decision-taking mind. Hence an aeons long search goes on for a General Theory of Suicide, exemplified most recently in the work of O’Connor (2011) and Joiner (2005). I hasten to add that I am not a member of any global search squad. Rather I am interested in understanding the idiosyncratic nature of each lethal event of human self-destruction. For me, and many others, shocked and distressed by family suicide, prevention is no longer possible: we have become survivors of bereavement by suicide. And choices exist, that are inevitable, unavoidable and essential, regarding our response to what has happened. Either, we can invest scarce energy in analysis of the impossible, i.e. how I, and/or others, might have prevented our family suicide event/s, or we might consider, in some systematic and disciplined way, how to deepen our understanding about what happened, not least inter alia to secure some fraction, large or small, of absolution in relation to our catastrophic loss. Understanding suicide is, I would argue, a prerequisite for reducing the incidence of suicide, including its prevention, for example by way of the recent heavily publicised “Zero Suicide” movement: you’ll not easily change what you don’t understand.   
Some think that ‘suicide prediction skills’ are a logical way ahead for countering suicide. Some say these ‘skills’ involve an awareness of both suicide ‘risk factors’ and counter-suicide ‘protection factors’ and their balanced application in psychotherapeutic work with each suicidal client. And I am sympathetic to the apparently rational nature of this approach. However most suicidologists will not disagree that such an apparent master/servant relationship between an expert therapist and a vulnerable client, may neither fully reflect nor align well with person-centred counselling theory and practice. In what follows I discuss some helping principles for reducing an individual’s suicide impulse by facilitating the individual to understand it and thereby to take control of it. [Note that I do not intend to refer to medical psychiatry nor the DMS nor pharmaceutical pathology in what follows as I am content to possess neither relevant qualifications nor practical knowledge of these esoteric areas.]   
The CAMS approach seems to be an attempt to situate therapist and client in a relationship of equals. This may also be as close as psychotherapy can get to a self-help, life-saving approach to suicide prevention.
REFERENCES
Joiner, T. (2005)  Why people die by suicide. Cambridge, MA: Harvard Univ Press
O’Connor, R.C. (2011) The Integrated Motivational-Volitional Model of Suicidal Behaviour (IMV). Accessed on 18 July 2017 at http://www.suicideresearch.info/the-imv
Shneidman, E.S. (1993) Suicide as psychache. Journal of Nervous and Mental Disease. v181:145–147 

