Minister of State at the Department of Health and Children (Deputy Kathleen Lynch): Any chance in public life to speak about suicide should be taken and I am grateful for today’s opportunity. As Minister of State with responsibility for mental health my priority will be to further advance the implementation of A Vision for Change, an excellent strategy which must be driven forward, and Reach Out, the national strategy for action on suicide prevention. Both strategies clearly identify the need to build resilience, support the development of services and programmes for unemployed people and to reduce the risk of engaging in suicidal behaviour.
The number of deaths by suicide fell steadily from 497 in 2003 to 458 in 2007. However, the recently published CSO vital statistics for 2008 reported that there were 506 suicides for that year, an increase of 10.5% over 2007. The provisional figures available for 2009 indicate a further increase of 4% to 527, the highest level of suicide deaths ever recorded in this country. This would appear to indicate that a new higher level of suicides now pertains and shows just how big a challenge we face. The increase is mainly in men in the middle age group. However, we are also seeing a rise in the number of women dying by suicide, although the numbers are still significantly lower than in men.
Deaths by suicide have a devastating effect not just on close family and friends but on the wider community. These deaths are even more tragic because we know they are preventable. We all ask the question “why” and wonder what we could have done to prevent such a tragedy. Undoubtedly, the current economic position is having an effect on people’s mental health and well-being. The impact of unemployment and the strain of financial difficulties on physical and mental health are well known. Following job loss, people report higher levels of stress, depression and anger. The loss of personal control and self-esteem makes it more difficult at times to keep in contact with friends and colleagues.
In this regard, the HSE’s national office for suicide prevention, NOSP, has launched a “tough economic times” programme following requests from organisations such as Citizens Information and the Money Advice and Budgeting Service, MABS, for information and training because of the increasing numbers of people presenting in distress. Some 150,000 information leaflets highlighting the practical actions we can take to protect our mental health were produced for the public, as well as a guidance book for organisations which advises how to prepare staff to recognise and respond to suicidal behaviours. Farmers’ marts were also targeted with information, as well as events such as the ploughing championships.
The increasing number of deaths by suicide is of great concern. As the recently appointed Minister of State with responsibility for mental health, I intend to work with the HSE and voluntary agencies to introduce initiatives to counteract this worrying trend. By harnessing our resources and our commitment, we can make a difference and reduce the number of suicides and suicide’s devastating effects on individuals and on communities. We must work more closely together. As a first step we must ensure that we avoid duplication of services and suicide prevention initiatives. This will help us get better value for the money that is available to us and make sure that we maximise our effectiveness.
Mental health promotion is of course a key component of any suicide prevention strategy. We must make people aware and encourage them to look after their mental health in the same way as they look after their physical health. We should promote resilience and encourage people to develop coping strategies, and in particular ensure people learn to recognise when professional help is required.
See Change is the national stigma reduction campaign launched by my predecessor, former Deputy John Moloney, and I pay tribute to him for the work in this area. It will continue in 2011 with the vision that every person in Ireland can be open and positive about their own and others’ mental health. The strategy is working to change attitudes to mental health in towns all over Ireland through public events, arts and cultural initiatives, personal stories and testimonies, training and education and innovative partnerships with organisations that share a positive attitude towards mental health. As part of this campaign, See Change is developing the Make a Ripple campaign with the objective of recruiting a dedicated on-line community of ambassadors, advocates, storytellers and volunteers who can help to push the campaign’s objectives and messages on to the national agenda. This campaign will contribute to eliminating the stigma so often associated with mental illness and I am very happy to lend my support to it.
A number of suicide prevention initiatives have been progressed in recent years, including the development and implementation of national training programmes. Since 2004, approximately 22,500 people have been trained in the 2 day ASIST – applied suicide intervention skills training – and 3,000 people in Safetalk, a half-day training programme that prepares anyone over the age of 15 to identify persons with thoughts of suicide and connect them to suicide first aid resources. ASIST is an internationally recognised two-day workshop which trains participants to reduce the immediate risk of a suicide and increase the support for a person at risk. The training is provided to health workers, organisations such as MABS, gardaí, defence forces, veterinary organisation, teachers, community workers, youth workers, volunteers and to people responding to family, friends and co-workers.
A national media monitoring programme – Headline – was introduced to promote responsible and accurate coverage of mental health and suicide-related issues within the Irish media. Headline aims to highlight mental health issues and address the stigma attached to emotional distress, suicidal behaviour and mental illness through the promotion of responsible media coverage. This year, the national office for suicide prevention is working to progress a more unified and consistent response to self-harm presentations in accident and emergency departments. This will include the development of clinical guidelines and the allocation of specialist staff to work with hospital emergency departments.
An evaluation will be carried out this year on two self-harm early intervention and referral services from primary care which are being piloted in south Dublin and Wexford. Support will continue for voluntary organisations working in the field of suicide prevention. Mental health awareness campaigns have been developed and will run again this year, including the Your Mental Health awareness campaign and the Let Someone Know campaign aimed at young people.
The total annual funding available to support suicide prevention initiatives is in the region of €8.7 million. This includes the annual budget of €4.2 million for the NOSP and an additional €1 million provided for 2011 to enable the office to build on initiatives to date and bring added momentum and new impetus to the activities to address the increasing incidence of suicide. The balance of funding of €4.5 million is used to fund resource officers for suicide prevention, self-harm nurses in hospital emergency departments and the development of local suicide prevention initiatives.
During 2011, the national office for suicide prevention will continue to develop both the number and range of training and awareness programmes, including the ASIST programme, to reach the most vulnerable in our communities. It will also improve and standardise the response to deliberate self harm presentations; develop the capacity of primary care to respond to suicidal behaviour and consider new models of response; and ensure that helpline supports for those in emotional distress are coordinated and widely publicised. Within each of these four areas an emphasis will be placed on the most vulnerable groups identified in Reach Out and more recent research.
Against a background of increasing numbers of presentations of self harm to our hospital emergency departments and a significant increase in suicides in recent years, it is important that we co-ordinate and improve our response to people in crisis at this time. The European Commission has reserved the number 116123 for emotional support helplines.
This helpline will enable callers to benefit from a genuine human relationship based on non-judgmental listening, and will offer emotional support to callers who suffer from loneliness, are in a state of psychological crisis or are contemplating suicide. I recently had discussions with my colleague, the Minister for Communications, Energy and Natural Resources, Deputy Rabbitte, in regard to the provision of a national freephone telephone helpline and I will meet with the relevant telecommunication providers in the near future to progress this proposal.
I acknowledge there is a great deal of commitment in many sectors to tackle this serious health and social issue. As policy makers and service providers, we must all work together more effectively than ever to identify people at risk and must put services in place to provide the help and support they need. This House can be assured of the Government’s unwavering commitment to improving our mental health services and of our response to the increasing level of suicides in the country.
Suicide and suicide prevention are issues for all of us. No single Government – not the last one, this one or the next one – can do this on its own. It is about every one of us being conscious when we meet people of the difficulties in which they may find themselves, being able to spot that and be aware. For that reason, I believe the programme Assist is essential. It trains people to be conscious of these difficulties and about where to direct them. Training young people in this area will probably save more lives than all the other steps put together. That is why we are so committed to it.
Deputy Seán Ó Fearghaíl: I congratulate the Minister of State, Deputy Kathleen Lynch, on her appointment to the Department. In her years in this House she has been one of a number of Members who have demonstrated a clear and genuine commitment to the area of disability and mental health issues. I agree with the point she made at the outset, that this is an area where we need to build consensus across the political divide. In the Joint Committee on Health and Children, of which she, Deputy Neville and I were privileged to be members in the last Dáil, this was an area where consensus existed. We should not lose that and must build on it.
In this House we have spent hours discussing the banks and the financial crisis which is, of course, both worthwhile and necessary. However, there is a human side to the recession which is entirely tangible. Suicide rates have increased and for people touched by such a tragedy its effects will stay with them for much longer than will those of the financial crisis. That is why it is imperative that suicide prevention remains a key pillar of public health policy
Most of us know a person who has died by suicide or we have a friend or relative who has lost someone close to them by suicide. Recently, at a very small social event in my constituency, I looked around and was conscious there were three families present who had lost young sons through suicide. In the past week in my constituency clinics I met two families in which two members of the same family had been lost. For those left behind there is sometimes guilt, always anguish and, in many instances, very many unanswered questions.
People take their own lives for many reasons but they do so because they are in intense pain and they want that pain to stop. There are a number of myths current about suicide that need to be dispelled. These include the idea that if someone wants to take his or her life there is nothing that can be done. Research clearly shows that medical assistance and professional intervention can help those in crisis and can deter them from taking their own life.
Another myth is that if a person develops suicidal tendencies he or she will forever be suicidal. That is not true. Many people take their own lives on impulse and suicidal feelings can be short lived. The EU consensus paper on prevention of depression and suicide states that, “adequate treatment of major mental disorders … decreases the risk of suicide and is an effective way to prevent suicide in healthcare”. Those struggling with depression and anxiety sometimes feel that their death would bring relief for themselves and their loved ones. Nothing could be further from the truth. Suicide is the ultimate waste of precious human life. The bereavement it causes shatters the lives of those left behind.
Suicide is a massive public health issue throughout the world. Globally, a person dies from suicide every 40 seconds. The National Office for Suicide Prevention has not released statistics for last year but we know that, officially, 527 people took their own lives in 2009, an increase of 24% on the previous year. It is probably reasonable to assume an increase will be recorded in 2010, given the impact the financial crisis has had on people and also because of the impact of pervasive negativity in many elements of the national media on people in their day to day lives.
In 2009, 78% of those who died by suicide were male. Although Ireland has the sixth-lowest rate of suicide in the EU among its total population we have the fourth-highest rate of youth suicide in the EU, behind Lithuania, Finland and Estonia. Young men between the ages of 16 and 34 are the highest risk category and this is deeply worrying.
Contrary to many people’s perceptions, depression is a very common condition that affects one in ten people at any one time. It does not discriminate in age, gender or background. Depression impacts how a person thinks and feels as well as on energy and behaviour. It can have a dramatic affect on a person’s home and working life and personal productivity. Many people who experience a period of depression will get the help and support they need and will move on with their lives. Others feel isolated, do not discuss their problems with anybody and cannot imagine ever feeling better again.
Some months ago The Irish Times weekend supplement had a series of articles from people who had lost loved ones to suicide, for which I compliment the newspaper. One story in particular caught my eye and deeply affected me. It was by a middle-aged lady who had married her college sweetheart. This man had started to experience depression relatively late in life and, with the encouragement of his wife, had sought help. However, the prospect of going into hospital to seek medical help as recommended by his GP was so disturbing to him that eventually he took his own life. Commenting afterwards, his wife remarked he would have felt no shame had he needed treatment for heart failure, cancer or any other condition. It is deeply worrying there is still such stigma in Irish society around depression.
The former Minister of State with responsibility for mental health and disabilities, John Moloney, worked tirelessly to champion the issue of suicide and mental health and I believe his work was recognised. During his time in office he introduced the See Change campaign, referred to by the Minister of State, Deputy Lynch. This is an alliance of organisations working together to bring about positive change in public attitudes and behaviour towards people with mental health problems. See Change tackles stigma through a targeted community-driven approach, designed to change how mental health problems are perceived. As part of the campaign, figures in the public eye have come forward and talked openly about their experiences with depression. I commend the public figures who have participated and led this initiative. The campaign has also involved television advertising, townhall meetings, seminars and public meetings and involves local groups and first-person accounts of mental illness.
There is no better example of this within the world of politics than that of the former Norwegian Prime Minister, Kjell Magne Bondevik, who addressed a cross-party group on mental health in the Oireachtas some years ago about his own depressive episode while in office in 1998. Mr. Bondevik left office for a number of weeks in order to deal with his illness. He then returned to work and went on to win a second term as prime minister, with increased electoral support. In his own words he had “hit a wall” and he decided to take the unprecedented step of being up-front about his illness. Explaining the background to it, he indicated his incident was related to his inability or failure to deal with significant bereavements within his family and social setting. Mr. Bondevik took this brave decision in order to avoid speculation about his condition and to combat the stigma surrounding mental health issues in general.
I congratulate the new Minister of State on her recent appointment and I hope that she will continue to support the See Change campaign. It is vital that we create an environment where people are more open and positive in their attitudes and behaviour towards mental health. We all need to connect with young people, young men and boys in particular, in their communities, in sports organisations and in schools, to encourage them to be open and talk about their emotions and to look after their individual mental health.
Fianna Fáil in government established the Office for Disability and Mental Health, which has a remit across four Departments. Likewise, we set up the National Office for Suicide Prevention, which is responsible for overseeing and implementing “Reach Out”, a national strategy for action on suicide prevention which runs over a ten year period.
There is no single problem that causes people to take their own lives, likewise there is no single approach that will in itself tackle the problem of suicide in Ireland. We need a whole series of approaches by a range of actors. Reach Out involves coordination and cooperation between statutory, community and voluntary groups and individuals and requires Government to ensure that its targets are met. It means a multi-sectoral approach to the prevention of suicidal behaviour to foster cooperation between health, education, community, voluntary and private sector agencies. It is vital there is cooperation and coordination between the many players in the voluntary sector and those who have a statutory function.
Despite the very challenging economic environment we faced, funding for mental health and disabilities was largely preserved in the last budget. This is commendable, especially when one considers the scale of the cuts across many Government Departments. In recognition of the seriousness of the problem, an extra €1 million was provided in the last budget for the National Office for Suicide Prevention to fund training and awareness programmes to reach the most vulnerable and for helplines for those in distress. It was also designed to develop the capacity of primary care to respond to suicidal behaviour and consider new models of response. The Minister of State is aware of the work of the last Oireachtas Committee on Health and Children and Deputy Neville in strongly advocating for the roll-out of a network of primary care facilities across the country. We were all ad idem that mental health services must be at the centre of those primary care centres.
A Vision for Change has been our template for reforming and reconfiguring the mental health service. This document has received cross party support and I was delighted to learn the new Government will continue to implement this strategy. It is estimated that the total cost of implementation is €150 million; perhaps the new Minister of State will outline how they will fund this policy in future given the enormous demands on the health budget.
I commend the Minister of State for continuing the last Government’s commitment to placing those with mental health problems into more appropriate community settings. For a long time, there was talk of putting those with mental health difficulties into a community care setting but for many in the early stages of that process, it meant abandonment in the community. Significant progress has been made in this regard. There are no longer acute admissions to the outdated facilities of St. Brendan’s in Grangegorman and St. Senan’s in Enniscorthy and these will be replaced by modern and more appropriate facilities. Work is also due to commence on a new psychiatric unit in Beaumont Hospital and another unit in Clonmel.
International evidence shows that good community-based mental health services are linked with lower suicide rates when compared with traditional hospital-based treatment. Cooperation will be needed, therefore, between the new Minister of State with responsibility for primary care and the Minister of State if we are to make progress in this area.
The issue of placing children in adult psychiatric facilities has been in the press recently. Again, progress has been made in this regard. Work is due to start this year to increase the number of beds in St. Vincent’s Hospital in Fairview and work is already underway on the Linn Dara child and adolescent mental health facility in Cherry Orchard. Bed capacity has increased from 12 beds in 2007 to 52 at present and will reach 58 beds by 2012. The recommendation under A Vision for Change is for 108 adolescent beds but this target is being reconsidered given the emphasis on community-based care. Perhaps the Minister of State can tell us if she is committed to delivering 108 beds as recommended.
As the Chairman of the Oireachtas Committee on Health and Children in the last Dáil, I can say with confidence that the subcommittee on suicide prevention worked extremely well and I am sure the members, Deputy Dan Neville, former Deputy Charlie O’Connor and Senators Mary White and Phil Prendergast would agree with me. There is a strong case to be made for something similar to be set up in the new committee structure which will be announced next week. I call on the Minister of State to ensure a subcommittee on suicide prevention is established under the auspices of the committee on health.
I conclude by praising the work of the voluntary sector in this area. Organisations like Aware, Amnesty, Grow and many more provide an amazing service on the frontline to those suffering from depression and their families. Without them communities and the HSE would be lost. I also commend Deputy Dan Neville, who has championed this cause for many years now and who has ensured that it has remained on the political agenda. The Oireachtas and the country owe Deputy Neville a debt of gratitude for his enormous contribution to the mental health debate and for his work in suicide prevention.
Deputy Caoimhghín Ó Caoláin: Cuirim fáilte roimh an Aire Stáit. By far the greatest tragedies in this economic crisis are the tragedies of people taking their own lives. That is an appalling reality that I have encountered directly. We can never fully answer the question of why individuals choose suicide but I know of cases where financial pressure pushed vulnerable people to the ultimate extreme of suicide.
These personal experiences are borne out by the figures. The Central Statistics Office states that registered deaths from suicide in 2009 reached a record figure of 527, a 24% increase on the previous year. That is a very significant increase. At the end of January this year the Central Statistics Office stated there were 127 deaths from suicide registered in the second quarter of 2010. Of those, 102 were male and 25 female. In the same period in 2009, 122 deaths were registered, 94 male and 28 female.
Geoff Day, Director of the National Office for Suicide Prevention, states in his preface to the office’s 2009 annual report:
International research would indicate that during an economic downturn suicide numbers increase, however, the size of the increase based on the provisional figures is extremely worrying… The impact of the economic downturn in 2008, and particularly in 2009, has led to substantial increases in both self harm and suicide numbers.
Elsewhere it is stated in the annual report:
It seems likely that the increase is primarily a result of the impact of the economic downturn with substantially more people unemployed and suffering from personal debt.
Clearly, the recession is making severe problem even worse but this problem is not, of course, primarily related to recessionary conditions. Greater awareness of the reality of suicide in our society, and initial steps to address it in a more effective way, began at the height of the economic boom. In 2006 the Oireachtas Committee on Health and Children published its report on the high level of suicide in Irish society. The report was especially critical of the state of our mental health services. It pointed out that people with mental illness are known to be at greater risk of death by suicide but “the type of mental health service one can access is a matter of luck”. Those who were members of the committee will remember that sentence. The report went on to say that funding for mental health services is “allocated in a random manner with scant regard for need”. Perhaps most damning of all in the context of suicide the report asserted: “The provision of mental health services for adolescents is high on aspiration but low on action.”
I regret to say that the situation in terms of mental health services has improved little since the publication of that report in 2006. On the other hand much good work has been done in raising awareness of mental health by the HSE and by the Office for Suicide Prevention.
Sinn Féin has identified suicide as a distinct priority area requiring concerted co-operation between Government, the health services, the voluntary sector and communities. Our youth section, Ógra Shinn Féin, has campaigned on this issue and we organised a seminar on suicide in Stormont in 2007 which I attended and addressed. On his own initiative, my colleague, Deputy Aengus Ó Snodaigh, published an information booklet on this issue for distribution in his constituency during the last Dáil.
