The unmentionable act

BY ÁINE Ní BHRIAIN

More people have died by their own hand in the Six Counties than have perished during the last four decades of political struggle.

Suicide has replaced road traffic accidents as the number one cause of premature death in young men, and it accounts for over 25% of all deaths of young people.

In the last 20 years, the number of young men in the Six Counties that have committed suicide has more than doubled.

Young women are more at risk, but male suicide attempts are more likely to be fatal.

There is an 80% chance that those who have attempted suicide, will try again.

There are approximately 150 suicides in the North each year.

75% of all suicide deaths are young men.

Incidents of self-harm - inflicting wounds, eating disorders, substance overdoses - are on the increase.

"Our son was the kind of fellow that would run to the ends of the earth for you. Always laughing and joking. I don't know what happened. A happy-go-lucky fellow puts a rope up and hangs himself? There's something not right."

Ireland has one of the highest suicide rates in the western world.

In North and West Belfast alone, 50 people have taken their own lives since Christmas 2002. Most of them were males under the age of 35.

No one wants to talk about it. The medical system is ill-equipped to deal with it. Support services are underfunded and overstretched. People in crisis don't know where to turn. Mental health facilities - particularly those equipped to treat young people - are difficult to access and have massive waiting lists. Young people are the most at risk, yet, paradoxically, are given the least amount of information on the subject.

And so, suicide remains a silent and often unpredictable killer. It not only takes lives - it destroys them - leaving devastated families, communities, entire generations in its wake.

It is an immense agony, cloaked in heartbreak and silence. Although it affects all nationalities in the world, crosses all boundaries of faith, age and gender, in the Six Counties it is also a reflection of four decades of conflict, violence and trauma.

It is not going to go away. In fact, all indications are that the problem is getting worse.

"Suicide is a feature of every society, and has a long history," says John McGeown, Assistant Director for Community Services, North and West Belfast Health and Social Services Trust. "There are no easy answers, no one reason, no easy solutions. There's no pill to protect someone from the possibility of suicide.

"If someone is seeing a therapist or community nurse, they may still take their own life. Even when medical health experts are available that may not be enough protection. There are more suicides in mental health hospitals than anywhere else. Families blame themselves but they must remember that experts also fail, it can still happen, so what chance does a family on its own have?"

Just 2% of the North's annual budget is spent on mental health services, compared to 7% or 8% in England, and although there is a shocking suicide rate in North and West Belfast, those areas are getting £3m less than they require for mental health services.

The remaining areas of Belfast annually receive five million pounds more than they require, leaving a gap of £8 million. While no one is suggesting that such monies should be stopped or diverted - as the need for updated mental health facilities remains a serious concern in all communities - there could be new ways to facilitate the distribution of such funds based on immediate need, population, available options, and the results of ongoing risk assessments for each community.

For example, official figures show West Belfast has a suicide rate of 19% per 100,000 people, compared to 11% per 100,000 in the rest of the North. This is a clear indication of an ongoing problem and it it is to be hoped that future funding can address this inequity.

Aside from financial concerns, one West Belfast therapist says there is also a large gap between the people doing the work on the ground through community organisations, and the much higher level provision of psychiatry.

"There seems to be a gap in the middle, which the health service tries to support by giving people community psychiatric nurse support, or clinical psychology support," says the therapist. "But those services are very, very stretched. So trying to make an appointment is really, really difficult."

Suicide remains one of the few unspoken taboos of the modern world. We don't want to talk about it. We don't even want to acknowledge it. It's almost as if we fear the power of the word, the raw despair of the act. Many people believe that talking about it might cause someone in crisis to consider it as a viable option. This is one of the many myths about suicide and self-harm.

Contrary to our own personal discomfort, health professionals say that talking about suicide or suicidal feelings can actually bring enormous relief to those who might be contemplating the act. They encourage people to talk openly about their suicidal feelings and say those who are trying to help others should listen without dismissing or avoiding such remarks, ask direct questions, and seek further help and support.

Parents speak out

What drives someone to take their own life?