​POLITICAL MURDER AND DOMESTIC SUICIDE IN NORTHERN IRELAND
AUTHOR: Philip O’Keeffe PhD MSc Reg MBACP (Accred)©2017 [Comments & queries: woppok@hotmail.co.uk ]
ABSTRACT
Almost the same number of lives were sacrificed in Northern Ireland’s (NI) 30 year ‘Troubles’ (3,600) as were extinguished by suicide (3,300) in the 15 years following the Good Friday / Belfast Agreement (1998). It is suggested that NI society’s response to political murder (1968-1998) attracted unlimited state investigative resources while domestic suicide (1998-2012) was largely ignored. The lives of survivors of bereavement, whether by political murder or by domestic suicide, are changed utterly as they attempt in the aftermath to come to terms with their unconscionable losses. This article argues therefore that each death by suicide, should be as fully investigated as if it were by murder. To fail to do so represents an ongoing missed opportunity to understand the actualité of suicide in NI and to supply an evidence base for realigning currently unsuccessful reduction and prevention policies. (140 words) 
AFTERMATH OF POLITICAL MURDER
Over 3,600 deaths by violence in UK/Ireland resulted from a 30 year-long attempted coup d’etat by a few hundred armed, Irish, irredentist revolutionaries that was vigorously resisted by UK state police and military power, allegedly in collusion (Cadwallader, 2013; Urwin, 2016) with renegade UK state forces and armed loyalist paramilitaries, in a ‘dirty war’ (Dillon, 1990) from mid-1969 until a truce was ratified by way of the Belfast/Good Friday Agreement (http://cain.ulst.ac.uk/issues/violence/cts/fay98.htm#tables; Belfast Agreement, 1998).
Each fatality and alleged perpetrator is given a brief, cursory mention in the Cain Website (2005 et seq) and in Lost Lives (McKitterick et al., 1999-2008). However those left to mourn these horrendous, but essentially and ultimately purposeless losses of their family member, merit little mention and negligible attention. Today – June 2017 – what are now known as legacy issues – the unanswered “when?”, “how?”, “where?”, “why?” and “by whom?” questions about each of a vast majority of these killings – dominate the North’s/Northern Ireland’s/North-east Ulster’s (hereafter NI) political agenda. Along with current issues related to Irish language and “equality” – the latter still undefined but whose civic & cultural absence from NI is said to be evident to all – what to do to assuage the unresolved predicament of grief-burdened survivors of 3,600 plus unjustified and savage losses, remains unaddressed: hence legacy issues.
An attempt was made in 2007/09 by a Consultative Group on the Past (2009) whose remit was summarised in the report’s Executive Summary, as follows:
“On 22 June 2007 Peter Hain, the then Secretary of State for Northern Ireland, announced the formation of an independent Consultative Group. The Group was asked to:
consult across the community on how Northern Ireland society can best approach the legacy of the events of the past 40 years;
make recommendations, as appropriate, on any steps that might be taken to support Northern Ireland society in building a shared future that is not overshadowed by the events of the past;
present a report, which will be published, setting out conclusions to the Secretary of State for Northern Ireland, by summer 2008 (Note: Report published in 2009).
The Right Reverend Lord Eames OM, former Archbishop of Armagh, and Mr Denis Bradley, the first Vice-Chairman of the Policing Board, co-chaired the Consultative Group on the Past. The following were members of the Group: Mr Jarlath Burns, Rev. Dr. Lesley Carroll, Professor James Mackey, Mr Willie John McBride MBE, Ms Elaine Moore, and Canon David Porter.
Mr Martti Ahtisaari, former President of Finland, recent Noble Peace Prize winner and founder of the Crisis Management Initiative, and Mr Brian Currin, former chair of the South African Prison Audit Committee and founder of the National Directorate of Lawyers for Human Rights, acted as international advisers to the Group. Mr Jeremy Hill acted as the Group’s Legal Adviser.” (Consultative Group on the Past, 2009)
Unfortunately, following a massively negative response in a public consultation upon the report, NI political parties could not agree to implement any of the Report’s recommendations (BBC, July 2010). Eight years on, the ‘Troubles’ legacy issues continue to fester, unrecognised, unacknowledged, unameliorated: they remain painfully alive in the memory for thousands of surviving relatives and friends of the murdered – including seriously injured people – their numbers gradually diminishing by time’s attrition.
I recall what my ‘boss’ (deceased, RIP, 1985)  in the civil service said – he was given to thinking aloud – in the late 1970’s about the then ongoing so-called “Troubles”: he said that our ability to keep careful, accurate, objective, criminal statistics offers confirmation that society hasn’t broken down: in other words each of these cowardly assaults, each one of these premature deaths, each of these inhuman crimes merits close attention so that when the killing stops, justice might be upheld.
This topic – referred to by some optimists as a truth and reconciliation process – is notionally on the agenda for current UK election (June 8) and possible ‘second Stormont election in a year’ although our uncompromising, solution-resistant, mirror-opposites bigotry could ensure little if any change in NI’s political, cultural or civic architecture, as expressed in 19 July 2010 (BBC, 2010).
AFTERMATH OF DOMESTIC SUICIDE
 Recently some academics calculated that the numbers of NI citizens deceased by suicide, viz. 3,300 premature dead, during 1998 to 2012,  i.e. 15 years since the above-mentioned truce (see ‘Belfast Agreement, 1998), was on a par with (See http://www.thedetail.tv/articles/suicide-kills-as-many-as-the-troubles: Torney, 2014) those 3,600 poor pawns, murdered during NI’s futile, power-lust driven slaughter by neighbours of their neighbours.
So what about a truth and reconciliation process for the grief-burdened survivors of these 3,300 innocent dead? Estimates vary (Berman, 2011) about how many individuals bereaved by a suicide, may be adversely affected materially and psychologically:
“. . . at least six loved ones are directly affected by the death . . . likely an underestimation [that] may not account for the emergency responders, health care providers, co-workers and acquaintances also affected by the suicide.” (Young et al., 2012)
Are these suicide deaths not as equally ‘horrendous, but essentially and ultimately purposeless’ as those murdered souls? The author’s family suicides (1982 & 1989) seriously adversely affected at least 31 immediate family members, partners, children, parents, siblings, nephews/nieces, in-laws. Could ‘public opinion’ in NI, per a consultation process and some level of political agreement generate a humane way to alleviate, assuage, and ease the pain generated by each of these losses, other than in our customary short-lived wringing of hands, that frequently morphs into longer lasting feelings of complicated grief, confusion, impotence? The wise Shneidman (2001) had no doubt that:
“each sad case [of a death by suicide] should be assessed, understood and treated in its own idiosyncratic psychological terms.” (Shneidman, 2001: 203) 
