NSRF News Round Up; June to October

Author: Fenella Ryan and Niall McTernan

Welcome to our latest news round-up. Our team have been incredibly busy over the past few months. We include some highlights below.

Journal articles

NSRF researchers have been involved in 14 peer-reviewed journal articles published since June:

1.Preventing Suicide in Health Systems: How Can Implementation Science Help? Archives of Suicide Research. Larkin C, Arensman E, Boudreaux.

2. Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice. Archives of Suicide Research. Benson R, Rigby J, Brunsdon C, Corcoran P, Dodd P, Ryan M, Cassidy E, Lascelles K, De Leo , Crompton D, Kõlves K, Leske S, Dwyer J, Pirkis J, Shave R, Fortune S, Arensman E. 

3. Mental health following an initial period of COVID-19 restrictions: findings from a cross-sectional survey in the Republic of Ireland. HRB Open Res 4:130. Troya MI, Joyce M, Khashan A, Buckley C, Chakraborti K, Hoevel P, Humphries R, Kearney PM, Kiely E, Murphy M, Perry I, Arensman E. 

4. The development and validation of a dashboard prototype for real-time suicide mortality data. Front. Digit. Health 4:909294. Benson R, Brunsdon C, Rigby J, Corcoran P, Ryan M, Cassidy E, Dodd P, Hennebry D, Arensman E.

5. Time of self-harm presentations to hospital emergency departments: a scoping review. Soc Psychiatry Psychiatr Epidemiol. McEvoy D, Clarke M, Joyce M.

6. Dialectical Behavior Therapy for Individuals With Borderline Personality Disorder: A Systematic Review of Outcomes After One Year of Follow-Up. Journal of Personality Disorders, 36:4. Gillespie C, Murphy M, Joyce M.

7. Real-time suicide surveillance supporting policy and practice. Global Mental Health, 1-5. Benson R, Brunsdon C, Rigby J, Corcoran P, Ryan M, Cassidy E, Dodd P, Hennebry D, Arensman, E.

8. Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries. eClinicalMedicine, 51. Pirkis J, Gunnell D, Shin S, Del Pozo-Banos M, Arya V, Aguilar PA et al.

9. Substance use and self-harm presentations during COVID19: evidence from a National Clinical Programme for Self-Harm. Irish Journal of Psychological Medicine, 1-6. Maguire E, Kavalidou K, Bannan N, Doherty AM, Jeffers A.

10. Police-reported suicides during the first 16 months of the COVID-19 pandemic in Ecuador: A time-series analysis of trends and risk factors until June 2021. The Lancet Regional Health – Americas, 14:100324, Gerstner RM, Narvaez F, Leske S, Troya IM, Analuisa-Aguilar P, Spittal MJ, Gunnell D (2022).

11. The role of work in suicidal behavior – uncovering priorities for research and prevention. Scand J Work Environ Health. Greiner BA, Arensman E (2022).

12. Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey. Eur Arch Psychiatry Clin Neurosci 1-15. Hogg B, Moreno-Alcazar A, Toth MD, Serbanescu I, Aust B, Leduc C, Paterson C, Ni Dhalaigh D, Arensman E et al (2022).

13. The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. Br J Psychiatry. Steeg S, John A, Gunnell DJ, Kapur N, Dekel D, Schmidt L, Knipe D, Arensman E, Hawton K, Higgins JPT, Eyles E, Macleod-Hall C, McGuiness LA, Webb RT (2022).

14. Intimate Partner Violence: breaking the silence. The Lancet, vol. 9(7),pp.530-531. Griffin, E and Arensman E

Reports

Ireland’s First National Suicide Bereavement Survey ‘AfterWords – A survey of people bereaved by suicide in Ireland’, a collaboration between the NSRF and HUGG, was launched by Minister Mary Butler on Tuesday 11th October 2022 at an event hosted by the Lord Mayor of Dublin, Caroline Conroy, at the Mansion House, Dublin.

The launch was followed by a key stakeholder workshop, which generated important action points and priority recommendations to inform service development and policy, along with further research in this area.

