IRELAND CURRENTLY HAS a very high incidence rate of attempted suicide and deliberate self harm.
Mary*, a 41-year-old woman from Cork, has experience of the devastation it can cause. She used self harm as a way of coping with her depression and suicidality.
“Anything at all would just make me really feel like I don’t want to live anymore because it was so hard,” she says as she recalls her younger self.
However, Mary’s life has changed dramatically because of a form of therapy that is being embraced by the HSE and Ireland.
Dialectical behaviour therapy (DBT) was made available to her and she signed a one-year contract with her therapist following a number of commitment sessions that deemed her suitable.
“I stopped self-harming completely and the thoughts of suicide are gone,” she says today.
“I have stopped judging myself harshly and have learned to deal with my anxiety, my thoughts and my depression. Participating in the programme was difficult but it was worth every second.
“Nowadays, I am more confident and more in control of myself, my reactions and my life overall. I have space in my head to think about my goals and the future – I could never do that before DBT.”
Mary explains that before her participation in DBT, she would not have any words to express how she felt.
“Anything and everything was too much. I would judge myself, tell myself I was stupid, ridiculous. Self harming was a long-standing way of coping for a long, long time.”
DBT was developed by US-based psychologist Professor Marsha Linehan to treat people who self harm and/or have repeated suicidal behaviour tendencies.
It helps people to let go of old patterns of self-destructive behaviour and improve their quality of life.
Speaking to TheJournal.ie, the doctor explains how it works.
“It is a psychotherapy – a psychological intervention which focuses on helping people build lives that they will experience as worth living.
“All lives are worth living but some people experience lives which they feel are not worthwhile.
“It combines too radically different approaches – both validation or acceptance and change.
“It brings together the opposites because focusing too much on change or too much on acceptance was a disaster.”
Patients are taught a set of skills to work towards regulating their emotions and being mindful of their current situation – not their past or future crises.
“It was developed for people who were highly suicidal but it’s really very effective for many disorders,” Professor Linehan continued.
“I use the skills I learned on a daily basis in every situation,” adds Mary.
“I focus on one thing at a time and practice mindfulness which helps me stay focused and calm. I no longer suffer from major depression and the other co-existing conditions are greatly reduced.
“Prior to DBT, I was a wreck, the slightest thing would make me fall apart and made me think that I didn’t want to live. Now I can rationalise things and deal with them as they come up.”
Mary works and has just finished her first year in college, noting that she saw the DBT programme offered to her by the HSE as a “lifeline”.
She says that they were taught a number of tricks and skills to enable them to cope with urges to self harm. She notes that one example is holding an ice cube in the palm of your hand until it melts.
Mary’s behaviour has altered and she says she could see the changes in the very first month.
“It’s worth getting past the first session (which she found disappointing) and sticking with it. It is intensive – it does go into a lot of things. You can really identify your problems, what way you’re thinking that causes you to feel anxious, upset, worry and judgement.”
I don’t think there is anything else out there. It is unreal, amazing what I can do now.
The HSE’s principal psychology manager, Daniel Flynn, is in charge of implementing DBT programmes nationally. He first became aware of the treatment in the 1990s and in 2010 he was among a group of HSE staff who self-funding their training.
He set up a project in Cork, during which 12 people were treated. As a result of that small, pilot scheme, hospital admissions were reduced and almost €145,000 saved.
“More importantly, it improved the quality of life of the people involved,” he told TheJournal.ie.
“We do have a significant problem,” he says, noting that there are particular concerns about teenage girls and young males in their early 20s.
“We need to target the treatment at this at-risk populations strategically, by using the registry of self harm.”
In 2012, that National Registry of Deliberate Self Harm recorded over 12,000 presentations to hospital. Those incidents involved 9,438 individuals.
DBT is proven to cut suicide rates in half, reduce emergency department visits by half and facilitate a 73% drop in inpatient admissions when compared to other expert, non-behavioural treatments.
This week, 165 mental health services staff from Ireland and the UK took the opportunity to train with Professor Linehan.
They learned the latest innovations in DBT, which involves group skills training, individual therapy and out-of-hours phone coaching for clients.
Linehan said she finds it “remarkable” that the Irish government has paid for the programme to be rolled out.
“I am extraordinarily impressed,” the American added. “I taught a whole lot of people who were already trained. I was stunned at the level of sophistication and, in fact, I learned a lot from them.”
Ireland will see 29 DBT teams established in the near future as part of the National Office for Suicide Prevention’s plans.
*Not her real name
Samaritans 116 123 or email firstname.lastname@example.org
Console 1800 201 890 – (suicide prevention, self-harm, bereavement)
Aware 1890 303 302 (depression, anxiety)
Pieta House 01 601 0000 or email email@example.com - (suicide, self-harm, bereavement)
Teen-Line Ireland 1800 833 634 (for ages 13 to 19)
Childline 1800 66 66 66 (for under 18s)