The forward focus of the NI Stormont Government’s health department and local academic researchers to some extent ignores suicides legacy issues other than to add ‘bereavement by suicide’ as an additional suicide risk factor, to an already burgeoning list (Scottish Government Social Research, 2008) for relatives, friends, and colleagues of the suicide deceased. This has a well intentioned purpose – honourable we must accept – to reduce future suicide quanta. Interestingly, their joint policy approach relies almost exclusively on an emphasis upon a disputed relationship that’s said to exist between ‘mental ill-health’, including ‘Troubles’-related trauma, and suicide. This ‘cause/effect’ myth and the psychiatric energy invested in adhering to it have not yet halted NI’s escalating ‘suicide rates’. See Torney (2014) for references to Bamford (Ulster University), and Stormont health department, illustrating their reliance upon this failed ‘all our eggs in one basket’ approach.
In the author’s view, the sooner we move away from ineffective ‘mental ill-health-related’ suicide prevention approaches, policies and practices, the sooner we might come to understand, as a starting point, that human suicidal behaviour in another person is as idiosyncratic as that person’s unique fingerprint, and may not otherwise be comprehended. The late Edwin S Shneidman, PhD, acknowledged in suicidology as one who knew more than anyone about human suicidal behaviour, did not rely upon portmanteau metaphors like mental health, mental ill-health or mental disorder when communicating his insights into suicide in innumerable books, journal articles, and media and personal interviews:
“It is my belief that our best answers, as therapeutic suicidologists, cannot come from medicine or physiology or group behaviour or epidemiology or sociology, not from Kraepelin nor the Diagnostic and Statistical Manual of Mental Disorders, and certainly not from Smith-Kline Beecham.” (Shneidman, 2001: 201)
 Rather, as a psychologist, he focused on psychological needs, emotional responses and ‘psychache’, a word he invented to describe unbearable psychological pain:    
“Shneidman . . .  described suicide as a "drama of the mind." He coined the term psychache, which is the psychological pain -- consisting of negative emotions and unmet psychological needs -- that an individual experiences. It differs from physical pain since it stems from emotional, rather than physical, discomfort. Psychache creates an overwhelming amount of distress in an individual so that he or she perceives suicide as the only way to escape the pain” (Clinical Tools, 2017).
Shneidman (2001: 203) explained further that if unrelieved psychological pain was a major source of suicide ideation, then, as an initial step, the helper might gently and compassionately invite the sufferer to answer questions like: ‘Where do you hurt?’ and ‘How may I help you?’
Earlier it was noted that ‘bereavement by suicide’ is a risk factor for suicide (The Right to Health Campaign, 2016). The “Safer Campaign” relied upon a World Health Organisation (2014) report to assert that:
“Studies . . . show that people who die by suicide often know someone who did the same recently and that ‘those who are affected or bereaved by suicide have themselves an increased risk of suicide’” (Right to Health Campaign: the SAFER campaign, 2016: 6) 
 And so the ‘where do you hurt?’ question may also usefully be gently put by therapeutic helpers to survivors of bereavement by suicide. This might be a start: but unless the helper – whether psychiatrist, psychologist, general medical practitioner, mental healthcare worker, psychotherapist/counsellor, Samaritan volunteer, social/community worker or simply friend, neighbour, colleague or bystander – has the knowledge, the time, the capacity, the humanity, and the developed skill to listen to the sufferer, actively and with compassion for as long as it takes, then we waste everyone’s time and need not have bothered. Such listening may need to be available to sufferers for a lifetime, because the pain of loss of a loved one by suicide may indeed be life-long for survivors. But is this all that’s required?
TRUTH PROCESS FOR SURVIVORS BEREAVED BY SUICIDE
You’ll have begun to notice that, in the author’s view, there may be a cross-over that connects the psychological needs of survivors of loss, due to NI’s bigotry-fuelled, political conflict (1969-1998) with survivors of loss by domestic suicide subsequently, viz. 1998-2012, and currently. The obvious difference here is that murder is against the criminal law while suicide, since 1966, in NI, 1961 in England/Wales and 1993 in Irish Republic, is not. [Suicide is not unlawful in Scots Law (https://en.wikipedia.org/wiki/Suicide_Act_1961).] With murder, the perpetrator is guilty of a serious offence, punishable in UK/Ireland on conviction by lengthy imprisonment. With suicide, the alleged perpetrator is not amenable, being dead. But legacy issues for both sets of bereaved, although different, do have much in common.
Four of these questions immediately arise – see above – for suicide bereaved as for murder bereaved: these are the unanswered “when?”, “how?”, “where?”, and “why?” queries. The fifth “by whom?” question becomes the focus for a criminal investigation where murder is suspected while a crime file is not opened where death is by apparent suicide. Readers will be familiar with the UK/Irish police statement’s formulaic words, viz. no suspicious circumstances, customarily used where cursory investigation of a death scene by police, that rules out natural, accidental or homicidal causation, leads rapidly to a conclusion by police that no crime has taken place, i.e. death was probably by suicide. Answers to the above four questions represent overlapping territory occupied by both sets of mourners. A truth and reconciliation process to examine legacy issues for survivors of political murder would seek answers to all five questions while such a process for suicide survivors would focus only upon four questions. At this point, any practical outcome from these comparisons evaporates: legacy issues for murder are on NI’s current political agenda while legacy issues for suicide are not.
Such contrasts between ‘Troubles’ murders and post-‘Troubles’ suicides are blatantly evident in media responses. Each of our 3,600 murders was fully reported in depth by print journalists who based their articles on police statements and later court reports. Editorial decisions about what ‘news’ is reported rely upon that nebulous concept known as ‘newsworthiness’. Very few of our 3,300 suicides made it to print media. Murder in NI, particularly political – or using the current, ‘peace process’ mantra, conflict-related – killing is always newsworthy. Suicide is not. Exceptions exist where editors may consider that a particular suicide-related incident meets ‘public interest’ criteria that facilitate media reportage. The term ‘public interest’ belongs to a parasitic class of imprecise, but influential subjective terms like ‘mental health’, ‘mental illness’ , ‘mental disorder’, national interest, ‘the right thing to do’, ‘what matters’ and so on employed by journalists, politicians and propagandists and described by an unnamed senior BBC news figure, in a study about the media, privacy and public interest (2002):
