Suicide prevention is a social justice issue | Siobhan O'Neill | TEDxOmagh

A lot has happened in Northern Ireland over the past 30 years. As a result of this, Siobhan O'Neill has been doing some truly inspiring work to help break the cycle of suicide and getting people talking about the taboo of mental health.

Siobhan O’Neill is a professor of mental health sciences at the University of Ulster, who specialises in mental health, suicide and health services research. Siobhan is also a Director of the Irish Association of Suicidology and a British Psychological Society, Chartered Health Psychologist. She leads several research programmes examining mental health, trauma and suicidal behaviour in Northern Ireland. She provides talks and training on these topics to a range of groups and has delivered presentations of her research on trauma, mental health and suicide at conferences locally and internationally.

Professor O’Neill has been employed as a researcher and lecturer at Ulster for over 14 years. Her primary degree was in Psychology, with Queen’s University, Belfast and she completed an MSc in Health Psychology at National University of Ireland, Galway, before working as a Public Health Research Officer in the Western Health board in Galway.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

From 2007 to 2012,

it's estimated that 476 men
and 85 women died by suicide in Ireland

as a result of the economic recession
and subsequent austerity measures.

Those figures were put out
in a journal article

in the International
Journal of Epidemiology

in June, this year.

And the findings went largely unreported,

even though that's the equivalent
of 20 or more bombings.

And the reason for that, I believe,

is that we still as a society
have this idea

that somehow suicide is a choice,

it's a decision people make,
it's a rational decision,

or alternatively, that people who die
by suicide are so mentally ill

that there's nothing
we can do to save them.

I believe that that's not the case.

I'm going to show you today
why that's not the case

and what we can do as a society
to drive those suicide rates down.

Epidemiology is a really
powerful research tool.

When we look at the figures,

we look at the population rates
of suicide from year to year,

we can see that social factors
make a massive difference.

Yes, most people who die by suicide
do have a mental illness,

and suicide and mental illness
are very much related,

but the really interesting thing
is that most people with mental illnesses

are not suicidal.

They don't die by suicide.

Suicidal thoughts and ideation
are very common,

but very few people
go on to act on those thoughts,

and social factors
are what makes the difference

between thinking about the purpose
and meaning of your life

and acting on those thoughts.

There's a wealth of evidence showing us

that people who attempt suicide
and think about suicide

don't necessarily actually want to die.

When we analyse the tweets,
the social media posts

of people who are suicidal,
who are thinking about suicide,

the most common word that they use
is not 'death,' it's not 'suicide;'

it's actually 'life.'

And when we do qualitative interviews

and ask people about
their thoughts of suicide,

they tell us about
the characteristics of that life

that they want to get away from.

They tell us about a life
that's characterised

by unending pain.

In fact, 'unbearable, unending pain'
is not adequate to describe it.

It's more like an unending torture.

It's an anguish.

People feel trapped -
there's no alternative.

There's often a lot of
ambivalence around suicide.

Conversations about life and death
aren't really relevant sometimes.

People are just doing something

to address the unbearable pain
that they find themselves in.

Kevin Hines so eloquently
speaks about his thoughts

just after he made a suicide attempt
from the Golden Gate Bridge

in San Francisco.

Very few people survive
suicide attempts from that bridge.

And as Kevin Hines was falling,

he tells us about the thoughts
that were going through his head.

'What have I done?

I don't want to die.

God, please, save me.'

So, suicidal behaviour is a response
to unbearable pain,

to hopelessness for the future,

to feelings of failure and entrapment.

And there's a lot of that
about in Northern Ireland.

In 2008, myself along with colleagues,

Professor Brendon Bunting
and Dr. Sam Murphy,

conducted the Northern Ireland
study of health and stress.

And that was a study
that was conducted in 30 countries,

and we led the Northern Ireland study.

We looked at over 4,000 people,
a representative sample of the population,

and we asked them
about their suicidal thoughts

and their mental health conditions.

In that study, we found

that Northern Ireland ranked
in the top three of all of those countries

for most of the mental health disorders.

So we're right up there.

And for post-traumatic stress disorder,
we topped the table -

we were number one.

Post-traumatic stress disorder

is a really, really interesting
mental health condition.

It's always associated with a trauma,
there's a traumatic event,

and the symptoms of PTSD
are what follows that traumatic event,

if things go wrong
with the memory-encoding processes.

