Suicide is a final act for which the survivors (family, friends, and professionals who have treated the victim) have no answers. Rates of suicide have risen throughout Europe in the last 50 years, and a recent alarming trend has been the increase in young male suicide. In recent years in Ireland, suicide has become the principal cause of death in men aged 15 to 34 years, and like other European countries, Irish rates show marked gender differences. This is outlined in the paper ‘Parasuicide and suicide in the south-west of Ireland’ published in this issue, in which the male suicide rate was 22.7 per 100,000 compared to a female rate of 5.5 per 100,000, a ratio of 4:1. The suicide rates for males in the 20to 34year age brackets were almost twice the overall rate recorded for males. What are the reasons for the increase in the number of young men who choose to end their lives through suicide? Dr Michael Kelleher (to whom the authors dedicate their paper) discussed factors which might have contributed to this increase. He included an increased prevalence of mood disorder and the use of illicit drugs among the possibilities. The contribution of ‘anomie’ — social fragmentation — has also been highlighted, and some measure of this can be made from indices such as population turnover, proportion of single person households, proportion of unmarried adults and proportion of persons in private rented accommodation. Dr Kelleher also comments on the tendency towards the exclusion of males from the family unit, and the negative effects this may have on male role models for adolescents. In a national review of suicide in Ireland, almost one-third of the men who committed suicide were unemployed compared with a national unemployment rate of 10%, and marriage appeared to have a strong protective effect. Unemployment, retirement, being single and sickness absence were significant risk factors for suicide in a recent national Danish review and appeared to be particularly important in suicide by males. However, mental illness was the predominant risk factor for suicide in both the Danish and the Irish studies especially depression. The results of a systematic review of psychological autopsy studies confirm that the variable most strongly associated with suicide is mental disorder, with median rates of illness of 90% and 91% for case series and case control studies respectively. Co-morbid substance abuse was also important. A previous history of deliberate self-harm and recent hospital inpatient psychiatric treatment were significantly associated with suicide in the Irish review, and the authors commented on the role of alcohol use and abuse. Assessing suicide risk among patients who present with parasuicide poses a major challenge to GPs, AE strategies to combat alcohol and drug problems (both at policy and educational levels); enhancing access to mental health services; ensuring assessment and follow-up of suicide attempts; training of healthcare workers, teachers, police and prison staff; promotion of self-esteem and mutual respect by programmes such as schools’ Social and Personal Health Education Programme; and efforts to reduce alienation, especially of young men. The media has an important role in its treatment of suicide deaths by limiting details, by emphasising the enormous negative effects on relatives, and the possible disabling effects of suicide attempts, and by providing information on helplines and counselling. ‘Aware’ argue for a broad, holistic approach to suicide prevention, including tackling the illnesses which are the antecedents of suicide. The recommendations of the National Task Force on Suicide, include the full implementation of ‘Planning for the Future’, with the provision of an extensive network of community-based psychiatric services, bringing specialised multidisciplinary psychiatric teams within easy reach, and with ease of access. This will require the proper funding and