Suicide Prevention Policy and Practice in Northern Ireland
Submitting InstitutionQueen's University Belfast
Unit of AssessmentSociology
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
Research on the scale and nature of suicide in Northern Ireland has
changed awareness of suicide as a problem and has informed the development
of suicide prevention strategies. The findings have received widespread
coverage in local, national and international media with impact on a range
of audiences. These include policy makers, suicide prevention
practitioners, mental health professionals and the wider public. Elected
representatives have used the research in debates in the House of Commons
and Northern Ireland Assembly. Psychiatrists, counsellors, suicide
prevention workers, volunteers for the Samaritans and the Commission on
Victims and Survivors have actively engaged with the research.
The research on suicide arose from a study commissioned by the
Dublin-based Combat Poverty Agency which considered the international
evidence of the impact of violent conflicts on poverty and other social
problems (Hillyard, Rolston and Tomlinson, 2005). The study found that the
internationally recognised social costs of conflicts include psychological
damage experienced by combatants, civilians and refugee populations.
Experience from the Balkans and other regions of conflict showed that
trauma and depression are long-lasting, often resulting in the
transmission of trauma between generations and in elevated suicide rates
among young people (Tomlinson, 2007b). In Northern Ireland, personal
experience of violence was significantly associated with poor mental
health, although on measures of happiness (Tomlinson 2013), people in
Northern Ireland score highly compared with most parts of Europe. The
study drew attention to rising suicide rates especially among men in
younger age groups over the ten-year period up to 2002. One recommendation
was for policy makers to recognise the growing suicide problem, given the
lack of a suicide prevention policy at the time.
The Department for Health, Social Services and Public Safety (Northern
Ireland) (DHSSPS) subsequently commissioned a systematic literature review
to explore the links between conflict, mental health and suicide
(Tomlinson, 2007a). `The Trouble with Suicide' challenged the conventional
wisdom that the conflict generated a high level of `wartime' social
cohesion, which was said to explain both the decline in suicides in the
early 1970s and the increase in the period of peace. On the contrary, the
1970s' trend is explained by some suicides being classified as
`accidents'. The study also questioned the idea that a more peaceful
society was a less cohesive one: the factors behind the rising suicide
rate were more complex than this. They include the changing age and gender
profile of competed suicides, the resilience of groups whose identities
and livelihoods were invested in the conflict, the greater awareness of
suicide especially among younger people, and evidence of huge increases in
the consumption of alcohol, prescription drugs and illicit substances
known to cause depression.
Unlike in neighbouring jurisdictions and regions, Northern Ireland's
suicide rate uniquely continued to rise from the late 1990s, with a very
steep increase between 2004 and 2012. Further attempts were made to
comprehend the post-conflict suicide trends using data going back to the
mid-1960s. Suicide trends were found to have distinct phases which varied
by age groups and gender such that the trends for some specific groups
went against the overall trend (Tomlinson, 2012). A cohort effect was
discovered such that male children and young people who grew up in the
worst years of violence (now in their middle years) have the highest and
most rapidly increasing suicide rates in the period of peace, and largely
account for the steep upward trend in suicides following the 1998
These findings have implications for the identification of at-risk
individuals, groups and communities, for understanding the disconnect
between services and those in need, and for public health strategies which
need to address middle and older age groups.
References to the research
Tomlinson, M. (2007a) The Trouble with Suicide. Mental Health,
Suicide and the Northern Ireland Conflict: A Review of the Evidence.
Belfast: Department of Health, Social Services and Public Safety (NI).
Supported by a grant of £9k.
Tomlinson, M. (2007b) `Suicide and Young People: The Case of Northern
Ireland', Child Care in Practice 13(4): 435-443.
Tomlinson, M. (2012) `War, peace and suicide: the case of Northern
Ireland', International Sociology 27(4): 464-482.
Tomlinson, M. and Kelly, G. P. (2013) `Is everybody happy? The politics
and measurement of national wellbeing', Policy & Politics
Details of the impact
Since 1996 the World Health Organisation has advised that research is a
key component of suicide prevention strategies. The `Trouble with Suicide'
was the first attempt in the Northern Ireland context to review the
international evidence of the relationship between violent conflict and
mental health. The report is available from the DHSSPS
Suicide Prevention resource site (218 downloads since August 2010).
It is also available for download from Youthnet
(the Network for the Voluntary Youth Sector) and from the National
Documentation Centre on Drug Use. The report is referred to on the
website of the US Suicide Prevention Resource Center in a
discussion of the Director's blog (posted
16 March 2012) and is discussed in a review of the needs of victims
and survivors carried out for the Commission
for Victims and Survivors in 2010. The author featured in a radio
Their Time' presented by Gerry Anderson (Falling Tree Productions,
broadcast by NewsTalk, Dublin, 16 April 2011).
The work is referenced in the following policy documents:
- Institute of Public Health (2008) Data
- Northern Ireland Association for Mental Health (2009) Dealing with
Suicide, a report on the needs of clergy. Armagh: Southern Health
and Social Services Board;
- Health Promotion Agency (2008) Briefing on Masculinity and Mental
- Department of Health, Social Services and Public Safety (2012) Evaluation
of the Implementation of the NI Protect Life Suicide Prevention
Strategy and Action Plan 2006-2011.