So PTSD is characterised
by nightmares, flashbacks,

like hallucinations,

that bring the person right back
as if they were in that experience.

There's avoidance behaviour ...

There's emotional numbing -

people numb their emotions
to try and manage that ...

And there's hyper-vigilance and arisal.

It's an incredibly debilitating condition.

And we found that
at any one point in time,

around 5% of the population
are suffering from PTSD,

and around 8% of people here have had PTSD
at one stage or other in their lives.

Going back to the Northern Ireland
study of health and stress,

we also asked people
about traumatic events

that they'd experienced,

and we found that 39%,
almost 4 in 10 people here,

had experienced or witnessed
a traumatic event

related to the Northern Ireland troubles.

We're talking here
about shootings, bombings,

seeing somebody dead or seriously injured
or being involved in riots.

That's a hell of a lot of people
in a small population

like Northern Ireland.

When I was growing up,

every evening the news in Northern Ireland
was a litany of deaths,

numbers of people who had been killed
or injured in bombs and shooting.

And Thomas Joiner argues
that when a society like ourselves

has been exposed to that level
of pain and violence,

we become numb, we become anaesthetised,

both literally and metaphorically,

to the effects of pain and violence.

And whenever we ourselves experience pain,

whenever we have existential feelings
when we wonder about our own future,

our automatic response then
is to turn to pain and violence.

It's what we do -

we've practised it.

Delving a little deeper
into that 42% of people

who've been most affected by the troubles,

we find that there's another
subpopulation in Northern Ireland,

and recent work that we've conducted
with the victims commissioner

has shown us that that's about 15%.

And those 15% of the population
have been exposed to multiple traumas,

multiple adversities

and multiple hardships,

and they're really, really, really
at risk of suicide.

When we analyse that group,

we find that they've had hard childhoods,

there's a lot of exposure
to pain and violence,

but they're continuing to be affected
by the economic and social legacy

of the Northern Ireland troubles.

There's lots of deprivation,
there's poverty,

there's low levels
of educational achievement,

high levels of substance use
and medication

for mental health conditions,

and sadly, high risk of suicide.

So we can see how in particular areas
there's a real breeding ground

for suicidal behaviour.

And we have suicide clusters -

we suicidal behaviour
that spreads in particular areas.

The problem is psychological pain,

and our response is violence
because that's what we do here -

we've practised it.

So what can we do about this?

At the minute, the suicide rates
in Northern Ireland are way too high.

We have almost 300 deaths every year.

And when we talk to people
who think about suicide

but don't act on those thoughts,

and ask them, 'What was it
that stopped you

from doing anything about that?'

they tell us that there's
social connectedness,

their relationships with others.

They think about their friends
and their family,

and that's what stops them from acting
on their suicidal thoughts.

We conducted a study a couple of years ago

where we looked at
the Coroner's data on suicides,

looked at those case histories
in over 1,400 suicides,

and the largest category
of life events prior to death by suicide

was interpersonal difficulties
and relationship difficulties.

And there's so much we can do as a society
to increase connectedness

and to help each other find that support

and find a way through emotional problems
and mental health difficulties.

We need to protect the disadvantaged.

We need to look very closely at that 15%

and consider the effects
of the economic recession

and the subsequent austerity measures
here in Northern Ireland

that are being introduced right now,

and how that's going to impact
on the most vulnerable.

Because what we don't want
is in several years

to be having our own
interrupted time series -

statistical analysis -

showing 210 extra deaths
in Northern Ireland,

because that's the equivalent proportion
that we'll be seeing

if we don't do something about this.

It's absolutely staggering to me

that a quarter of gay
and lesbian people in Northern Ireland

have attempted suicide.

That's shocking, and it's wrong.

And there's a very
simple thing that we can do:

we can introduce marriage equality

to send out a very powerful message
to gays and lesbians in Northern Ireland

that they're part of our community,

that they're a welcome
and valued part of society,

that they're absolutely equal.

For me,

the only morally acceptable target
for suicide is zero.

Suicide deaths are preventable,

and we should all be working as a society

to drive those death rates
right down to zero.

And how do we do that?

We provide evidence-based treatments

for trauma-related
mental illnesses specifically

and for mental illnesses in general.

And we also look at inequality
and social justice

until we make sure
that everybody in our society

feels equal, valued and respected.

Thank you.

(Applause)