“[public interest] will always be a grey area . . . I don’t see how you can logically, and rationally, impose some sort of blueprint which enables you to know whether it’s in the public interest or not . . . . National interest these days can mean whatever the government wants it to mean, in a particularly cynical way. Public interest, by the same token, could easily mean whatever the editor [or owner] of a newspaper wants it to mean.” (Morrison & Svennevig, 2002: 8)
Relevant local examples where ‘public interest’ may determine the extent, if any, of media reportage of suicide include public coroner’s inquests, murder/suicide incidents, multiple suicides meeting specific, restricted, geographical or time-related criteria, sometimes referred to as ‘suicide clusters’, so-called celebrity suicides, child/young person suicides, suicides enacted in public places, and so on:
“The Coroner will seek to establish the cause of death and will make whatever inquiries are necessary to do this e.g. ordering a post-mortem examination, obtaining witness statements and medical records, or holding an inquest . . . The NI Coroner’s Service ‘inquire into deaths that appear to be . . . unexpected or unexplained, as a result of violence, an accident, as a result of negligence, from any cause other than natural illness or disease, or in circumstances that require investigation.’ NI Courts Service (2017)
Because public inquests into deaths by suicide in NI are infrequent, the outcomes of coroners’ investigations do not often enter the public sphere. In recent years academic researchers have secured restricted, partial access to records of deaths by suicide, and by undetermined intent, as identified by NI’s local coroner’s service. Some recent findings are described next.
SUICIDE RESEARCH AND THE FOUR QUESTIONS – WHEN, HOW, WHERE, WHY.
With few honourable exceptions, suicide research in UK/Ireland uses quantitative methods, focused on numerically large-scale statistical analyses of commonalities rather than a qualitative approach that may focus upon one or more individual case studies. Each approach seeks to understand human suicidal behaviour as a window into suicide reduction and prevention. The four questions may be considered by either research model.  
A recent research paper (Benson et al., 2017) explored the use (and abuse) of prescribed medication by suicide deceased using a quantitative analysis of coroners’ records of 1,371 suicides, including ‘police reports, medical notes, and statements from next of kin’ (p3). At the outset, it is clear that researchers’ interest was narrow, being largely restricted to deceased’s use (or not) of prescribed medication in relation to their medical status before and at death. However, researchers also had access to each deceased’s ‘socio-demographic variables [and] details relating to the suicide [that] included the method of suicide, adverse events prior to suicide and . . . suicide notes (if any)’. It’s evident that only the ‘why?’ question remained unanswered since coroners files may have provided adequate factual evidence regarding the ‘when?’, ‘how?’ and ‘where?’  of each suicide.
The paper (Benson et al., 2017) identified that medication prescriptions for over half of the deceased were for ‘mental health disorders’ (51.7%) while under half of the deceased were prescribed for ‘a physical condition’ (45.2%) and almost a third (31.6%) were prescribed medications ‘for both mental and physical health conditions’ (p6). Over one in 20 (6.7%) died by overdose while under one in 10 (7.9%) died by drowning. No information was available in the paper about how the remainder (85.4%) died.
The glaring absence in this research, albeit meticulous, cautious and expert, but limited, is that it tells the reader nothing about the deceased individual’s suicide trajectory: we learn nothing about the ‘why?’ question. Edwin Shneidman’s classic text (2004) examined in detail one man’s death by suicide: he demonstrated that it is possible to get close to an answer to the ‘why?’ question – but only if a coroner or a researcher completes the potentially complex investigative work involved and can command sufficient resources to achieve this.
SUICIDE – A DRAMA OF THE MIND
Essential reading for researchers who customarily employ quantitative methodology is Edwin Shneidman’s classic case study (2004). In a short text (177 pages) Shneidman joined eight expert colleagues in investigating the recent death by suicide of Arthur, a 33 year old lawyer, apparently by drug overdose. Arthur’s mother Hannah gave Edwin a copy of Arthur’s eleven page hand-written suicide note which he included in his book (Shneidman, 2004: 165).  Hannah asked Edwin if he might be able to offer her some insights and some solace about her boy’s death (p3). This is indeed the ‘why?’ question that family members, friends and colleagues of our 3,300 deceased ask: please may we have some insights and solace about the sudden, violent, premature, tragic death of our fellow human? [The author has personal experience of this continuing unmet need, 34 years later, for ‘insights’ into his family members’ deaths that were not available despite his participation in two excruciating public inquests.] Shneidman’s response to Hannah was that he ‘would try to generate information, hoping there would be insights and solace in that new material’ (p5).
This ‘new material’ consisted of nine verbatim, (edited for anonymity) transcribed interviews with Arthur’s relatives (4), friends (3), his psychotherapist and his treating physician. This ‘evidence’ – described by Shneidman as a ‘psychological autopsy’ (p xiv) – along with the suicide note were shared with eight of Shneidman’s professional colleagues, all ‘world-class experts in suicidology’, and each produced a short report. In particular, they were invited to comment upon what, if anything, might have been done to save Arthur’s life.
Readers can access and read Shneidman’s text for themselves. I recall being surprised and a bit disappointed when, during a ‘networking’ conversation at a local suicide prevention seminar, a professional acquaintance, reputedly an expert in suicidology, conceded that they had neither heard of nor read Shneidman’s text. It may be that a psychological autopsy following a suicide is as good as it gets for survivors. Clearly Arthur’s grieving mother did not have access to such a detailed investigation into Arthur’s death prior to Shneidman’s intervention. Nor have I regarding our two family deaths.
I have no knowledge as to the extent of use of a ‘psychological autopsy’ (PA) methodology for some, all or even any of the 3,200 suicide deceased in NI from 1998 to 2012. Some perhaps serious flaws have been identified in psychological autopsy, for example, the illogical attempt to assign a reliable psychiatric diagnosis of mental disorder upon someone – the deceased – by interviewing someone else (Hjelmeland et al., 2012). Further, Salvatore (2015) offers a detailed, somewhat critical examination of PA that also suggests the need for change:
“. . . psychological autopsies remain a practical and viable research strategy for use in gathering information about the background, actions, and experiences of suicide victims. However, their use should be untethered from the mental illness model of suicide and not be restricted to trying to define the mental states of the deceased who took their lives.” (Salvatore, 2015: 13)
 
