Murder-suicide impossible to predict – but we must do more to stop it
MURDERSUICIDE is when a person kills one or more other people, then takes his or her own life. It is very rare. There are fewer than two in Ireland per year. This is the same as the rate in England and Wales and less than a quarter of that in the US.
Each case presents a complex combination of possible contributory factors. There is never a single, simple explanation.
Most perpetrators are men (88pc), most commonly in their mid-40s. The most common life event in the run-up to the murder-suicide is the loss of, or a significant change in, a close personal relationship.
Up to two-thirds of perpetrators have a history of mental illness, most commonly depression, but only one in 10 has had contact with specialist mental health services in the year prior to the murdersuicide. A majority (between 77pc and 90pc) have never had any contact with mental health services.
As a result, it is not clear how many perpetrators of murder-suicide are truly mentally ill at the time. It is stigmatising to the mentally ill to presume that everyone who perpetrates murdersuicide is mentally ill. Similar acts can be committed by people who are not mentally ill and some cases of murder-suicide may relate more to domestic violence than to mental illness.
In these circumstances, it is possible that targeted interventions and supports might help prevent escalation to the point of murdersuicide.
Given that there are two cases of murder-suicide per year in Ireland’s population of 4.7 million people, accurate prediction is impossible.
Even with the best use of current evidence, the risk factors linked with murdersuicide (male gender, mid-40s, past depression) are so common that it is simply not possible to predict with any degree of accuracy if a given person will engage in murder-suicide or not.
Even so, general preventative measures can be taken at population level. Given that many people who engage in murder-suicide have a history of depression, it is possible that better treatment of depression might help prevent it.
While it is not feasible to prove this definitively, there are already many other good reasons for better treatment of depression, including alleviating suffering, improving quality of life and possibly preventing suicide. It may also help prevent certain cases of murdersuicide in the long-term.
Are there any particular features of depression, especially severe or psychotic depression, that should prompt concern? The National Suicide Research Foundation (www.nsfr.ie) points out that 90pc of murder-suicides involving mothers and 60pc involving fathers are associated with a desire to alleviate real or imagined suffering in their children. This suggests that this clinical feature might present particular cause for concern.
Again, however, it remains the case that the vast majority of people who express such concern about their children will not engage in murder-suicide. So this risk factor needs to be evaluated with care in each individual case.
Overall, the best approach to prevention lies in improving mental health services for everyone who needs them, not just those with risk factors for murdersuicide.
We also need better support services for those bereaved, focused on timely and direct provision of information, practical assistance in the aftermath of the event and continued psychological support for family members, relatives and friends (eg school friends and staff).
Previous murder-suicides have led to calls for greater emphasis on child risk assessment in psychiatric evaluations. While there is no evidence that child risk assessment can statistically predict the risk presented by murder-suicide or reduce its incidence, assessing child welfare when a parent is mentally ill certainly deserves more attention than it currently receives.
This is not based on the
There are two cases per year in our population of 4.7 million; accurate prediction is impossible
idea that such assessment can reduce risk, but on meeting the needs of all family members, therefore delivering better care.
This would help ensure the welfare of children and possibly reduce the general risk of murder-suicide, homicide and, indeed, suicide.
Public discussion and awareness are also important, once the former is sensitive, proportionate and focused on understanding and support. The National Suicide Research Foundation provides advice on factual reporting in order to minimise further harm.
As is the case with suicide, incidences of murder-suicide often prompt people to speculate that there were signs that were missed or that various professionals could have predicted the outcome.
Statistically, however, there is no way that anyone can predict murder-suicide in any individual case.
This should not deter efforts at prevention. Two murder suicides per year are still two too many. The best preventive measures are to provide timely interventions in cases of domestic violence, accessible mental health services for all who need them, improved riskassessment and support in relation to children and increased public awareness of mental illness and its treatment.
This matters to everyone. One in four people will develop a mental illness at some point in life. There is no ‘them’, there is only ‘us’.