Towards an understanding of bereavement in the pathway to suicide

Abstract Key Points 1. Suicide bereavement is associated with increased depression and risk of suicide. The increasing rate of suicide in Northern Ireland presents a major challenge to health and social care policy. 2. To date policy development on the topic has been hampered by a lack of local evidence. Contextually specific research reports are now emerging to strengthen the evidence-base. 3. The findings from our own study suggest that people bereaved by suicide include extended family members and members of the wider community, who can experience lengthy periods of depression and anxiety. 4. Bereaved family members and significant others, may require more nuanced, multi-dimensional interventions, provided over extended periods of time, in order to facilitate varied and complex grief processes. 5. A focus on empowerment, education and information may provide results that are as effective as increasing access to psychological services – these approaches should exist in tande

Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians

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Suicide in post agreement Northern Ireland: A Study of the Role of Paramilitary Intimidation 2007-2009

Since the end of the ‘Troubles’ in Northern Ireland, there has been a rise in the number of acts of intimidation and Paramilitary Punishment Attacks (PPA). Anecdotally, some suicides have been linked to such incidents. To date, there has been a lack of research examining this association. This article details a case series study exploring how individual deaths by suicide in Northern Ireland were connected to intimidation. Data from Coroners, GP records and interviews with family members were examined to identify experiences of intimidation among a two-year cohort who died by suicide. Further case based analysis was conducted using a modified version of the psychological autopsy method. Our results indicate that in 19 male suicides there were incidents of intimidation in the twelve months prior to death. The suicides of these men are discussed in relation to the suicide model of entrapment. Our findings highlight the continuing problem of intimidation in Northern Ireland and suggest further research into the connection between these incidents and suicide is warranted

Providing Optimal Palliative Care for Persons Living with Dementia: A Comparison of Physician Perceptions in the Netherlands and the United Kingdom

BACKGROUND: The European Association for Palliative Care (EAPC) recently issued a framework that defines optimal palliative care in dementia. However, implementation of the guidelines may pose challenges for physicians working with dementia patients in practice. OBJECTIVE: To measure and compare the perceptions of physicians in two European regions regarding the importance and challenges of implementing recommendations for optimal palliative care in dementia patients. DESIGN: Cross-sectional observational study. SETTING: The Netherlands and the United Kingdom. SUBJECTS: Physicians (n = 317) providing palliative care to patients with dementia. MEASUREMENTS: Postal survey. RESULTS: Physicians in the Netherlands and Northern Ireland (NI), United Kingdom, prioritized the same domains of optimal palliative care for dementia and these match the priorities in the EAPC-endorsed guidelines. Respondents in both countries rated lack of education of professional teams and lack of awareness of the general public among the most important barriers to providing palliative care in dementia. NI respondents also identified access to specialist support as a barrier. The results indicate that there is a strong consensus among experts, elderly care physicians, and general practitioners across a variety of settings in Europe that person-centered care involving optimal communication and shared decision making is the top priority for delivering optimal palliative care in dementia. CONCLUSIONS: The current findings both support and enhance the new recommendations ratified by the EAPC. To take forward the implementation of EAPC guidelines for palliative care for dementia, it will be necessary to assess the challenges more thoroughly at a country-specific level and to design and test interventions that may include systemic changes to help physicians overcome such challenges

Spying and Surveillance in Shakespeare’s Dramatic Courts

This thesis examines representations of spying and surveillance in Shakespearean drama in conjunction with historical practices of espionage in later sixteenth-century England. The introductory chapter outlines how spying operations were conducted in Elizabethan England, with specific attention to the complex attitudes and behaviour of individual agents working in the broader context of the religious wars, both hot and cold, taking place between Protestant England and the Catholic powers of continental Europe. It also provides some analysis of the organisational structures within which those agents worked and examines a wide range of particular cases to illustrate how surveillance operations might play out in practice. The memory of Sir Francis Walsingham, often described as the ‘spymaster’ of Elizabeth’s government and noted for his skill in intelligence work, would have loomed large for any dramatist thinking about espionage at the turn of the seventeenth century. Subsequent chapters each examine a specific play in light of the material presented in the introduction, comprising Much Ado About Nothing, The Tempest, Measure for Measure, Henry V and Hamlet. Each chapter seeks to elucidate how Shakespeare draws upon the world of Elizabethan espionage to provide vital structural components in his dramatic plotting, especially as regards inter-personal relationships between courtiers, secretaries and agents on the ground. Real individuals and the spies depicted in Shakespeare’s plays all behave in a manner that is personally inflected to a profound degree, and it is this particular aspect of early-modern espionage that provides the single most important connection between history and drama. Periodically, this thesis also reflects upon the metatheatrical relationship between characters’ schemes and Shakespeare’s own plotting as a dramatist

When health services are powerless to prevent suicide: results from a linkage study of suicide among men with no service contact in the year prior to death

Aims: To investigate cases of suicide in which there was no healthcare contact, by looking at history of help-seeking and evidence of previous mental health vulnerability. To identify any life events associated with suicide for which individuals did not seek help. Background: Previous research has suggested that non-consultation is the main barrier to suicide prevention among men. Estimates suggest approximately 22% of men who die by suicide have not consulted their GP in the year before their death. Little is known about the lifetime pattern of engagement with services among these individuals and whether or not this may influence their help-seeking behaviour before death. Methods: Coroner records of suicide deaths in Northern Ireland over 2 years were linked to general practice (GP) records. This identified 63 individuals who had not attended health services in the 12 months before death. Coroner’s data were used to categorise life events associated with the male deaths. Lifetime mental health help-seeking at the GP was assessed. Findings: The vast majority of individuals who did not seek help were males (n=60, 15% of all suicide deaths). Lack of consultation in the year before suicide was consistent with behaviour over the lifespan; over two-thirds had no previous consultations for mental health. In Coroner’s records, suicides with no prior consultation were primarily linked to relationship breakdown and job loss. These findings highlight the limitations of primary care in suicide prevention as most had never attended GP for mental health issues and there was a high rate of supported consultation among those who had previously sought help. Public health campaigns that promote service use among vulnerable groups at times of crisis might usefully be targeted at those likely to be experiencing financial and relationship issues