CONCLUSIONS
 
What has been briefly examined above is the clear contrast that separates NI society’s approach to political murder from its consideration of domestic suicide. Whether there is ever a determined attempt to reduce the existing gulf between the quantum of scarce public, taxpayers’ resources variously deployed in investigating these tragedies remains to be seen. Unlimited public funds appear to be available to investigate the consequences of 30 years of political murder, while comparatively negligible amounts are dedicated to the aftermath of domestic suicide. Currently this latter issue does not feature strongly enough as a discrete element in NI government programmes (Right to Health Campaign, 2016). Local human rights charities, like Participation and the Practice of Rights (PPR), have had some recent success in highlighting the physical and psychological health needs of potentially thousands of survivors of bereavement by suicide. What remains ‘off the table’ however is energetic strategic action in NI with respect to Edwin Shneidman’s dictum regarding the uniqueness of each suicide death:
 
““each sad case [of a death by suicide] should be assessed, understood and treated in its own idiosyncratic psychological terms.” (Shneidman, 2001: 203) 
This represents a lost opportunity for learning about, and enhancing, our understanding of the actualité of human suicide, and how more insightful prevention and reduction strategies might be designed and implemented so as to replace over time our current, largely unsuccessful policies.
 
[3634 words (excl references)]
 
REFERENCES
Bamford (2011) Accessed on 18 May 2017. https://www.ulster.ac.uk/bamfordcentre/the-bamford-centre
Benson, T., Corry, C., O’Neill, S., Murphy, S. and Bunting, B. (2017) Use of prescription medication by individuals who died by suicide in Northern Ireland. Archives of Suicide Research, 0:1-14
BBC (2010) Information accessed on 11 May 2017 at: http://www.bbc.co.uk/news/uk-northern-ireland-10677957
Belfast Agreement (1998) Information accessed on 11 May 2017 at: http://cain.ulst.ac.uk/events/peace/docs/agreement.htm
Berman, A.L. (2011) Estimating the population of survivors of suicide: seeking an evidence base. Suicide and Life-threatening Behaviour, 41(1), 110-116
Cadwallader, A. (2014) Lethal allies: British collusion in Ireland. Cork, Ireland: Mercier Press
CAIN Website (2005 et seq) Cain Web Service: Conflict and Politics in Northern Ireland. Accessed on 10 May 2017 at http://cain.ulst.ac.uk/index.html
Clinical Tools (2017) Medical education for physicians. Accessed on 11 May 2017 at: http://www.larasig.com/node/1695
Consultative Group on the Past (2009) Report. Accessed on 11 May 2017 at: http://cain.ulst.ac.uk/victims/docs/consultative_group/cgp_230109_report.pdf  
Dillon, M. (1990) The dirty war. New York, NY: Routledge
Hjelmeland, H., Dieserud, G., Dyregrov, K., Knizek, B.L., and Leenaars, A.A. (2012) Psychological autopsy studies as diagnostic tools: are they methodologically flawed? Death Studies, 36, 605-626
McKitterick, D., Kelters, S., Feeney, B., Thornton, C. and McVea, D. (2007) Lost lives: the stories of the men, women and children who died as a result of the Northern Ireland Troubles (2nd Edn). Edinburgh, Scotland: Mainstream Publishing Company
Morrison, D.E. and Svennevig, M. (2002) The public interest, the media and privacy. BBC, London. Accessed on 22 May 2017 at: http://downloads.bbc.co.uk/guidelines/editorialguidelines/research/privacy.pdf 
NI Courts Service (2017) Website accessed on 22 May 2017: https://www.courtsni.gov.uk/en-GB/Services/Coroners/about/Pages/coroners_about.aspx
Participation and the Practice of Rights (PPR) (2017) Accessed on 2 June 2017 at: http://www.pprproject.org/about-ppr  
Right to Health Campaign (2016) Families bereaved by suicide: the right to timely and appropriate support. The Safer Campaign. Page 6. Belfast, N. Ireland: Participation and the Practice of Rights (PPR) Accessed on 31 May 2016 at: http://www.pprproject.org/launch-of-safer-campaign
Salvatore, T. (2015) Do 90% of suicide victims have serious mental illness? Psychological autopsy studies, psychopathology, and suicide. Discussion draft 8 April 2015. Available at
 https://www.researchgate.net/publication/274710108
Scottish Government Social Research (2008) Risk and protective factors for suicide and suicidal behaviour: a literature review. Joanne McLean et al. Web only publication. www.scotland.gov.uk/socialresearch
Shneidman, E.S. (1995) Suicide as psychache. New York, NY: Jason Aronson
Shneidman, E.S. (1996) The Suicidal Mind. New York, NY; Oxford University Press. 
Shneidman, E.S. (2001) Comprehending suicide. Washington, DC: American Psychological Association
Shneidman, E. S. (2004) Anatomy of a suicidal mind. Oxford: Oxford University Press.
Stormont Health Department (2017) Health Improvement Policy Branch. Accessed on 1 June 2017 at https://www.health-ni.gov.uk/contacts/health-improvement-policy-branch
Torney, Kathryn (2014) Suicide kills as many as the ‘Troubles’. The Detail. Accessed on 10 May 2017. http://www.thedetail.tv/articles/suicide-kills-as-many-as-the-troubles    
Urwin, M. (2016) A state in denial: British collaboration with loyalist paramilitaries. Cork, Ireland: Mercier Press
World Health Organisation (WHO) (2014) Preventing suicide: a global imperative. Accessed on 31 May 2017 at http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/  
Young, I.T., Iglewicz, A., Glorioso, D., Lanouette,N., Seay, M., Hapakurti,M. and Zisook, S. (2012) Suicide bereavement and complicated grief. Dialogues in Clinical Neuroscience, Vol. 14, No. 2, p178
Philip O’Keeffe PhD MSc Reg MBACP (Accred)©2017
Caveat: This paper may be copied and circulated but only if the author’s name and copyright are acknowledged.
 
