Programme to reduce suicide, self-harm

  • Deborah Condon

A US expert on suicide and deliberate self-harm has spent the last week training Irish mental health professionals in how to apply an intervention that has been found to significantly reduce the risk of suicide.

Dialectical behaviour therapy (DBT) was created by Dr Marsha Linehan, a psychologist at the University of Washington. Through her work, she found that people who repeatedly self-harm are often affected by borderline personality disorder (BPD).

The main features of BPD are problems with managing emotions, self-harm and suicidal thoughts or actions. Dr Linehan discovered that people with a poor ability to regulate their emotions try to cope in other ways, however these can often add to their underlying distress.

Those affected need to learn that the way they are coping is not effective, but that they can learn new ways to deal with issues in their lives. DBT works by helping those affected to find balance between accepting their problems and changing how they respond to them.

"DBT has varying levels of intensity depending on the person's level of disorder. You must match the intervention to the individual's needs and highly-suicidal individuals need the full standard treatment. For such people, standard DBT cuts suicide in half, cuts emergency department (ED) visits in half and cuts inpatient admission by 73% when compared to other expert non-behavioural treatments," Dr Linehan explained.

Currently, 16 teams throughout Ireland are being trained in how to deliver DBT. The co-ordination of this is being headed up by Daniel Flynn, principal psychology manager of the Cork Mental Health Services.

The first DBT programme run by Mr Flynn was established in 2010, in the North Lee Adult Mental Health Service in Cork. In its first year, 12 people took part and an evaluation of the programme showed a reduction in the incidence of self-harm, a reduction in ED visits and hospital admissions, and a reduction in BPD symptoms and depression.

Furthermore, in the 12 months prior to this programme, the cost of treating affected people in this area was estimated to be almost €145,000. This included 49 ED visits. In the three months after the programme, there were no ED visits and just one hospital admission, which cost around €700.

Based on an evaluation of this programme, the National Office for Suicide Prevention (NOSP) agreed to provide funding to co-ordinate DBT training in this country. This led to the establishment of the National DBT Project Office in Cork last year. Of the 16 teams nationwide being trained by this office, eight have already completed their training. The remaining eight are due to be trained this coming September.

"Having worked with people who self-harm and their families, I know that change is possible and that with good treatment those who want to change can learn skills to cope more effectively," Mr Flynn said.

However, he noted that suicide and self-harm continue to be ‘significant problems' in Ireland.

"Data from the National Suicide Research Foundation's Registry of Deliberate Self-Harm highlights that in 2012 the incidence was 12% higher than in 2007. We buck the international trend with higher incidence of male self-harm. Suicidality and repeated self-harm is one of our main priorities as these individuals account for 8% of all ED self-harm attendances," Mr Flynn explained.

Meanwhile, Dr Linehan said that the Irish mental health professionals she worked with this week ‘are more sophisticated than many of the people I've worked with'.

"I'm most impressed by the professionals' high level of commitment and by the work they have been doing to advance the provision of effective DBT in Ireland," she added.



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