Report: https://www.nsrf.ie/wp-content/uploads/2022/10/Suicide-Bereavement-Survey-report_digital.pdf

Our 2021 Annual Report was published in September and is a great way to learn more about the work of the NSRF and our activities in 2021.

NSRF-annual-report-2021-digital.pdf

The 2020 Annual Report of the National Self-Harm Registry Ireland was published on November 9th, in addition to a data briefing covering the period January-June 2021, utilising data from a sample of 22 hospitals.

2020 report – https://www.nsrf.ie/wp-content/uploads/2022/11/NSRF-National-Self-Harm-Registry-Ireland-annual-report-2020-Final-for-website.pdf

2021 Data Briefing – https://www.nsrf.ie/wp-content/uploads/2022/11/Hospital-presenting-self-harm-during-January-June-2021-data-briefing-November-2022.pdf

Presentations

Disseminating and sharing our research findings is important to us. Team members attended various national and international Conferences and Seminars, delivering informative presentations and connecting with other suicide and self-harm researchers. This included the large European ESSSB19 Conference in Copenhagen in August. All NSRF presentations at ESSSB19 listed below.

Events

Members of the NSRF attended a meeting of the Pan-European Mental Health Coalition in Copenhagen on August 23rd. NSRF areas of expertise in relation to key priority areas within the European Framework for action on Mental Health 2021-2025 were discussed.

On September 15th, we hosted a World Suicide Prevention Day Webinar at which we launched our new HRB Ireland Research Training Programme – MHAINTAIN.

An EAAD-Best training demonstration & the iFightDepression website were also highlighted.

On October 14th, we held a Suicide, Self-Harm and Mental Health virtual Seminar to mark World Mental Health Day.

Congratulations!

Huge congratulations to Ruth Benson, who successfully passed her PhD Viva in October. Ruth’s thesis addressed: Real-time surveillance for evidence-based responses to suicide contagion and clustering, which she conducted in the School of Public Health and the National Suicide Research Foundation.

Congratulations to Dr Caroline Daly for winning the best poster presentation award at the 19th European Symposium on Suicide and Suicidal Behaviour in Copenhagen for her work on ‘Preventing intentional paracetamol overdose in countries with increasing rates and existing sales legislation’

Looking ahead

As we approach the end of the year, our team will be finalising projects and reports and beginning to reflect on 2022 as a whole. For all our latest news and updates, keep an eye on our Twitter, our Publications and Outputs and our Upcoming Events page.

World Suicide Prevention Day 2022

Authors: Margaret Kenneally and Dr Mallorie Leduc

‘Creating Hope Through Action’

The National Suicide Research Foundation and the School of Public Health, UCC hosted two interrelated Webinars yesterday to honour World Suicide Prevention Day 2022. The Webinars offered the opportunity to present the remarkable work that occurs behind the scenes on a daily basis. The organisation of these Webinars has been a rich experience for the team, highlighting the great work and progress made on both the MHAINTAIN and EAAD-Best projects.

The International Association for Suicide Prevention (IASP) created the theme for World Suicide Prevention Day 2022, ‘Creating Hope Through Action’ – an inspiring theme that goes hand-in-hand with both projects discussed during our Webinars.

MHAINTAIN

The first section of the Webinar introduced the new HRB-funded project MHAINTAIN.

MHAINTAIN is a research training network addressing the need for doctoral training and career paths to improve early identification and intervention of self-harm and suicide risk.

The MHAINTAIN research training programme includes four Doctoral Projects, with five PhD Scholars. There were presentations from several members of the MHAINTAIN consortium, which consists of an interdisciplinary team of researchers and health professionals.  The consortium aims to improve capacity building in the assessment of the risk of suicide and self-harm and evidence-based interventions across patient-focused research, health services research, and population health research.

Principal Investigator, Professor Ella Arensman and Co-Lead, Dr. Paul Corcoran introduced the Webinar, welcoming attendees.

“Mhaintain that resilience”

– Prof John Cryan

Professor John Cryan, (Vice President for Research and Innovation, UCC) began the summit, applauding Professor Arensman for her determination in securing the HRB Collaborative Doctoral Award.