 

​A New Theory of Suicidal Behaviour
Imagine my surprise when finding yet another theory of suicidal behaviour on offer to add to the existing fifteen or sixteen already available to suicidology. I mention this because unfortunately I’ll not be able to make it to Boston (Harvard Medical School) on 9 December 2016 to hear Tom Joiner deliver his latest insights upon ‘a new theory’. But why ‘surprise’, I hear you say.
Well it takes me back to Aristotle’s ‘well-known’ definition of truth:
 “To say of what is that it is not, or of what is not that it is, is false, while to say of what is that it is, and of what is not that it is not, is true.”
[Accessed on 22 Aug 2016 at http://plato.stanford.edu/entries/truth-correspondence/]
Further ‘research’ via Dr Google offered the following from ‘Daniel Super, Game Programmer’ on the subject of opinion and truth:
“People have many different opinions because they have different life experiences and perspectives. Very little can be said with absolute certainty outside the realm of mathematics. 
In many things there may be no truth at all. Moral questions cannot be answered definitively for all possible conditions, even the ones that seem obvious like ‘is it immoral to kill another human?’ have notable exceptions in most people's eyes. As for religions, I'm convinced that none of them even remotely approach any sort of truth.”]
[Accessed on 22 Aug 2016 at https://www.quora.com/Why-do-people-have-so-many-different-opinions-Is-there-only-one-truth-to-things].
So here’s my argument. I shall not attempt here to delineate any or all 15 or 16 theories about human suicidal behaviour, but you can find out more here (Lester, 1994). I tend towards the view – or it’s my opinion – that each act of suicidal behaviour, properly defined, is unique. The exhaustive efforts by suicidology to categorise, classify, typify, generalise, compare, contrast and/or rationalise human suicide behaviour represents, in my opinion, mission impossible. That is not to say that a journal article by David Lester (1994) offering a method for studying the lives of those deceased by suicide by application of multiple theories of suicide was not a more than useful exercise. It does make interesting reading.
Ten years on, Leenaars’ (2004) important, 460 page text offered additional insights into understanding suicide that (he argued) are essential for psychotherapists (and others) working in suicide prevention. On his first page, he stressed the uniqueness of each human being: “We must do justice to the fascinating individuality of each person [that] is humankind’s complexity . . . this is as true for suicide as for any behaviour. Suicide is complex.” (Leenaars, 1994: 1). Shneidman (1985) agreed, arguing that “each suicide is an idiosyncratic event . . . there are no universals, absolutes or ‘alls’ ” (Shneidman, 1985: 121). “To understand what [suicidal behaviour] is about, one has to know the problem that [suicide] was intended to solve” (Shneidman, 1985: 129).     
References
Harvard Medical School (2016) Assessing and treating self-destructive behaviours. Two day course, Dec 9-10 2016. Fairmont Copley Plaza Hotel. Boston, Massachusetts
Leenaars, A.A. (2004) Psychotherapy with suicidal people: a person-centred approach. West Sussex, England: John Wiley and Sons, Ltd
Lester, D. (1994) Research Note: A comparison of 15 theories of suicide. Suicide and Life-Threatening Behaviour, 24(1), Spring 1994
Shneidman, E.S. (1985) Definition of Suicide. New Jersey: Jason Aronson Inc.

