Limerick Suicide Intervention ProjectA 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’?

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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International• WHO Mental Health Action Plan (2013 to 2020) Members

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

• Limerick Local Economic and Community Plan (2016 – 2021) identified “high levels of suicide” as a “community threat”.

Local

What was/is the process?

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About the DatasetLimitations 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

Of these 991, 48% occurred within Public Places.

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.

4028 32

24 2130 33

140

110 102117

96

116102

0

20

40

60

80

100

120

140

160

180

200

2012 2013 2014 2015 2016 2017 2018

Suicide Suicide Attempt

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How is it happeningUnsurprisingly, 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.

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)

Method Method

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%

Method of Suicide/Suicide Attempt

Private Public

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All based on the initial impression of Gardaí at the scene

Where is it happening

The centre of each circle borders the river. This peripheral area represents 84% of all drownings by suicides/suicide attempts in Limerick Division 2012-2018.As previously stated it covers approximately 4.19km’s in length.

NB: This represents 26% of ALL suicide/suicide attempts 2012 to 2018 (both Private and Public)

4%

17%

11%

5%

12%

17%

11%

6%

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Who is involved in these Drowning attempts

45% Female,

55% Men

42% of victims 20 -29 yrs,

25% 30 to 39 yrs

254 persons are linked to the 306 drowning incidents

94% Irish, 2% British/Polish

43% of all drownings happen between 10pm

and 3am

10% of those that attempt suicide by drowning are successful

18% of those that survive an attempt in the river will reattempt (often using a different MO)

The 2nd attempt was found the most lethal for 2 reasons• Most frequent choice of 2nd attempt was hanging

which has a higher success rate• These are more frequently conducted in private

places

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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

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v

A pragmatic approach needs to be taken according to what is feasible in each location…

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2. 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

What we need to do?Environmentally design the issue away

from the river based on the needs of each location

1. Scoping study to identify what could be done in the 8 different locations

• Put structural deterrents in a persons way (barriers, partitions, net),

• Improve lighting in key locations• Appropriate signage in key

locations• Use existing IT functionality from

Community Cameras i.e. the ‘line crossing’ on cameras adjacent to the river to speed up response times

Portfolio of the Local Authority

1. Streamline the communication between emergency services. Have all emergency service providers working off one channel.

2. Joint training exercises to streamline provider responsibility.

- Portfolio of Emergency Service Providers (Coast guard, Fire Service, Marine Search and Rescue, Civil Defence, Water Safety Ireland, Harbour Master, An Garda Síochána

1. Ensure a crisis nurse is available at all times to Gardaí with a compliant victim who is willing to attend hospital

2. Ensure all support services/structures are relayed to the victim

3. In the case of non compliant victims a process should be created whereby a follow up is contact is made if/where possible (by either AGS or HSE)

Joint Portfolio of AGS and PH/HSE

Conduct review analysis once alterations, policies or practices are fully implemented to identify if they

have had a positive impact on behaviour

Portfolio of An Garda Síochána Analysis ServiceConfidential

Get publicans together

Focus on the area which has resulted in

the most suicide/suicide

attempts

The River

Developing policies and practices to

sufficiently support those likely to attempt again

Evaluate 12 months after alterations

have been implemented

Better protect the 10% who engage and

are successful

Identify specific service providers in

need of ASSIST training

Engage with both Suicide Watch

groups

Complete the toolkit and analyse national data to support other

communities

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‘Not to Act, is to Act’Francis W. McPeek

…..lets choose to make a difference