Sinn Féin has included suicide prevention as a key element in the policy document, Healthcare in an Ireland of Equals, which I published in 2006. Among our key proposals were: to make suicide prevention an area of co-operation under the North-South Ministerial Council to give the issue the strategic co-ordination it requires; to frame and implement a fully resourced, comprehensive all-Ireland suicide prevention strategy, including actions to promote mental health among the general population, delivered through schools, youth services, workplaces and the media; mental health promotion actions targeting specific sections of the population, incorporating their diverse needs into tailored suicide prevention sub-strategies; mental health promotion and suicide prevention actions targeting groups identified as at higher risk of suicide; actions to assist individuals identified as at risk of suicide; actions to assist people who are bereaved through suicide; to invest in further clinical and community-based research on suicide prevention; to develop national mental health awareness and anti-stigma campaigns to help tackle the issue of suicide; and to include parasuicides, people at risk of suicide, families bereaved by suicide and families of people at risk of suicide in policy-making on this issue, that is to say, the widest possible consultation.
We agree with the Joint Committee on Health and Children and its report calling for targets to be set for the reduction of the rates of suicide in the country. Targets help; they focus each and every one of us. I commend the Irish section of Amnesty International on its work on mental health and suicide. In particular, Mr. Barry Johnston has been focused and exercised on this issue in recent years and I commend him personally on his efforts. Amnesty International has played an important role in raising awareness, especially in lobbying for more effective and rights-based mental health legislation and mental health services. As Amnesty International has stated simply and clearly, better mental health services mean fewer people dying by suicide.
More work is needed to target those people in our society most at risk of mental illness and suicide. Sadly, it is a fact that the example I cite relates to lesbian, gay and bisexual people. The Gay and Lesbian Equality Network, GLEN, has stated that despite the progress in Ireland in recent times, lesbian, gay and bisexual people can still experience discrimination, harassment and exclusion in their everyday lives. Many years of research supports the view that a lesbian, gay or bisexual orientation per se is not linked with mental health problems. However, given the stresses created by inequality, marginalisation and harassment, lesbian, gay or bisexual people are at an increased risk of psychological distress because of these experiences. This is often referred to as minority stress, a term used to describe the mental health consequences of stigmatisation, social exclusion, discrimination and harassment of minority groups.
It is important and I have every confidence that the Minister of State in her new role and with her new responsibilities will reflect this area of need of address in all that she will pursue in the time ahead. In our health manifesto, a shortened document on our overall health policy position that I launched in the recent general election, Healthcare in Ireland – There is a Better Way, we called for the following: the development of mental health services on an all-Ireland basis – a proposal I commend to the Minister of State – progressing from increased co-operation to integration of services on the island; improved accountability and transparency in planning and financing mental health service reform; modernised mental health legislation in line with the new Convention on the Rights of Persons with Disabilities; the promotion of cross-departmental action to combat social exclusion, prejudice and discrimination against people with mental health problems; the ring-fencing, in accordance with the World Health Organisation recommendation, of 12% of the annual Department of Health and Children budget for mental health services; the development and promotion of suicide prevention strategies; and the provision of required child and adolescent community-based mental health services and ending the placement of children in adult in-patient facilities. Sadly, as the Minister of State is aware, there are still several of these. Progress has been made in some of these areas and more is promised in the programme for Government. For our part, Sinn Féin will continue to press these demands in the 31st Dáil and as a campaigning party.
Effective community-based mental health care is essential. My constituency of Cavan-Monaghan was the forerunner where the template was developed over many years and those at the helm deserve to be congratulated. There must be continuing care of people with mental illness. Too often, we hear of people treated in hospital emergency departments after incidents of self-harm or even attempted suicide and discharged with no immediate plan for follow-up care. If one gets a gash in one’s leg and receives stitches, one would get an immediate follow-up appointment, yet people with mental illness are too often not regarded as being in need of ongoing monitoring and early follow-up, an issue which must be addressed. The attitudes behind this must change but this will only happen as a result of leadership from Government, all elected voices and our public health services.
The Government review of mental health legislation is especially important. Health legislation should be strengthened to ensure that it is firmly based on the rights of patients to adequate care and that the obligation on public health services to provide care is clear and based firmly on laws and regulations that can be implemented effectively. I urge the Minister and the Minister of State to set out, at an early date, how mental health care fits into the proposed health reform programme of the Government. Elsewhere, I have set out Sinn Féin’s concerns about the many shortcomings of an insurance-based model of health care. I will continue to express concern about the model the current Government appears to be intent on pursuing.
I am especially concerned that mental health, which must be a priority in terms of public health care provision, could be neglected in the model of delivery based on the insurance sector now being contemplated. We must see the Minister’s plans as soon as possible not only in outline form, but at the earliest time in respect of the detail of what is intended. While we will debate these issues and deliberate on the way forward we have an obligation to work together, which we have demonstrated in our collective welcome and declared support for A Vision for Change. Such constructive opposition was demonstrated by all parties, including both parties now in Government. The sane and balanced position which we all took, and which I shared with the current Government, will continue in respect of what the Government does well and right in the interests of health care needs, in particular those of mental health. This will continue to be the disposition that Sinn Féin and I hold. We all have a responsibility and those of us in the Opposition will continue to play a responsible role. We have an obligation as citizens to play our part in raising awareness and in making people at risk aware that they are not alone, that help is available, there is light after darkness and that together we can properly and rightly remove for now and all time the stigma that associates with mental health issues.
I conclude with a quotation from the National Office for Suicide Prevention which states in its declared work programme: “Even in these difficult times our individual and collective efforts will make a difference.”
I hope the Government and Opposition will work together in this House to make a difference and regardless of whatever will separate us on this, which will allow for intense debate, that in the time ahead we will look back on 31st Dáil as a time when real progress was made together on the issue of mental health and real suicide prevention measures.
Acting Chairman (Deputy Joanna Tuffy): The next speaker is Deputy O’Sullivan and I understand she is sharing time with Deputies Luke ‘Ming’ Flanagan and Richard Boyd Barrett. Is that correct?
Deputy Maureen O’Sullivan: Yes.
Acting Chairman (Deputy Joanna Tuffy): Is that agreed? Agreed.
Deputy Maureen O’Sullivan: Dublin’s north inner city has been devastated by the drugs industry and allied to that was and is the number of suicides. It is very significant that some of those are in families who suffered institutional abuse.
I want focus on a particular project and model from the north inner city, the Oasis Deora Counselling Centre in North Wall, which has been to the fore in providing counselling and services for those facing loss through suicide. One of the ways it does this is by providing the ASIST – Applied Suicide Intervention Skills Training – programme, to which the Minister of State referred. This is suicide first aid. What is most significant about this centre and the training it provides is that the training is being given to those working directly in projects with people at risk of suicide.
The emphasis in ASIST training is on helping a person at risk stay safe and seek further help. Those who have done this training learn how to recognise the signs for seeking help and identify people who have thoughts of suicide. They can reach out and offer support, apply a suicide intervention model and then link the person with community resources and other supports. This ASIST training has been evaluated and the evaluations have shown that the workshop increases the caregiver’s knowledge and confidence to respond to a person at risk of suicide. The intervention skills are retained over time and put to use to save lives. In one year this project in six training sessions trained 150 people in the two-day workshop and it also provided a tune-up refresher. In that one year alone it managed 47 clients who were suicidal.
When I chaired the North Inner City Drugs Task Force I had the opportunity of doing the two-day ASIST training course, therefore, I know its value. I also attended the refresher half-day course, which was also attended by youth workers, community project workers and staff from hostels for the homeless. The first question we were asked was how many of us had used the training since we had received it. I was very struck by those workers all saying that they had used on many occasions, thus saving lives.
We have the National Office for Suicide Prevention but I believe the model I have discussed from Oasis Deora has been invaluable because the training is going to those directly involved with vulnerable people at the risk of suicide. They do the training voluntarily. It is not seen as part of their job and they use the training.
I also acknowledge the support from the previous Minister of State, the former Deputy John Moloney, for this project to rollout further training. Some of that training will involve mindfulness-based training, which is a proven technique in managing stress, depression, anxiety, loss and also for relapse prevention for those in recovery from addiction to help in managing cravings. It is training that should be introduced in our prisons.
In terms of the cost of what I have discussed from that one project, the amount of €10,000 annually with Deora enabled ASIST training for 140 to 150 people, including follow-up time and crisis intervention. The amount of €15,000 annually provided training in mindfulness for 150 people who could go on to train others. The amount of €25,000 annually could make such a difference in preventing suicide and we know that suicide is preventable. I stress the value of that project because the training it provides is going to those who are directly working on a daily basis to those who are at risk of suicide.
One in four people in this country experiences a mental health issue but mental health does not get a proportionate amount of the health budget that would acknowledge that. A person can present at an accident and emergency department with a particular physical ailment and he or she might be on a chair or a trolley for a number of days but that person will be seen and will get treatment. However, if a person presents with a self-harm issue, an eating disorder, an overdose or depression, the scenario is very different.
Deputy Richard Boyd Barrett: The incidence of suicide is shocking. There were 5,270 suicides between 1996 and 2006, and that was during the good times. Since the onset of the economic crisis the incidence has dramatically increased, with 527 people taking their own lives in 2009, which is a 25% increase on what is already a shockingly high incidence of suicide. In the second quarter of 2010 there were 127 suicides. It is not an exaggeration to call this a slow massacre of people who are driven to that level of despair that they would take their own lives. Beyond the incidence of suicide there is a huge incidence of self-harm, suicide attempts, all of which have increased dramatically in the past few years.
Every tragic case of suicide, of a person taking his or her own life, has unique and complex factors that often relate to people’s family backgrounds, particular difficulties in their lives, histories of mental health and so on. One cannot always do something about those individual circumstances. One cannot legislate for everything, for all the complexities of human existence. However, all serious analysis shows there are patterns to this and factors which we as a society can influence, which can and do have a tangible effect on the degree of suicide, mental health problems in a society and despair and alienation, essentially that people feel can lead them to these extreme courses of action.
Specifically, all serious analysis shows that we have a disproportionately high incidence of suicide and self-harm among our young people. It shows that there is a strong link between suicide and pre-existing mental health problems and, very importantly, that there is a very strong link between suicide and unemployment. The dramatic increase in suicide and self-harm during the past few years since the onset of the economic crisis bears out that there is a strong link between suicide and unemployment. These are factors we can do something about and given the tragic nature and huge scale of suicide, we have an obligation to prioritise very serious action to change the situation and influence the factors over which our society and us, as elected representatives, have some control.
In this regard, it is clear that cuts kill. It is as simple as that. Social welfare cuts and cuts to invalidity pensions and disability payments all disproportionately hit the vulnerable sectors of our society and those sectors where the incidence of suicide is highest. Recognising that these cuts kill and that we cannot seriously address this problem unless we reverse cuts in areas which affect young people, vulnerable people and the unemployed is a start to our being able to impact on addressing this problem. Health cuts affect people with mental health problems who need our assistance.
In Sallynoggin, a working-class area of my constituency, the local library was recently closed. The library service is being massively affected by the public service recruitment embargo because its staff numbers are being gradually reduced. The first library to go as a result of what is happening was that in Sallynoggin. The library in question was not great in the context of the number of hours for which it opened and the quality of service on offer. However, it did provide a service. The profile of Sallynoggin library was completely different from those of other libraries because young and unemployed people frequented it and used it as a social centre. It was a place where they could go and represented one of the few resources or amenities in the area. As already stated, it was the first library to be closed.
If one does not give young people something to do or a place to go or if one does not provide those who have lost their jobs with the resources to find new employment or educate or upskill themselves, it leads to despair. We campaigned against the closure of Sallynoggin library, stating that it would affect people and cause further alienation in an area which already suffers disproportionately from unemployment, youth alienation and other problems.
There has been a 15% cut in the funding available to family resource centres. One of the consequences of that is that the, albeit inadequate, service whereby psychiatrists are present in such centres for a few hours each week has been adversely affected. Family resource centres should be the first port of call for those who are in despair, who are suffering or who are developing suicidal tendencies. These people should have access to a facility close by where they can obtain counselling. However, the funding for such facilities is being cut. I wonder whether the Government intends to reverse these cuts.
Consideration should be given to the group which comprises taxi drivers. There have been some 34 suicides in recent years among taxi drivers and these were directly attributable to the disastrous policy of deregulating taxis. As a result of that policy, there are now more taxis in the city of Dublin than there are in New York city. This was the madness of the process of deregulation introduced by the then Minister, Mary Harney who, ironically, later became Minister for Health and Children. Are we going to regulate the taxi profession in such a way as to ensure that taxi drivers will not feel such despair that they will be prompted to take their own lives?
We need to reverse the cuts that affect the vulnerable in society. In addition, we must prioritise job creation. There is a need for immediate and dramatic action to create jobs – rather than worrying so much about bailing out banks – if we are going to deal with the social problems and alienation that lead to such despair that people consider taking their own lives.
Deputy Finian McGrath: I welcome the opportunity to speak in this extremely important debate. I commend the Minister of State, Deputy Kathleen Lynch, and Deputy Neville on the work they have done in respect of this issue in recent years. That fact that this matter is on today’s agenda makes an important statement to the effect that the Government takes this issue very seriously. As an Independent Deputy, I will be giving strong support to any measures that are introduced. I will also give such support to most of the proposals contained in A Vision for Change.
We must all face up to the fact that there is a major crisis in this country in the context of mental health and suicide. The latter is a growing problem, with over 400 deaths per year. Suicide rates have increased by 24% and the rates of self harm by 11% in recent years. When discussing issues of this nature it is important to reflect on the fact that people who are contemplating committing suicide are suffering and need our support.
I would like the Government to create a dedicated executive position within the HSE and that the individual appointed to such a position would be responsible for implementing A Vision for Change. The lead-in this regard should be provided by a director of mental health services with executive powers.
It is important that we should enact legislation to assist those with mental health issues and people with intellectual disabilities. There is a strong link between mental health issues and suicide. Many of the responsibilities of the state with regard to mental health equally relate to suicide prevention. I strongly support the adoption of a human rights-based approach which would require the State to provide mental health services that are accessible, acceptable and of good quality in order to ensure that those at risk of or experiencing mental health problems will have access to the underlying social determinants of good mental health, such as education, housing, employment and welfare. These are key aspects to be considered when dealing with this matter. Meeting the criteria to which I refer would also meet the Government’s objective to reduce suicide rates.
Recent evidence suggests that the problem of suicide in Ireland is becoming worse. However, suicide is preventable. This is the key matter in respect of which all Members should unite. The programme for Government contains a proposal on this matter and I am sure there is cross-party support for it. As an Independent Member, I will be strongly supportive of the policies that are being implemented. However, I will also monitor the progress the Government is making in the context of their implementation. The changes that are being introduced are important and need to be brought into play as a matter of urgency. I do not want to hear anyone whinging or moaning about the costs involved. These are important issues and money is being spent on other projects. There is no reason why the matter before us for discussion should not be made a priority.
Deputy Dan Neville: I welcome the opportunity to contribute to this debate. I wish the new Minister of State every success. She deserves the full support of Members on all sides and I am sure she will receive it. I hope the Government will support her by providing the resources she will require to reform our mental health services and to deal with matters such as suicide prevention, suicide research and suicide postvention. Each of the three aspects of suicide to which I refer are extremely important. We often concentrate on prevention but it is important to carry out research to discover why people are driven to commit suicide. In addition, postvention is vital in the context of dealing with the difficulties experienced by those who are bereaved as a result of a loved one or friend dying as a result of suicide. Prevention is vital but the other two aspects are almost equally important. In the context of postvention, we must ensure we have in place the support services necessary to deal with the unique bereavement experience of the families and frief those who die as a result of suicide.
We must be careful with regard to the language we use. For a long period we have asked people not to use the words “commit suicide”. There is no other way one dies which is referred to by use of the word “commit”. Suicide was a crime up to 1993. I do not know if it ever was a sin but it is neither a crime nor a sin now. The language we use in respect of suicide is extremely important.
It is enormously difficult and stressful for families, friends and communities to face up to the tragedy of suicide. In almost all cases, the suicide of a person will not only evoke among their friends and family members the normal emotions associated with bereavement but also many other complex emotions such as anger and confusion. People also ask unanswerable questions as to why it happened and should they have known.
In the first half of the 1960s, an average of 64 people died by suicide each year. The most recent statistics indicate that 527 people took their lives in 2009. Of these, 422 were male and 105 were female. The figure for 2009 represents an increase of 24% over that for 2008. It is accepted that the level of suicide remains under-reported. Experts estimate that in excess of 600 people died by suicide in 2009. In fact, in that year there were over 190 deaths in which coroners were unable to determine the cause of death. In other countries, such deaths are often included with the statistics for suicide. Experts in this country believe that at least 40% of deaths which remain undetermined are suicides. The figure in this regard is unacceptable.
Last year 212 people died on the roads. Of course, the figure for the level of road accidents is still far too high. The suicide figure of 600 is also too high. Suicide is now the most common cause of death among 15 to 24 year olds in Ireland and a disturbing feature is the level of male suicide, which accounts for 80% of all deaths in that age group. Ireland has the fourth highest rate of youth suicide in Europe.
Research dating back to the 1890s demonstrates that the incidence of suicide or mental illness increases at times of recession and that suicide is linked with financial difficulties. It should not come as a surprise, therefore, to learn that we are continuing to see higher stress, suicide and mental illness levels in the current economic climate. The potential psychological impact of the economic recession on public health is severe. Persons who are unemployed are three times more likely to die by suicide than those in employment. The high rate is partly due to the fact that people with a psychiatric illness are at greater risk of losing their jobs. There is a close association between unemployment and suicide. However, even among individuals with no record of serious illness, unemployment is associated with a 70% greater risk of suicide.
Among the factors in other countries that have been found to correlate highly with the suicide rate are an increase in indictable crime, alcoholism, births to single mothers and the rate of marriage breakdown. This can be taken as representing a lack of integration or cohesiveness within society. Let us examine this aspect in an Irish context. The numbers of unmarried mothers show an increase in each successive year since 1970. In early 2009 some 24,500 children, or 33% of the total, were born to single parents. In each year since 1995 there has been an increase in the incidence of alcoholism, as measured by the numbers of admissions to hospitals for the disease. In 1970 the marriage rate was 704 per 100,000, while in 2009 it was 480 per 100,000. The number of separated and divorced persons has increased considerably in recent years. These four measures – the rates of births outside marriage, the crime rate, alcoholism and the insecurity of marriage – confirm international figures in an Irish context. This does not offer a cause of suicide but suggests the same factors that lead to these changes are influencing rates of suicide.
The changed social and economic environment in Ireland requires us to re-evaluate and prioritise the actions for suicide prevention to respond to the current tough economic circumstances. The Irish Association of Suicidology, of which I am a co-founder and the current president, has set out priorities for the prevention of suicide and deliberate self-harm. We recommend: the provision of training agencies to work with people who are unemployed and experiencing financial hardship; guidelines for the assessment and aftercare of deliberate self-harm presentations to emergency departments and the national roll-out of self-harm awareness training programmes; expanding suicide support and information systems to support families and communities affected by suicide; an accreditation process for voluntary and community organisations involved in suicide prevention, intervention and postvention; developing protocols to address the issue of access to minor tranquilisers; and publishing a revised edition of the 2002 suicide prevention in schools best practice guidelines.