An opening address from Professor Vincent Russell (National Clinical Lead, National Clinical Programme for Self-Harm and Suicide Related Ideation) shortly followed. There were presentations from Professor John Browne, Professor Eugene Cassidy, Dr. Olivia O’Leary, Dr. Eve Griffin and Professor Kairi Kolves. 

EAAD-Best

The second portion of the Webinar focused on the EAAD-Best and the Cork Kerry Alliance Against Depression demonstration workshop, entitled, ‘EAAD-Best: Perspectives on Early Identification of Suicide Risk and Prevention’. This topic greatly compliments the IASP’s theme ‘Creating Hope through Action’.

EAAD-Best is a European Union funded project that aims to improve care for patients with depression and to prevent suicidal behaviour in Europe by transferring the community-based 4 level intervention concept and promoting the uptake of the iFightDepression tool.

The event provided a brief background on the overall EAAD-Best project and highlighted ongoing work undertaken in partnership with the Cork Kerry Alliance Against Depression. An interactive demonstration workshop showcased the aspects of the training opportunities that are available for General Practitioners and Mental Health Professionals and community stakeholder groups such as pharmacists, clergy, counsellors and social workers, geriatric care givers, and journalists.

A live demonstration of the iFightDepression website and iFightDepression Tool was provided to highlight their respective features and support systems. There was also an opportunity to express interest and register for upcoming training sessions on depression and suicidality.  

 To learn more…

Recordings of these two webinars will be available soon. For more information or to learn more about EAAD-Best, and upcoming training opportunities, please contact the team at eaadbest@ucc.ie. The MHAINTAIN website is currently under construction and will be launched in Autumn 2022. For more information please contact mhaintain@ucc.ie.  

Screengrab of Webinar attendees 15/09/2022

Blog post: SHOAR: Improving care pathways and understanding of self-harm in older adults

Author: Dr Isabela Troya

SHOAR is a two-year study led by Dr Isabela Troya, funded by a Government of Ireland Fellowship (2022-2024).  SHOAR aims to examine individual and psychosocial determinants of self-harm in older adults to improve risk assessment and management of self-harm in later life.

About the Project- What is SHOAR?

Self-harm, the act of harming oneself, is an increasing societal concern worldwide. Annually in Ireland, more than 400 people die by suicide and a further 12,500 present to hospital following self-harm, of which approximately 15% are older adults (aged >60).

Older adults who self-harm have a high risk of suicide. They have higher levels of suicidal intent compared to any other age group, placing them at higher suicide risk. Older adults who self-harm are 20 times more likely to die from unnatural causes, and 67 times more likely to die by suicide when compared to their peers who have not self-harmed.

Worldwide, the age group that is most likely to die by suicide is represented by older adults, in particular men. In Ireland, there is limited research examining self-harm and suicide in older adults. Specifically, the profile of older adults who self-harm is not well known, or what factors affect older people who self-harm.

To gain a better understanding of self-harm in older adults, and to inform policy, patients, clinicians, and the Irish healthcare system, this study will examine the factors that lead to older adults hurting themselves.

This is a multi-method study, using two large national databases (National Self-Harm Registry Ireland from the National Suicide Research Foundation and The Irish Longitudinal Study of Ageing from Trinity College Dublin) combined with primary research (interviewing health practitioners who support older adults).

Personnel Involved

Dr Isabela Troya is a Government of Ireland Fellow at the School of Public Health, University College Cork and the National Suicide Research Foundation. She leads the two-year study SHOAR, funded by the Irish Research Council.

Previously, Isabela was a Post-Doctoral Researcher on the Health Research Board funded programme led by Prof Ella Arensman ‘Individual and Area Level Determinants of Self-Harm and Suicide in Ireland: Enhancing Prediction, Risk Assessment and Management of Self-Harm by Health Services’. In her 2 years working in the HRB funded project, Isabela managed and co-led the development and implementation of an advanced skills training for health professionals supporting people who self-harm: Self-harm Assessment and Management Programme for General Hospitals (SAMAGH) Training Programme.