​DEATH: SUICIDE v MURDER  
A few nights ago, in bed, I made the effort to get up, find a pen and paper and write down some thoughts about death, murder and suicide.
Recently close to where I live in Belfast, a 91 year old woman, just returning from the Post Office having collected her state pension, was assaulted on the street by a criminal thug and robbed as she arrived home. I believe that this unfortunate, innocent, fellow citizen has survived after being hospitalised but clearly her sense of herself, her personal safety and integrity are “changed utterly” and negatively by her experience. Police afterwards issued a leaflet to folks in our neighbourhood appealing for information, presumably not unrelated to our local streets being included in a voluntary crime prevention scheme called “Neighbourhood Watch”. I hope that the above-mentioned cowardly miscreant is rapidly identified and removed from society until he learns some manners.
Back to death, murder and suicide. Death is “the only certainty” for humans, as for all forms of mortal life – cell, plant, animal and human. Let’s just agree that the life cycle represents “an iron law”, unavoidable and indisputable (https://en.wikipedia.org/wiki/Iron_law) for my garden’s daffodils, as for my late pet dog, Basil, as well as for everyone, including me and you, good reader, who has lived, is living or will live on planet Earth. We’ll leave for the time being extraterrestrial life (per Webster-Merriam “coming from or existing outside the planet Earth” - http://www.merriam-webster.com/dictionary/extraterrestrial).
I’ll try to shorten this up.
Murder, across the globe, is regarded as a crime. The saga of Cain and Abel resonates (https://en.wikipedia.org/wiki/Cain_and_Abel). Each human death is a murder if and when directly attributed to the intentional actions of another or per Dr Google: “the unlawful premeditated killing of one human being by another” (https://www.google.co.uk/#q=murder). And each such death is idiosyncratic. It is investigated, vigorously or otherwise, by governmental agencies seeking to identify the culprit. Lessons are learned or at least attempted by relevant media publicity. As for those left to grieve the loss through murder of a loved one, states generally accept their duty to bereaved citizens to ameliorate their loss by compensation, and, in some cases psychological support in the aftermath. In Northern Ireland, the Victims Support organisation provides this service:
“Victim Support NI is a charity supporting people affected by crime. We offer a free and confidential service, whether or not a crime has been reported and regardless of how long ago the event took place. We are an independent organisation - not part of the police, courts or any other criminal justice agency.” (http://www.victimsupportni.co.uk/)
SUICIDE NOT A CRIME
So that’s alright then. Now let’s look at death by suicide. Here since 1966, suicide is no longer a crime:
“The Suicide Act 1961 (9 & 10 Eliz 2 c 60) is an Act of the Parliament of the United Kingdom. It decriminalized the act of suicide in England and Wales so that those who failed in the attempt to kill themselves would no longer be prosecuted.
The text of sections 1 and 2 of this Act was enacted verbatim for Northern Ireland by sections 12 and 13 of the Criminal Justice Act (Northern Ireland) 1966. The Act did not apply to Scotland, as suicide was never an offence under Scots Law (https://en.wikipedia.org/wiki/Suicide_Act_1961).
In the Irish Republic (variously Republic of Ireland, Ireland, The South) the crime of suicide lasted for over a further quarter century until 1993:
The Criminal Law (Suicide) Act, 1993 at section 2 provides: (1) Suicide shall cease to be a crime (http://freepages.genealogy.rootsweb.ancestry.com/~irishancestors/Law/Suicide.html).”
 Just like that – yesterday a crime alongside murder, viz. self-murder, but today not so. Reading the parliamentary debates (Westminster, Stormont, Leinster House – Ireland) leading up to legislative changes from 1961 to 1993 is revealing indeed. More on that may (DV) feature in a later blog, including the recent awakening in UK / Ireland of arguments in favour of legalisation of a so-called “assisted death” movement. Ironical indeed, given our national propensity to ‘assist death’ for political (i.e. power seeking) purposes in Ireland most recently for over 30 years from 1966.
SUICIDE v MURDER
For today, I’ll simply contrast our society’s treatment of suicide with that of murder. Clearly each suicide is idiosyncratic in nature, like any other death event. Police services, representing state resources, refer to deaths by suicide as having “no suspicious circumstances”, in other words, no crime. However, suicidology (“the scientific study of suicidal behaviour and suicide prevention” - https://en.wikipedia.org/wiki/Suicidology) has tended to focus upon prevention, paying most of its attention to what are known as “suicide rates”, then to the attributes of those fellow-humans deceased by apparent suicide, and finally to supposed cause/effect relations between a ‘do nothing’ approach and the material / psychological elements of ‘suicide prevention’ strategies. Unfortunately, psychological autopsy, the method most often relied upon in related research, is deeply flawed:
“. . . as a diagnostic tool psychological autopsies should now be abandoned. Instead, we recommend qualitative approaches focusing on the understanding of suicide beyond mental disorders, where narratives from a relatively high number of informants around each suicide are systematically analyzed in terms of the informants’ relationships with the deceased (Hjelmeland et al., Death Studies, 36: 605–626, 2012).
SUICIDE RATES
The incidence of death by suicide, represented in statistics, is as reliable as the human, bureaucratic recording systems that generate them. Making comparisons across countries based upon “suicide rates” may represent a waste of time and effort:
Incidence of suicide tends to be under-reported due to both religious and social pressures . . . and possibly completely unreported in some areas. Since the data might be skewed, comparing suicide rates between nations is statistically unsound. (https://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate).
GENERALISING SUICIDE
One of the dominant stupidities of suicidology is its reliance upon comparisons, its search for commonalities, and its quest to generalise causes of suicide – most culpably represented in the ludicrous notion that all suicides are rooted in mental illness/disorder/disease. I tend to share Heidi Hjelmeland et al’s view that suicidology needs a paradigmatic shift from quantitative approaches (i.e. counting them) to “qualitative approaches focusing on the understanding of suicide beyond mental disorders” (cited above).
EACH  SUICIDE IS UNIQUE
Each suicide needs investigated by the state “as if” it was a murder, albeit self-murder. Only when each citizen, from birth to death, is valued equally in social systems that render ‘profit’ below ‘people’, will our society begin the journey towards arriving at a deeper understanding of the human behaviour called suicide. This may not happen or even begin to happen anytime soon. Still Carroll and McCann (People before Profit Party) were recently elected to our local legislature. So don’t give up . . . . never give up.    
        