The association gave a comprehensive document on these issues to the former Minister of State, Mr. John Moloney, in November. Time does not allow me to expand on this matter, but we will forward a copy of the document to the Minister. It is available in her Department. I commend the former Minister of State whose heart was in the right place and who worked very hard with all those who contributed to his work as Minister of State with responsibility for mental health and suicide matters. I found him to be extremely progressive. Many of his objectives were hindered by a lack of resources, which was frustrating.
In 2009 there were 11,966 presentations to hospitals due to deliberate self-harm. This was a significant increase of 5% on the level in 2008 and the third successive annual increase in the national rate of hospital treatments for deliberate self-harm. International and Irish experts estimate that for each self-harm presentation at an accident and emergency department there are several others who do not present. In fact, it is estimated that there are seven others for each person who presents at a hospital. Some are dealt with by their general practitioner, some do not seek help and some do not even inform their families that they have self-harmed. Therefore, the level of attempted suicide and deliberate self-harm in Ireland is in the region of 80,000 people per annum. Consistent with previous years, self-harm presentations in 2009 were largely confined to younger age groups. Some 45% were people under 35 years of age. As in previous years, the peak rate for women was in the 15 to 19 age group, while the peak rate for men was in the 20 to 24 age group. There is an urgent need to develop crisis counselling intervention measures in accident and emergency departments to tackle this issue.
The Fine Gael and Labour Party programme for Government outlines the Government’s policy on mental health and suicide, which I warmly welcome. The programme states:
Our policy on mental health incorporates the recommendations of A Vision for Change. We are committed to reducing the stigma of mental illness and ensuring early and appropriate intervention and vastly improving access to modern mental health services in the community.
We will ring-fence €35 million annually from within the health budget to develop community and mental health teams and services outlined in A Vision for Change, to ensure early access to more appropriate services for adults and children and improve integration with primary care services. Part of the ring-fenced funding will be used to implement Reach Out, the national suicide prevention strategy to reduce the level of suicide.
The programme for Government has specifically committed resources for suicide prevention programmes. The Fine Gael policy which was unanimously agreed by the Fine Gael Front Bench and parliamentary party in January committed the party to increase resources for the National Suicide Prevention Office to €10 million during the lifetime of the Government from the current figure of €4.2 million referred to by the Minister. I ask the Minister to confirm that the mental health programme specifically includes the increase in the budget for the National Suicide Prevention Office to €10 million during the lifetime of the Government. Fine Gael gave this vote of confidence to the National Suicide Prevention Office to ensure it would develop its work within the HSE and its relationship with non-governmental organisations. I do not say there is any suggestion this will not happen, but I would like to hear the Minister confirm that it will be the case.
There is a need to regulate the activity and professionalism of practitioners involved in psychotherapy and counselling services. There is an urgent need to ensure those who offer services in this area have a level of competency and have completed professional training to an accepted defined level. Those who practise in the area of psychotherapy and counselling need only obtain an office for consultation and put up a brass plate at the entrance.
It is also unacceptable that organisations are advertising a range of short courses and are granting advanced diplomas when in most cases there is no basic qualification required to enter such a course. Individuals then set up as professional counsellors to vulnerable people, many of whom will suffer from extremely complex conditions, with emotional, psychological, psychiatric and physical health conditions. This is a very serious situation which must be tackled.
Last December I introduced a Private Members’ Bill on this issue, the Health and Social Care Professionals (Amendment) Bill. I was disappointed that it was not included in the programme for Government and I ask for the Minister of State’s comments.
I compliment the voluntary sector, as have previous speakers. I refer to the National Suicide Regional Research Foundation based in Cork which does excellent work and bodies such as Aware and Grow, Amnesty and Pieta House. The directors of Pieta House are present in the Chamber and in the Visitors Gallery. I know Pieta House very well and it is a model for other places. If I may be parochial and welcome them to Limerick because their work on dealing with those who are extremely suicidal is highly professional and is a model. Assistance in developing the services in other regions of the country would be very welcome. I wish the Minister of State well in her role.
Deputy Robert Troy: I wish to share time with Deputy Charlie McConalogue. Although this is not my maiden speech, at the time I omitted to take the opportunity to thank the people of Longford-Westmeath for putting their faith and trust in me and my three colleagues who were elected to represent the constituency four weeks ago. I put on record my sincere gratitude to the people of Longford-Westmeath for electing me to Dáil Éireann.
As a person who has actively promoted the issue of suicide awareness in my own community over the past number of years, I welcome the opportunity to make a statement on this very serious topic. I compliment the former Minister of State, John Moloney, for his commitment to this cause and Deputy Dan Neville for the work he has done to date. I also wish the new Minister of State well.
Recent evidence indicates that the number of people who die by suicide has risen in the past number of years. In 2009 there were 527 registered deaths by suicide which was an increase of over 24% on 2008. In my opinion, the figure is not totally accurate as I believe a more realistic figure is higher as there are a number of deaths that are not as easily attributable to suicide, for instance, single car collisions, which are not included in the official figures. Suicide is more prevalent among males than females and again the official figures indicate that in 2007 it was in the region of four to one, increasing to 6.4 to one for males aged between 20-24 years.
While I welcome the commitment in the programme for Government to treat this issue as a priority, collectively as citizens we too can play a major role in keeping this issue in the public domain. For far too long there was an awful stigma attached to people who suffered from a mental illness and people were reluctant to speak about family members who suffered from a mental illness. We have all heard of psychiatric hospitals been referred to as lunatic asylums. This is very wrong. Psychiatric illness is an illness the very same as a physical illness and which needs specialist care. The national stigma reduction campaign, See Change, should continue in 2011. The aim of See Change is to change positively social attitudes and behaviour, to inspire people to challenge their beliefs about mental illness and to be more open in their attitudes and behaviour and to encourage people in distress to seek help.
Recently in conjunction with Josephine Rigney of the HSE, I organised an ASIST, applied suicide intervention skills training, course in Mullingar. This is a two-day interactive workshop in suicide first aid and is suitable for all care givers, health workers, teachers, community workers, gardaí, youth workers, volunteers and people responding to family, friends and co-workers. Most people thinking about suicide signal and share their pain and they offer us opportunities to respond. This training can help participants to be more vigilant to a situation and enables participants to respond to invitations for help. It can also increase our confidence to ask about suicide when someone’s safety may be in the balance. If someone is at risk, suicide first aid prepares us to work with them to increase their immediate safety and get further help. It is a very worthwhile course and I encourage people to consider it. In my view, it should be compulsory for people who are actively working with the most vulnerable groups. Other courses are organised by the HSE through the National Office for Suicide Prevention and like the ASIST course I encourage people to participate in these courses.
Of course this issue will not be solved by people on their own and there is an urgent need for Government to increase funding to the National Office for Suicide Prevention. Last year the previous Government increased funding by €1 million. However, the funding level is still too low as it is far below what is allocated to road safety. While I do not deny the need for funding for road safety, we have seen the benefits of increased funding over the past number of years leading to a reduction in the number of deaths on the road. The fact is that more people die by suicide every year than on our roads, twice as much, if not more. It is imperative that extra funding is allocated to the National Office for Suicide Prevention.
I recently attended a presentation by Dr. Harry Barry, a general practitioner who has almost 35 years’ experience as a medical doctor. He has a long-standing interest in mental health, in particular, in improving our understanding of the role of neuroscience in both the cause and the treatment of the main mental health illnesses such as major depression, anxiety disorders, addiction and suicide. He spoke about the logical and emotional brain; the stress system and its role in causing acute and chronic stress in the body and the crucial link between chronic stress and major depression. The main stressors in modern Ireland most likely to lead to suicide include unemployment, financial pressures, housing problems, alcohol or drug abuse, bullying etc.
There are three stages in brain development: the developing brain, the mature brain and the ageing brain. The developing brain is in those under 30 years of age, the category most at risk. The particular issues facing young men which put them most at risk include unemployment, loss of self esteem, bullying, drugs, sexual identity, relationship problems and alcohol misuse. The stress created by these issues is so toxic to men and so often it is tragically interlinked with alcohol.
International evidence shows that good community-based mental health services are linked with lower suicide rates, compared with traditional hospital-based treatments. Therefore, it is important to continue with the implementation of the strategy A Vision for Change. Amnesty International recommends making amendments to the Health Act 2004 and the Mental Health Act 2001 and perhaps this could be considered by this House.
Not everyone who is contemplating suicide needs psychiatric care. There needs to be centres that people can attend without fear of stigma and where they will be treated immediately and effectively. Pieta House, based in Lucan, is a good example. The Centre for the Prevention of Self-Harm or Suicide was officially opened in January 2006. In the past five years it has helped over 3,000 people and opened two outreach centres and two other centres of excellence in Dublin and Limerick.
MABS provides another very important service in this economic climate but its service is limited to dealing with personal debt rather than business debt.
A service should be established to assist business people by providing them with a plan to address their debts. The Department of Social Protection should immediately introduce a scheme to assist the thousands of self-employed people who have lost their jobs and are not entitled to a social welfare payment. This is causing undue financial and mental pressures on thousands of families. The introduction of a social welfare scheme to support unemployed sole traders would help address this problem immediately.
Many groups, both voluntary and State sponsored, are providing invaluable assistance to people who are contemplating suicide. The Government should promote specific cross-departmental action on mental health. Departments with responsibility for social welfare, education, employment and housing should indicate how they will implement A Vision for Change and one person should be made responsible for all co-ordination.
Deputy Charlie McConalogue: It is important that Dáil Éireann takes time to address suicide by facilitating Members to make a contribution on policy surrounding the issue. That time has been provided to discuss suicide is indicative of the time and profile required to address the issue at all levels of society with a view to removing the age old stigma attached to mental health and suicide which contributes to higher suicide rates in Ireland.
Mental health has still not been given the priority it deserves in society. Too often, people do not pay sufficient attention to their personal mental health and well being. The brain is the most complex and important organ in the human body but it is hidden and the symptoms of health problems associated with it are not as obvious as visible physical injuries. For this reason, mental health has not been given sufficient attention except when expressed in advanced symptoms, often following a failure to address a mental health problem at an earlier stage.
Unfortunately, suicide numbers in Ireland are stark. In 2009, there were 527 deaths by suicide, an increase of 24% on the previous year. These figures show the enormity of the issue facing us. The National Office for Suicide Prevention has linked the increase in suicide incidence to the deteriorating economy and resultant stresses. Deputies will have little difficulty accepting that this is the case given our personal experience of observing how hard times and high unemployment have brought a range of new pressures to bear on members of the public.
The suicide rate is the tip of an iceberg as mental health problems cause many more layers of suffering. In 2009, some 11,966 incidents of deliberate self-harm were recorded, a 5.5% increase on 2008. Under this layer of self-harm lies a further layer of daily suffering experienced by thousands of people with various degrees of mental health problems. We must tackle suicide and mental health in two ways.
We must increase public awareness of the importance of active management of personal mental health and provide adequate and well resourced mental health care facilities in our communities and hospitals. To address the issue of awareness, the former Minister of State at the Department of Health and Children, Mr. John Moloney, introduced a national stigma reduction campaign known as See Change. Having known the former Minister of State for some years, I commend his contribution on this issue and his decision to use personal experience to help ensure people take responsibility for their mental health.
The aim of See Change is to positively change social attitudes and behaviour, inspire people to challenge their beliefs about mental illness, be more open in their attitudes and behaviour and encourage people in distress to seek help. A network of national and local organisations is promoting the anti-stigma message through local broadcasts and print media and a range of other activities. I have seen the impact the campaign has had in north County Donegal where local groups have used local people to front activities aimed at getting the message across in local communities.
To address the issue of improving mental health services for members of the public the previous Fianna Fáil Party-Green Party Government established the Office for Mental Health and Disability. Special consideration was given in the most recent budget to the mental health and disability sectors, which experienced a smaller reduction in funding – less than 2% for 2011 – than other sectors.
The previous Government also introduced the policy document, A Vision for Change, with a projected investment of more than €150 million over seven to ten years. Development funding totalling €54 million has been allocated to the Health Service Executive since the launch of the report in 2006. To further the implementation of A Vision for Change the 2010 employment control framework for the health service provided an exemption from the moratorium on recruitment and allowed 100 psychiatric posts to be filled by nurses or therapists. While implementation of the strategy has been much slower than originally anticipated, progress has been made, including shorter episodes of inpatient care, improvements in child and adolescent mental health services, fewer involuntary admissions and the involvement of service users in all aspects of mental health policy, service planning and delivery.
The same proactive interventions made to try to catch public attention in the area of road safety should be adopted in our efforts to address suicide and mental health.
Deputy Dominic Hannigan: I wish to share time with Deputy Derek Keating.
I thank the voters of Meath East for placing their trust in me. It is with great honour that I take a seat in this Chamber to represent them. I congratulate the Minister of State, Deputy Kathleen Lynch, on her appointment and wish her every success in her role.
In 2009, some 529 lives were torn apart by suicide in 2009, an increase of 24% on the previous year. Trends for 2010 indicate the figure will increase again. These are only the recorded numbers and unofficial numbers are likely to be higher still. The sad reality is that there are many reasons a person takes his or her life. Each of these reasons deserves to be debated and a solution found in order that when people find themselves in a dark place, they will know they are not alone.
I will focus on two specific areas associated with the causes of suicide, namely, the recession and homophobic bullying. According to the National Office of Suicide Prevention, international research indicates that suicide numbers increase during an economic downturn. During the election campaign, I met people on a daily basis who were deeply concerned about their personal sense of worth in the Ireland in which we find ourselves. This was particularly the case for some younger families who had bought a house and car and had children before the crippling effects of the downturn began. It was especially the case for those who started their own business, took on debts beyond households debts and subsequently lost everything.
Throughout the campaign I listened to elderly parents who were worried about the effects of the recession on the state of mind of their grown-up children. A few short years previously, the same parents had watched with pride as their children set up businesses or invested to provide for their families’ future. With the recession, their children have lost everything and the parents worry about their sense of hopelessness. The question they posed to us was how we could help them out of that dark place.
We must do more for the people affected by offering them hope that they will emerge from despair. Suicide prevention is not only the responsibility of the Department of Health and Children or Health Service Executive; it is about every Department working together to give opportunities to people again.
I suggest that the Departments of Education and Skills, Enterprise, Jobs and Innovation and Finance should play key roles in providing such opportunities to people. We need to give people financial independence through job creation and educational prospects. In that context, I was delighted to hear the Tánaiste announce yesterday that the jobs budget will take place next month. The types of programmes that will be put in place as a result of the mini-budget will help people to regain a sense of worth and ownership over their lives.
I would like to speak about the effect that bullying in our schools is having on the mental health of our teenagers. We are all aware of high-profile cases in the media of teenagers who have sadly taken their own lives because of bullying in and out of our schools. Last Thursday, I was asked to launch officially an anti-homophobic bullying campaign, “Stand Up”, which is run by Belong To, an organisation with a long history of work with young gay teenagers in Ireland. Research from the National Office for Suicide Prevention shows the devastating effect homophobic bullying can have on a young person. It tells us that three out of five gay young people are bullied at school, half of all gay young people have seriously thought of ending their lives, a quarter of them have self-harmed at least once and one in five of them has attempted suicide. All of this is due to homophobic bullying.
The idea underpinning the “Stand Up” campaign is simple. It encourages teenagers and teachers to stand up for their gay friends and pupils. Some 1,600 resource packs have been sent to schools and youth clubs across the country. One of the difficulties with any awareness campaign is communicating to young people in a language they understand. This is one of the reasons a video, featuring a group of young people, has been produced as part of the resource packs. The video was posted on YouTube last weekend and has been viewed by 250,000 people to date, a phenomenal achievement and a credit to the team behind it. The video features the story of a young person who is being bullied and his reaction to the bullying. His isolation in the classrooms and hallways of the school is shown vividly, until it is broken by his friends gathering around him and creating an environment of support and respect. The “Stand Up” campaign is about creating an environment of empowerment so everyone can fulfil his or her potential in school and beyond.
Belong To is just one example of an organisation that is trying to make a difference in our schools. We need to develop further strategies to combat bullying in our schools. With this in mind, I am pleased there is a commitment in the programme for Government to “encourage schools to develop anti-bullying policies and in particular, strategies to combat homophobic bullying to support students”. Strategies that help to confront bullying will reduce the incidence of young people being driven to feel that ending their lives is their only option. We need to work across all Departments to ensure we provide opportunities to people through jobs, education or support so they do not find themselves in a dark place, alone, without an answer or without hope. I intend to work closely with the Minister of State, Deputy Kathleen Lynch, on this issue. I will provide any support I can to reduce the scourge of suicide in Ireland.
Deputy Derek Keating: I thank Deputy Hannigan for sharing time. As this is the first opportunity I have had to speak since I was elected to the 31st Dáil, I would like to thank everyone who helped me to reach this point in my life – my family, my close friends and my party. In a special way, I thank the people of Dublin Mid-West and express my sincere gratitude to them for sending me to this House as a Teachta Dála.
In the early days of this Dáil, we have focused our attention on the economy, the national debt, the banks, emigration and unemployment. One of the hidden effects of our failing economic circumstances is the growing problem of suicide. The issues of suicide and self-harm are of great importance. I place the social crisis of suicide alongside the national crisis that is our economic future. My personal and political belief is that for the first time in our history, we are preparing to confront directly the issue of suicide in Ireland. Previously, we were not even prepared to talk about suicide. Perhaps as a result of the stigma associated with suicide and the message of failure, we were happier to skirt around the edges. I have seen expensive advertisements relating to issues like food safety and health promotion. It has often struck me that we make little or no effort to advertise suicide prevention, even though hundreds of necessary lives are being lost unnecessarily through suicide each year.
I suggest we need to consider the economic impact of a single suicide. We should think about the many people, including members of immediate and extended families, work colleagues, social friends and neighbours, who are affected by each suicide. We should consider the impact on our economy of the deaths of thousands of people by suicide over recent years. The cost of suicide has been estimated to be €900 million per annum. Suicide is hurting us more than ever. The number of cases of suicide is increasing and anxiety is rising. Suicide is casting a shadow at national level. At local level, it is piercing the heart of every community and parish. Other countries, including Australia, Scotland and England, are tackling youth suicide successfully.
Projects like Pieta House, which has been mentioned, are making remarkable strides at local level. Those involved have a vision for a better future and a determination to save more of the lives of the most vulnerable people in our society. As a proud director of the Pieta House charity, I welcome its chief executive, Joan Freeman, its chairman, Joe Houghton, and his wife, Penny, to the Dáil. I ask Members to imagine what would happen if Pieta House did not exist. Almost 4,000 people have visited Pieta House in its five-year existence – they would be forever in darkness if the charity’s services were not available. The good news is that almost 4,000 people are alive today having been to Pieta House. This is a brand, or new model, that works. It focuses its services on the crucial area of intervention. It is a new concept of care. People from all walks of life and all corners of Ireland visit Pieta House every day. The youngest visitor to date was six and the oldest was 83.
As we move forward with a new brand of vision and belief, in the interests of sustaining a healthier Ireland, it is of critical importance that a suicide crisis centre be available no more than 100 km from any citizen. I look forward to taking on that challenge during my time as a Deputy. I will work with the Government and the Opposition and share the journey with my constituency colleagues – the Minister, Deputy Fitzgerald, Deputy Tuffy and Deputy Dowds. The Taoiseach made a powerful statement when he ended the pre-election party leaders’ debate by speaking about the subject of suicide. He spoke again about the issue in a compassionate and determined manner last week. I am pleased that the matter is being debated at length at this early stage of the 31st Dáil. I understand additional time will be allocated next week.