Dr Troya trained and qualified as a Clinical Psychologist (2015) at University San Francisco de Quito, Ecuador, and completed an MSc in Global Mental Health (2016) at King’s College London and London School of Hygiene and Tropical Medicine. Her PhD thesis, titled ‘Understanding self-harm behaviour in older adults was awarded PhD prize of the year (2020) by the UK’s Society for Academic Primary Care.

Steering Group

Isabela is supported by an advisory group made up of experts including clinicians, academics, and policy makers. These include:

Prof Ella Arensman, Professor in Public Mental Health UCC & Chief Scientist, NSRF
Dr Robert Briggs, Consultant Geriatrician St James Hospital, TCD
Prof Eugene Cassidy, Consultant Psychiatrist CUH & Clinical Professor, UCC
Dr Paul Corcoran, Head of Research, NSRF
Dr Eve Griffin, HRB EIA Research Fellow, UCC
Sally-Ann Lovejoy, Nurse Clinical Lead Self-Harm Programme, HSE

Dr James O’Mahony, Lecturer, UCC
Dr Faraz Mughal, Academic GP and NIHR Doctoral Fellow, Keele University
Prof Vincent Russell, National Clinical Lead Self-Harm Programme, HSE
Dr Mark Ward, Senior Research Fellow, TILDA, TCD

Recent Publications

Troya, M. I., Spittal, M. J., Pendrous, R., Crowley, G., Gorton, H. C., Russell, K., … & Knipe, D. (2022). Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis. EClinicalMedicine, 47, 101399.

Troya, M.I., Cully, G., Leahy, D., Cassidy, E., Sadath, A., Nicholson, S., . . . Arensman, E. (2021). Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: Mixed-methods study. BJPsych Open, 7(4), E125. doi:10.1192/bjo.2021.962

Troya, M. I., Gerstner, R. M., Narvaez, F., & Arensman, E. (2021). Sociodemographic Analysis of Suicide Rates Among Older Adults Living in Ecuador: 1997–2019. Frontiers in public health, 9.

Cheung, G., Chai, Y., Troya, M. I., & Luo, H. (2020). Predictive factors of nonfatal self-harm among community-dwelling older adults assessed for support services. International Psychogeriatrics, 1-14.

Troya, M.I., Babatunde, O., Polidano, K., Bartlam, B., McCloskey, E., Dikomitis, L., Chew-Graham, C.A. (2019) Self-harm in older adults: a systematic review. British Journal of Psychiatry, 214(4), 186-200. doi:10.1192/bjp.2019.11

Troya, M. I., Chew-Graham, C. A., Babatunde, O., Bartlam, B., Mughal, F., & Dikomitis, L. (2019). Role of primary care in supporting older adults who self-harm: a qualitative study in England. British journal of general practice, 69(688), e740-e751.  

Troya, M. I., Dikomitis, L., Babatunde, O., Bartlam, B., & Chew-Graham, C. A. (2019). Understanding self-harm in older adults: a qualitative study. EClinicalMedicine, 12, 52-61.

Contact

If you would like to contact us about this research, you can contact Dr Isabela Troya at isabela.troya@ucc.ie

The NSRHI and Data Registration Officers

Authors: Fenella Ryan, Dr Mary Joyce and Dr Paul Corcoran

What is the National Self-Harm Registry Ireland?

The National Self-Harm Registry Ireland (NSHRI) is our principal project here at the NSRF. The Registry records hospital-presenting self-harm at Emergency Departments (ED) across Ireland. It was established by us in 2000 at the request of the Department of Health and Children. The Registry is funded by the Health Service Executive’s National Office for Suicide Prevention.

Role of Data Registration Officers

The NSRF employs 16 Data Registration Officers (DROs) who visit their allocated hospitals across Ireland to collect data on self-harm presentations. We collect data in 32 hospitals since obtaining full national coverage of all general and paediatric hospital EDs in 2006.

DROs review hospital data and obtain the necessary information for the minimal dataset we record. Data are pseudonymised by DROs before compiling it for return to our office-based team of researchers.

