Where once the crackling of gunshots and the whirring of police helicopters constituted the regular sounds of daily life in Belfast, more recently they’ve been replaced by something equally deadly and sinister – the sound of hopelessness and despair.

What does it sound like? There’s the sobs of friends and families as they carry the casket of the latest young victim of suicide to their grave. There’s the impassioned pleas of campaigners working daily to try to break the tide of suicides which have rocked Northern Ireland since 1998. There’s the prevaricating of politicians struggling to enact measures to deal with the issue.

And amidst all the noise and confusion, the suicide rate continues to rise – it is still the highest in the UK for the third consecutive year, according to figures from the British Office for National Statistics.

The extent of the problem in Northern Ireland is truly startling. From the beginning of the Troubles in 1969 to the Good Friday Agreement in 1998, more than 3,600 people died as a direct result of the conflict. In the 18 years after that, over 3,800 people died by suicide. By comparison, in the 32 years from 1965 to 1998, there were 3,983 deaths by suicide. In other words, the suicide rate has increased by almost 90%.

To what can we attribute this rise?

Siobhan O’Neill is Professor of Mental Health Services at the University of Ulster. She has been researching the issue in Northern Ireland for the last number of years and has conducted two major studies in this area; one looks at suicidal behaviour and the other specifically analyses deaths by suicide.

“There are different factors that lead to suicidal behaviour,” says Siobhan. “Suicide rates are going up generally in the western world, but our rates are disproportionally high and the legacy of the Troubles definitely has an impact. In our study of suicidal behaviour, we discovered that people who were exposed to the trauma of the Troubles – a high percentage of people in Northern Ireland – were at a risk of suicide.

“But there’s a new phenomenon with younger people committing suicide who weren’t alive or didn’t grow up during the Troubles. Looking at the transgenerational effects on young people, we found that a lot of deaths are a result of people whose parents were worst affected by the conflict. Trauma can have an effect on our behaviour with others, leading some parents to become detached from their children. It can also lead to them struggling to respond to their child’s needs or even engaging in the use of physical punishment.”

Social issues also play a part, says Siobhan. “If you implement austerity, you’re increasing the danger of poverty and you’re putting pressure on people. So the austerity measures that are being implemented throughout Ireland are leading to increased risk of suicide. And in Northern Ireland specifically, we also see that 25% of LGBT people have attempted suicide, which is an appallingly high rate. Something like marriage equality could theoretically bring down that rate by increasing the visibility of marginalised groups and improving their sense of connectedness in society.”

Unresolved legacy issues from the Troubles also feed into the sense of futility that can ultimately lead to suicidal thoughts. “Communities that have been directly affected by the Troubles have suffered a lot and in post-conflict Northern Ireland, people oftentimes struggle to find meaning in that suffering, because they feel everyone has forgotten what they’ve been through. So if you’ve been part of a paramilitary group, there can be feelings that you haven’t achieved what you set out to achieve and that you haven’t seen the dividends that you expected. Other groups, including victims of the conflict, may also feel that they have seen no justice in what has happened.”

In Northern Ireland, navigating the truth and finding a shared legacy for the Troubles can seem like an impossible issue. Indeed, in Stormont’s “Fresh Start Agreement”, published at the end of 2015, the major political parties opted to flat-out ignore legacy issues despite the fact that it has been 18 years since the Good Friday Agreement was signed. Siobhan argues that this is a crucial issue for the country’s collective mental wellbeing. “Events never seem to stay stuck in the past in Northern Ireland and we have little sense of the truth. People can reinterpret different events that they were involved in or witnessed and see them in a completely new light, which begins to haunt them all over again. Hearing about state collusion, finding out which groups were involved in particular atrocities or murders – all that can be difficult for people to process mentally.”

So what can be done to reduce the suicide rate in Northern Ireland?

“We need greater access to mental health services for people who self-harm,” says O’Neill, “because those people are at a really high risk. Studies have shown that around 1 in 5 young people are self-harming in Northern Ireland. With self-harming you’re effectively practising suicidal behaviour and you’re using it as a response to stress, and that just puts you further along that continuum. So our mental health services need to improve. People aren’t getting the treatment they need.

“There’s also more that can be done to reduce the stigma surrounding mental health. When we carried out our study on suicidal deaths, we found that 30% of people who had died were never known to have had mental health problems. They’d never come forward or been diagnosed. And I’m talking particularly about young men, where the suicide rate is the highest. The whole notion of toxic masculinity has led to Ireland having one of the highest rates of male suicide in the world.

“The way we treat masculinity has led to men feeling that they have to present themselves as always feeling fine, like they shouldn’t need to ask for help. They have to be wealthy, they have to be a good providers. Gender roles generally are not helpful for mental health. You have young women feeling that they’re not attractive enough, and then you also have transgender people – where suicide is a really serious issue – feeling alienated because they don’t fit into either prescribed gender role.”

Northern Ireland also needs to address certain aspects of its educational system.

“With that sense of alienation, we can also include the fact that separate education systems exist in Northern Ireland,” says Siobhan. “We need integrated education to help break down the barriers of our understanding of each other. The highest rates of suicide occur in areas where division is most prominent; there are feelings of disaffection and hostility held by people living in these areas. These issues need to be dealt with, before we can see a reduction in the suicide rate in Northern Ireland.