There are almost 430,000 people on the live register. More than 2,000 people, most of whom are young, are being forced to emigrate each week. We have more than one national emergency. As Deputies, we can be smothered with statistics but we must not lose sight of the fact that the individual experiences of people can change actual lives and often do so. I had such an experience when I was canvassing outside Clondalkin parish church one Sunday during the general election campaign. I noticed a lady who made sure she avoided me by passing me without making eye contact or speaking. My life-changing experience happened later that day, when the lady in question, Margaret, returned to tell me her story. When Margaret goes to bed every night, she wishes that God had taken her. She has no money and no heat. I am aware that she went to bed early on Christmas day because she did not have heat. It is important for me to maintain contact with Margaret. It is of critical importance that, as a Dáil and as a society, we care for those who are most at risk
I reiterate my promise to do all I can to work with my Dáil colleagues in the interests of suicide prevention. I acknowledge the work of the Minister and Deputy Neville.
I look forward to playing my part in doing all I can to save the lives of those most at risk. If, by the end of this Dáil, I have achieved nothing more than that, I will be satisfied.
An Ceann Comhairle: I congratulate Deputies Hannigan and Keating on their maiden speeches.
Deputy Gerry Adams: Tá mé fíor-bhuíoch dóibh siúd a chuir an t-ábhar tábhachtach seo ar an chlár inniu. Tá an Teachta Dan Neville ag déanamh sár obair ar an ábhar seo le blianta anuas agus táimid buíoch dó. Mar adúirt cainteoirí eile, bhí ardú sa mhéad daoine a chuir lámh ina bás féin an bhliain seo caite, suas le 500 duine sa Stát seo agus suas le 300 eile sna Sé Contae. Ciallaíonn sin go bhfuair suas le 800 duine bás trí féinmharú agus go ndearna mílte eile díobháil dóibh féin. Is géarchéim náisiúnta uile Éireannach í seo. Tréaslaím go háirithe leis an Teachta Neville as an obair atá déanta aige agus tréaslaím fosta le teaghlaigh agus tuismitheoirí na daoine a fuair bás agus leis na scoileanna, múinteoirí agus daoine ag obair sna seirbhísí sláinte as an obair atá déanta acu go dtí seo.
One of the first groups which asked to meet me when I became a Deputy was PIPS, the Public Initiative for the Prevention of Suicide and Self Harm, which is based in Dundalk. I was conscious of this group because it was begun in north Belfast by a friend of mine whose young son took his own life. It is a voluntary organisation which was established in 2008 and publicly launched in 2009. It seeks, like many other voluntary organisations, to save lives and support those affected by suicide and self harm, and also to raise awareness about suicide. It works with bereaved families and provides crisis intervention. I commend all such groups across the island who work on this issue.
The issue of suicide was brought home to me very clearly. I was walking on the Falls Road when a woman called me into her home. She told me her son, who had been subjected to sex abuse, had attempted to take his own life a few times. I went in and talked to the young fellow. I listened to what he had to say and later went back to see him and provided him with some books. I tried to be a friend and to point out the futility of suicide, his responsibility to his siblings and so on, all in a very gentle and, I hope, helpful way. However, like everybody else here, I was very busy. One day, this young man met the perpetrator in the street and went home and killed himself. I went to the wake house and felt in some way that I had not done enough, that this was in some way something lacking in me, that I should have spent more time or found the space. It brought home to me how a parent, a partner or a sibling must feel that they did not spot the signs, did not know or did not do enough, and that this happened without any warning. Apart from the lives lost, there is the huge trauma for a family of guilt and the feeling they are in some way responsible.
To give some statistics, it is estimated a greater number of people have lost their lives through suicide than is recorded in the official statistics, which do not even deal with attempted suicides. There are numerous stories of people who try to take their own lives and fail to do so, and who do not then get proper help, even though they are brought to a hospital, a doctor or some professional. If a person goes in with a broken leg or concussion, he or she will be given another appointment and somebody will have the person’s details and check on him or her. However, if the person goes in with a mental problem, that type of connection is not made. A person who I will not name but who has done wonderful work on this issue once told me suicide is not a political priority because there are no votes in it. If that is true, it is a huge indictment of all of us.
We organised a number of conferences in the North, which Deputy Dan Neville kindly attended to speak and give us the benefit of his wisdom. To return to PIPS and County Louth, the Louth county coroner recently said that more people are dying in his area of responsibility as a result of suicide than of car accidents. We have often used the example of the campaign for safer driving – which includes heavy advertising, consciousness raising efforts, the promotion of safer driving, change of regulations and so on, quite rightly – and then contrasted that with the lack of a similar approach to an issue which is costing more lives than are lost on our roads.
A few months ago, there was a surge of suicides of very young people in west Belfast. It is a very tight community there, and they came together and sought to work together. I invited the Deputy First Minister to the area and, together, we met young people and bereaved families, and he invited them to meet him at Stormont to explore suicide prevention strategies. I mention this because I tried to get the same approach here from the former Minister for Health and Children, Ms Mary Harney, and she would not even meet on the issue. We must consider the hurt of those who are directly affected. When suicide happens in a community just as I have described, the fear grips everybody – every big brother, big sister, parent and grandparent – and they ask whether their child or family member will be next.
While suicide is now better understood, there is still the awful phrase “committing suicide”. In the past, a suicide victim in the Catholic Church’s protocol could not be buried on consecrated ground but all of that is now gone. Nonetheless, bereaved families resent the use of the term “committed suicide”, which suggests the person had committed a sin – I say this as a consciousness raising effort. Rather, it is “taking a life through suicide” or “taking your own life”. In Irish, the term “committing suicide” is never used and “taking your own life” is always used.
While the issue is now better understood and there is more compassion, there is not sufficient funding in this regard. I appreciate this debate taking place today. I thank the Minister of State, Deputy Kathleen Lynch, for that, and Deputy Finian McGrath , who raised this issue last week, is also to be commended. There is a need for more funding and for an all-island approach. In the North, there is a suicide prevention strategy implementation body, which I commend to the Minister of State, and there is also a regional strategy and an executive sub-group. While the resources are inadequate there also, they are ring-fenced. Here, there is the National Office for Suicide Prevention and the strategy. However, funding in both states on mental health and suicide prevention is inadequate given the scale of the crisis.
I referred to road safety and it is quite right the Road Safety Authority is undertaking all of its campaigning. It receives €40 million a year, which is eight times what is provided for suicide prevention. Mental health provision remains the Cinderella of our health services. All of this must change.
We need an all-island suicide prevention agency, with the health authorities North and South working with other bodies and voluntary and community groups to put together effective strategies. We must have effective remedies backed up by dedicated funding and resources. Such an initiative must also be cross-departmental as it incorporates the remit of various Ministers. The North-South Ministerial Council, or a body arising out of it which is answerable to both Ministers for Health, could make a significant impact in dealing with this. As another speaker observed, other states have brought forward successful strategies to deal with this awful blight.
In 2008, 420 people in this State were reported as having died by suicide. In the same year in the North, 282 suicides occurred. Last year 500 people died through suicide in this State and approximately 300 in the North. That is a total of 800, bearing in mind there may be under-reporting. Suicide is predominantly a male problem with the highest rates occurring among young men aged 18 to 24 years. The figure is also very high for men aged 60 to 64 years. For reasons we do not understand rates of suicide among women never exceed 9.5%, with that rate occurring among women aged between 50 and 54 years. In all cases the effect of suicide on families, friends and communities is absolutely devastating.
Self-harm is also an issue of great concern. Many GPs are not trained in dealing with mental health issues such as depression. Patients who present at hospitals with self-inflected injuries are often released without intervention even though it is frequently the case that people succeed in taking their own lives only after a period of self-harming.
Tá plean gníomhaíochta uile-oileán ann ag an Chomhairle Aireacht Thuaidh/Theas agus, ar mhaithe le daoine óga go háirithe, tá sé práinneach go ndéanfar obair ar bhonn náisiúnta, trasteorann Tá sé níos práinní anois ná mar a bhí riamh go n-oibreoidh nRanna anseo leis na Ranna ó Thuaidh.
Professor Kevin Malone of the school of medicine and medical science in UCD and St. Vincent’s University Hospital recently gave evidence on suicide to the Oireachtas Joint Committee on Health and Children. He reported that the incidence of suicide is significantly higher than the official statistics suggest. There must be follow-up on this finding; to resolve a problem we need to knows its depth.
I commend all the groups working with those bereaved by suicide and to prevent the incidence of suicide. I mentioned PIPS because it is the organisation with which I am most familiar; many others also do important work. In almost every community one will find good people trying to deal with this problem, raising consciousness of the issue and intervening in emergencies. Many people would fall through the cracks if not for the work of these groups.
I agree with other speakers that the incidence of suicide may increase as the economic recession bites and people become distressed and desperate. However, let us put this in context – suicide rates reached unprecedented levels at the height of the Celtic tiger. This may be a warning that the situation could get worse, but it also lets us know there are causes other than economic distress.
Tá mé buíoch den Aire Stáit as an ábhar seo a chur ar an chlár oibre inniu. This is an important debate but what is vital is that we deliver, in a measurable way, for the people affected by this issue. We must prove not only that we care but that we can bring forward strategies to deal with it.
Deputy Andrew Doyle: I thank the Government for making time available for a discussion of this sensitive and disturbing issue which affects all strands of society, different communities and the families therein. For many years suicide, mental illness and mental health issues were not prioritised by Government. The road to hell is paved with good intentions. Many people wanted to do the right thing but, when priorities came to be decided upon, strategies to deal with mental health issues and suicide were put on the back foot.
The statistics speak for themselves in terms of the extent of the problem for our society. We must get the message across that such a high incidence of suicide is unacceptable and that suicide is preventable. The National Office for Suicide Prevention is to be commended on the work it does on a limited budget. It has a fraction of the resources of the Road Safety Authority, for example, even though the statistics for accredited deaths in road deaths are very similar, if not slightly lower, than those by suicide. With limited resources the National Office for Suicide Prevention and, to some extent, the Health Service Executive are doing worthwhile work.
Several fundamentals must be taken on board in terms of how we deal with suicide in the future. Above all, the response must be based completely on community services. It is no longer acceptable to focus merely on the symptoms of the problem, dealing with individual cases in isolation. The reasons that people contemplate, try or succeed in suicide are multiple, but are not being addressed in a comprehensive way. For instance, I know of children in residential care who come from family backgrounds where there are multiple and serious problems. When they reach the age of 18 the State no longer has any duty of care to these young people or responsibility for their well-being. I understand the Government is considering legislative provisions whereby the State will be mandated to maintain responsibility for young people in its care beyond the age of 18. These people often have a host of problems which may manifest in a desire for or attempt at suicide.
It is important to note that financial worries are a cause for concern in this area. In the farming community, for example, the number of suicides increased from 24 to 33 between 2008 and 2009. Given that 2009 was the first of several years of significant economic hardship it seems safe to conclude that financial pressures were a contributing factor in the increase.
Deputy Mary Mitchell O’Connor: The incidence of suicide presents a real and growing problem. There were 527 deaths by suicide in 2009. This figure shows a worrying trend and represents a real tragedy in homes throughout the country. Unfortunately, this trend increased in 2010. Figures for the second quarter of 2010 show there were 127 deaths by suicide. This may only represent a small increase of 4% on the figure for the same period in 2009, but it is an increase nonetheless and each individual suicide represents a tragedy for a family and a community. Our focus must be on reducing the figures as a matter of urgency.
There is a need to address the underlying problems that lead to suicide such as alcohol and drug abuse, bullying and eating disorders. A recent UNICEF study of young people in Ireland found that more than half of teenagers between the ages of 16 and 20 years had experienced bullying. While I acknowledge many of our schools are running excellent anti-bullying courses and Professor Mona O’Moore from Trinity College has been highlighting the effects of bullying among young people, much more needs to be done in our schools, homes and communities.
While the suicide figures are shocking, the incidence of suicide is vastly under-reported, due in large part to the stigma surrounding mental health issues. In April 2010 See Change commissioned MillwardBrown Lansdowne to conduct a study of Irish attitudes towards mental ill health. One of the findings highlighted the problem of stigma. While seven out of ten Irish people believe anyone can develop a mental health problem, one in two would not want others to know if he or she had such a problem. The stigma around mental health issues is especially important for young people, many of whom are afraid to talk to someone about their problems.
In that context, I commend the new initiative by O2 and Headstrong, a community-based youth mental health service. The project is called Share a Happy Thought and encourages young people to share positive thoughts on Facebook and Twitter. For every happy thought O2 will donate €1 to support the provision of mental health services for young people. This is a worthwhile initiative both in terms of funding – the project could raise up to €200,000 for mental health services – and also being a great way to use social networking to raise awareness among young people of mental health issues and the services available to help them.
Much has been written about how the current economic climate has increased the risk of suicide. Unfortunately, this theory is confirmed by the 2009 figures for deaths by suicide which show a 15% increase on the figures for 2007. We need a multifaceted approach to dealing with suicide and depression. The programme for Government aims to reduce the pressure on families which are struggling to meet mortgage repayments. The upcoming jobs initiative is designed to reduce the very high unemployment figures which are, no doubt, contributing to high rates of mental health problems. However, our main focus must be on providing access to mental health services for communities.
Amnesty International has welcomed the Government’s plans to prioritise mental health. One of the issues Amnesty International highlights is the importance of dealing with mental health in the community setting. It calls on the Government to deliver on its commitment to improve access to modern mental health services in the community. Amnesty International cites international evidence which shows that treating mental health problems in the community setting, rather than in a hospital setting, has a much higher success rate. Many of the key barriers to mental health treatment, such as cost and stigma, could be reduced if someone suffering from mental health problems could avoid going to hospital and instead be treated in familiar surroundings in their own area. Amnesty International highlights that both the 1992 Green Paper on mental health and the 1995 White Paper, A New Mental Health Act, called for legislation which would enable the health service to provide access to comprehensive community-based services. We can no longer leave reports such as that gathering dust on shelves. We must act now to make the recommendations of those papers a reality.
There are already many excellent organisations working to prevent suicide in the community and voluntary sector across the country, alongside primary care teams and local health offices. One of the agencies supported by the National Office for Suicide Prevention, Mental Health Ireland, has its head office in my constituency of Dún Laoghaire. It is a national voluntary organisation overseeing 104 local mental health associations throughout the country run by health professionals and lay people providing care and support for the mentally ill within the community setting. The Dún Laoghaire-Rathdown outreach project also does great work in supporting individuals, families and communities affected by substance misuse – one of the major contributors to suicide in this country. Organisations such as those need our support. We must set up a co-ordinated approach to providing mental health services in community settings.
Before I refer to the Government’s plan I wish to acknowledge the excellent work done by my colleague, Deputy Dan Neville, in this area for many years. He is president of the Irish Association of Suicidology. He has long been an advocate of greater supports for those affected by suicide and a stronger effort on suicide prevention. The programme for Government has committed to ring-fence funding of €35 million to develop community mental health teams and services. Part of the funding will be used to recruit additional psychologists and counsellors which will be integrated within primary care services.
Another positive development is the commitment by the Government to ensure that a comprehensive range of mental health services will be included in the standard insurance package under the planned universal health insurance scheme. Early intervention is key to reducing the risk of suicide and these measures will go a long way towards supporting community-based initiatives in treating mental illness and preventing suicide. I hope that the proposed reforms will take account of the organisations already working locally such as the ones I have mentioned in Dún Laoghaire. They are the people with the experience on the ground, who know intimately the mental health needs of the communities which the plans in the programme for government hope to serve.
An Ceann Comhairle: We now move on to the Technical Group. Deputy Flanagan will speak first, followed by Deputy Murphy, Deputy McGrath and Deputy Wallace. They are sharing time and have approximately four minutes each.
Deputy Luke ‘Ming’ Flanagan: Thank you, a Cheann Comhairle, for giving me the extra 15 seconds. I could have sat down and done a massive amount of research on the subject and come to the House with figures but I decided to talk about my experience and that of my community, what suicide has done to it, what seems to have caused it and perhaps what are the solutions.
One often hears experts in this area talk about nature versus nurture. With the significant rise in the amount of suicides in recent years it is clear that the nurture aspect of the issue is the problem at the moment in this country. It is not a problem of nurture within the family; the problem is the lack of nurture from the State. The consequences of society falling apart socially and economically are that more people feel they do not have any choice but to take their lives. There are a variety of reasons for that, such as financial, due to the economy falling apart. People are afraid they are going to lose their house and that they will not be able to put food on the table. That makes people miserable and leads to a downward spiral.
One of the major problems in this country in terms of suicide is due to the thinking that is prevalent around the world that style is more important than substance and that if one is somehow different that one is fair game to get abused. We had an example of it in the Dáil Chamber today. When Deputy Boyd Barrett made a comment, a retort was made from the other side of the Chamber to the effect that his style of dress was not even good enough for a council chamber. What does it matter about how one looks, how big or small one is, how long or short one’s hair follicles or what type of clothing one wears? That is irrelevant. It is a rotten message to send out from the Chamber.
We are all different. Some of us are a little bit more different. When I was going to school I was a little more different – perhaps I still am. So be it. I had to put up with jibes from people. It put pressure on my life and made me feel insecure about who I was as a person. Fifteen years ago I went to the doctor and told him I was feeling a little depressed. I could not really work out what was wrong. Since then I worked out that perhaps many people in society did not accept me for what I was. Fortunately, I have grown up since then and I do not really give a damn about what society thinks. I am who I am and I am proud of it. A lot of young people should take encouragement from that. One can be who one is. One does not have to be who they say one has to be in those stupid bloody magazines. Excuse my language but I hate them.
An Ceann Comhairle: That is unparliamentary language.
Deputy Luke ‘Ming’ Flanagan: I am sorry about that. Apologies. I do not like the magazines. I cannot think of a word to describe them without going outside the parameters of parliamentary language. They tell people on the front page that it is all right to do this, that or the other but when one opens up the magazine a contradictory message is given. On the front page they say it is all right to be fat but on the inside page they say it is not. They give a lot of mixed messages and confuse people.
What are the solutions? We are not going to find them today but I hope that over the five year term of this Dáil we look for real solutions. We will not solve all the problems but we should adopt the policy of vive la différence because we are all different and we should respect that. If abuse is constantly thrown at Members because of the way they look, that will send a signal to young people that if they do not look the same as everyone else then there is something wrong with them when there is not.
Deputy Mattie McGrath: I too am very concerned about suicide. It behoves all of us to make a real and sincere effort to get to the root of the problem. I compliment Deputy Neville for his arduous work over many years in this area.
Suicide has touched many lives and is a tragedy for both the victims and survivors. It permeates through the wider family and into the community. Suicide is all too prevalent. Eight out of ten suicides in this country this year will be males. That is what the statistics tell us. I do not have great confidence in statistics because, as the previous speaker indicated, statistics on role models, for example, do not help the situation. Perhaps we need to have more humanity and understanding. We must ensure a greater appreciation of the importance of the human being no matter what role they take in life. We should value all people from a young age to those in old age.
