August 31, 2012Dear Sir,The Royal Gazette columnist, Dr Phillip Brownell, wrote about suicide in his recent column of August 21: “Recognising the signs of suicidal intent”.Suicide is an important public health issue that can have devastating consequences for individuals and their families. Dr Brownell is to be commended for raising the awareness of this issue in his column. The Bermuda Hospitals Board would like to provide some additional information to the content which appeared in Dr Brownell’s column. Dr Brownell stated: “Clinically depressed people frequently kill themselves.” A robust finding from international studies using the technique of psychological autopsy suggests that 90 percent of people who commit suicide have a potentially treatable mental disorder, most commonly Major Depression. Therefore people who kill themselves frequently have a mental disorder such as Major Depression. The population lifetime suicide risk varies between countries. In the UK, USA and Bermuda it is less than one percent. The international literature estimates the lifetime suicide risk of untreated Major Depression at nearly 20 percent.“In contrast, the lifetime suicide risk in people who have been diagnosed and treated for Major Depression is substantially less than ten percent. Therefore whilst the clinical syndrome of Major Depression elevates the individual suicide risk, many times compared to the general population, 90 percent or more of the people who have received treatment for this diagnosis will not commit suicide.”The international literature estimates the percentage of homicides committed by people with psychotic disorders at less than ten percent of total homicides. The statement that “people with delusions often kill not only themselves but others as well” should be placed in this context. The last reported case of a homicide by a person with a psychotic disorder in Bermuda occurred more than 15 years ago. Whilst there is a positive correlation between mental illness and violence, this is a modest association and the majority of people who suffer from mental illness are not violent. In fact they are much more likely to be the victims rather than the perpetrators of violent crime. Mental illness is treatable and is much more likely to prove fatal if untreated. Data from the UK indicates that 75 percent of people who commit suicide are not in contact with mental health services, highlighting the important role which treatment can play in improving outcomes. BHB would advise anyone who is feeling depressed or suicidal to contact MWI through the switchboard at 236-3770 to access treatment. This number functions as a 24/7 helpline. Depression is the theme for Mental Health Awareness Week this year and public announcements will follow.Dr Chantelle Simmons, Chief of Psychiatry, MWIDr Grant Farquhar, Consultant Psychiatrist, MWIDr Anna Neilson-Williams, Consultant Psychiatrist, MWI