MEDICAL MATTERS/DR TOM O'DOWD: The current rising incidence of suicide in Ireland is baffling. It always occurred but we called it something else.
The Catholic bishops blame it on our spiritual malaise, others blame alcohol and rapid cultural change. Whatever the cause, the impact of a suicide on remaining family and friends cannot be underestimated. General practitioners report increased use of services afterwards and at anniversaries of the death. It seems to stalk families through the generations.
Most suicides are men at either extremes of adulthood. "He is the last one I would have expected to do this" is a common comment afterwards. This is not always true as there are groups of men who are at particular risk. However, there is little awareness of the occasional warnings signs of suicide among the general population.
Men with unsuccessful schooling, poor employment prospects, drugs and alcohol misuse, psychiatric illness, troublesome relationships, loneliness are among the vulnerable. Add to this the lack of language for expressing emotional distress and it is indeed an inflammable mix.
Lots of help is available for distressed people who may be thinking of ending their lives. The thing is they don't ask for it straight out or at all. They may drop hints but not to the usual helping agencies. This is where we need to be radical and work together as an organised society.
To whom are young men likely to drop hints, share their unhappiness or perhaps say it but not have it heard? They may be people who work in pubs and clubs, the Garda Síochána, teachers and line managers in factories and warehouses.
As an organised society we need to engage with the Licensed Vintners Association and night club managers to persuade them to include a module on active listening in their training courses. Similarly, small and medium-sized enterprises that have contact with people, mainly men, have a role to play in responding to vulnerable people.
The trade union movement in Ireland has been enlightened in healthcare matters and needs to be engaged in what has become a form of national emergency.
Men are avid users of the internet, including sites with pornography and gambling. Whatever your opinion about the content, it is a fact of life. The hosts of such sites have an opportunity to play a part in suicide prevention by alerting users to the warning signs of suicide among themselves or a friend. They could include links to sites that might be of help.
We are now aware that single car accidents may occasionally be suicides. Young men want to drive early and to adorn their cars with gadgets and dark glass. The driving test material needs to include advice on what to watch out for in suicide intent. The insurance companies similarly could reinforce such material.
When I was a medical student, psychiatrists warned us never to ever ask about suicide as it put ideas into patients' heads.
We now know that suicidal ideation, merely thinking about it, is common and patients who trust their doctor will often admit to what is probably escapism from a current awful situation.
A small minority will reveal plans and are biding their time. Some will deny it and may subsequently on impulse plus alcohol commit suicide.
At present, the question "have you ever thought of harming yourself?" is in the domain of the clinician. There is no reason that the question could not become part of a well-planned training programme. A kind of first aid for the mind. It is a question that may well open up a can of worms, and there is a need for back-up and access to professional support.
It has of course got to be done sensitively. However, First Aid and the Samaritans have a valued and respected role in our society. It is often easier to talk to a stranger on a train who you will never meet again than to family or friend. Listening does not come naturally to most of us as the self comes in the way. It can be taught and may save lives.
In writing about suicide I am particularly mindful not to make things worse for families who spend lifetimes seeking explanations. I am sure many bereaved relatives would be willing to advise organisations that are interested in putting suicide prevention programmes in place.
Dr Tom O'Dowd is professor of general practice at Trinity College Dublin, and a practising GP.