Experts tell us there is no single cause, but some of the factors linked to suicide are alcohol and drug abuse, relationship problems, unemployment, physical and sexual abuse, depression, and social isolation. However, some bereaved families believe that suicide can also be unpredictable, a momentary lapse, an impulse gone wrong.

Recently, several bereaved parents bravely addressed a public forum on suicide in North Belfast. One of them, Phil McTaggart, was part of the panel. It was a courageous and selfless effort to dispel the stigma attached to the act, and speak frankly about a deeply personal loss in the hope that it might spare another family the same pain.

"If this talk had happened a year ago, I wouldn't have been here," said McTaggart, whose son - also named Phil - died only a few months ago. "I was one of those people who thought this was someone else's problem. It was not going to happen to me.

"My son would have been 18 this September. He was taking driving lessons, buying a car. He was going on a holiday and had a new job. He never gave us reason to be concerned. I felt he was a happy fellow.

"He didn't actually hang himself, he strangled himself. He wasn't able to make a proper noose so he just tied the rope around his neck and knelt down. It was that simple. Like turning off a light switch. In three seconds, he was unconscious. In a minute, he was dead. The autopsy revealed he had less than twice the legal limit of drink in his system and he hadn't taken any drugs.

"My son had lots to look forward to and he knew he was loved. I think that young people have lost the skills they need to cope. They need more social interaction. Now if they feel bad they just go upstairs. You ground them and they're not really grounded, they've got a TV and video games. The videos are very graphic and if they kill a character off, they get a new life. I wonder if they somehow think the same. That nothing is final. Like, I'm not really going to die here, it's OK. Is that what my son thought? That he wasn't really going to die?

"Not for one second did I ever think my son would take his life. I find it more difficult now - three months on - than when it first happened. The only thing keeping me going is my wife and my other children. If I knew then what I know now... it may not have saved my boy, but I might have been better placed to help him."

Other parents added their own stories.

"When we went for help it was not there," says one. "We must put pressure on the government to provide more funding and services. If we only get a small piece of the cake in North Belfast, then maybe the cake is too small. We need to make this a priority.

"One thing that annoys me is the terminology used by the public and the press," added another parent. "You don't 'commit' suicide, you commit crimes. I want to see mental illness decriminalised."

One mother spoke chillingly of how being aware of the possible signs of suicide had actually helped her make sense of her own child's distress.

"He came home quietly one afternoon and said 'I'm going upstairs to do my homework'. And I thought, 'that's strange - he never does that'. So I followed him up and found him in his room with a rope."

Although knowing what to look for may have helped this parent, health professionals are quick to point out that warning signs such as some of those mentioned above, or extreme changes in personality, are only indicators of a possible problem.

"I would say that if anybody does spot the signs, they probably do so with hindsight and not at the time," says a West Belfast therapist. "People often say it comes out of the blue because the way a child may be presenting to their parents may not be the way they are presenting to their friends. So the parents may not see anything different, but their friends may see something different, or the school may see something different, or the training centre - somebody... it isn't necessarily the parents.

"Usually people say things like, 'I didn't see any signs' because they are trying to imagine what they might have been able to do to prevent it. It's not guilt. It's their grief and anger, their sense of helplessness. They are trying to make sense out of something that - for them - is totally bewildering. So they may start to say things like, 'if I had only noticed' as a way to trying to find some kind of control over a completely bewildering event."

The impact caused by the loss of so many deeply loved young people in one area, in one small community, cannot be underestimated. Behind the mathematics of devastation are real people in real pain - each with their own individual story - and families, friends, neighbours and communities whose lives have been changed absolutely.

Families of suicide victims say they often feel they have nowhere to turn for support, finding themselves isolated and depressed in their bereavement.

"Schools could be doing a lot more to help," says one parent. "The same goes for social clubs, teen centres and the church. They should be helping to prepare our kids for life, not just telling them to shut up and behave.

"People can sympathise, they can empathise, but they don't recognise," says another mother, whose son took his life after being sexually abused. "They don't recognise that it could be their child. We are losing our children. My child knew he was loved. He knew it to the core of his bones. And he loved himself. But the monster was too great. In the end, he just couldn't fight it."

