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.

Underpinning 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 Agreement.

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

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 documentary, `Before 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:

1. Institute of Public Health (2008) Data Briefing. Dublin/Belfast.
2. Northern Ireland Association for Mental Health (2009) Dealing with Suicide, a report on the needs of clergy. Armagh: Southern Health and Social Services Board;
3. Health Promotion Agency (2008) Briefing on Masculinity and Mental Health. Belfast.
4. 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.
5. Department of Health, Social Services and Public Safety (2012) Protect Life, A Shared Vision. The Northern Ireland Suicide Prevention Strategy 2012-2014.

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 Telegraph. 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 O'Toole.

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 (see Dealing 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:

1. 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 Prevention Lifeline.

2. 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).
3. The British Medical Association responded to the publication of `War, Peace and Suicide' with a press release calling for measures to control alcohol consumption.
4. The author was invited to present to the Victims and Survivors' Forum of the Commission for Victims and Survivors, 15th January 2013.
5. The author was asked to discuss the suicide research with psychiatrists working in the Belfast Trust area (1st March 2013 — 45 attendees).
6. Belfast Samaritans invited the author to present the findings at its Annual General Meeting (14th May 2013).

Sources to corroborate the impact

1. 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.
2. Northern Ireland Assembly, Official Report 10th September 2012, Session 2012/13. World Suicide Prevention Day debate.
3. Opposition Day debate on suicide prevention, House of Commons Debates 6th February 2013.
4. ScienceNews 19 October 2012: `Suicidal Threads: Early abuse weaves its way into the brain, with potentially tragic consequences'.
5. British Medical Association, `Suicide increase prompts call for alcohol action'. Press release, 1st August 2012.
6. IrishCentral `Suicide rates in Northern Ireland have doubled since the Troubles ended,' 25th July 2012.
7. Henry McDonald, `Children of the Troubles most prone to suicide in Northern Ireland', The Guardian, 26 March 2012.
8. RTÉ News, `People who grew up during Troubles more prone to suicide, study finds' 25th July 2012.
9. Irish Times, `Sharp rise in NI suicide rates', 25th July 2012.
10. Department of Health, Social Services and Public Safety (2012) Protect Life, A Shared Vision. The Northern Ireland Suicide Prevention Strategy 2012-2014.