In attendance: Regina Ward, Ross Hattaway (Department of Health), Dr Philip Dodd (National Office for Suicide Prevention), Dr Suzi Lyons (HRB National Drugs-Related Deaths Index), Emer O’Neill (Pieta House), Superintendent Kevin Gately (Gardaí), Jackie Hickey (General Registration Office), Dr Deirdre O’Reilly (Irish Prison Services), Brian Ring, John G.O’Connor and Carol Anne Hennessy (CSO), Prof Ella Arensman, Dr Paul Corcoran and Eileen Williamson, (National Suicide Research Foundation).
Apologies:
Date: Wednesday, February 19th 2020 at 11.00am
Meeting of Central Statistics Office (CSO) Liaison Group on Suicide Mortality Statistics
CSO Offices, Ardee Road, Rathmines, Dublin
Accompanying Documents
2.1 Minutes of meeting held on December 6th 2018
3.1 Policing Authority Commentary in Relation to the Garda Síochána Homicide Investigation Review Team Final Report
7.1 Pages 53 and 54 Connecting for Life
Mr Brian Ring welcomed everyone to the meeting and made the relevant introductions.
The Minutes of the meeting held on the December 6th 2018 were unanimously agreed.
Superintendent Kevin Gately outlined the sections of the Report that are relevant for the Group namely:
2. (A) The Review Team recommends that organisational policy is issued providing guidance surrounding the creation and classification of deaths (and other incidents) on Pulse. It is recommended that existing policy is consolidated, but also expanded to include the classification of non-crime incidents. The central tenet of the policy should be the ‘Crime Counting Rules’ (HQ Directive 139/2003), with associated policy considered in the revised consolidated policy.
(B) The Review Team also recommended a Pulse upgrade (IT fix) to allow for the rationale for decisions made around the categorisation of incidents (particularly deaths) to be recorded.
8. The number of death classifications types on Pulse should be examined, with the possibility of introducing sub-categories to reduce the number of primary categories (Category), with sub-categories (Type) providing specific information surrounding the death. This process should be done in consultation with GISC and the CSO.
12. The Review Team have identified inconsistencies surrounding the recording of deaths, which on the ‘balance of probability’ are (or are not) suicides. The Review Team believe An Garda Síochána should not be the sole providers of data surrounding suicides and the data collection requires a multi-agency approach.
Superintendent Gately spoke about the C71 Form that is completed by Gardaí in the case of sudden deaths including deaths where suicide is suspected. He reported that a Garda sergeant is always involved in incidents of sudden death and that the C71 Form is completed within 24 hours of the death and is sent to the Garda Superintendent and the Coroner of the district in which the death occurred. Superintendent Gately proposed that Gardaí could include an opinion as to the manner of death on the C71 Form instead of on the Form 104 that is used by the Mortality Coder as a source of additional information to aid accurate coding. Superintendent Gately further proposed that it would be possible to do an IT fix on the Pulse system to facilitate this. There was discussion concerning the possibility of the C71 Form being scanned to the CSO instead of manual transfer.
It was agreed that a recommendation from the Group in relation to Form C71 be sent to the Garda Commissioner.
In line with GDPR, the CSO Data Office policies and the Researcher Co-ordination Unit there is no matching allowed of CSO microdata to an external dataset. However, Vital Statistics microdata is of great interest to medical and social researchers engaged in valuable research projects. The question of whether the vital statistics area can be made an exception of in relation to the existing rules/policies has been raised at Assistant Director level but must be discussed further. Whether vital statistics data should be brought in under the Statistics Act 1993 is another issue that must be discussed at senior management of CSO.
Professor Ella Arensman tabled a document entitled Development and Implementation of a Real-Time Suicide Surveillance System: Review of the Pilot Phase of the Suicide and Self-Harm Observatory for the internal use and information of the Group.
Professor Arensman summarised a number of key findings of the pilot phase of the Observatory, which is funded by the HRB. Key findings include:
While most people had died following hanging (58%) and drowning (14%) which are frequently used methods for suicide in Ireland, the Observatory also recorded less common methods, such as self-immolation and decapitation. In this regard the Observatory may identify emerging methods of suicide whereby cultural factors or impact of the media may increase contagion of suicide.
The pilot phase of the Observatory has demonstrated a number of important benefits of this system, in particular:
As a next step, the NSRF is in communication with NOSP about the possibility of upscaling the Observatory and wider implementation in all regions in in Ireland, which would be in accordance with other real-time suicide surveillance systems, such as in Australia (Queensland and Victoria) and New Zealand (national).
It had been noted at the previous meetings and repeated at this meeting that there is an emerging trend of increased late registered deaths. Carol Anne Hennessy advised that the most recent report which was for 2017 of the CSO further highlighted this issue.
The numbers of late registrations are increasing annually in recent years
There were:
573 Late Registrations in 2015
757 Late Registrations in 2016
819 Late Registrations in 2017.
This emerging issue has an impact on establishing the number of suicides that occur in a particular year as it is not possible to have such a definitive number within 22 months from the end of the relevant year. All unnatural deaths (deaths from accidents, suicides, poisonings etc.) must be referred to the Coroner’s Office for further investigation and these deaths tend to be registered late as a consequence. There are a variety of reasons for these late registrations including the holding of inquests, investigations by An Garda Síochána, the involvement of the office of the Director of Public Prosecutions (DPP), the Health and Safety Authority, Engineers reports etc. Furthermore, most deaths occur in areas with a higher population of persons and hence there is a larger workload for Dublin based Coroners.
Example of the Impact of Late Registration in 2014
No of Suicides published in Annual Report 486
No of late registered suicides registered in 2016 and occurred in 2014 74
No of late registered suicides registered in 2017 and occurred in 2014 6
Updated total 566
This figure of 566 could be further increased when the 2018 figures are published. However, the trend is what one would expect, i.e. that any further increase would involve smaller numbers of cases being registered. In other words, the bulk of the additional cases added arise within 2 years of the published data per the annual report.
Tables VSD33 and VSD34 in the CSO Databank, record the most up to date position.
This issue has been raised and discussed with the General Registration Office.
The external cause of death is assigned manually by the Mortality Coders in the CSO.
Dr Philip Dodd advised the Group there was agreement in principal that the National Strategy for Suicide Reduction: Connecting for Life, the original timeframe of which was 2015 to 2020, would continue to 2024. Dr Dodd spoke in particular about Goal 7 of the strategy that aims to improve surveillance, evaluation and high-quality research relating to suicidal behaviour and advised that the National Office for Suicide Prevention was examining the comparability of data from different sources to inform the implementation of further actions in the Connecting for Life Strategy. The following Objectives are relevant for the Group:
7.2 Improve access to timely and high-quality data on suicide and self-harm.
7.3 Review (and, if necessary, revise) current recording procedures for death by suicide.
Ms Regina Ward advised that she envisaged more involvement between the Connecting for Life Cross Sectoral Group and the CSO in the next phase of the Strategy.
It was noted that in May 2019 the Court of Appeal in England and Wales upheld a 2018 ruling of the High Court that the standard of proof required for a conclusion of suicide, previously a verdict of suicide, should be the civil balance of probabilities standard rather than the civil beyond reasonable doubt standard. It is anticipated that the change will result in an increase in deaths recorded as suicide in England and Wales.
The date of the next meeting was not agreed but it was proposed it would be held in September or October.
