ALTHOUGH he was a quiet and retiring man, it is likely that the death of Eamonn Healy in December 1989 will have a far greater effect on Irish society than did the recent death oft Pat Tierney, who literally may have died to make a good news story. Each took his own life. The one chose to arrange publicity in advance, the other slipped away without letting anyone know.

A judge, however, has decided that the death of Eamonn Healy was a consequence of negligence by the health services. What are the implications of this?

Courts assume that doctors and psychologists can predict suicide, after careful examination, with accuracy. Such a view was fundamental to the judgment in the X case. Because the professional opinion given predicated suicide, the judges assumed that, without the option of termination and the right to travel in search of it, the death of the mother would be the outcome.

However, most suicidal people do not die by suicide. Of those who engage in acts of parasuicide, (acts linked to suicide which do not result in death), only 1 per cent commit suicide in the succeeding year, and 10 to 15 per cent in the succeeding 10 to 15 years.

It is true that most suicides are mentally ill. The opposite is not true, however. Most of the mentally ill do not end their own lives. The huge clinical difficulty is to decide into which category the patient falls - whether mentally ill only, or mentally ill and suicidal.

Careful clinical inquiry may determine the difference. Key questions centre on diagnosis, intention, support structures, previous behaviour, attitude to the future and personal commitment to get well.

A well trained doctor will assess all of these. He ought also to commit his findings to paper. Insurance companies who indemnify doctors never tire of emphasising the importance of good records. On such, a court case will stand or fall.

America gave Europe the whiplash. Irish courtrooms which 30 years ago did not know what a whip lash was would not be complete today without several litigants wearing cervical collars. The danger is that failure to recognise either suicidal impulses or to respond to suicidal threats, may become the psychiatric "whiplash" of the future. In the new world it is big business. Doctors, psychologists and lawyers have developed specialist practices in this regard.

Suicide is always upsetting to others, particularly when it occurs within an institution. Research has shown that there is a high association between having been in a mental hospital and suicide. It may occur within the hospital, while waiting for admission, or soon after discharge. However, the same may be said of heart attacks and cardiac units. They occur most commonly among those recently admitted awaiting admission or recently discharged.

In Britain there is a confidential inquiry on every suicide occurring in association with the institutional mental health services. Such inquiries should be done in a non judgmental manner. It should not be a search for a scapegoat. Like a match analysis by a good football coach, the aim is how to play better in the future rather than the attribution of blame in the past. We need to develop a similar approach here.

Our services are, however, changing. There is less slack in mental hospitals today. Twenty five years ago when Eamonn Healy was first admitted to a mental hospital, there were many more bed places than now. Staying there three months was less a logistic problem than it would be today.

For a hospital to run efficiently it has to be on the basis of a 90-95 per cent occupancy in order to cope with emergencies. Most psychiatric admissions are emergency admissions. Courts rightly see hospitals as places where clinical skills are concentrated and not simply a place with a particular number of hospital beds. If the person needs it, he must be admitted. In practice, this can only be done if there is an empty bed, which means the discharge of someone else in advance.

TODAY there is a great pressure on doctors and nurses to assess on a daily basis who has to come in and by the same token who is well enough to go out. This requires skill, judgment, and an ability to communicate with nurses, colleagues and most of all with patients and their relatives. Sometimes a person will threaten suicide in order to gain admission or to remain within the service.

It is not an easy decision. My earliest memory of psychiatry is sitting as a student with a consultant while a young man pleaded to be allowed home. Reluctantly, the psychiatrist agreed. The boy drowned that afternoon. I can still see him in my mind's eye. He said his "thoughts were like cotton wool". It was not my decision. Yet I was and still am involved.

Eamonn Healy's death and the judgment which followed it may well change clinical and medical legal practice in Ireland. Not only must sound clinical judgments be made but these must be carefully recorded. Defensive psychiatry may follow defensive medicine. Research into suicide and attempted suicide must continue to develop. One of the questions that the Suicide Research Foundation is investigating is how best to predict future suicides and acts of parasuicide.