The Catholic Church's response

The Catholic Church's position on suicide has also had a profound effect on the way the subject is dealt with in Ireland, but there are signs that that too is softening, due to a better understanding of the subject.

Father Gary Donegan, of Holy Cross Church in North Belfast, has been called upon to help those in the midst of a life-threatening crisis on several occasions, and to assist and support families after a suicide has occurred. He says the Church is moving away from regarding suicide as a mortal sin.

"As a priest, you're on a very painful learning curve there," he says, "because it doesn't matter how many times you've been called to a home - even with natural bereavement taking place - it's like the first time."

"But first and foremost - and I'm speaking personally here - I believe that a suicidal person has gone beyond rational thought. Therefore they are not responsible, in that sense, for their actions."

"If anybody is in the hands of God, if anybody is close to God at that particular time - it is that person. And it doesn't matter what walk of life someone may come from, because it can happen to people of any age, any walk of life. It can happen to anyone, at anytime.

"Our role as priests is to literally, at the time, swamp the person with as much love and comfort as possible. Then, if it is possible, to build up some sort of support structure for them, because initially you're going to have a massive outpouring of sadness and all that. But then the next thing is, when the crowds have walked away - how are you going to deal with it?"

It is important that those bereaved by suicide feel able to express the entire range of emotions they will go through, but each individual has to grieve in their own particular way and time. It is a process that cannot be rushed or controlled, unique to each loss and each bereaved person. The best way for people to help, and the most valuable thing one can do, is to let the bereaved know you are available to listen whenever they need to talk.

The impact of conflict

In spite of their strength and resilience, four decades of conflict have left its mark on the people of the Six Counties. People survived torture, intimidation, and violence by remaining silent - saying nothing, showing nothing, hiding their emotions and vulnerability from the enemy that sought to destroy them.

But now it is that silence itself, that inability to allow emotions to flow freely and express them fully, which threatens to inflict the deepest damage. Young men in particular are reluctant to talk about their feelings, and as they are most at risk, there are now several projects in the works to remedy this.

One recent project involved an advertisement and was launched at the Queen's Film Theatre. The advert, entitled "If your head's away, just say" was devised by a focus group of 40 young men from North and West Belfast. The resulting short film was run in both the Yorkgate and Kennedy Centre cinemas for three months during the summer, in an effort to encourage young people to talk to someone about their problems and concerns. The film was also supported by a poster and website campaign, in a further effort to reach young people at risk.

Many young people in crisis say they can't talk to their families because they "don't want to hurt them". Sometimes talking to an outsider is more useful, but it makes a big difference if that person is informed and trained to deal with such a crisis.

Talking is an essential part of the grieving process, but in the aftermath of a suicide, many families - and their friends and neighbours as well - may find this extremely difficult.

The grieving process may not be shared. It may be construed by the family or the public as something that should be done "behind closed doors" and in private. Some people may even feel that public displays of grief are a sign of weakness.

In other situations, people might try to avoid the subject altogether because they are unsure of what to say or how to show their support. This too, can cause the bereaved further pain and isolation. They may feel like they are "marked" and that everyone knows the details of their loss.

In instances of very public suicides, families have not only suffered an immense loss, but have been subjected to local gossip, curiosity and macabre behaviour. In one instance, people had actually gone as far as placing chairs outside their homes so they could watch a body being removed.

Struggle for treatment

Local GPs and even hospitals may also be ill equipped to deal with the rising rate of suicide and depression, leaving families to battle for treatment on their own.

In one recent case, a young man was turned away from the Mater hospital in Belfast three times, after trying to take his own life twice in three hours. His family says they phoned every hospital and statutory body in the phone book trying to get help, before returning to the Mater in desperation.

"Eventually we phoned a friend of the family whose own son had committed suicide several years ago. She told us to go back to the hospital and refuse to leave until he got treatment. She said, 'if you take him home he will be dead in the morning'."

In another case, a woman who had been referred to the Mater had a similar experience.

"I was referred to the Mater, says the woman, "but they wouldn't do anything for me. So my brother took me to Lagan Valley where I sat for hours waiting to see their top psychiatrist, but he wasn't even there. They told me to go home and they would see if they could get me a bed in Derry. In the end, I cut my wrists in the graveyard, sitting on my mother's grave. I woke up in hospital with 14 stitches in each wrist."