The dominant fact of Ireland’s suicide death toll is that it is overwhelmingly male. Any suicide, whether it is male or female, young or old, is a tragedy, but suicide on this island is mainly a killer of men, usually young men. I am concerned about the incidence of single vehicle road traffic accidents. Not enough investigation has taken place into them
Some of the deaths may be from suicide, especially where there are strange types of accidents.
We are very aware of the despair being caused by unemployment. This has been the case for decades. The Tipperary hurling team was buoyant after winning the all-Ireland final last year. Afterwards many of the players returned to unemployment, which was unheard of in previous years. We will have to tackle this in many areas. People who are idle may have too much time to think and may get into a rut and not mix with friends.
We must have campaigns that aggressively target depression in young men. The Choose Life campaign in Scotland has met with no small degree of success in reducing that country’s suicide rate. It is good to see O2 and other organisations coming on board to make an effort. Given that young people spend so much time on social networks, it is good to see the benefits of social networks being explored.
A counselling centre in Peter Street in Clonmel opens on the first Wednesday of every month. It should be open for many more hours. I compliment the counsellors involved. Services such as theirs are needed in every town and in rural areas. There is much work to be done. In this regard, we should join Deputy Neville in trying to make a serious effort in this Parliament to address this most sad issue.
Deputy Catherine Murphy: The first step in resolving any problem is to acknowledge it. It is very important to have this debate. The interest in the debate has been an indication of the concern in all our communities. There is not a Member in the Chamber who cannot describe the impact of suicide on a community, particularly where a young person is involved.
We know young men between 18 and 24 are the most likely to commit suicide. We must bear in mind, however, that suicide is not confined to young people or one gender. Suicide does not just occur in poor economic circumstances because there was a very high rate of suicide during the better times. It is, therefore, a much more fundamental problem than might be supposed.
In 2009 in north Kildare, there was a series of tragic deaths by suicide. As it happened, the victims were mainly girls between 12 and 14. There was a complete sense of panic when the suicides occurred. There was profound sympathy for the families who were and still are coping with the tragedies. They will continue to do so. The suicides had an impact on the community. They occurred during the local election campaign, during which time we were going from door to door and could measure the precise impact. It was important for people to feel there was a measured response and that the situation was not being made worse. It is very important, therefore, that we proceed in a thoughtful and measured way.
For all the criticism the HSE, it did in other guises, put together a response. It had a health promotion day shortly after the aforementioned tragedies. I found this very useful. A group was formed on foot of the promotion day to promote mental health and minimise the risk of suicide. A youth drama project was launched that gave young people the space to articulate their emotions. Very often they feel there is no vehicle for them to do so.
I was very impressed with the north Clondalkin Community Action on Suicide group, which came to the promotion day and made an effort. It felt it gave people the space, confidence and freedom to talk, which is important.
Should it be a surprise that there is a stigma attached to suicide? One need only consider what was done in the early years of the State and prior to its foundation. People were often incarcerated, frequently by their families, when they had a breakdown. There is much work to be done to deal with stigmatisation, which is at the heart of why people are unwilling to talk about mental health issues. This must be addressed, including at community level, in a very meaningful way.
Deputy Mick Wallace: The more one considers suicide and the various opinions on how we should better deal with it, it becomes pretty obvious there is considerable divergence of opinion on how we should do so. There are no easy answers. One gets the impression that the psychologists and philosophers have divergent views right across the board.
Three of my young under-16 players in Wexford, whom I knew well, committed suicide over the years. Two people who worked for me committed suicide. The most common characteristic of the five was poor communication skills and the inability to express oneself sufficiently. We need to work on this. There are no easy fixes. The manner in which youths are prepared for life is central to how they perform in life and deal with the problems that arrive on their plate.
Depression comes in many forms and we are told it is strongly linked to the decision to take one’s own life. In a two-and-a-half-year period in Wexford, during which time two of my players committed suicide, 45 youths under 25 took their own lives in the county. Of those, 44 were boys and one was a girl. Research shows that girls suffer a little more from depression than males, yet they are much better at dealing with it. Girls have greater skills than boys in dealing with emotional problems and expressing their feelings. We need to concentrate on this issue. Boys must be taught to be more open and must learn to express themselves better. A problem shared becomes lighter. I note from my own children that girls are much quicker to cry and open their hearts to their friends when they have a problem. This area deserves attention, with particular focus on the early years of childhood. There is a need to develop skills in the areas of problem solving, communication and seeking help in an effort to prevent social isolation, frustration and hopelessness.
There is no doubt that the abuse of alcohol and other drugs is not helping matters. There is a good chance this is linked to the increasing suicide rate because the level of abuse has increased during my lifetime. We must examine this issue.
Schools need information on managing the concerns of young people. It is sad that, for the sake of the few million euro being saved, the number of resource teachers and learning support teachers is being cut. I am not saying any of us knows best how to deal with suicide but surely taking away good teaching facilities and much-need extra supports from young children cannot be positive.
An Ceann Comhairle: I ask Deputies to ensure their mobile phones are switched off because they interfere with the recording of the proceedings.
EDeputy Brendan Ryan: As this is my first statement to the House, I wish to extend my profound thanks and gratitude to the people of Dublin North for their support in the general election and for the trust they have placed in me. I will endeavour to repay this trust during the lifetime of the 31st Dáil.
I have chosen the issue of suicide prevention on which to make my maiden statement to the House as I strongly believe, as I know all in the House do, that the task of suicide prevention needs increased attention from all sections in our society, including all in the House.
I wish my colleague, the Minister of State, Deputy Kathleen Lynch, well in her work ahead. I thank her for the comprehensive introduction to the debate which she made last Thursday. I also wish to acknowledge the work of Deputy Dan Neville in this area, and the great work in this area of the previous Minister of State, Deputy John Moloney, which I saw at first hand when I was a Member of the Seanad.
For too long, suicide has dwelled at the very edges of our national comfort zone. We are on the verge of changing our approach to this entire issue, and I know it is a priority for the Government to fundamentally improve how we tackle the issue of suicide and suicide prevention. There is no doubt we are experiencing an emergency with regard to suicide. Between now and when we sit in the Chamber next Thursday, a further ten people will have lost their lives to suicide in this country. I am sure all Members will agree that ten people a week, more than one person every day, is a shocking statistic. Even more worrying is the belief that this figure is likely to remain this high, if not climb even higher, given the hardship placed on so many of our citizens by the recent economic crisis.
It remains true that many instances of suicide occur in people with no previous history of mental illness or depression. Rather, it may be the circumstances of life that conspire to leave people in such a distressed state that suicide becomes the best option they can see. The loss of one’s job, the breakdown of a relationship, sudden separation from family or circle of friends and other related factors can all lead a person on a path where suicide is contemplated.
We need to arrest the rise in suicides now. In the limited time I have, I would like to discuss three possible areas where I think the Government’s suicide prevention strategy can focus. These are as follows: primary care within the community; raising awareness among children and especially teenagers through direct education in schools; and tackling the stigmatisation of suicide.
With regard to primary care in the community, it is vital, as set out in the programme for Government, that we ensure people have access to psychologists and counsellors in the primary care setting. This will require strengthening the services offered in GP surgeries and local clinics throughout the State. Modernising and improving our health service in local communities will be the front line in our suicide prevention strategy. The deconstruction of the old system of acute cases being sent to asylum-era institutions, such as St. Ita’s in Portrane in my constituency of Dublin North, needs to be accelerated. It will be one of my priorities during the lifetime of the Government to ensure Ministers stick to their promises in this regard, and I believe they will. I know the Minister of State, Deputy Kathleen Lynch, will drive this agenda.
It is also vital that we harness and support the important work done by voluntary organisations such as Pieta House. In its short lifespan of five years, Pieta House has counselled more than 3,000 people struggling with suicidal thoughts. Pieta House is just one of many organisations voluntarily providing care to people suffering with suicidal thoughts. We need to include such organisations in our suicide prevention strategy to create a joined-up plan for harnessing the care and compassion these organisations provide.
With regard to education, there must be a commitment from the Government to deliver on the education of young people on the issue of suicide awareness, and schools can play a key role in this regard. There are a number of initiatives we could implement in the short term to raise awareness and to provide a support structure in schools for students who may be at risk of suicide. These include curriculum-based presentations to students, self-reporting for students and school-wide screening for identification of at-risk individuals. Teachers can play a key role, but they must be provided with adequate skills and therefore there must be increased in-service training for primary and post-primary teachers on suicide prevention. It may be asking a lot of teachers to spot every behavioural characteristic of every student. However, if we give our teachers a better chance of identifying a potential child at risk through improved training, then we will save lives.
With regard to destigmatising suicide, we need a change of culture around suicide. We need to treat suicide with care, understanding and support. For too long, suicide has been a dirty word in Ireland. It is a cause of shame, when it should be a cause for empathy and compassion. Our local and national media outlets have a responsibility in this regard to report on suicide with due understanding and intelligence. I must commend the national campaigns launched by the National Office for Suicide Prevention, including some very powerful national TV advertisements aimed at young people, and the development of the letsomeoneknow.ie website.
The Government needs to continue to support such campaigns which confront the stigma surrounding suicide. Only through understanding and care at all levels, from the personal to the political, will we ever be able to successfully tackle suicide. I wish the Government well in this regard.
Deputy Gerald Nash: I welcome the opportunity to make a contribution on this important debate. I wish my colleague, the Minister of State, Deputy Kathleen Lynch, well in the task ahead. I know she has a deep personal interest in this matter. I also pay tribute to the groundbreaking work done by Deputy Dan Neville over the years on highlighting this issue. I recall approximately 15 or 16 years ago when I was involved with the students’ union in UCD I invited Deputy Neville to speak to students and he made a very interesting and inspiring presentation.
Suicide rates in this country have reached disturbing levels. A national consensus is required on a determined, forthright and inclusive national effort to save lives in the face of this crisis. The CSO records that in the second three months of 2010, 127 people took their own lives. The deeply troubling rates of suicide continue to climb each year. On its website, the National Office for Suicide Prevention refers to these climbing figures as a “worrying trend” and I completely agree. It is, frankly, a national emergency which requires those of us in positions of responsibility to build towards a comprehensive national response.
What makes the situation particularly disturbing is the fact that the frequency of suicide is highest among men in their 20s. We are all aware of the emerging trend whereby suicide occurs at a much younger age than was previously the case. This is a deeply troubling fact which requires the attention and focus of all of us.
In terms of mortality rates, recorded incidents of suicide exceed the number of deaths on our roads, and this has been the case for a number of years. When we switch on the news on a Sunday morning, it is not uncommon to hear of multi-vehicle car crashes throughout the country claiming multiple young lives. That same weekend there may have been several cases of people having made the tragic decision to take their own lives. Suicide is a different matter entirely; it is a relatively silent, but equally painful phenomenon and experience for those who have been left behind. We do not hear about it the same way as we do about road crashes. It is treated differently by the media for very legitimate reasons. I want to acknowledge the responsibility shown by the national and local media throughout this country in terms of the sensitivity demonstrated and expressed and the care and professionalism shown in general in coverage of incidents of suicide, its aftermath and how the matter in general is dealt with.
An enormous amount of work is done by the National Office of Suicide Prevention and organisations such as the Save Our Sons and Daughters organisation based in my constituency. They are all dedicated to dealing with this multi-faceted and complex social challenge.
As a public representative, since this deep recession hit I have seen a sharp increase in the number of people experiencing serious distress and mental health difficulties. Some have confided that they have at one stage or another considered taking their own lives. Public representatives are in the front line. It is important that Deputies and all public representatives are guided by the relevant agencies to be able to identify people who are at risk and in difficulty, and in so far as is practicable, given the confidential nature of the relationship Deputies have with their constituents, to direct them to those who can support them best. It would be more than useful if agencies made themselves available so we could all work together to try to develop a model and framework in which we would be better equipped to deal with the issue ourselves and ensure we could direct people the relevant support and agencies.
We need to break the silence and tackle the stigma around mental health.
We must engender a culture of openness and frankness in which discussing one’s mental health is seen in some respects as a strength rather than a weakness, as has unfortunately been the case in Irish society until now.
There will soon be an opportunity to embark on a review of the Mental Health Act 2001 and we should use that to do some simple and straightforward things. We must emphasise the need for mental health services to be brought into the open and we must resource community-based organisations to better engage with those who need mental health service support. I accept that progress has been made already in this regard but far more must be done. I look forward to working with the Minister of State and Members of the House who have an interest in this issue on progressing this and ensuring we have the best possible services for those who need them most.
Deputy Anne Ferris: I welcome the opportunity to speak on this important issue, which has long been subject to stigma in society in general. I congratulate my colleague, the Minister of State, Deputy Kathleen Lynch, on her appointment. I am delighted she has responsibility for this area.
To say the number of people who commit suicide every year in Ireland is a national emergency is an understatement. Indeed, this is illustrated by the 527 men and women who took their own lives in 2009, an increase of 24% over the previous year. Based on the latest figures available for the first quarter of 2010, it appears there has been a further increase on the 2009 figures. It is clear that the ever-increasing numbers can be correlated to the deterioration in economic conditions. Many thousands of people have lost their jobs and their homes. Many more are struggling to hold on to what they have, while they see friends and family leave their community for foreign shores. This is certainly true for the communities in my constituency. From my conversations with representatives of the chambers of commerce in County Wicklow, it is clear that companies are on a knife edge as they struggle to stay in business and keep their employees in jobs. Far too many companies have been forced to close down and this has put a huge burden on local people.
The depression and despair these losses have caused have not been met with adequate support services. The previous Government not only failed to look after the economic well-being of the nation, but also failed to provide the funding and joined-up thinking necessary for proper mental health facilities. Sadly, the soaring numbers of those who have taken their own lives do not take account of the number of failed attempts, which is estimated to be ten to 20 times the number who have died. Indeed, even the most recent official figures available are likely to under-report the numbers. Sourcing accurate data is undermined by many factors, including insufficient evidence to determine intent and concealment for religious reasons, fear of stigma and for life assurance.
It was also startling to learn that in most European countries more people die from suicide than from road accidents. The reason there is such an increase in the incidence of suicide can certainly be attributed to the economic downturn. The previous Fianna Fáil Government left an economic mess that must be dealt with as quickly as possible. The number of unemployed has reached 14.7%. The last time unemployment reached that level was in April 1994. More businesses are seeking credit lifelines as they seek to keep their heads above water. This downturn, coupled with job losses, has left many families struggling to pay mortgages. Indeed, the negative equity that home owners face has become impossible to ignore.
Problems in the mental health services sector were always an afterthought in the Celtic tiger economy. Gross income inequality was allowed to grow unhindered and, perhaps, it is no surprise that Dickensian hospitals sufficed as modern mental health infrastructure. It is also no surprise that other necessary resources, from establishing prevention programmes to training front line professionals, have gone by the wayside. The challenges faced by the new Government, therefore, are not small. Equally, however, they are not insurmountable.
The programme for Government contains a range of measures that will go some way towards reducing the number of people who take their own lives. Recommendations incorporated in the A Vision for Change programme will be followed. Among the measures in the programme for Government is the introduction of universal health insurance, which will ensure that mental health services will be included as part of the standard insurance package offered. The services that people can access will also be of greater value due to the commitment to ensure that general practitioners will have better training in mental health issues. Access to these and other professionals such as psychologists and counsellors will hopefully decrease the startling suicide figures. Unsuitable psychiatric institutions will also be closed and more appropriate community based facilities will be developed.
Organisations such as the Wicklow Mental Health Association in my constituency are swimming against the tide, but still manage to provide much needed services. In April and May this year it is providing training programmes, and information on these can be accessed on the association’s website. Another organisation, Suicide or Survive, provides the Eden programme. It is to be congratulated on this as well. Amnesty International has put forward recommendations in this regard and I urge the Minister to take them on board. Support and acknowledgement of national programmes such as See Change Ireland, which challenges the stigma surrounding suicide, is also important.
We must deal with the despair and depression engendered in people as a result of losing their jobs and homes and seeing the effect of emigration on their friends and family. The programme for Government provides commitments in this regard, not least the jobs initiative which is due to be launched in May. Overall, these strategies demonstrate the joined-up thinking that is necessary for meaningful reform, and meaningful reform is needed. Suicide is preventable, perhaps not 100% of the time but a significant reduction can be achieved. If the same resources that have been put into reducing the number of road deaths were put into reducing the suicide rate, there would be fewer suicides and fewer families would have to suffer.
An Ceann Comhairle: I congratulate Deputy Brendan Ryan on his maiden speech. I call Deputy Browne.
Deputy John Browne: I thank the Minister of State, Deputy Kathleen Lynch, for putting this issue on the agenda for debate. I also wish her well in her new office. She has a deep interest in many issues and I am sure she will do a good job in this area.
The first line in the document See Change speaks about changing minds about mental health problems in Ireland. Minds have been changed in recent years. I grew up in Enniscorthy town where St. Senan’s Psychiatric Hospital is located. When I started attending the local CBS school the hospital was surrounded by huge walls. Many of us young children at the time said the hospital was where the mad people were. It was only when we grew older that we realised it was not where mad people went but where people with a mental illness went. The nurses and doctors in the hospital worked hard, in difficult times, to try to change the perception of mental illness in that area of County Wexford. They also tried to work on cures for people. If one has a physical illness, one can get a cure and it is important to convey the message that if one has a mental illness, there are people to help one on one’s way back into being part of society.
As Deputy Wallace mentioned, Wexford has experienced its share of suicides in recent years. It probably has one of the highest rates of suicide in the country. It is very alarming. In the past four months nine people, most of them young, have died from suicide. It is a great concern. The county has also experienced some terrible tragedies in the last two years in which entire families died. That engendered a doom and gloom in the county. Among many communities there was a huge sense of hopelessness and of not knowing what to do. People were seeking answers as to why such tragedies happened.
It is important to realise that suicide knows no boundaries. An analysis of the suicides that occurred in Wexford show that some of the people came from very well off families while others were from families that were not so well off. The people concerned were both young and old. There is no real pattern, which is, perhaps, one of the reasons it is so difficult to deal with the problem of suicide and to find solutions. The one pattern that emerges is that suicide occurs mainly in the male population. That is the case in County Wexford and I am sure it is the case in other counties also.
I acknowledge the work Deputy Dan Neville, both as a Senator and Deputy, has been doing in this area through the years. In this House he has single-handedly tried to raise awareness of the issue of suicide. We must also confront the fact that a stigma was attached to suicide in the past and we are trying to get away from that.
It certainly was not good. It nearly turned people and families into outcasts in communities where suicide was involved and this was an unfair way of dealing with the issue.