How Registry data are used

The data returned by DROs are analysed by the office-based research team who seek to identify the extent and nature of hospital-presenting self-harm, with a view to monitoring trends over time and by area. Having comprehensive data on self-harm hospital presentations also allows us to contribute to national policy regarding suicidal behaviour and helps to advance prevention strategies.

Research findings

We publish findings from the NSHRI in regular Briefings and Reports. Registry data is often used as the data source for a wide-range of peer-reviewed journal articles, a recent example being: ‘The impact of guidance on the supply of codeine-containing products on their use in intentional drug overdose’ by NSRF team members Dr Eve Griffin, Dr Paul Corcoran and Dr Caroline Daly alongside collaborators Dr Emma Birchall and Prof Ivan Perry.

Data collection challenges

Our DROs have faced unprecedented challenges in the past 2+ years including the COVID-19 pandemic, which prevented DROs from entering hospitals to collect data, and the HSE Cyberattack in May 2021 which resulted in the loss of some hospital data. Despite these challenges, the Registry team has recently finalised their dataset for 2020, the results of which will be published in an Annual Report in the coming weeks.

Training and support

Earlier this month, we brought our DROs together in-person for the first time in two years. It was wonderful to meet with DROs in-person after multiple online meetings during the pandemic. As well as training updates and support, it also allowed for some well-needed social interaction for both DROs and office-based team members!

International surveillance systems

The success of the Registry in Ireland has led to the use of our Standard Operating Procedure as a template in other countries worldwide. One example of this is the Northern Ireland Registry of Self-Harm, which was established in 2012 with input and support by the NSRF. Other examples include work being undertaken by Prof Ella Arensman and NSRF colleagues with the World Health Organisation to implement similar self-harm surveillance systems in countries including Poland, Ecuador, Kazakhstan, Guyana, Suriname and Trinidad & Tobago.

Upcoming publications

Keep an eye on our Twitter and Publications pages for new research published based on Registry data.

NSRF News Round-Up; March – May

Author: Fenella Ryan

We have been reflecting on some recent highlights for our latest news round-up!

Journal articles

NSRF researchers have been involved in five peer-reviewed journal articles published since March:

Reports

Our report on the Mental Health of Veterinary Professionals in collaboration with The Veterinary Council of Ireland and The National Office for Suicide Prevention was published in April.

Presentations

Prof Arensman presented a Keynote Lecture at the 10th International Association for Suicide Prevention Asia Pacific Conference in Queensland May 3rd – 5th.

Irish Examiner article

An article published in the Irish Examiner on May 5th Concerns about suicide rates among Travellers due to self-harm presentations at A&E was based on research by NSRF team member Dr Katerina Kavalidou.

EAAD-BEST

On March 24th and 25th, the EAAD-BEST Consortium held their second plenary meeting in Barcelona. A key outcome from this meeting was the preparation of a Ukrainian version of the iFightDepression programme, rolled out in April 2022.

On May 6th, the NSRF launched the Cork-Kerry Alliance Against Depression in collaboration with EAAD-BEST.

A virtual Kick-Off Seminar entitled Preventing suicide and self-harm via improving awareness and care for people with depression was held with speakers including:

  • Mental health and healthcare professionals
  • People with lived experience
  • Resource officers for suicide prevention
  • Researchers

C-SSHRI

On March 29th, the C-SSHRI Network (Connecting Suicide and Self-Harm Researchers on the Island of Ireland) held their second meeting. The get-together focused on self-care and included presentations from Professor Ella Arensman (NSRF & UCC) and Susan O’Mahony (UCC).

Congratulations!

Congratulations to two NSRF team members, Mr Pawel Hursztyn and Ms Almas Khan, who recently graduated from the Master’s in Public Health programme in University College Cork.

Pawel’s dissertation was co-supervised by Dr Eve Griffin and Dr Paul Corcoran and focused on ‘Trends of Hospital Presenting Self-Harm in Cork City area and individual level factors’.

