Limerick Suicide Intervention Project - A Pilot Project in Limerick City - Team: Dr Marie Casey (PH), Dr Douglas - LEPH 2019 in Edinburgh.
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Limerick Suicide Intervention Project
A Pilot Project in Limerick City
Team: Dr Marie Casey (PH), Dr Douglas
Hamilton (PH), Analyst Katie Evan (PH) and
Intelligence Analyst Lynda Breen (AGS)
Why study ‘Suicide in Public Places’?
• WHO Mental Health Action Plan (2013 to 2020) Members
International states resolved to implement national strategies for suicide
prevention
National • NOSP: Connecting for Life Strategy
Regional • Connecting for Life Mid West Prevention Plan 2017-2020
Local • Limerick Local Economic and Community Plan (2016 – 2021)
identified “high levels of suicide” as a “community threat”.
So what could be done!!
According to UK figures around 1/3 of all suicides take place outside the home, in
a public location.
Public Health Limerick brought together the key stakeholders to begin consultation
to address the necessary changes.
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What was/is the process?
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About the Dataset
Limitations of the data
• Includes only Suicide and Suicide Attempt (can be viewed
independently or combined) but does not break down to
self harm.
• Only incidents recorded by Gardaí
• Is based on the impression of the Garda member at the
scene and not a medical determination (however all Gardaí since
2014 are ASSIST Accredited in their basic training in Templemore)
Benefits of the data
• Location of incident
• Day and time of incident
• Name, age, gender and home address of the victim
• Method employed (inputted manually based on narrative)
However this is not the usual purpose of recording Pulse data and therefore
it is not 100% consistent with other national databases i.e. boundary lines,
etc.
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What is happening
In the Limerick Division between 2012 and 2018 there have been 991 suicide/suicide attempts recorded by An
Garda Síochána. Of these 21% (208) were completed suicides while 79% (783) were suicide attempts.
200
180
140
160
140
117 116
120
110 102 102
100
96
80
60
40
40
20 28 32 30 33
24 21
0
2012 2013 2014 2015 2016 2017 2018
Suicide Suicide Attempt
Of these 991, 48% occurred within Public Places.
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How is it happening
Unsurprisingly, the MO varied between Private and Public however the largest portion of incidents
were linked to drowning. In fact, all 306 drownings were linked to public places.
Method of Suicide/Suicide Attempt All based on the
initial impression of
Method Private Method Public Gardaí at the scene
Hanging 167 32% Drowning 306 65%
Overdose 166 32% Hanging 67 14%
Knife/Blade/Shard 143 28% Knife/Blade/Shard 29 6%
Other 43 8% Other 70 15%
Moreover, it was found that drowning was responsible for 31% of all suicide/suicide attempts in the
Limerick Division over the 7 year period.
And….. 84% of these drownings occurred in the city, on the periphery of a stretch of water between
Steamboat Quay, Thomand Bridge and Georges Quay (approximately 4.19km in length)
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Where is it happening
The centre of each circle
borders the river. This
peripheral area
12%
represents 84% of all
drownings by
suicides/suicide attempts
in Limerick Division
5% 2012-2018.
As previously stated it
17% 6% covers approximately
4.19km’s in length.
4%
11% NB: This represents 26%
of ALL suicide/suicide
17% attempts 2012 to 2018
(both Private and Public)
11%
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Who is involved in these Drowning attempts
254 persons are linked to the 306 drowning incidents
45% Female,
55% Men 10% of those that attempt suicide by drowning are
successful
94% Irish,
2% British/Polish 18% of those that survive an attempt in the river will
reattempt (often using a different MO)
42% of victims 20 -29 yrs, The 2nd attempt was found the most lethal for 2 reasons
25% 30 to 39 yrs • Most frequent choice of 2nd attempt was hanging
which has a higher success rate
• These are more frequently conducted in private
43% of all drownings places
happen between 10pm
and 3am
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Recap of Main Findings
• A marginal decrease in suicides/suicide attempts from 2012 to 2016. However, similar results have not
been found for 2017 & 2018. Still an issue!
• Public places are responsible for almost half of suicide/suicide attempts (48%)
• The 4.19km stretch of the river in Limerick City is responsible for 26% of all suicide/suicide attempts
• Almost the same amount of women (45%) as men (55%) use the river as their MO
• The river has a 10% fatality rate.
• This 2nd attempt was the most lethal with 66% changing MO (generally to private locations with a more
lethal MO)
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International research has shown that 4 things work
1. Restrict Access (very strong evidence)
• Close all or part of the site
• Install Physical barriers to prevent jumping
• Introduce other deterrents e.g. lighting
v
A pragmatic approach needs to be taken according to what is feasible in each location…
Confidential2. Increase opportunity & capacity for human intervention
• Improve surveillance using CCTV etc.
• Increasing staffing or foot patrols
• Providing suicide awareness/intervention training for staff working at/near the site
• Increasing whole community awareness
3. Increase opportunities for help seeking by the suicidal individual (strong
evidence)
• Providing Samaritans signs and/or free emergency telephones
• Providing a staff sanctuary or signposts to one nearby
4. Change public image of the site; dispel its reputation as a ‘suicide site’
• Ensuring media reporting of suicidal acts are in line with national guidelines
• Discouraging personal memorials and floral tributes at the site
• Introducing new amenities/activities, renaming and re-marketing location
ConfidentialWhat we need to do?
Environmentally design the issue away
from the river based on the needs of each 1. Ensure a crisis nurse is
location available at all times to
Developing policies
Gardaí with a compliant
1. Scoping study to identify what could be and practices to
Better protect the sufficiently support victim who is willing to
done in the 8 different locations 10% who engage and attend hospital
• Put structural deterrents in a those likely to
are successful attempt again
persons way (barriers, partitions, 2. Ensure all support
net), Focus on the area
services/structures are
• Improve lighting in key locations which has resulted in relayed to the victim
• Appropriate signage in key the most
locations suicide/suicide Get publicans 3. In the case of non
• Use existing IT functionality from attempts together compliant victims a process
Community Cameras i.e. the ‘line should be created whereby
crossing’ on cameras adjacent to The River a follow up is contact is
the river to speed up response Identify specific
made if/where possible (by
times service providers in either AGS or HSE)
Portfolio of the Local Authority need of ASSIST Complete the toolkit
training and analyse national Joint Portfolio of AGS and
1. Streamline the communication between PH/HSE
emergency services. Have all emergency data to support other
service providers working off one Evaluate 12 months communities
channel. after alterations
have been
Engage with both implemented Conduct review analysis once
2. Joint training exercises to streamline
Suicide Watch alterations, policies or practices are
provider responsibility.
groups fully implemented to identify if they
have had a positive impact on
- Portfolio of Emergency Service Providers
behaviour
(Coast guard, Fire Service, Marine Search
and Rescue, Civil Defence, Water Safety
Portfolio of An Garda Síochána
Ireland, Harbour Master, An Garda Síochána Confidential Analysis Service‘Not to Act, is to Act’
Francis W. McPeek
…..lets choose to make a difference
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