ON SUNDAY, INDEPENDENT TD Michael McNamara made a claim regarding the measurement of self-harm and suicide statistics in Ireland during the pandemic.
Speaking on RTÉ radio, the TD said that “we have stopped measuring suicide and self-harm in this country”.
McNamara made the claim while questioning whether the National Public Health Emergency Team (NPHET) takes mental health statistics into consideration when making recommendations to government about Covid-19 restrictions.
The claim is, as confirmed by a HSE body, inaccurate.
His statements were part of a wider conversation about how these statistics are used.
The impacts of the pandemic on mental health over the past few months and into the future have been flagged by experts in the field.
The Psychological Society of Ireland warned in August that the impacts are likely to be with us for a “long period of time”, causing long-term mental health issues in society.
With that in mind, let’s go through this piece by piece.
Speaking on the Brendan O’Connor show on RTÉ Radio One last Sunday morning, McNamara was addressing another panellist Dr Gabrielle Colleran, the vice-president of the Irish Hospital Consultants Association.
Colleran said the public health physicians sitting on NPHET considered the impacts on mental health alongside other factors when deciding on recommending restrictions to government.
In response, McNamara said: ”We have stopped measuring suicide and self-harm in this country. How on earth can you take account of it if we’ve even stopped measuring it?”
Colleran questioned McNamara on this, saying: “Where’s your evidence for that? You’re just making a random statement.”
McNamara responded: “I’m not. The self-harm registry, it has been covered at length in the media, we have stopped measuring self-harm in Ireland. We stopped collating that data at the time of the first lockdown… It was covered at length in the Irish Times which is a reasonably reputable outlet.”
McNamara furthered his point on Twitter after the radio show with a link to a piece published in the Irish Times on 9 June.
This piece states: “Data collection on suicides by Irish hospitals were suspended as a result of the lockdown, meaning there are no current figures on suicide and self-harm rates, according to the National Self-Harm Registry.”
Although this was true as of 9 June for self-harm figures from the National Suicide Research Foundation (NSRF) registry, this has not been the case since July and was not the case when McNamara made the claim.
Further, the HSE continued to collect the figures through a different system - and has continued to do so – even when the registry was suspended.
Although the recording and collating of self-harm statistics presenting to emergency departments was largely suspended in the national registry between March and July, hospitals continued to record when patients presented for treatment of self-harm, the HSE’s national clinical programme continued to collect the information, and other HSE services were able to access and use this data.
The NSRF resumed gathering the data for the national self-harm registry around four months ago and has continued to gather and backtrack for the months prior ever since.
The HSE National Clinical Programme for the Assessment and Management of Patients presenting to emergency departments following self-harm tweeted on Sunday to say McNamara’s statement about self-harm statistics gathered during lockdown was untrue.
This programme is a joint initiative between the HSE and the College of Psychiatrists of Ireland.
The National Clinical Lead for the programme, Anne Jeffers, said figures related to self-harm are “measured in a number of ways”.
There is the national self-harm registry provided by the National Suicide Research Foundation (NSRF), which is covered further on in this piece; and there is the HSE’s national clinical programme, which also gathers data on presentation for self-harm and suicidal ideations in emergency departments.
This HSE programme was not put on pause or ceased during the lockdown period as the information is gathered by clinical nurse specialists in mental health, who were able to continue working in emergency departments.
This was different for data registration officers at the NRSF who were largely unable to gather data during the lockdown as they were not considered to be essential workers in emergency departments.
Jeffers said the HSE programme’s work is similar to the National Suicide Research Foundation and the two bodies work closely together, as they are collecting the same information – but for different reasons.
The national clinical programme is aiming to “improve the standard of care” whereas the NSRF’s registry is solely for “collecting the data”.
The HSE programme’s data is published in a HSE Mental Health Service Report, the latest of which was published in June this year containing 2019 data.
This report is described as a “very valuable tool” in allocating resources to the mental health areas in greatest need.
The NSRF, on the other hand, goes into much greater detail in its annual report on self-harm statistics, providing more in-depth analysis than the HSE overarching report on mental health services.
Jeffers said she had “concerns” hearing McNamara’s comments on Sunday as she knew “the clinical nurse specialists have continued to work and continued to provide a service” in collecting data on self-harm presentations to emergency departments during the lockdown.
The registry
The National Suicide Research Foundation (which is funded in part by the HSE) operates the National Self-Harm Registry Ireland National Self-Harm Registry Ireland (NSHRI).
The NSRF collects and publishes data relating to people presenting for self-harm to all general hospital and paediatric emergency departments in the country.
The organisation’s data registration officers who gather this information in emergency departments were not permitted to work in hospitals between the end of March and 29 June.
Therefore, they were not able to gather the same data they could during normal periods of time.
“Once the restrictions were eased, our staff began to return to work in [all] the hospitals and we are now operating as we were before Covid-19,” he said.
When they were able to return to emergency departments, the data registration officers were able to trawl through the months of previous records from hospital emergency departments to retrieve the information.
Hospitals always recorded when people attended for self-harm treatment, so these figures were able to be recorded and used in the registry.
In terms of whether there is any real difference between the ‘collection’ of data, the term used in the Irish Times report relied on by McNamara, and the ‘collation’ or ‘measurement’ of data, Corcoran said there isn’t a huge difference in these processes.
Although data collection work was suspended for the NSRF in emergency departments during the lockdown period, four hospitals continued to submit information electronically to the organisation.
This was analysed by NSRF workers who retrieved further details on each case involving self-harm.
NPHET has said that it takes mental health considerations into account when making decisions on advice for government.
