How much of the recent rise in reported suicides reflects a genuine upturn and how much is due simply to better recording mechanisms? This is one of the key questions suicidologists have been grappling with in recent years.
There is little doubt that suicide was under-recorded in the past. Before 1993, it was a criminal offence as well as a highly stigmatised phenomenon. As a result, says Dr John F Connolly of the Irish Association of Suicidology, "the real suicide rate was probably twice the official rate".
Under Section 30 of the Coroners' Act, 1962, coroners were precluded from returning a verdict of suicide as they were not allowed to make anyone civilly or criminally liable for their own death. A large proportion of suicides were recorded as being of "undetermined cause" or "death by misadventure".
This situation was meant to have changed with the Criminal Law (Suicide) Act, 1993. However, confusion arose after a Supreme Court ruling on a suicide case in 1995. One interpretation of the ruling was that coroners were still prohibited from returning a verdict of suicide despite the change in law.
The 1998 Report of the National Task Force on Suicide recommended that the Coroners' Act, 1962, be reviewed to facilitate the returning of suicide verdicts where appropriate.
The issue was addressed by a Department of Justice, Equality and Law Reform working group, in a review of the coroner service. In its report last December, the group recommended that suicide verdicts should be returned as appropriate "in the interests of society generally, including relatives". The Government has approved the preparation of legislation based on the report. However, a date for its introduction has yet to be agreed.
Mr Paul Corcoran, chief statistician with the National Suicide Research Foundation (NSRF), said anecdotal evidence suggested there were "huge variations" between coroners. According to one survey, only one in three suicide cases was being returned as such. "I was told of one coroner who apparently said he had never given a verdict of suicide," he said.
In light of such uncertainty, the Central Statistics Office has come to rely on information from the Garda Siochana for the compilation of its suicide statistics and, in particular, a report form completed by gardai after an inquest, known as a Form 104. This records the investigating garda's opinion of the cause of death, and on its basis the CSO decides whether to categorise a death as suicide.
More accurate Garda information has helped reduce the number of "undetermined" deaths from 120 in 1979 to five in 1995. The numbers have since crept up, however, to 43 in 1998 and 46 in 1999.
In an effort to improve the situation, the task force recommended that a revised Form 104 be introduced, detailing the social and personal circumstances of the deceased, including evidence of drug or alcohol dependency and mental/physical medical history. The amended form was first used last year.
Figures for the year should be available by the summer, said Mr Corcoran, who is examining the forms with the CSO. One matter which, he said, he hoped to establish was the exact disparity between the Garda figures and coroners' verdicts.
The CSO believes that any understatement in the official statistics amounts to less than 5 per cent of all suicides. Others contest this, however.
A study last year, conducted by Dr Connolly with health board officials in the east, south and west, showed the official figures understated suicides by 28 per cent in Mayo and 16 per cent in Kildare. The authors of the report adopted the civil law concept of balance of probabilities rather than the criminal law concept of suicide being established beyond reasonable doubt to calculate their figures.
Dr Connolly said he hoped to repeat the exercise this year.
A further initiative in the area is the establishment by the NSRF of the National Parasuicide Registry, a data bank of attempted suicide cases. Under the scheme, launched in January, health boards are to forward details of incidents of self-harm - importantly, without names or addresses of patients - to the Cork-based research foundation. The first year for which figures are expected to be available is 2002.
It is hoped that with improved statistics through initiatives such as this it will become easier to evaluate suicide prevention and intervention strategies.
It is estimated there are more than 6,000 attempted suicides each year, a figure based on the Republic's population size and information from some accident and emergency units.