St. Senan’s hospital is now more or less closed, although it is not closed in the way we wanted it to be and I hope the Minister will do something that the previous Minister from my party did not do. We had many arguments and rows about the closure of St. Senan’s hospital and the lack of an acute admission unit for those suffering from depression in the county. A Vision for Change spoke of facilities within the local area, but in recent months in Wexford, given that St. Senan’s is closed, patients must now go to Newcastle in Wicklow or to Waterford. We fought the good fight with the then Minister of State, Mr. John Maloney, and we were not successful. The matter needs to be revisited, and I do not say that in any political way. As a group of Oireachtas Members, we made a strong case for the retention of the admission unit in Wexford. A new 50-bed unit is to be built at Wexford hospital over the next year or two and I ask the Minister to look seriously at providing what we were promised – a designated unit within the county where people can go. It is a long way from north County Wexford, or, indeed, from any part of Wexford, to Waterford. In addition, the Waterford building is totally unsuitable. Already in the past couple of weeks those referred to Waterford have been returned within an hour or two without getting the treatment they deserve.
With the Ceann Comhairle’s permission, I will refer to a letter I wrote recently to the HSE in Wexford on behalf of a mother who contacted me about her daughter, who was recently a patient in Wexford General Hospital because she was suicidal. She was sent home without any proper care or backup support from the HSE. She was informed leaving the hospital that a HSE liaison officer would call to see her on the Monday – I think she went into the hospital on a Friday. That did not happen despite the fact that she was still very ill. Eventually, after a number of telephone calls to the HSE in Wexford, the family were informed that she would be seen on 14 April, that is, two weeks after she was admitted to Wexford hospital because she was suicidal. The family are concerned that the hospital would send her home in her condition and that the HSE personnel in Wexford ignored their calls for help. They are seeking an explanation and that is what I wrote to the head of the HSE in Wexford. This is a common complaint in the south east, that people are not getting A proper service from the HSE.
Depression does not stop at 5 o’clock on a Friday evening. I am not criticising the new Government because we did not deal with it either, but every county needs some kind of contact point, available 24 hours a day, seven days a week, where those suffering from depression or suicidal tendencies would have a form of backup service. General practitioners and Caredoc do their best to provide some kind of service, but it is important, if somebody is admitted to a hospital and is sent back home, that there is some contact point within the HSE so families can express their concerns or a matter can be dealt with as quickly as possible.
A number of organisations have been set up in recent years because of the situation in Wexford. These include Touched by Suicide in Enniscorthy, a voluntary group which set up its own good-as-new clothes shop. It raises funds and helps out families, making moneys available for those visiting hospitals, etc. It also raises awareness. Each month, or every two months, it holds an all-night candle-lit vigil on Vinegar Hill to make people aware that there are groups and organisations to which they can turn to talk and seek help.
The mental health association is another voluntary group in Wexford – I am sure it is right across the country – led by Mr. Joe Casey, the former director of nursing at St. Senan’s hospital. It does tremendous work promoting mental health and a renewal model. Representatives visit schools, organisations and groups to talk about mental health and the need to see it as something that should not been hidden away but brought to the front, and also that if one has a problem, help and support is available.
They have also led the way in closing wards in St. Senan’s, placing people in communities and asking local authorities to provide houses. This is where I and other politicians in Wexford have been deeply involved, particularly as members of the county council and the town councils. I remember everyone was dumbfounded when the first request was made to Enniscorthy urban council to provide two houses to the mental health association for patients who wanted to leave St. Senan’s. We took the decision to make the two houses available in the town, in a place called Moran Park, and the former patients fitted into the community. As a result, we have houses in Oilgate, Glenbrian and different parts of the county where people reside in independent-living accommodation, having left St. Senan’s. People realised the former patients were not some kind of monsters, but ordinary individuals who wanted to live in the community. With the backup of the outreach nurses, they are able to live in and become part of the community. They are involved in the local GAA clubs, go out for a drink and participate in whatever other social activities they want. Great credit is due to the mental health association in that area, and particularly to Mr. Casey and others who have been working almost full-time since they retired from St. Senan’s to ensure these people are looked after. They also ensure that such houses continue to be built and allocated by local authorities and also that land is made available for the mental health association to build houses.
I was struck by the recent announcement of President Mary McAleese when she set up a social initiative with the GAA and the president of the GAA, Mr. Christy Cooney, a Cork man – although, in fairness, the IRFU, FAI and GAA have also been working flat-out to help people in this area. I am glad to say that my club in Enniscorthy, Rapparees Starlights, was one of the first to implement the social initiative for older men, although the women were not happy that there was a men-only section within the club. The 100 people at the social initiative launch in Enniscorthy were each presented with certificates. They were all over the age of 50 and they have held a number of meetings since then. Last week, they went to Croke Park by bus and then went for tea in the afternoon with President Mary McAleese. The group meets on a regular basis and some of them have rejoined the club they left a number of years ago. They are now coaching young people and being actively involved again.
We need to promote such initiatives. I would like to see the FAI, the IRFU and the GAA coming together to launch a campaign similar to the road accident prevention campaigns. We are very much aware of deaths due to car accidents, but figures in recent years show that the number of people dying from suicide is probably 100% greater than the numbers killed on the roads, but there is not the same awareness. That is an issue we need to deal with and there needs to be more television programmes about it. We need more high-profile persons involved in raising the problems of suicide and depression because it is an issue that can be dealt with. It is important that we send out the message that there is always someone there to talk to. In our own small way, we try to do this in GAA, soccer and rugby clubs and other organisations. If one speaks at a function, one says that people should remember that there is always someone there to talk to. We need to get that message out.
Many Deputies have outlined the facts and figures and I will not go through all of those.
The stark reality is that 527 deaths by suicide were registered in 2009, which is probably twice the number killed in road accidents. We need to highlight these issues and we must be able to tell those who suffer from depression that help is available for them. Carn House in Enniscorthy does a tremendous job but we also need to consider developing a 24/7 service through out country. I accept that would be expensive but perhaps it could be developed in conjunction with funding from pharmaceutical companies and the other organisations which are making huge amounts of money from the Department of Health and Children. The service could be rolled out as a public private partnership.
Some people believe there are too many individual organisations working in this area and perhaps we need to pull them together but we can deal with this issue if we take the right attitude. Suicides bring great heartache to communities. I do not have all the answers but we can work together to solve the problem and I look forward to hearing the Minister of State’s views. It is important, however, that a 24/7 service within the HSE be considered.
An Leas-Cheann Comhairle: Deputy Paudie Coffey will be sharing time with Deputies Brian Walsh and Anthony Lawlor. The Deputies have five minutes each.
Deputy Paudie Coffey: I welcome the opportunity to contribute to this important debate on suicide. I carefully chose this subject for my maiden speech in the Dáil because it has a huge impact on many families. I am sure many of my colleagues have had personal contact with families that suffered from suicide.
I thank the electorate of Waterford for putting their trust in me to represent them in Dáil Éireann. I will do my utmost to promote the best interests of Waterford and the country in this House at every opportunity I get. I congratulate the Taoiseach and his Cabinet, as well as the Minister of State, Deputy Kathleen Lynch, who has a deep interest in mental health issues, and wish them the very best as they confront the serious economic challenges we face as a country. We are all behind them and we are ready to assist and support them in their work.
When discussing suicide, we need to take a careful look in the mirror in terms of how we developed as a society over the past several decades. When I was growing up in the 1970s, my mother was a public health nurse and I recall many occasions when people from our community knocked on our door to seek my mother’s help. They were looking for a listening ear rather than the medical assistance for which my mother was qualified because they were often suffering emotional turmoil from crises such as family break-ups. When public health nurses, teachers, doctors and gardaí lived amongst the community, they offered strong and accessible leadership. We no longer see that in our society.
We can only imagine how desperate people feel when they reach the point of suicide. I have lost close friends to suicide and I have often asked myself what I would do if I had been around at that moment. Would things have been different if my friends had access to a listening ear? Today, many people’s doors are closed to their neighbours and residents of many housing estates do not know who lives two or three doors away from them. That is the result of the society that developed during the Celtic tiger years.
I recognise we need services but listening must start in our own families and communities. We need to be there for one another. Several speakers made an important point about the importance of networks in our communities, whether GAA clubs, the ICA or Muintir na Tíre.
The loss of six good friends to suicide was the spur for me and others in my community to take action. I was very involved in the local GAA club and with the co-operation of the HSE and other suicide experts we developed a ten week course to teach community leaders to identify and assist those at risk. The course helped us to understand that it is not always necessary to seek help from a service or agency when people are in need. All of us would like a 24/7 service but a listening ear is most important when people reach that point of desperation.
I commend Deputy Neville for putting the issue of suicide onto the political agenda. However, few of the recommendations from the 2009 report of the Joint Committee on Health and Children, with which he was closely involved, have been implemented. Our challenge in Government is finding ways of implementing these recommendations in order to assist those who are desperate enough to take their lives. Every politician in communities across the country, whether urban or rural, bears a responsibility for assisting these individuals. I welcome the Minister of State’s contribution to the debate and I look forward to supporting her in addressing the challenges.
Deputy Brian Walsh: As a fellow county man, this is my first opportunity publicly to congratulate the Leas-Cheann Comhairle on his appointment and I wish him every success. I also congratulate the Minister of State, Deputy Kathleen Lynch, on her appointment and acknowledge the hard work and commitment of her predecessor, John Moloney, who tirelessly championed the issue of suicide and mental health during his time in the House. Deputy Neville’s efforts in this area over many years similarly deserve recognition. He was a lone voice when it was not politically correct to speak about the issue.
Our country faces many challenges at present, not least the financial circumstances in which we find ourselves. However, the issue of mental health is one of our greatest challenges. Economic activity operates in cycles and produces periods of boom, bust and renewed growth. I do not doubt we will return to prosperity but when we lose a person who suffers from depression, that life is gone forever. Statistics show that an increasing number of young people are dying in this manner. In 2009, some 529 lives were lost through suicide, an increase of 24% on the previous year, and preliminary statistics for 2010 indicate that the number will increase further. It is worth noting these are only the recorded numbers because there are suggestions that unofficial figures are even higher.
Death by suicide has a devastating effect on the wider community as well as on close family and friends. The tragedy is increased because we know it is preventable. Those who are left behind experience not only the normal emotions one would associate with bereavement but also feelings of confusion and anger, and questions about what they could have done differently.
I welcome the Government’s commitment to A Vision for Change, which was published by our predecessor, and the promise of additional resources for the area. We need to change fundamentally our attitude to mental health and suicide. I concur with my colleague, Deputy Coffey, in regard to how society has changed as a result of the Celtic tiger.
A fundamental change in attitude is needed. We can start by changing the language we use when dealing with this issue. We say a person commits suicide as if to suggest he or she has committed some sort of a crime. It was a crime in the past but it is no longer one and we should lose that type of language. We also say a person took his or her own life as to suggest he or she had a choice in the matter. Somebody who is profoundly ill and suffering from depression has no choice but simply cannot continue, so we need to lose the term “taking one’s own life”. If a young person gets into a car, is involved in an accident and unfortunately dies, we do not suggest he or she took his or her own life nor or do we suggest a person who has been a heavy smoker over the years, gets lung cancer and dies took his or her own life. Therefore, why do we use that term when someone dies as a result of depression?
We need to remove the stigma and convey the message that people should not have to hide, or be ashamed of, suffering from depression. It is an illness from which many people suffer. We must encourage people to talk openly about it and to seek help. We should promote initiatives to get people to talk about their difficulties and problems. Perhaps the Minister of State should consider a national day of mental health awareness and invite professionals into schools and colleges to talk to young people and suspend the curriculum for a day or a half day. I know from experience that there would be a very willing audience. During my term as mayor of Galway, I organised a youth conference on a range of issues relating to young people from career prospects to mental health, which was a big issue, to bullying to diet and fitness to other issues of concern. They came in their droves to listen to the speakers on mental health. That is something the Minister should consider.
The banks have been blamed for much of the economic difficulty in which we find ourselves. Some banks are now contributing to mental health awareness. Bank managers became involved in an orgy of credit and were very quick to extend loan facilities to people, possibly without going through due diligence or in a prudent manner. We all remember getting letters or constituents approaching us about letters asking us if we needed a new car or an extension to our homes and telling us to sign a form, send it back and that the cheque would be sent to us within days. That kind of reckless orgy of credit was driven by a bonus culture which existed in some banks.
The people who wrote those letters and extended those loans are now placing huge financial pressure and strain on people. Helicopters were sent to bring large or commercial customers to the races or to play golf. They are now sending the bailiffs in lorries to collect personal assets and so on. I encourage the banks to demonstrate a sense of leniency and fairness when dealing with their customers.
Deputy Anthony Lawlor: I congratulate the Leas-Cheann Comhairle on his elevation to his position and the Minister of State, Deputy Kathleen Lynch, on her appointment. She has a daunting task ahead of her. I also wish the Taoiseach and his ministerial colleagues all the best in trying to pull this country out of the mire. As this is my first speech, I thank my wife Margaret for her support during the election campaign as well as my family and friends, Fine Gael members and the people of Kildare North who gave me the responsibility of being their representative in Dáil Éireann. I will raise the issues of concern to them and will ensure that issues, which are important to the country, are brought to the fore in the Dáil.
I thank Deputies McGrath and Neville for raising this topic in the Dáil. One of the issues is that people do not communicate and talk about suicide. When people are in a black hole or see no light at the end of the tunnel, they want to be able to talk to someone about it and yet people shun individuals who may be in this state of depression. It is vitally important we remove the stigma associated with people who take their own lives and give them the dignity and burial they deserve.
On the morning of the election, a young woman came into my office to talk to me. She had lost her brother through suicide approximately a year before. She cried in front of me trying to explain the pain through which she and her family were going. She indicated to me that in the nine months before he took his own life, he was suffering from depression and no matter what people said to him, he could not see any way out of the black hole he was in or any light at the end of the tunnel.
My wife Margaret is a volunteer counsellor with Pieta House. When I visited that organisation several weeks ago, I learned of the serious situation in which it finds itself in regard to funding. It is amazing that the Road Safety Authority is allocated €40 million each year for the prevention of road accidents and yet only €5 million is allocated by the HSE to prevent suicide. Almost two people take their own lives each week. Many car accidents – approximately 38% are single vehicle road fatalities – could also be associated with people taking their own lives.
A number of organisations care for people. Aware makes all of us familiar with what is going on before people commit suicide. Console helps the families of the bereaved. Organisations such as Pieta House help those on the verge of committing suicide. I met the director of Pieta House, Ms Joan Freeman, and when I went into the reception area, I was struck by the fact that most of the signs were about fund-raising. I encourage all Deputies to take what is known as the walk from darkness into light in early May and to raise as much funding as possible for those who listen to people on the verge of committing suicide.
An Leas-Cheann Comhairle: I congratulate Deputies Paudie Coffey, Brian Walsh and Anthony Lawlor on their first addresses in the Chamber.
Deputy Seán Crowe: The last time this issue was discussed in the House, I received a telephone call from a friend whose sister-in-law of 20 years of age had taken her own life. As one does, I turned up at the church as did large numbers. I do not know how many funerals I have attended of people who have gone down this road. Everybody was a bit stunned because this girl was full of life. People talked about how lovely the person was and that they did not see the signs or the triggers. Families ask what if they had done something else, what if they had seen the signs and so on. We do not have any answers for them, or certainly I do not.
I am conscious that there are children in the Visitors Gallery. At some stage in their lives, someone belonging to them or close to them will go down this path.
The responsibility we have as legislators and public representatives is to come up with solutions. Deputy Mick Wallace referred to the divergence of opinion on how to address this. I remember a former Member of this House who had the attitude that people who commited suicide were “selfish Bs”. That is a human reaction, but any of the people I knew who went down that path were not summed up by that description. It did not sum up their lives. While it is a human reaction, the description does not help. It does not help their families and does not turn people away from following that path. That attitude needs to be consigned to the past.
Prevention is the key. People talk about what we can do and there is a great deal we can do. If someone comes to see us, help is available. In many cases, people do not know how to access help from organisations such as Teen-line, of which I am a patron. I knew Darren Bolger who took that path. I know his family well and the great work Maureen Bolger has done as an advocate for change. She works with schools and talks to young people. I refer also to Samaritans, the volunteer services, Pieta House and the national suicide helpline. It is a matter of supporting these services but also of changing attitudes in society. If someone in a family goes down this path, it is not a dirty secret. People need to talk about this. The profile is of young men of a certain age and we must consider what we can do.
I will give a few examples to show how the system fails. Last year a young lad from a neighbouring constituency took part in a play as part of a suicide awareness programme. Having taken part in it, one would have expected him to realise the pain and suffering his family, friends and colleagues would go through, but he ended up taking that path. On his first anniversary another kid from the same school took that path. Support is available in that school. I asked one of his schoolmates how he felt and how he was affected. He told me support was available but that if they wanted counselling, they slipped a note under the door of the school principal. Then they were called out of class. If one is not a hard chaw – many of these kids are not – they will be asked why they were called out and the principal wanted to see them. Young men and boys do not want people to know that they need counselling or help. The system in place in that school does not work.
Friends of mine from a local school came to see me. The mother had been sorting socks and jocks and came across a note written by a young lad of seven years of age. It suggested he was being bullied in school and was thinking of committing suicide. The family had been to the school on three occasions to deal with the matter. They asked me, as a public representative, what I would recommend. I recommended contacting the school board. In the end, they moved the kid out of the school and moved out of the area. Thankfully, he is a survivor and has not gone down that path.
Another case affected me greatly. Before I was elected for the first time, a colleague of mine took the path of suicide. His wife rang me at 7 a.m. to ask me if he had arrived at my house. I told her I would turn on the lights and draw the curtains in order that he might come in. I went over to their house and a young man was lying in the field. I wanted to identify the body because I knew it was him. However, given that he had shot himself, the Garda Síochána was interested in how he had access to a weapon. No one knew. He had previously tried to throw himself under a bus. He had taken alcohol and tablets and locked himself in a toilet in one of the local shops. He had been thrown out and then tried to throw himself under a bus. He ended up in the accident and emergency unit in the local hospital before being released and sent to his GP who gave him a prescription for tablets. Ironically, he was the kind of guy who would not take a tablet if his life depended on it. My point is that the system did not work in this case and many others.
What does a family do when they are concerned about a loved one who may be self-harming or considering self-harm? One cannot section an individual in every case. It is a matter of telling the person concerned that help is available, that he or she is loved and that there is an alternative. I have talked to survivors, people who had decided to go down that path but were saved or changed their mind.
As legislators, there is much we can do and some of it concerns accident and emergency units. One volunteer was involved in counselling and came across a young girl of 15 years who talked about taking her own life. The volunteer talked to her for hours on the telephone and asked her to come into the office. As there was no adult at home, she was brought to the accident and emergency unit. Having built up a relationship with the girl, the volunteer who acted as advocate could not remain with the girl because there was no link. The accident and emergency unit was bedlam at a time, but the girl had been brought in on her own. I raised this point with Mr. Geoff Day. If there was a chill room as part of the hospital system, an advocate could remain with the person concerned. There is a room for bereaved family members, but that is not normally situated beside the accident and emergency unit. If it was located in a secure part of the hospital, it could be used. Most hospitals have such rooms, but there is a need for the system to realise that when people are vulnerable, they need to sit outside the madness of the accident and emergency unit. We all know such stories.
We must set targets. Other speakers referred to the number of deaths on the roads and the amount of money spent in tackling that problem. There is no urgency in tackling this issue. We must set targets to reduce the figures. Opinion-makers in society must speak out and tell people help and support services are available. We must also train people to identify triggers.
