‘There are political, moral and ethical imperatives’

Ian Florance interviews Siobhan O’Neill, around her policy work on suicide and self-harm.

When I spoke to Siobhan O’Neill, she was working on a British Psychological Society briefing paper/position statement on suicide and self-harm. This sort of publication raises a number of questions including how they come about and their authors’ motivations in getting involved.

‘A group of us are looking at what we know about suicide and self-harm, evidence about the efficacy of different interventions and, based on this, what future directions we’d recommend.’ This is a particularly timely project for Siobhan, who is Professor of Mental Health Sciences at Ulster University. ‘Suicide rates are high in Northern Ireland; and they are rising when rates are declining in the rest of the UK. That we’re in a post-conflict situation is probably one of the causes. Twenty years ago the focus of suicide studies was young people, but rates are the same across the 20–60 age groups, and suicidal behaviour in those older age groups is an important area for us to understand.’

It was clear from Siobhan’s passion and animation that this is more than a purely intellectual or research interest for her. ‘You cannot study a subject like suicide and not think about practical implications. We need psychological models to underpin more accurate ways of talking about, understanding and addressing suicidal behaviour. Without these, critical questions such as those around assisted suicide, the responsibilities of the media in reporting the issue and the impact of therapeutic interventions for depression on suicide will be difficult to answer. Obviously, many professions and people have interesting perspectives on the issue – but psychologists have a genuinely unique contribution to make.’

I asked Siobhan to expand on how psychology could affect society on this critical issue in such a direct way. ‘We can contribute to policy and research – we have very specific tools in cognitive psychology to help understand the vital issue of how thought turns into action. We can work at the points of interaction of thoughts/action/death so we can affect policy as well as clinical practice. Connectedness is an important predictor of suicidal behaviour – here social psychology can inform social policy to help us reduce suicide rates in marginalised groups. In Northern Ireland it is vital to examine how behaviours are passed from one generation to the next. Mental illness, substance abuse and suicidal behaviour are being passed from people with direct experience of the Troubles to their offspring. Attachment and parenting behaviours are important here, as well as the provision of mental health services for those directly affected.

‘We also have a role in affecting how suicide is talked about, described, dramatised. Speculation and sensationalism do not help understanding, damaging those undergoing serious problems and the families of those who have died by suicide or have attempted suicide. This latter point is critical, since the families of people who die by suicide are at high risk. We need to normalise suicidal thoughts – many of us have them at some time or another – and emphasise the fact that most people recover, survive and flourish.’

Siobhan is clear that suicide is a behaviour. ‘It’s obviously associated with mental illness, but is not itself one – and for me as someone who trained as a health psychologist this is central to my understanding – seeing suicide as a behaviour means that we look at aspects such as the impact of substances on impulsivity and access to means of death including information about methods. How does media reporting influence the behaviour of vulnerable people? We must not shy away from public debate or from challenging the media about the language they use and the impact of perpetuating unhelpful myths. How we communicate the findings via lobbying, public relations and media work is part of the job – and a part I enjoy.

‘There are political, moral and ethical imperatives to what we do. We have responsibilities, and one of those is to change society for the better. I refuse to accept that suicide is an inevitable or acceptable outcome in any society – for example there should be outrage that the recession in Ireland has been implicated in more than extra 500 suicides [see NSRF study at tinyurl.com/noadlbr]. Raising awareness of suicide won’t prevent it – if done badly we know this awareness-raising might even cause acts of self-harm. Many interventions in this area are counter-intuitive. For instance you can’t just import contracts into suicide prevention – they work in other areas but not here. Talking about a topic isn’t enough. Predictive models are not always helpful in preventing deaths, and qualitative methods can be particularly enlightening in understanding this behaviour. There is so much to learn.’

Siobhan is very busy working with organisations looking at specific issues in groups such as Irish travellers and LGBT. She came to psychology after ‘almost studying art – and art and music are still fundamental to my life, but I finally studied psychology and then did a master’s in health psychology. I considered clinical psychology, but there’s a real difference between treating mental illness and understanding why people behave the way they do – and that’s what I was interested in.

‘This work is one of the things that gives my life meaning and purpose. I’ve had depression myself, and I think it’s important that we as professionals feel able to disclose our issues and are authentic in our advocacy of patients. Through this research I am learning all the time and hopefully improving my understanding of why people want to take their own lives. They talk about burdensomeness – the sense that they’re a burden to others and about killing themselves as being somehow a mercy killing, an end to unbearable pain. Until we take these existential understandings seriously we won’t understand suicide and be able to make the unique contribution I am sure psychology can make to this area.’

I thank Siobhan for the honesty and passion she showed in this interview. Read more about suicide in our archives.

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