- Department of Health, Social Services and Public Safety (2012) Protect
Life, A Shared Vision. The Northern Ireland Suicide Prevention
The Northern Ireland Assembly's Committee for Health, Social Services and
Public Safety took oral evidence from the author (31st January 2008) as
part of its Inquiry into the Prevention of Suicide and Self-harm
(Volume 1, paragraphs 953-1012, May 2008).
The discovery of a cohort effect linking suicide trends to the conflict
attracted widespread publicity in print and electronic media. Over one
hundred media outlets used a press release (July 2012) based on the `War,
peace and suicide' journal article. TV and radio interviews were carried
out for the BBC (Radio 4, Radio 5, Radio Ulster), for Radio Telefis
Éireann, Ulster Television and for several commercial radio stations.
Print and web-based coverage included The Guardian, The Mirror, Irish
Independent, Irish Times, Irish Examiner, News Letter, and Belfast
Internationally the research was followed up with interviews for Deutsche
Welle, the World Service and the US-based ScienceNews. Web-based
media that have carried the research include IrishCentral (US),
Freshties.com, thedetail.tv, thejournal.ie, eamonnmallie.com, the LSE's
politics and policy blog, and Slugger
Another strand to the impact is that the research has been referred to
during parliamentary debates. On World Suicide Prevention Day 10th
September 2012, the main findings were discussed in the Northern Ireland
Assembly. Suicide prevention was debated in the Assembly on 15th April
2013 and members across the Unionist/Nationalist divide quoted from the
research. The debate was on a motion proposed by the Chair of the
Assembly's Health, Social Services and Public Safety Committee, calling on
the Executive to prioritise suicide prevention as a cross-departmental
concern. A seminar delivered by the author in Parliament Buildings on 11th
April 2013 was referred to. This had pointed out the exceptional nature of
Northern Ireland's recent suicide trends and presented six possible
explanations. The Knowledge Exchange Seminar Series is hosted by the
Research and Information Service which makes video recordings of the
proceedings and distributes the briefing papers and presentation slides
with suicide). (In feedback, 100% of respondents found the
presentation `relevant to the development of policy and law').
William McCrea (Democratic Unionist Party MP) led the House of Commons
Opposition Day debate on suicide prevention, held on 6th February 2013. He
relied heavily on the suicide research, naming the author and quoting
statistics and argument (House of Commons Debates, 6th February 2013, col.
326). Similarly, Nigel Dodds (DUP) contributed to the debate by reading
out the main conclusions from the International Sociology article
(House of Commons Debates, 6th February 2013, col. 349).
A range of professional groups involved in suicide prevention have
engaged with the research:
- The author addressed 270 mental health professionals at a conference
on suicide prevention
(22nd November 2012, organised by ContactNI — http://contactni.com/),
sharing a platform with the World Health Organisation's leader on
international suicide prevention strategy, Professor Annette Beautrais,
and with David Covington, the chair of the US National Suicide
- The Children of
Conflict conference (March 2012) attracted 250 international
delegates working with children and young people. The author's
presentation on `Young people and the legacy of conflict' included a
discussion of suicide (see The
Guardian 26 March 2012).
- The British Medical Association responded to the publication of `War,
Peace and Suicide' with a press release calling for measures to control
- The author was invited to present to the Victims and Survivors' Forum
of the Commission for Victims and Survivors, 15th January 2013.
- The author was asked to discuss the suicide research with
psychiatrists working in the Belfast Trust area (1st March 2013 — 45
- Belfast Samaritans invited the author to present the findings at its
Annual General Meeting (14th May 2013).
Sources to corroborate the impact
- Northern Ireland Assembly, Committee for Health, Social Services and
Public Safety, Session 2007-8 Third Report. Inquiry
into the Prevention of Suicide and Self-harm, Volume 1, May
2008, paragraphs 953-1012.
- Northern Ireland Assembly, Official Report 10th September 2012,
Session 2012/13. World
Suicide Prevention Day debate.
- Opposition Day debate on suicide prevention, House
of Commons Debates 6th February 2013.
19 October 2012: `Suicidal Threads: Early abuse weaves its way
into the brain, with potentially tragic consequences'.
- British Medical Association, `Suicide increase prompts call for
alcohol action'. Press
release, 1st August 2012.
IrishCentral `Suicide rates in Northern Ireland have doubled
since the Troubles ended,' 25th
- Henry McDonald, `Children of the Troubles most prone to suicide in
Northern Ireland', The
Guardian, 26 March 2012.
- RTÉ News, `People who grew up during Troubles more prone to suicide,
study finds' 25th
Irish Times, `Sharp rise in NI suicide rates', 25th
- Department of Health, Social Services and Public Safety (2012) Protect
Life, A Shared Vision. The
Northern Ireland Suicide Prevention Strategy 2012-2014.