They need to be trained to identify those people showing signs of going down that road. We must support all the different groups working in this area. I do not believe we need legislative change, rather we need to change attitudes in Irish society, including the attitude that young men should not cry.
An Ceann Comhairle: Deputy Connaughton is sharing time with Deputies Mulherin and Kyne.
Deputy Paul J. Connaughton: I thank the Ceann Comhairle for the opportunity to make a statement on suicide prevention. There simply is not enough time in the five minutes allowed to speakers to go over all the specifics and complexity of this immense issue.
Suicide is an area of great interest to me, as it is to many others in this Chamber who will know of someone or a friend of someone who has committed suicide. Unfortunately, a friend of mine with whom I lived in college and with whom I studied for four years took his own life only 12 months ago. All that his family and friends are left with are questions. Could anything have been done? Did they miss something and did they ever ask him how things were going? The question can be asked: is this story sad? It is, and, unfortunately, it is becoming all too familiar. I fear that we are beginning to treat suicide as merely another problem in the country. Trying to find a solution to such a massive problem is not easy and we should not think it is. The time has come for meaningful effort to solve this problem.
In recent years, I have noted that the number of suicides here is often compared to the number of lives lost on the roads. Both are tragic occurrences, both destroy families and communities, and yet the way we react to each is very different. If someone is killed in a road accident, the story will almost certainly be carried that evening on the news, the area will be sealed off and there will be a detailed investigation into why the accident happened and how we can make the scene of the accident saver to ensure an accident does not happen again. However, when a suicide happens, there is an outpouring of grief over a few days and weeks, and then the commotion dies down. The family, friends and community are left to pick up the pieces and the total number of suicides has gone up by one. Instead of going on about statistics and figures over the next few minutes, I would rather concentrate on the ways in which we may be able to start to solve this terrible problem.
At this point I compliment and thank the groups and individuals who continue to work on this area, many in a voluntary capacity and on extremely low funding, without whose help and support this problem would probably be a great deal worse.
Before being elected to this Dáil, I was a youth worker for four years with Foróige, which is the national youth organisation. In the role, I worked with young people from many different backgrounds, but all of whom faced the same challenges. Youth mental health was a challenge that came up repeatedly. This also included the areas of self-harm and potential suicide.
In that time, I became aware of two excellent services that I believe are going a long way to help solve the issues of youth mental ill health. The first is the big brother big sister programme with is a mentoring programme which partners a young person with a volunteer for up to a year. This opportunity allows the young person to meet once a week with someone in a friendly and safe environment. It allows that young person an opportunity to bring up any issues he or she may be going through, express himself or herself to someone from outside the family, but to enjoy himself or herself. This programme is becoming popular, but, more importantly, has a proven track record in helping build the confidence of a young person and his or her self-esteem.
Jigsaw is a service which was set up in Galway in 2008 and is a collaboration between Headstrong, the HSE and Mental Health Ireland. It is aimed at prevention and trying to alleviate the many issues before they become problems. It is run in a professional manner with excellent staff. This service was established when it became obvious that youth mental health has needed its own department for many years. It allows people to drop in for a chat and when they arrive, they are met by friendly staff who are equipped to deal with whatever issues they may have. The Jigsaw service is about listening. It is about find out where a young person is at, but, more importantly, to where he or she wants to go. It understands the concerns of young people in areas such as school or college; work or unemployment; family, friends and other relationships; sexuality and sexual activity; and maybe drugs and alcohol abuse. The areas I have described cover the areas of youth mental health but, unfortunately, as we all know, mental health issues affect persons of all ages and backgrounds. I welcome the developments of late that have brought this area away from the old style of thinking and that, for instance, better premises are being built that correctly highlight the importance of this problem, but also that someone who suffers from mental health issues is seen not as a burden on the State, rather as someone who is simply looking for help.
Finding a solution to this problem will not be easy for many reasons. It is complex and difficult. Sitting on our hands waiting for another report will not solve the problem. We must use every possible tool at our disposal to help solve it. I believe in a community-based approach, involving local community groups, youth groups, the GAA and any kind of youth club, to help combat the problem of suicide. This country has the people who have the skills and capacity to help in this area, but they need help to organise properly. They also need funding to make them effective. The one thing parties from all sides of the House can do is show that the 31st Dáil is serious about helping to combat the problem of suicide in our communities.
Deputy Michelle Mulherin: There is a terrible sense of isolation in rural Ireland, especially in Connacht, and this is reflected in the high rates of people taking there own lives, which is now compounded by the added stress and despair caused by the recession.
Since prevention is the title and point of this discussion, I commend the work and initiative of self-help groups addressing the question of social inclusion and I urge the Minister to prioritise and invest in the formation of more such groups, which create networks of support for vulnerable individuals. I am familiar with the work of such groups in my town, such as Ballina Migrant Health Forum and The Dolmen Clubhouse, which seek to bridge the gap between the vulnerable and professionals. The emphasis is on getting those affected to appropriate professional help where necessary and creating a platform for various care professionals to help train and inform local members.
I congratulate all those proactive groups around the country, many of which are born from the loss of a loved one where family and friends choose to make a stand in combating this malaise which does not discriminate across social classes. All is not lost. Aside from professional views of suicide, there is always personal loss. It takes many deaths before we become aware of what death really means. Someone said that while it ends a life, it does not destroy the relationship we had with that life – a father remains a father and a brother remains a brother, and the same applies to a sister, a friend, a lover and so on. They take something of us from the earth. So the questions as to why and the multitude of reasons given by professionals who try to make sense of the psychology of it, and by priests on the spirituality underpinning the dreadful decision that brings an individual to this very lonely and dark place, for this is an act that invariably takes place in secret – perhaps we all know this place to a certain degree – helps to comfort those left behind but it never diminishes the loss. To those left behind, we absolve them from guilt; to those contemplating it, we say, “Reach out and talk to someone”. For my own part, my office will always welcome anyone seeking help.
Deputy Seán Kyne: I am grateful to be afforded the opportunity to address the House on such an important issue. There is not a Member of this House who has not been affected by suicide or other mental health issues.
Since the House discussed this issue two weeks ago, 25 more people in Ireland have taken their own lives. This is the statistical rate at which people in Ireland are succumbing to the scourge of suicide and is based on the 2009 figure, which showed that 527 people died by suicide. That figure was a staggering 25% increase on that of the previous year for the number of people who died by suicide, and yet it was only the “recorded” figure. Experts believe the actual suicide figure is much higher. It is quite clear that the recession and the economic difficulties are having a direct negative impact.
Only today 1life, the suicide helpline, revealed that it received more than 700 calls over the Easter week and that half of these were callers presenting with serious suicidal thoughts. As shocking as the statistics are, they hide the fact that each case of suicide reverberates throughout a community where families, neighbours, colleagues and friends must endure the horrendous pain the loss of a loved-one in this manner brings. Of all the questions with which family and friends are left, the primary ones are: why? Why did he or she do it, and why did I not see it coming? However, there are no easy answers.
Undoubtedly, the financial crisis and its effects have played a part. Unemployment, unpaid bills and unmanageable debts all place enormous strain and pressure on people, with, in some cases, tragic and fatal consequences.
Loneliness and isolation are also factors which affect a lot of older citizens, particularly in more rural and remote locations.
One figure which particularly concerns me is the number of our young people, particularly young men, who take their own lives and again, we must ask why. Bullying, discrimination and abuse are just some of the reasons which drive our young people to self-harm or to take their own lives. Teenagers have many pressures in their lives, such as exam pressure, career worries, peer pressure to fit in or to rebel and issues of how they think they appear to others. It is well documented that some people are more vulnerable than others, such as gay and lesbian people many of whom have to contend with discrimination, prejudice and abuse, both mental and physical, in our towns, villages and rural communities.
In the United States, it was a succession of several teen suicides among lesbian and gay school students last year which prompted the “It Gets Better” campaign to reach out to gay and lesbian young people via YouTube and social networking and assured them they are neither alone nor without support. Such a campaign highlights why the Civil Partnership Act, as incomplete at it is, is extraordinarily important in sending out a positive message to Ireland’s young gay and lesbian people. I would like to take this opportunity to commend GLEN, the Gay and Lesbian Equality Network, and other organisations whose efforts and work were so crucial in securing this significant step towards full equality.
We are very fortunate to have a strong network of community and voluntary organisations in Ireland which provide support and comfort to people suffering as well as focus and direction for Government and policy-makers. Numerous organisations work in the area of suicide prevention and mental health. Some, such as the National Office for Suicide Prevention and Headstrong, the National Centre for Youth Mental Health, are statutory organisations. Many more are non-governmental organisations or community groups such as Aware, Console, Shine and 3TS.
In my constituency of Galway West, as Deputy Connaughton stated Jigsaw is a wonderful organisation which is a support service for young people. It is a partnership between Headstrong, the HSE and Mental Health Ireland which has been providing support and information via its drop-in service in Galway City since 2008 and recently moved to larger premises. It is imperative that every community in Ireland has access to such a service which, l am in no doubt, can save lives.
Given the constraints on funding, it is more important than ever that we work together to combat the problem of suicide. I urge greater co-operation, and more sharing of resources and tasks to achieve what are common goals. As a people, we must ask ourselves what is the point of fixing the banks and the economy if so many of our people are suffering. We must prioritise the needs of our people. We must all remember that it costs absolutely nothing to be supportive, to listen, to be compassionate and to be there for family and friends who are suffering.
The old Irish phrase, ar scáth a chéile a mhaireann na daoine, is as relevant today as it ever has been, and with that in mind, I will take this opportunity to ask the Minister for Health and Children to ensure that mental health funding be protected and directed towards primary mental health care where it is most needed, which is in the community.
Deputy Seamus Kirk: I am glad of the opportunity to say a few words on this most important of subjects. It has come into public focus and debate in a much sharper way in recent years for very obvious reasons. Suicide is not someone else’s problem, it is everybody’s problem. An individual dies but the whole community suffers. A loss of life affects all strands of the community. Effective action is needed to approach the stigma of suicide and, in turn, help people become more aware of suicide and its impact.
In 2009, there were 527 deaths by suicide, and 527 families and communities all felt the huge loss which suicide brought to the area. This is a major issue which needs to be dealt with. The more support networks we have, the better the chance for people to talk about how they are feeling and the more lives will be saved.
The HSE National Office for Suicide Prevention is responsible for overseeing the implementation of Reach Out: A National Strategy for Action on Suicide Prevention 2005-2014. The main vision of Reach Out is of a society where life is valued across all age groups, where the young learn from and are strengthened by the experience of others and the needs of those going through a hard time are met in a caring way. Reach Out calls for a multi-sectoral approach to the prevention of suicidal behaviour, in order to foster co-operation between health,education, community, voluntary and private sector agencies.
In the most recent budget an additional €1 million was provided for the programme for 2011 which will enable the office to build on initiatives to date and bring momentum and new impetus to their activities. The areas to be targeted are developing both the number and range of training and awareness programmes, including the ASIST programme, to reach the most vulnerable in our communities; improving and standardising the response to deliberate self-harm presentations; developing the capacity of primary care to respond to suicidal behaviour and considering new models of response; and ensuring that helpline supports for those in emotional distress are co-ordinated and widely publicised. In each of these four areas an emphasis will be placed on the most vulnerable groups identified in Reach Out and more recent research. The details of these initiatives will be discussed and agreed with the office.
An initiative established by the former Minister of State, John Moloney, is See Change, run in co-ordination with the national stigma reduction campaign. The aims of See Change are to reduce the stigma associated with mental health problems and challenge discrimination in society; create an environment where people are more open and positive in their attitudes and behaviour towards mental health; promote a greater understanding and acceptance of and support for people with mental health problems; and empower individual people with experience of mental health problems to gain equality, respect and rights.
The total funding for mental health in 2010 was approximately €970 million. Innovation funding of €3 million was provide to Genio through the HSE to support the transition from institutional to person-centred care. A further €5 million will be provided for Jigsaw, an innovative community-based support service for young people.
When in government, Fianna Fáil established the office for mental health and disability. Special consideration was given in the budget to the mental health and disability sectors, which will ensure a maximum reduction of only 1.8% in the 2011 allocation for the sectors. The relatively lower reduction, compared to that in other health sectors, was an indication of the priority which the then Minister for State, John Moloney, afforded to this most important area.
It goes without saying that in areas of economic or health problems, research programmes are vital to finding longer-term solutions to many of the issues, and those affected have varying levels of mental health issues. The Minister of State will bear in mind the importance and necessity of ensuring co-ordination at European level between research programmes here and those under way in other member states. Perhaps such co-ordination and availability of information will give hope to those who live night and day with mental health issues and the threat and worry of suicide that a solution may be found, if not in all cases at least in a percentage of them. At this point in time, we could ask whether stem cell research holds out any prospect of better days ahead for the families unfortunately affected and afflicted by mental health issues and the threat of suicide.
Deputy Ciara Conway: Ba mhaith liom buíochas a ghabháil le muintir Phort Láirge as an tacú a fuair mé i rith an toghcháin. I have not had an opportunity to thank the people of Waterford as my maiden speech was on the very important matter of the nomination of the Taoiseach, and I would like to take this opportunity to thank them for their support.
I welcome this opportunity to speak on this matter and it is with mixed emotions that I do so. Suicide is every family’s worst nightmare and traditionally it is rarely discussed. The public attitude towards mental health and suicide must change if we are to be able to provide for those who need help and for people to be able to accept help. One in four people in Ireland have a mental health difficulty, which is an alarming statistic, making it an issue of national importance. Since my involvement with Labour Youth and as I moved through the ranks in Dáil na nÓg, I have always spoken out on this issue. I have attempted to shine a light on an issue which has been allowed to stay hidden in the shadows for far too long. I saw first-hand in my work as a child protection social worker and later in my work with Barnardos how suicide and mental health issues affect not only an individual but entire families, particularly children.
It is welcome that €35 million has been ring-fenced in the health budget to develop community mental health teams and services, such as psychologists and counsellors in primary care teams throughout the country.
The programme for Government states: “We will endeavour to end the practice of placing children and adolescents in adult psychiatric wards.” I have been outspoken on this issue for several years. There are no services for children between the ages of 16 and 18 because they fall through the net of services for children and adults. This is a barbaric practice which needs to be addressed immediately. The problems caused by the admission of young people to adult mental health wards were such that a report was commissioned by the Mental Health Commission in 2010 to investigate the inappropriate care of young people aged between 16 to 18 and examine the factors contributing to their admission to adult wards. Alarmingly, in the first six months of 2010 the young people who were admitted to adult approved centres included 11 children aged 15 or younger. In some cases, the children concerned did not even have mental health problems and would have been more appropriately cared for by social services. A young person should only in exceptional circumstances be considered for admission to an adult psychiatric ward. The report identified confusion within the psychiatric community in regard to who is best placed to look after young people with mental health problems, particularly those aged 16 and 17 years.
The State’s mental health watchdog has expressed concern about the occupation of scarce beds in child and adult mental health wards by patients who do not have mental health disorders. What is happening at present is akin to the practice of the past whereby people were inappropriately placed in institutions. This practice needs to be discontinued. Young people without diagnosable mental health disorders or with social problems have reportedly been admitted to child and adolescent units simply because there is nowhere else for them to go. This is a terrible indictment of our system but I am heartened by the new Minister for Health and Children and hope he will work in partnership with the Minister for State at the Department of Health and Children, Deputy Kathleen Lynch, to address this issue as a matter of urgency.
The children who are admitted to psychiatric wards are among the most vulnerable people in our society. Greater investment is needed in community resources if we are to address this problem. We have to invest in the mental health of our young people and think outside the box in terms of acting to prevent these problems from arising. The problem will not be solved by individual Ministers because it requires co-operation from the Departments of Health and Children, Education and Skills and Community, Rural and Gaeltacht Affairs. By pooling their resources, they can ensure the social and emotional needs of our young people are put to the fore over the lifetime of this Government.
Many of the speakers during this debate have focused their remarks on adults but if we are to prevent suicide we need to be proactive in investing in children from the age of three. A study commissioned in America in the 1970s, the Perry preschool project, invested in young children between the age of three and five and followed them until they were in their 40s to find out how the investment paid off. The quantitative and qualitative evidence from that study has categorically shown that the investments made an improvement in the lives of the individuals concerned. Every euro invested in young children provided a saving of €16 later on. Social scientists in America often base their work on the objective of keeping people out of prison and in this House we have been discussing community service orders over the past several weeks. If we invest in quality preschool programmes that address the social and emotional development needs of young children alongside the services required to address their concerns as they grow up, they will be given the language they need to seek help and we will no longer have to deal with an unfortunate group of people who on reaching adulthood find themselves in such despair that they chose to take their lives.
I have the courage of my convictions on this issue and the statistics are available to support my argument. We have an opportunity to think differently about mental health. I am keenly aware from my work in the community and voluntary sector over the past ten years that we need to get the most that we can out of the money we are given. I appeal to all the Ministers involved in this area to push for quality and evidence based programmes that deliver happier and healthier outcomes for our children and young people. If we invest in the happiness and health of young people, they become more productive workers and people. The US study indicated that people who received preschool investment went on to be more productive members of their communities, had better relationships in adulthood and were less likely to engage in anti-social behaviour and crime. If by investing early we can prevent young people from reaching a dark place, it is a no-brainer that we should endeavour to do so.
Given that I also worked in mental health services during my time in social services, it would be remiss of me not to state that some of our most committed people work in this area. People who have mental health difficulties deserve to be treated in palaces and given the best of services. They should not be locked away in the dungeons I visited while I worked in mental health services. We need to open the doors of community services to our people.
I ask the Ministers concerned to think outside the box by investing in our young children and ensuring they grow up to be happy, capable and productive members of society.
Deputy Aodhán Ó Ríordáin: I welcome the opportunity to speak on suicide prevention. Members on all sides of the House made many excellent contributions on the issue and I will endeavour not to repeat points which were previously raised. I will focus on younger children, how this society is failing to protect their mental health and what we must change to ensure we intervene at the earliest opportunity to protect the most vulnerable.
This country has returned to the days of high unemployment, mass emigration and social despair. The most tragic by-product is the increasing rate of suicide. This tragedy is not confined to any particular class or corner of the island but is affecting rich and poor, old and young, male and female. In 2009, the rate of people taking their own lives increased by a startling 24%. These are people who see no way out of the despair they feel, whether because of negative equity, addiction issues, unemployment, discrimination or depression. They took their lives because they could see no hope for their future.
We can address this national emergency by creating a better society that provides people with the best of services, education, social protection and health care. However, what about the children who are the victims of circumstances beyond their control and are growing up in households ridden by despair? They are fragile, impressionable, easily corruptible and can be permanently damaged by the environment in which they live. What interventions are available to us to care for delicate minds or childhoods filled with nights in which heated words are exchanged by financially crucified adults so close to the brink that they see no way out?
What about children who live in areas where the only viable economic activity is the drugs trade? Older siblings get sucked into a hopeless spiral of street corner loitering and low-level anti-social behaviour and often on to full-scale membership of violent gangs, incentivised by easy money, street credibility and a perverse sense of empowerment. Communities such as these are rarely understood, chronically under resourced and frequently stigmatised with outlandish generalisations by media outlets. If we accept that it takes a village to raise a child, is it any wonder that children of such a village will grow up with a poor sense of self-esteem, negative self-image and feel totally disempowered and disconnected from the mainstream of Irish society?