Almas’ dissertation examined ‘Sexual health and Physical Disability: A scoping review exploring the services and supports available to the persons with disability in the EEA and United Kingdom’ and was supervised by Dr Martin Davoren.

Looking ahead

The Summer months ahead are already looking busy! Keep an eye on our Twitter, our Publications and Outputs and our Upcoming Events page for news and updates.

Dispose of Unused Medicines Properly (DUMP) Campaign – March 14th to April 22nd

Author: Dr Caroline Daly

The safe disposal of unused or unwanted medications is a means by which pharmacists can restrict access to means of suicidal behaviour. Unused or out-of-date medicines can build up in the home for a variety of reasons. Storing these medications long-term is not safe and can result a variety of adverse outcomes including accidental poisonings, intentional overdose, inappropriate sharing of medicines and environmental damage.

In Ireland the Disposal of Unused Medication Properly (DUMP) campaign has run successfully in regions including Cork and Kerry since 2007.  In 2007 this campaign resulted in the return of 12 tonnes of pharmaceuticals, and the medicines most commonly returned were those most frequently used as means of suicidal behaviour.  

Louise Creed, HSE Pharmacists highlights the importance of the DUMP campaign “We would strongly urge people to take this opportunity to get rid of out of date or unused medicines. Medication can pose a real hazard in the home, particularly to children or other vulnerable people. Clearing out your medicine cabinet is something that should be done on a regular basis. Check all the dates and remove anything that is out of date or no longer required. Medicines have an expiry date for the same reason food does and out of date medicines could do more harm than good.”

From Monday March 14th until Friday April 22nd almost all pharmacies in Cork and Kerry will be taking part in the DUMP campaign. You can return your unused or out-of-date medicines to any Cork and Kerry pharmacy free of charge within these dates.

  • You can find more important information regarding safe storage of medications here
  • For more information on previous DUMP campaigns please visit here

Our work with the World Health Organisation

Author: Niall McTernan

Following our designation as a World Health Organization (WHO) Collaborating Centre for Surveillance and Research in Suicide Prevention in December 2015 and redesignation for a further four years in 2019, the NSRF has been involved in several exciting projects at the request of the WHO.

What is a WHO Collaborating Centre?

The remit of WHO Collaborating centres is to conduct research and evaluation and provide technical guidance to the WHO. The aim is to enhance countries’ capacity to develop and implement national policies and plans in line with the 2013–2020 global mental health action plan and the UN Sustainable Development Goals for 2030. Mental health promotion, prevention, treatment, and recovery services improved through advocacy, better guidance and tools on integrated mental health service are stated WHO outputs.

How does the NSRF assist the WHO?

The NSRF’s agreed work plan comprises four main activities:

  1. Support WHO in having surveillance systems for self-harm and suicide established in countries
  2. Provide technical advice to WHO in support of its work towards the implementation and evaluation of national suicide prevention strategies
  3. Support WHO in providing technical assistance to countries for the development, revision, implementation and evaluation of national suicide prevention strategies
  4. To inform WHO’s activities on suicide prevention and mental health promotion in occupational settings.

Our primary work has been in assisting the development and implementation of multi-centre self-harm surveillance systems in a range of countries across Europe, Central Asia and South America including Poland, Kazakhstan, Ecuador, Guyana, Suriname, Trinidad Tobago and Russia*.

Moreover, in 2019 the NSRF led the development of an E-Learning Programme for countries to use in setting up a public health surveillance system for suicide attempts and self-harm cases presenting to general hospitals.

NSRF researchers, in addition, have supported WHO in providing technical assistance to Palestine, Namibia, Iran and the Republic of Korea in the development and implementation of their national suicide prevention strategies.

NSRF – Centre of Excellence in Suicide Research and Prevention

We are thrilled to be recognised as a centre of excellence in suicide research and prevention and privileged to support the WHO in increasing awareness of the public health significance of suicidal behaviours. It is paramount that the prevention of suicidal behaviours are high priority considerations on the global health agenda and countries are encouraged and supported to develop comprehensive suicide prevention strategies, with the aim of reducing the incidence of self-harm and suicide globally.

