In attendance: Regina Ward (Department of Health), Hugh Duane (National Office for Suicide Prevention), Eileen Williamson, Prof Ella Arensman and Dr Paul Corcoran (National Suicide Research Foundation), Dr Suzi Lyons (National Drugs Related Deaths Index), Emer O’Neill (Pieta House), Superintendent Kevin Gately (Gardaí), Keith McSweeney and Carol Anne Hennessy (CSO).
Apologies from: Jackie Hickey (General Registration Office), Dr Deirdre O’Reilly (Irish Prison Services) and Gemma Duff (CSO).
1. Welcome/Introductions
2. Agenda item No 2 - Agree Minutes of previous meeting of the 19thApril 2018
and matters arising.
3. Late Registrations
4. Coroners (Amendment) Bill 2018 (copy attached)
5. Update on Suicide and Self-Harm Observatory
6. AOB
Keith McSweeney welcomed everyone to the meeting, made the relevant introductions and conveyed the apologies of the non-attendants to the meeting.
The Minutes of the meeting held on the 19th April 2018 were unanimously agreed.
Status of Actions Arising from Previous Meeting:
There is one action outstanding from the previous meeting (Sept. 2018) i.e. The Health Research Board (HRB) is to forward the specific criteria that they apply to determine that death is a result of intentional self-harm. The HRB advised that this information and methodology is available on the National Office for Suicide Prevention (NOSP) website and will be updated as necessary going forward.
Update on access to PULSE data (Agenda item No 3 of 19\04\2018)
The CSO advised that Suicide data for 2015 on PULSE system was made available to the CSO by the Gardaí for analysis. There were 501 records in this file and the mortality coders in the CSO identified that 418 of these records were attributed an ICD-10 (X60-X84) code by the CSO. A further 45 records were coded to other external causes (i.e. accidental or undetermined) based on the narrative on the death certificate and the Form 104 (where returned). There were 3 records where a natural cause of death code was assigned based on the death certificate.
The CSO discussed the possibility of getting the narrative that is recorded on the PULSE data by the Gardaí as this would be a valuable additional source of information that would assist mortality coders in the CSO in attributing the most accurate underlying cause of death.
Superintendent Kevin Gately advised that a Policy Document would have to be put in place in respect of this civil issue and advocated that if this was in place the CSO could get the narrative from the PULSE data once an updated form could be populated electronically by the Gardaí. This form would have to be devised by their IT division. The Gardaí complete a form C71 after attending the death scene and the information on this form provides the initial report of the incident on the PULSE system. While the Form 104 is issued after the inquest and is concerned with the Inquest, the form C71 is concerned with the death. In addition, this information on the PULSE system could be available to the CSO prior to inquest. If the CSO could get this additional information from the PULSE system, it would:
a) Supplement all those records where a Form 104 was not returned to the CSO.
b) Avoid the possibility of Garda that attended the scene of the death rubberstamping the Coroners verdict to Question 24 of the Form 104.
c) Lead to a more consistent approach by getting timely and accurate information for statistical purposes for non-crime deaths.
If the CSO does get the data from PULSE and it makes a significant difference to the suicide numbers, then this will have to be explained to data users and CSO will have to look at its processes around this potential change.
The Health Research Board (HRB) suggested to cross check this information with information from the National Drugs Related Deaths Index (NDRDI) and NOSP.
Actions:
Comments in the media re the undercounting of suicide figures by former Coroner, Dr Brian Farrell (Agenda item No 5 of 19\04\2018).
Following up on a letter sent to the President of the Coroners group re the above, the CSO issued a reminder by email to the President of the Coroners group requesting a response to letter of the 20 November 2017 on the 23\04\2018 but no reply received to date.
Late Registered Suicide Deaths (Agenda Item No. 6 of 19\04\2018))
This item to be discussed under item No. 3 of the Agenda of the 6th December.
Variations in deaths from suicide versus deaths of undetermined intent over time by Coroner District – (Agenda Item No 7 OF 19\04\2018)
The CSO provided Paul Corcoran (NSRF) with relevant data by Coroner district for the period 2007 – 2015 inclusive. Paul circulated a paper and presented his analysis/findings to the meeting. In summary, there is a lot of variation in the relative proportions of accidents, suicides and deaths of undetermined intent by registrar’s districts. The CSO asked Paul for his permission to use his findings in support of our request to receive suicide data recorded in PULSE system. He agreed to this.
Actions:
Paul Corcoran’s (NSRF) paper to be included in submission to the Gardaí when formally requesting access to suicide data in PULSE.
AOB (Agenda Item No 9 OF 19\04\2018)
The legal issue that around research microdata files i.e. the non-commencement of Section 73 f the Civil Registration Act 2004 has been resolved.
The CSO pointed out that a trend is emerging in the last 3 years of increased late death registrations. There were 84 late registered suicide deaths in 2016 (i.e. the most recent final data published in the Vital Statistics Annual Report on 31st October 2018). Of these there were 74 deaths from suicide in 2014 bringing the current total of suicide deaths that occurred in 2014 to 560 (See Table VSD33 in the CSO databank). This figure may be added to in the future if there are further late registered suicide deaths that occurred in 2014.
The CSO circulated copies of tables VSD33 and VSD34 for reference. These are the tables that are updated annually on the CSO Statbank for data users. It was suggested by the CSO to add labels to the horizontal and vertical axis of Table VSD34 which provides details of Late Registered Deaths (i.e. Year of Registration and Year of Occurrence labels).
The NSRF pointed out that although the late suicide deaths are published annually in the CSO Vital Statistics Annual Report and updated on Statbank, this additional data is not reflected on the Eurostat website. At a recent meeting with WHO, Ella Arensman had discussed the discrepancies between the final suicide data published in the Vital Statistics Annual Reports, which is submitted to Eurostat and the final suicide data + late registered suicide deaths, whilst the Eurostat data forms the basis for WHO global reports on suicide trends. She provided them with the link to the relevant CSO Tables. The discrepancies are significant, e.g. for 2014 both the number (560) and rate of suicide/100,000 (12.1) was higher than during the recession years (2008, 2009). WHO will review the Eurostat suicide data for all European countries.
Action
CSO to add further labels to table VSD34
The NSRF circulated a copy of the Coroners (Amendment) Bill 2018. The NSRF advised to note in particular Page 11 and Page 24.
(I) Page 11: Coroners proposal to seek advice externally in some cases
(II) Page 24: There is more diversity in causes\manner of death e.g. self-neglect, eating disorders etc.
The Bill has been published by the Minister for Justice and is not yet enacted.
The NSRF circulated paper providing an update on developments of the Suicide and Self-Harm Observatory (SSHO), funded by the HRB and in accordance with the Queensland Suicide Register for real-time (fortnightly) suicide data (attached). Ella Arensman provided an update of the main progress since the meeting in April: Ethical approval has been granted for the operation of the system in collaboration with the Coroners, the Gardai and HSE in County and City Cork, which has started in December. Next steps: implementation of the SSHO in counties Kerry, Donegal and Cavan.
The next meeting will be scheduled for some time mid 2019 with meeting commencing at 11.00am
Carol Anne Hennessy
CSO
7th December 2018.