"Where are the parenting courses, advice for new or young mothers and fathers?" asks another parent. "Why are those not being taught in schools? How can our children raise healthy kids when they haven't the skills to cope with life themselves?"

For their part, young people say that bullying - whether it be at school, work or home - alongside pressure to use drink or drugs, to get good marks in school, relationship problems and sexual and physical abuse, are just a few of the issues that cause them stress and confusion.

Those involved in anti-social behaviour might also be acting out in an effort to be heard or seen, or reflecting an inner turmoil that they are unable to express. The resulting fallout from their actions often only serves to alienate them further from their community and families, and confirms their negative self-beliefs.

"If a child is involved in anti-social behaviour or the like, there is a tendency to blame the child," says one therapist. "But the child is only reflecting his or her society. There is a desire to 'fix' the child, prevent their behaviour, but one must recognise that they act this way because we don't live in a normal society. It has changed us. Rather than see the truth of that, it is easier to blame the child. There are a million reasons why a child might be acting as they are."

As a result of the rising suicide rate, in May 2003, more than 30 teachers and youth workers from West Belfast took part in workshops to learn how to identify and support young people at risk. The initiative, titled "Suicide intervention skills training" was based on a Canadian programme and there are hopes it could be expanded across the North.

In the same month, a booklet on coping with suicide was written by families affected by the issue and produced by North and West Belfast Health and Social Services Trust. The booklet is available from the Trust on request.

Relatives For Justice have also produced an information pack which includes information on understanding bereavement, dealing with trauma, loss and injury, anxiety, depression, counselling and a list of support services aimed at enhancing recovery and wellbeing.

Meanwhile, the NSPCC says it believes every school pupil should have access to a counsellor and it is calling on schools to implement the change. There are several new websites available which enable young people to ask for help or get answers to questions in a private and confidential manner, in many cases from the security of their own bedrooms.

In July, a special task force was set up by the North Belfast Partnership Board to look into the crisis. The group is planning to do a leaflet drop to homes in the area to raise awareness and tell people how to access the services that are there for them.

Another new initiative, called Pips, is aimed at promoting suicide awareness, and preventing the rise in suicide and self-harm incidents. The cross-community group is made up of parents and community leaders from North and West Belfast and was named in memory of Phil McTaggart's son, whose nickname was Pip.

"We can't hide this subject any longer," said McTaggart recently. "There is an epidemic of young people attempting suicide or harming themselves. This can no longer be brushed under the carpet."

There are other campaigns in the works. As mentioned above, the organisers of the New Lodge Fleadh included an information session and panel discussion on suicide as part of the festival line-up.

"It may not seem like the best time to talk about such a serious matter," said organiser Irene Sherry to the gathered crowd, "but it is public time, and the Féile staff wanted to offer help and support to families as best we could."

Public discussions, raising awareness, removing the stigma, education and funding... Will this be enough to save our children? To save adults in crisis and families with nowhere to turn?

Think about the extent of the problem once again: more people have died by their own hand in the Six Counties than have perished during the last four decades of political struggle.

Failure is not an option.

It is fatal.

Useful contacts

• Lenadoon Counselling Project, Belfast: (02890) 600641
• Community Response, Belfast: (02890) 600641
• New Life Counselling Service, Ardoyne, Belfast (02890) 391630, Email: [email protected]
• Parents Advice Centre, (02890) 238800, Email: [email protected]
• Samaritans: 08457 909090 (email and website also available)
• North and West Belfast Health and Social Services Trust - Main number: (02890) 327156, in North Belfast: (02890) 566000
• Aware Defeat Depression, Derry: (02871) 260602
• Relate/Relate Teen, Belfast: (02890) 323454
• Childline, Freephone: 0800 1111
• Contact Youth, (help for young people aged 11-25): Phone (02890) 457848, email: [email protected], or freephone 0808 808 8000
• Cruse Bereavement Care, Belfast: (02890) 434600
• Citizen's Advice Bureau: (02890) 231120, website: www.citizens.advice.co.uk