Sir, - Your coverage of suicide in Ireland raises important social, medical and legal issues (February 1st and 2nd). Within the context of an alarming modern increase in suicides, such deaths challenge traditional complacencies about individual autonomy medical competence, and adequate health and social services.
Padraig O'Morain prompts timely discussion of the possible role of the Eastern Health Board in the suicide of Katherine Dwyer ("Is anyone to blame for this suicide?" - January 27th). The judgment of the High Court on January 31st against the NorthWest Health Board for negligent discharge from hospital of Eamonn Healy, a depressed patient, who committed suicide four days later suggests that litigation will increasingly affect psychiatric decision making.
While negligence suits have a useful role in identifying individual responsibility and providing an arm of restitution, such apportionment of wrongdoing is insufficient.
Beyond the certainty of blame lies the imprecision of predictions of dangerousness and a growing concern about inadequate provision of comprehensive community based services for those with mental health problems. Beyond the dyad of in or out patient treatment lies a matrix of needs including therapeutic communities; decent housing; occupational support; advocacy and care plans that take account of a person's developmental and social place. By the image of genderless mental illness lies a disturbingly large proportion of women struggling to cope with inadequate child support, fewer and more poorly paid jobs than men, and burden some societal expectations.
The report of a British government inquiry in January into homicides and suicides by persons with mental health problems suggests a further range of considerations, which might be relevant to mental health services in Ireland. These include better communication between health professionalist and improved face to face con tact between them and patients.
The inquiry expressed an "uncomfortable feeling that more strenuous efforts to insist on maintenance of contact might have been rewarded with fewer deaths.
This Government's current proposals for reform of the anachronistic 1945 Mental Treatment Act are welcome. It is to be hoped that adjustment of the substantive and procedural criteria for involuntary commitment, among other intended reforms, does not foreclose consideration, and adequate funding, of ways of addressing the needs of those in emotional distress and grave social need such as Katherine Dwyer and Eamonn Healy. - Yours, etc.
Downpatrick,
Co Down.