Work completed so far

*Work programme concluded in 2021.

NSRF News Round-Up; January – March 2022

On this first, bright and sunny * day of March, we decided to reflect on some achievements since the beginning of the year.

*in Cork at least!

Journal articles

NSRF researchers have been involved in three peer-reviewed journal articles published since January:

Presentations

Prof Ella Arensman presented on ‘Mental Health and the COVID-19 Pandemic’ at the first UCC School of Public Health Seminar of 2022: Presentations – National Suicide Research Foundation (nsrf.ie)

Niall McTernan presented at a HSE Community Healthcare West Workshop on ‘Safe & Sensitive Reporting of Suicide & Promoting Positive Mental Health & Wellbeing on February 1st.

National Suicide Bereavement Survey

This survey, which launched on October 5th 2021, closed for responses in early February 2022. The team are now analysing data and will have initial findings in the next few months.

SAMAGH

A very successful SAMAGH training day took place in Cork on February 27th. The next training will take place in Dublin in April. Our SAMAGH Training Leaflet may be useful to those working in the area of mental health who are interested in improving supports for individuals who self-harm: Leaflet_SAMAGH-Training_-26-01-2022.pdf (nsrf.ie).  

Policy Submission

The NSRF submitted a briefing to the Department of Justice, Review of Alcohol Licensing consultation on January 21st.

Next up

Our researchers continue to work on a wide number of research projects. Keep an eye on our Twitter and our Publications and Outputs for news and updates.

Are tougher regulations on paracetamol availability justified?

Author: Dr Caroline Daly

Content warning: This article contains sensitive material and mention of self-harm methods, which some readers may find distressing. If you need support, please visit Finding Help.

For many of us paracetamol is never far away. It’s in our bags, kitchens, and bathroom cabinets. If and when we want more, we can restock from our nearest corner shop or supermarket. To me, the availability and accessibility of paracetamol warrants questioning and address, and I will explain why.

I’m a Postdoctoral Researcher at the NSRF with a particular interest in preventing intentional drug overdose (IDO). Through the National Self-Harm Registry Ireland we know that paracetamol is the drug most frequently taken in intentional overdose, accounting for approximately 2,300 presentations each year.1 Most people who take paracetamol in overdose are female and under 25 years old.2 Many of these IDOs are clinically serious, and as a result the risk of liver transplant following paracetamol overdose in Ireland is 6-times the European average.3 These physical consequences occur in tandem with social and psychosocial impacts of IDO on individuals and their wider circles. Worryingly paracetamol IDOs by young people are increasing each year.2

Restricting access to means of self-harm and suicide is the single most effective prevention measure, working best when implemented concurrently with multilevel interventions. Statutory legislation in Ireland since 2001 restricts the sale of over-the-counter paracetamol to a maximum pack of 24 tablets in pharmacies and 12 tablets in non-pharmacy outlets, with authorisation for one pack to be sold per transaction. These restrictions have led to a decrease in deaths involving paracetamol and a reduction in the toxicity of IDOs.4-6 However pack size restrictions have not reduced the frequency of paracetamol IDOs, and Ireland still has one of the highest incidences of such in Europe.7 In addition adherence to existing legislation in Ireland is reportedly poor.8,9

So where can we go from here? In recent years two measures have shown promise in reducing or preventing paracetamol IDO. Paracetamol overdose is significantly lower in countries where the sale of paracetamol is restricted to pharmacies only.7 There are costs to implementing such a measure in Ireland, predominantly to those who use paracetamol safely; however, the benefits in terms of potential reductions in self-harm and overuse of paracetamol are likely to be much greater. In Denmark, confining the sale of paracetamol to those aged 18 and over has also led to significant reductions in their overdose.10 It seems inconceivable that paracetamol can be sold to a child without question, considering its potential harms; especially when we have a justifiable stance against the sale of alcohol to this same subgroup.