 

REASONS TO CHANGE HOW I AM LIVING, BEHAVING, BEING IN THE WORLD
There’s one great reason and it’s about integrity – to match my ‘walk’ to my ‘talk’ starting today, now.
I spend too long every day achieving nothing more than existing for another day – another day older, still lonely, low mood, unhappy, frustrated, dissatisfied, tired out, feeling aches and pains, fixed on a screen, or lying around dozing in the chair.
Until just now I failed to connect my online life with this sad, unfulfilled ‘actual’ life, my short life. And it’s the time-wasting, unproductive online life that is killing me.
Listening to Eckhart Tolle’s short video, I related most strongly to his bubble metaphor. Each bubble floats free in the air moving about as the breeze takes it. Yet a child’s finger reaches for it . . . . touches it . . . . and it’s gone . . . . just as if it had never been. Eckhart’s notion that each of us, me in particular, is represented in that bubble metaphor: now in this moment you’re here, you seem to have some sort of actuality, an existence . . . . for a few wet days and then an instant later . . . . gone, emptiness, formlessness replaces each of us . . . . and I’m in that moving flow of human bubbles awaiting the child’s touch. . . . but totally denying that reality in how I live my life.
It’s good therefore to be blessed with this timely insight. Question is what am I going to do about it today.  
Philip O’Keeffe PhD©2016
​

Since July 2015 I've attended several CPD meetings to meet professional accreditation criteria. Most recently, on 11 Nov 2015, I participated in a 'free' seminar organised by Contact, a N Ireland charity that administers a 24 hour telephone help-line - Lifeline - for the vulnerable and/or at risk of suicide. If you're familiar with the Samaritans listening organisation, Lifeline listens, but also seeks with the caller's informed consent and when judged appropriate, to engage in a therapeutic mode. A Lifeline telephone counsellor may offer face-to-face counselling, by a colleague, that is described as 'wraparound'. In short,  a Lifeline counsellor may become an available, accessible provider of brief family therapy (up to six sessions). I'm unsure of Contact's training syllabus, but Lifeline's approach appears to be influenced somewhat by David Jobes's Collaborative Assessment and Management of Suicidality (CAMS) model described as "a collaborative . . . approach to assessing and managing suicidal risk [that emphasises] individual differences in treating suicidal clients [accepting] that there is 'not a one size fits all way of understanding all suicidal people' ”. (www.psychalive.org). You can get much more about this approach via the afore-mentioned website. 

One serious issue for therapists in "helping people at risk of suicide" is the quality and depth of their informed compassionate empathy, including aptitude, education/qualifications, training and effective hands-on experience. I'd be interested to learn from colleagues about how well they feel that they meet these criteria - I would argue they're necessary but perhaps not sufficient - for working effectively with souls at risk of self destruction. Why not sufficient? For the most obvious yet largely intractable of factors: establishing connection with these almost invariably isolated souls who often suffer unbearably yet in silence behind a mask of 'normality'. 

Helping theory has demonstrated beyond any doubt that I cannot help a fellow human without establishing and maintaining an effective therapeutic relationship. I recommend the late Dr Israel Orbach's approach (article available on request from me or your local library) "Therapeutic empathy with the suicidal wish:  Principles of therapy with suicidal individuals. Israel Orbach. American Journal of Psychotherapy; 2001; 55, 2; 166-184. Read what Dr Orbach says about his 'uncompromised confrontation of self-destructiveness' and how you can learn to work compassionately and more effectively with the client at serious risk. 

One final point re the November 2015 Contact seminar. One attendee describing himself as a psychiatrist, stressed the individualistic - I would use the term idiosyncratic - nature of human suicidality, defined as 'tendency towards intentional self-destruction'. Each of us is a unique representation of the species, and worthy of inestimable respect as such. 

I plan to complete and submit the lengthy consultation document on the future of the Lifeline service to the DHSSPSNI. At the outset, I cannot envisage the NI Ambulance Service as a suicide prevention organisation. Further, my view is that bottom line GB government austerity considerations appear to hover like a thunderstorm over the current Contact-managed, much admired, effective and efficient life-saving Lifeline service. I shall argue accordingly in my submission.

YOU WANT TO HELP? THEN GET THE LIFELINE CONSULTATION DOCUMENT COMPLETED AND SUBMITTED IN TIME - BY THURSDAY 19 NOVEMBER 2015 LATEST.  

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.