Dr Corcoran said the Department of Health and the HSE have requested self-harm data from the organisation a few times in recent months.
Earlier this week, Corcoran added that the Department of Health asked the HSE to provide the Chief Medical Officer Dr Tony Holohan with a briefing on suicide and self-harm.
The HSE then requested this data from the NSRF.
More information on self-harm during this period
As well as the two methods mentioned here which have a record of self-harm figures throughout the period, there is some information available from other sources which shows how hospitals were keeping track of, and in some cases analysing, the figures.
A study was published last month in the Irish Journal of Psychological Medicine about emergency presentations to University Hospital Galway (UHG) between 1 March and 31 May this year.
The study found that the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May.
This comparison is based on data from the same weeks and months in three previous years – 2017, 2018 and 2019.
This study said it is likely that more economic instability would “further impact the mental health of the population, along with rates of self-harm and suicidal behaviours”.
The information for this study came from the liaison psychiatry team at UHG which maintains a database of all patients referred for assessment by the service.
This is another way self-harm data is collected within hospitals in Ireland.
NPHET
When asked at a NPHET press briefing on Tuesday by TheJournal.ie whether mental health impacts were considered in decision-making, the Chief Medical Officer Dr Tony Holohan said NPHET looks at “all the health impacts” when considering its recommendations to government.
“We’re conscious of all of those so when we talk in terms of seeking as one of our key objectives… The first thing is to protect public health in its broadest sense from this preventable infectious disease,” he said.
He said NPHET also looks at protecting education and childcare, and the continued provision of health services across the board.
“A whole range of health services that are provided that the HSE has re-established that had to be curtailed, and were curtailed by people not attending through fear in the early part of the year, have all been recommenced.”
In response to the same question, consultant psychiatrist and HSE integrated care lead Dr Siobhán Ni Bhriain said the mental health impacts of the pandemic are “affecting different age groups differently”.
“So, older people are more likely to suffer from anxiety and loneliness, younger people are more likely to suffer from suicidal ideation or thoughts of self harm,” she said.
That’s not translating at the moment into actual suicide numbers but we’re very conscious of that and we’re very aware of it, and our mental health services are building up responses to that as well.
TheJournal.ie also contacted the Department of Health to query if and how NPHET took mental health issues into consideration when making recommendations but did not receive an answer to our questions.
Suicide statistics
McNamara had also said that “we have stopped measuring suicide” in Ireland.
Information on deaths by suicide is published by the Central Statistics Office (CSO). There was no interruption or change to this system during the pandemic.
It takes up to two years for a death by suicide to be registered with the CSO.
All unnatural deaths, which includes those by suicide, must be referred to the coroner’s office for further investigation. As a result, the CSO said these deaths “tend to be registered late [compared to other deaths] as a consequence”.
They are late for a lot of reasons including the holding of inquests, garda investigations etc. Coroners were not sitting at inquests for a few months at the beginning of the pandemic.
“Furthermore, most deaths occur in areas with a higher population of persons and hence there is a larger workload for Dublin based Coroners,” the CSO said in a statement.
The decision as to whether a person has died by suicide is a legal decision made by a coroner, not a medical decision made by doctors or the HSE.
The number of people who die by suicide in Ireland is recorded annually and the CSO released provisional figures for 2019 in May this year. The most recent final statistics available online are for 2017.
Response
Responding in a statement for this FactFind, McNamara said: “If data on self harm during the lockdown has not been collated (and cannot be fully collated due to the lack of data from some hospitals), how can the harm posed by lockdowns be considered by public health advisors?”
McNamara also said in response that the “collection and collation” of data relating to suicide in Ireland also ceased during the lockdown period.
The TD has submitted a Parliamentary Question to the Minister for Health relating to this issue.
He has asked Stephen Donnelly if staff involved in the national self-harm registry “will be classified as essential workers in this lockdown, which they were not during the last, resulting in the inability to collect collate data to date pertaining to the last lockdown”.
McNamara also asked if the “collection, collation and dissemination” of data pertaining to suicide during the last lockdown and the period of the current lockdown will be prioritised.
He has also asked if the Department of Health has data on suicides pertaining to the last lockdown at its disposal and if the minister “will share any such data; and if he will make a statement on the matter”.
Although the collection and collation of data by the NSRF relating to self-harm presentations in emergency departments was impacted by the lockdown period in Ireland for the national registry, this information was gathered in the same way as normal by a HSE programme.
Emergency departments also continued to record this data.
Similarly, data on suicides published by the CSO is a process which takes up to two years after the death has occurred. There was already a delay on the publication of this data prior to the pandemic, unrelated to Covid-19.
McNamara was incorrect to say, on 18 October 2020, that the country has stopped measuring suicide and self-harm statistics in Ireland.
While one measurement for self-harm was suspended for just over three months, this has been reinstated since July.
Since lockdown began in March, the HSE and individual hospitals have continued to collect data on self-harm presentations to emergency departments across the country, and the data collected, collated and measured between March and May 2020 in one such hospital was the subject of a detailed analysis published by the Irish Journal of Psychological Medicine last month.
NPHET has said that it takes mental health considerations into account when making decisions on advice for government.
Dr Corcoran from the NSRF said the Department of Health and the HSE have requested self-harm data from the organisation a few times in recent months and that the DoH asked for figures to provide the CMO with a briefing on suicide and self-harm earlier this week.
Further, on the issue of measuring deaths by suicide, there is always a delay in the publication of figures relating to deaths by suicide as it is a lengthy determination process, but the measurement of the figures never stopped.
Edited by Christine Bohan
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