With each paracetamol IDO recorded, and every individual affected by these acts, I am assured that further regulations are not only justified but essential to addressing IDO and self-harm here in Ireland. In an effort to address these concerns and supported by robust evidence, colleagues and I have set up an interdisciplinary Working Group to review and implement effective interventions to reduce access to paracetamol in Ireland, in collaboration with government, the pharmacy and retail sectors. I hope that in time and with evidenced measures in place, I might report back with positive news about reductions in paracetamol IDOs in Ireland.

If you have been affected by the content of this article, please visit Finding Help.

  1. Joyce M, Daly C, McTernan N, Griffin E, Nicholson S, Arensman E, Williamson E, Corcoran P. (2020) National Self-Harm Registry Ireland Annual Report 2019. Cork: National Suicide Research Foundation.
  2. Daly C, Griffin E, McMahon E, Corcoran P, Webb RT, Ashcroft DM, Arensman E. (2020) Paracetamol-related intentional drug overdose among young people: a national registry study of characteristics, incidence and trends, 2007-2018. Soc Psychiatry Psychiatr Epidemiol. 56(5):773-81.
  3. Tittarelli R, Pellegrini M, Scarpellini MG, Marinelli E, Bruti V, di Luca NM, Busardò FB,  Zaami S. (2017) Hepatotoxicity of paracetamol and related fatalities. Eur Rev Med Pharmacol Sci. 21(1 Suppl):95-101.
  4. Morgan OW, Griffiths C, Majeed A. (2007) Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. PLoS Med. 4(4):e105.
  5. Hawton K, Bergen H, Simkin S, Dodd S, Pocock P, Bernal W, et al. (2013) Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses. BMJ 346:f403.
  6. Hawton K, Simkin S, Deeks J, Cooper J, Johnston A, Waters K, et al. (2004) UK legislation on analgesic packs: before and after study of long-term effect on poisonings. BMJ 329(7474):1076.
  7. Morthorst B, Erlangsen A, Nordentoft M, Hawton K, Groth Hoeberg LC, Dalhoff K. (2018) Availability of Paracetamol Sold Over the Counter in Europe: A Descriptive Cross-Sectional International Survey of Pack Size Restriction. Basic Clin Pharmacol Toxicol 122, 643-649.
  8. Molloy P, Chambers R, Cork T. (2016) How well are national guidelines relating to the general sales of aspirin and paracetamol, adhered to by retail stores: a mystery shopper study. BMJ Open 6(1):e010081.
  9. Ni Mhaolain AM, Davoren M, Kelly BD, Breen E, Casey P. (2009) Paracetamol availability in pharmacy and non-pharmacy outlets in Dublin. Ireland. Ir J Med Sci. 178(1):79–82.
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Looking ahead in 2022

Authors: Fenella Ryan and Niall McTernan

2021 Reflections

The year of 2021 was tough in many ways, particularly for our researchers as individuals. Like many others, our organisation faced numerous challenges throughout the year, but even in the face of these challenges, we are very proud to have achieved so many goals and to have strengthened our commitment to providing high-quality research related to suicide and self-harm in Ireland.

2021 Highlights

In 2021, our staff members co-authored 22 papers published in peer-review journals, including several high-impact journals and papers relating to the mental health impacts of the COVID-19 pandemic. The team presented more than 45 lectures at local, national and international Seminars and Conferences (virtually) and we were represented on more than 40 advisory and steering groups at national and international level. We hosted several (virtual) Workshops, Seminars and training events, as well as launching our new website. We formed new and close working collaborations, and we optimistically look forward to meeting each other over an actual coffee and scone this year!

A busy year ahead!

2022 is set to be a very busy year for us. As well as the continuation of many projects, including the National Self-Harm Registry, the National Suicide Bereavement Survey and MENTUPP, and the expansion of others such as C-SSHRI and our WHO Collaborating Centre work, we look forward to the launch of exciting new projects such as HRB CDA MHAINTAIN and the establishment of our Lived Experience Panel. We will be adding an overview of these new projects very soon, so please check back in!

Get in touch

Whilst we continue to work from home for now, please know our team can be contacted by emailing infonsrf@ucc.ie. Wishing you a very Happy New Year from all at the NSRF!

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