OPINION:The right systems and supports can go a long way in tackling suicide among young people
In the last week we have witnessed two appalling examples of the preventable loss of young life. I arrived in Dublin from Australia on Thursday to be shocked by the death of the second of two teenage sisters, Shannon Gallagher, in Ballybofey, Co Donegal. By coincidence, my grandmother was born in Ballybofey, and Shannon’s funeral was in the church in Stranorlar where my grandparents married in the late 19th century.
The second tragedy was of course the mass murder of much younger children in the US community of Newtown by a disturbed young man. How can these tragedies be prevented? In each case there has been confusion, a hunger to understand why such events happened, and a desperate call for prevention.
Mental ill health, broadly defined, facilitated by potent social forces, has almost certainly played a role in both tragedies. However, the first is much more preventable than the second. Gun control seems out of reach in the US, and identifying and responding to disturbed young men in time in the absence of a collectivist culture or a functioning mental health system for young people seems impossible.
The scale of the two causes of premature death deserves comment. Mass murder even in the US kills relatively few young people. Yet every year in Ireland hundreds of young people die from suicide.
These deaths are increasing. In Australia, where I work in youth mental health, suicide also overshadows the road toll as the major preventable cause of death in young people. Youth suicide is not the mystery that it seems and rarely comes out of the blue in mentally healthy people.
There are many forces driving it. The final common pathway in nearly every case is the enduring experience of unbearable emotional pain, which young people are generally poorly equipped to deal with. Their support systems are also frequently poorly equipped to help them.
One factor underlying the “copycat phenomenon” is that there are many young people close to the edge and an illusory “solution” is thrust in front of them by one of their peers. This is compounded if the act or the young person is idealised as courageous rather than seen as suffering severely, becoming overwhelmed, with nowhere to turn.
Unlike some of my colleagues, I believe that the media should prominently report suicide, obviously within guidelines and with great sensitivity to the families, to overcome secrecy and taboo, and ensure that the public are aware of the scale of the challenge. This should be done in a manner that deters and reduces risk by revealing the devastation that is left in suicide’s wake. The media must not mystify or glamorise suicide, treat it in a superficial or fatalistic manner, nor imply that it is ever a solution or acceptable.
Suicidal risk is nearly always relatively transient if effective help is provided. A fundamental problem is that the latter is in short supply for young people. Media reporting of the US tragedy features a demand for action. Media reporting of suicide should create the same pressure, which has a much better chance of success in reducing preventable death.
We know that the transition to adulthood is a challenging personal journey for each of us, and of course, our families. Our world is changing, and so are our bodies, brains and minds. This has been well captured by the hugely valuable “My World” survey of young people in Ireland, conducted recently by Dr Barbara Dooley and the Headstrong/UCD team.
We also know that mental ill health worsens during the transition to adulthood and that 50 per cent of young people will experience diagnosable mental ill health at some stage between the ages of 12 and 25. While many die, most survive, though a substantial subset will suffer enduring and disabling mental ill health across the decades.
These facts are increasingly well known yet decisive action has not yet occurred. These young people need support, help and usually special expertise, but in a new way. The first thing they and their families need is somewhere to turn to, to be heard and where they will receive genuine help to stay alive and to flourish.
Ireland has begun to solve this problem and a solution is within reach. I spent a sabbatical in 2009 based at Headstrong, the National Youth Mental Health Foundation of Ireland, where I have been privileged to be a member of the board since its inception in 2006, until recently.
Headstrong was founded, in part as a response to mounting concern about youth suicide, through the philanthropic vision of the One Foundation, and has been expertly led by Dr Tony Bates with the support of an inspirational band of people. Headstrong “Jigsaw” services have been successfully established in several communities and more are rolling out. These are “soft entry”, stigma free, one-stop shops where young people, and their families too, can find a welcome and a listening ear, and are heavily influenced by the voices of young people.
They can also draw on genuine expertise in mental healthcare. Donegal is establishing a Jigsaw service.
These holistic primary care portals need specialist mental health back-up systems. But these cannot be “more of the same”; they, like Jigsaw, must be heavily influenced by youth and family participation, cover the full transitional age range up to the age of 25 (since the risk increases further between 18 and 25 years), and be integrated with primary care.
Perhaps to the surprise of many, this is quite feasible in Ireland. While there are increasingly positive signs that the Health Service Executive is beginning to make the necessary investments in both Jigsaw and the specialised back-up care, the recent preventable deaths underline the need for a clear commitment.
Ireland is facing some painful challenges. While many young Irish people are emigrating, I hope fervently that Ireland will take the best possible care of those who remain and give them the chance to return from dark and painful places.
PAT McGORRYis professor of youth mental health at the University of Melbourne