What is the Suicide Support and Information Study (SSIS)?
The SSIS is an innovative pilot study that was developed to provide access to support for the bereaved, while at the same time, obtaining information on risk factors associated with suicide and deaths classified as open verdicts.
What are the aims of the SSIS?
- To improve provision of support to the bereaved.
- To identify and better understand the causes of suicide
- To identify and improve the response to clusters of suicide and extended suicide e.g. (filicide-suicide and familicide)
- To better define the incidence and pattern of suicide in Ireland
- To identify individuals who present for medical treatment due to deliberate self harm and who subsequently die by suicide
How is the SSIS structured?
The SSIS operates according to a stepped approach:
Step 1: Pro-actively offering support to family members bereaved by suicide
Step 2: Obtaining information from sources and individuals who had been in contact with the deceased in the year prior to death, including close family members, health care professionals and also information from coroners’ records.
Where was the SSIS carried out?
In 2008, The National Office for Suicide Prevention (NOSP) commissioned the National Suicide Research Foundation to establish a National Suicide Support and Information System (SSIS) to be initially piloted in the Cork region.
The SSIS pilot study was conducted in County Cork over the period September 2008 – March 2011.
How many cases of suicides were included in the SSIS?
178 cases of suicide and 12 open verdicts (total 190) were ascertained in the Cork region during the pilot phase of the SSIS.
What are the outcomes of the SSIS so far?
- In 39.5% of cases, the SSIS pro-actively facilitated bereavement and other support.
- In 47.5% of cases, bereavement support had been obtained prior to contact with the SSIS team.
- In 8.2% of cases, the bereaved did not wish to avail of formal bereavement support from a specific service, but they welcomed further contact with a member of the SSIS team.
- A small proportion (4.8%) did not wish to receive further contact following the initial letter from the SSIS team.
Mental health risk factors associated with suicide including:
- Mood disorder of the deceased
- Mental disorder of family members
- History of deliberate self-harm
- Lifetime alcohol abuse in the year prior to death
Major precipitating factors in the month prior to suicide including:
- Significant losses
- Significant (or perceived significant disruption) of a primary relationship
- Significant life changes
Evidence was found for the impact of the economic recession in terms of job loss, increased suicide risk associated with specific occupations, financial problems and loss of possessions, such as house, car etc…
Evidence was found for long term adversity in the lives of people who died by suicide, often starting in childhood or early adolescence and continuing in later life, such as:
- Mental and physical maltreatment
- Problems in making contact with others
- Loneliness over a long period of time
The majority of the deceased had been in contact with their GP or a mental health service in the year prior to death, and those who had contacted their GP had done so 4 times or more.
- The SSIS has been able to use official data sooner than the Central Statistics Office (CSO), which has facilitated the identification of emerging suicide clusters.
- Through the multiple sources of information accessed by the SSIS, contagion effects could be identified and direct/indirect relationships among the suicide cluster cases could be established.
Though the number of open verdicts was relatively small, comparison with confirmed suicide cases revealed more similarities than differences, such as:
- Alcohol consumption at time of death
- History of Deliberate Self Harm
- High prevalence of mood disorders
- Use of psychotropic medication
Examination of suicides and deaths classified as open verdicts showed that at least 10% of cases had been medically treated for deliberate self harm in the Cork region (between 2007-2009).
Has the SSIS been Evaluated?
In September 2010 an independent evaluation of the SSIS was conducted by the University of Manchester. The evaluation recommended:
- That the SSIS is an innovative and valuable system that contributes to improved prediction of suicide risk and improved support for families bereaved by suicide
- Maintaining the Suicide Support and Information System in County Cork and expanding to County Limerick.
- That the NSRF has a history of successful regional and national roll-out of research programmes. For example, the National Self-Harm Registry Ireland is based at the NSRF and would serve as a model for the regional roll-out of the SSIS. The NSRF has the infrastructure to continue to host the SSIS, and to co-ordinate and run a national roll-out of the SSIS.
The SSIS Team
Professor Ella Arensman, Dr Carmel McAuliffe, Dr Paul Corcoran, Ms Eileen Williamson, Mr Eoin O’Shea, Ms Sara Kelly, Professor Ivan J Perry.
For further information, please contact Professor Ella Arensman, Director of Research National Suicide Research Foundation, Western Gateway Building, Room 4.28, University College Cork, Ireland.
Tel: +353 (0)21 420 5551