Our education system is charged with the responsibility of identifying, diagnosing and treating children who display a variety of emotional behaviour disorders. As currently constituted, the system outrageously misplaces resources in a manner that inevitably benefits children from middle-income backgrounds and not those more in need. Our education supports for those most in need of help are misplaced and poorly structured.
This happens in two main ways. First, the allocation of resource teachers is based on the general allocation model introduced by the previous Government, which allocates teachers on the basis of the school enrolment number and not on the basis of need. As a result, children who attend schools with a smaller enrolment do not receive the same level of support irrespective of the level of need. This is a crude, blunt and indeed cruel arrangement that must be amended to ensure that our most vulnerable children are supported.
Second, in the allocation of resource hours sanctioned by the special educational needs organiser, SENO, schools with access to private psychological or clinical assessments receive more resource hours. Those who depend solely on the under-resourced National Educational Psychological Service, NEPS, receive fewer. School leaders, teachers and school principals are left in an almost impossible position when attempting to provide supports for children who present with specialised care needs. They have to juggle referral forms and representations to the National Educational Welfare Board, NEWB, NEPS, agencies such as the Mater Child Guidance Clinic, the relevant social worker, the home school community liaison service and, if they are fortunate, supportive parents. I have been the principal on the telephone to agencies being told that the child is not suicidal and that I am wasting my time.
If a parent or parents prove obstructive or difficult, the school is powerless to proceed. This is just one more glaring example of why our children’s rights referendum is so sorely needed. Our children now live in a society that is at breaking point, in a culture that shortens childhood to maximise corporate profit, in a country that purports to cherish every child equally, but only punishes our vulnerable rather than liberating them. We must liberate our children from the dark clouds that hang over their minds. We must empower them with the ability to express their feelings, to understand their circumstances and encourage them to believe that they truly are more powerful than they could ever contemplate.
We cannot fail them at the earliest stage, the stage when they depend on us the most. The risk of internalising the hurt permanently is too great, and the potential of becoming another suicide statistic too real.
Deputy John Halligan: I propose to share time with Deputy Clare Daly. Sometimes we are damned with statistics when they are put in front of us but statistics are important on the serious issue of the severity of suicide in Ireland. The latest statistics show we have the highest recorded rate in our history. This amounted to 527 deaths in 2009, representing an increase of over 4%. Anecdotal evidence suggests the figures in Ireland continue to rise. Some 127 deaths from suicide were registered with the CSO in the second quarter of 2010 and the increase is mainly in men in the middle age category. Many experts throughout Europe have said there is a sharp rise in people taking their own lives and self-harming over the past year and that this is linked to the recession. The term recession depression has emerged. International research indicates that during an economic downturn, suicide numbers increase markedly. Since the economic crisis occurred in Ireland, there is a clear spike in deaths among people between 25 and 44 years of age. Social welfare cuts, cuts to invalidity pensions and disability payments hit the vulnerable sections of society disproportionately. The incidence of suicide is at its highest in these sections. As mayor of Waterford, I addressed a conference in Waterford on taking the stigma out of mental health.
The statistics were startling, showing that between 300,000 and 400,000 people were presenting with problems, from mild to medium to severe depression and many of those presenting to a general practitioner felt suicidal at one stage. In Ireland, suicide has become the principal cause of death of men between the age of 15 and 34. Ireland now has the fourth highest rate of suicide among young men in the EU, behind Lithuania, Finland and Estonia.
Successive Governments have displayed a distinct lack of urgency in dealing with this problem. The budget in 2010 was €5.6 million, which is a drop in the ocean compared to what is needed. The HSE moratorium on recruitment had a devastating impact on an overstretched health service. Over 700 members of staff left mental health care services from 2009 and only 65 were replaced. That had a major impact on the suicide rate. Incredibly, more lives are lost to suicide than to road tragedies. However, the budget to reduce road traffic deaths is almost eight times the budget dealing with suicide.
The Government and Opposition parties should examine a case study. Scotland had one of the highest rates of suicide but has managed to reduce significantly the number of people taking their own lives by spending €25 million on preventative services. This shows that resources and allocating money into prevention can reduce the number of people taking their lives. Scotland has been internationally recognised for its “Choose Life” programme and the education and awareness programme called “see me”. It is internationally recognised that Scotland was able to reduce a high rate of suicide. Statistics from Scotland show that 600 people took their lives last year, of whom 450 were men. This was reduced by 87, which is almost a quarter. This is attributed to the resources and services available. Officers trained to deal with suicide intervention have been employed in every local authority in Scotland. They reduced the suicide rate and the number of people presenting themselves with mental health problems. This has reduced the amount spent on health and mental health services and the prevention of suicide in Scotland. The budget can be reduced because the death rate and the number of people presenting with mental health problems is reducing.
The causes of suicide are multifaceted and complex. Some argue it is a fundamental human right to take one’s own life. That is a worthwhile debate. However, for most people, suicide is not chosen; it happens when pain exceeds resources for coping with pain. These are not my words, although I would like them to have been. This is a matter of resources. I urge the Government to examine the case history of Scotland. A small amount of money out of a substantial budget has helped to reduce the suicide rate. I passionately urge the Government to deal with this point. Let us consider the number of people dying from suicide compared to road accidents, given the amount of money spent.
It is only right that we should put substantial amounts of money towards reducing the number of deaths on our roads but if we put half the amount of money into suicide prevention, going by the Scottish example, we could at least reduce the number of deaths by one third.
Deputy Clare Daly: I want to make some brief remarks. Like other Deputies I, too, appreciate the opportunity to discuss this important issue. It is appropriate that the House has spent so much time on it because a discussion must take place in society and awareness be raised about these issues. That is important, but the discussion must be purposeful and have an outcome. In that sense, regarding some of the remarks made by some of the Government spokespersons in particular, cognisance should be taken of the fact that they are the Deputies who are in power. It is their Government that has the ability to implement measures which can make the difference in terms of dealing with some of these issues which have blighted so many lives and which are a growing problem in the country.
The point was made during the debate about the way road traffic deaths are treated and the funding that is allocated to that area compared to the lack of funding for suicide prevention, given that suicide results in many more deaths than those from road traffic accidents. That is true. It is the case that advice and investment in trying to reduce road traffic accidents has developed here, and we must do something similar in regard to suicide.
Removing the stigma is important. There is a value even in discussing the issues. That is important, but it must be linked to the overall position of funding from a number of aspects. Mental health is an area that must be invested in and the question of overall funding must be dealt with because it is inadequate. There must be implementation of A Vision for Change. There must be a development of community-based services but to be honest, we must not laud an expenditure of €35 million as being enough. It is not nearly enough. It is hardly five euro per person. We need resources to back up the services that are necessary but the reality is that we are moving in the opposite direction. The implementation of severe cutbacks in health, education, social welfare, public sector recruitment and so on will succeed in having a negative impact on dealing with the current suicide problems. It is not good enough to just talk about the problem. We must implement measures that assist in dealing with it.
It is obvious that suicide is a growing problem in Ireland. That that the only dedicated suicide helpline does not get any funding is a poor indication of our approach. That organisation takes thousands of calls every month. On average, it takes 100 calls a day. It is an indication of the scale of desperation people are experiencing that 100 people make the call. How many more hundreds are thinking about it but do not know that the resources are available or that they can access them? Promoting these helplines and the resources available, albeit limited, is important.
There is no doubt that the rising suicide figures are linked to the economic downturn and the devastation being experienced by many people throughout this country. As Deputy Halligan said, this is not just a problem of mental health. For many people suicide is a rational decision on the part of the people who make it. The scale of their problems, be it some personal catastrophe or a severe economic crisis which they see no way out of, leads them to believe that is the only way out for them.
The cases of suicide among taxi drivers was well highlighted by the taxi drivers’ unions. Many taxi drivers took their own lives because economically they were pauperised as a result of decisions that were made including the freeing up of licences. These people were on the road from morning to evening without being able to eke out any sort of a wage for themselves or their families. The problem of their mortgages was getting on top of them, and if they give back their taxi plate they are not entitled to any social welfare payment because they were self-employed. That is severe pressure to put on anybody’s shoulder. They cannot see a way out because we have not given them a way out, and economic policies have not been put in place which deliver for those people a standard of living that enables them to keep a roof over their heads and provide for their families. Unless we address these issues we will have a continuation of the problems.
The key problem is for the people left behind after suicide and the questions people ask such as “What could I have done? Could I have intervened if I had known the severity of the problems? Was there something I could have done that would have made a difference in terms of the decision the person made to take their own life?”. We must avoid the situation where those questions have to be asked. Everybody needs to know where they can access the support that is available. The problem is that there is not enough support available and people do not know about the support that is available. If this debate assists in that regard, it is welcome but it is not enough on its own. There must be a massive investment in education and in personal development for our young people in the existing health services.
Crucially, this debate is linked to the overall economic position facing ordinary people because as a result of the policies being pursued and the fact that taxpayers’ money is being poured in to bail out the banks and so on, our services are being cut and people’s livelihoods being devastated. Unless we invest in people’s social, personal and overall economic well-being, we will be returning to these issues and finding that the position has not altered at all, rather worsened.
Deputy Simon Harris: I wish to share time with Deputies O’Donovan and Doherty.
An Leas-Cheann Comhairle: There are five minutes available per Deputy.
Deputy Simon Harris: I take this opportunity to congratulate the Minister of State, Deputy Kathleen Lynch, on her appointment. I have not had an opportunity to do so to date. I welcome the opportunity to speak in this important debate on proposals to tackle suicide levels within our society. I take great encouragement from the scheduling of this debate which shows the intention of those on all sides of this House to prioritise mental health. I am encouraged that we are talking about suicide in terms of tackling the problem as that is exactly what we must set about doing.
I agree wholeheartedly with Deputy Clare Daly on this issue. It is not enough for us to just speak about the issue today, tick a box and say, “job done” and not return to it. I do not believe anyone on the Government side and, I presume, on the Opposition side of the House looks at it like that. We will certainly not shirk our responsibility on it.
We cannot have a discussion on suicide without a discussion on our mental health services as a whole and the way those services are provided in a community as well as a clinical setting. I recently met an impressive campaigner, Caroline McGuigan, who is the chief executive officer of Suicide or Survive, a charity based in Arklow, County Wicklow, in my constituency. She had an interesting and simple way of comparing how we think about mental health to the way we consider dental care. She asked three simple, mundane questions. Where do we first learn about dental care? The answer was that we learn about it in our schools. Do we brush our teeth every day? One would hope the answer is, “Of course”. If something happens to our dental health such as a toothache or needing a filling, are we embarrassed? Again, the answer is “No”. These are the issues children learn about in regard to their dental health in our schools on an almost daily basis. We teach them that it is something that must be looked after every day. We give them the tools to look after their dental health and they know that if there is a problem or something that needs attention, it is nothing to be embarrassed about. We must give our children from the youngest age possible in our school system the same tools to deal with their mental health. We must get to the point where school children see mental health care as part of their development and overall schooling.
I want to put a few points to the Minister of State for her consideration in regard to the way we will serve the mental health needs of our community. As I know she will be aware, we must be sure that the involvement of service users is not just tokenistic. It must be a vital part of the planning process, and anyone I talk to involved in suicide prevention or mental health groups is very keen on this idea. Those at the coalface of our mental heath service with direct and personal knowledge of its impacts, strengths and weaknesses must be recognised as key stakeholders. In that regard I am encouraged by the work of the See Change initiative and the support given to this group by the previous Minister of State, John Moloney, and now by the Minister of State, Deputy Lynch.
We need transparency of funding in our mental health services. Having served as the chairperson of my local Health Service Executive regional health forum, I am only too aware of the current difficulties in this regard. It is imperative that we are able to work out how much this State spends on promoting positive mental health each year. This is a huge problem and at a time when we see the HSE board being asked to stand down we must try to clear these lines of miscommunication and get to the bottom of how much this State allocates to mental health on an annual basis. I implore the Minister of State to contact the HSE and insist that we are provided with a greater breakdown of the way mental health services are funded each year.
In any case, it is clear that the annual budget for mental health services can best be described as dismal. Nobody likes comparing one tragic cause of death to another, but as other Members of the House have said, the success of the Road Safety Authority in reducing the number of deaths on our roads highlights the impact that targeted resources can have. Mr. Gay Byrne has proved to be a successful and highly effective chairman of the RSA’s road safety campaign. I ask the Minister of State to find a similar champion, advocate or series of advocates for the cause of mental health promotion in Ireland, thus giving a strong and coherent voice to the many stakeholders, advocacy groups and clinicians working in this area.
We also need to examine seriously the after-care provisions being offered to people who present themselves to our health services. I am not referring solely to mental health services in this respect. UK statistics indicate that up to one third of suicide deaths occur among people who have interacted with the health service in the previous 12 months. These are people who have turned up in hospitals, in community or clinical settings, presenting with some illness, yet within 12 months they took their own lives.
A successful system is currently operating in Belfast whereby people presenting at hospitals who exhibit any of the potential indicators of suicidal behaviour are immediately given a referral card. We should examine the potential for introducing such a system here. I encourage the Minister of State to examine the legislative perspective of this matter with a view to amending the Health Act 2004 and the Mental Health Act 2001. Both the Green Paper in 1992 and the White Paper in 1995 recommended that any legislation must deal with outpatient services, but this is not reflected in the current legislation, which focuses on the provision of inpatient care. I urge the Minister of State to consider this matter when the legislation is reviewed next November. Let us bring accountability back to this House and the Minister of the day. The HSE should set a statutory plan each year so that it is accountable to the Minister who, in turn, is accountable to this House. We can then take political responsibility, once and for all, for mental health services in this country.
Deputy Patrick O’Donovan: At the outset, I want to congratulate you, a Leas-Cheann Comhairle, on your appointment and wish you well in that role. I also wish to congratulate the new Minister of State, Deputy Kathleen Lynch, who has responsibility for mental health services. As a Deputy representing County Limerick, it would be remiss of me not to pay tribute to my constituency and party colleague, Deputy Dan Neville, for his contribution to the debate on suicide prevention. Since his time in the Seanad, he has championed the cause of decriminalising suicide, thus destigmatising it and placing the debate on a national platform whereby people can speak openly about the subject, as we are now doing. Great credit is due to Deputy Neville for having done that.
I want to discuss the impact of suicide on families. There is a temptation to trivialise the issue by categorising people according to statistics, including how they died and the possible causes. In fact, however, we will never know the reasons that most suicide victims die because in many cases they do not leave notes or other communications. We are, therefore, left to agonise afterwards and wonder why they felt it necessary to take their own lives.
According to a study by the Family Therapy Association of Ireland, mothers experience intense and prolonged grief, along with many psychological and physical symptoms, following a suicide in the family. Several participants in the study experienced strong suicidal thoughts, while one such mother had attempted suicide herself. The misuse of medication and alcohol was also identified by some women as a coping strategy. Other findings of the study concerned the participants’ reasons for wanting to die in order to be with their children, as well as the impact of guilt and blame on their belief system.
Unfortunately, suicide affects every community, which is why so many Deputies have participated in this debate in recent weeks. The National Suicide Research Foundation has found a worrying trend of suicide clusters in Ireland. A cluster is a chain of suicides by young people in a particular geographical area over a short space of time. Experts believe that such suicide clusters are becoming more common. In one instance, a group of 17 young adolescent men from one area committed suicide within 18 months. The National Suicide Research Foundation has produced a report with information to map suicide in Ireland. This is operating on a pilot basis in Cork in collaboration with the region’s coroners.
Earlier in this debate, reference was made to the role of social networking, including comments that are left by people in the aftermath of a friend’s suicide. The UK police have examined the social networking activities of young people to try to discover their reasons for committing suicide. It has become common for bereaved friends to set up memorial pages on social networking sites, such as Facebook and Bebo. Research by the department of epidemiology at Bristol University has shown a connection between media reports of suicide and copycat deaths. In addition, the research stated it was likely that discussions on websites would have a similar effect.
I urge the Minister of State, in conjunction with her colleague, the Minister for Education and Skills, to address this problem through the schools system in particular. In that way, young people could be encouraged to understand the seriousness of what they are doing in leaving messages on social networking sites. We may find it difficult to comprehend but some young people feel it is possible to communicate with the dead through social networking. Sometimes, this is a mechanism for them to cope with the grief and mourning they are going through. It is a cry for help from them, which needs to be addressed, and I think schools are the best venues in which to do this.
In recent weeks, Facebook launched a facility in association with the Samaritans that allows people to get help for a friend whom they believe may be suicidal. It allows friends to alert the Samaritans through the Facebook help centre where they can provide content that suggests a friend may be suicidal. The Samaritans have also launched an awareness campaign on their Facebook page that tells people how to recognise risk factors for suicide among their friends. These factors include a family history of suicide, easy access to means of suicide, a previous suicide attempt, a history of behavioural disorder, drug abuse, alcohol abuse, family dysfunction, marital status, physical illness, imprisonment and unemployment. Unfortunately, in most cases, it is scarily obvious that the bulk of deaths by suicide involve young men.
In primary schools, the SPHE course encourages children to talk about their physical health and well-being. Teachers should also be exploring mental health issues at a much earlier stage, as well as bringing them up at second level. Children and adolescents are under massive pressures, including economic ones. We should not pile any further pressure on our young people, but mechanisms are required to let them discuss such problems in order to relieve them.
I wish the Minister of State well in her new portfolio. In addition, I acknowledge the work of my colleague, Deputy Neville, in this respect.
Deputy Regina Doherty: I wish the Minister of State the very best in her role, which is an extremely important one for our society as a whole. Ireland is a small nation, yet we have one of the highest incidents of registered deaths by suicide in Europe. There is not a community in the country that has not been affected by suicide.
The programme for Government has set out proposals to develop and improve mental health facilities, starting in the community. It is proposed that €35 million will be ring-fenced from the annual health budget to build community mental health teams and services for adults and children. The programme for Government also sets out plans to strengthen the training of general practitioners to deal with mental health issues that may arise in the community. This is vitally important because a GP may be the first person with whom someone suffering from depression engages. If GPs cannot service that need or open the door to other services that are available, therein lies the biggest initial problem.
It is always said that a general practitioner should be the first port of call for physical illnesses, but we must make it the same for mental health issues. A review of the Mental Health Act 2001 and the Mental Health (Amendment) Act 2004 will take place under the new Government. The promise we made to introduce a mental capacity Bill, in line with the UN Convention on the Rights of Persons with Disabilities, must be delivered upon.
Recent studies conclude that instances of suicide have increased since 2009. One reason attributed to the increase in such deaths is the economic downturn and the pressure under which people have found themselves. It is wholly unacceptable that people should be committing suicide due to a lack of money and resulting pressures. The stigma attached to depression, however, often prevents people from asking for help. We desperately need to change this situation. The greatest sadness concerning suicide is that is it totally preventable.
Amnesty International states that four fifths of mental health service resources remain tied up in hospital-based treatment, which in itself has negative connotations. We must move away from that and deliver on our promises to give people the option of having access to the services they need at a local community level.
We must implement A Vision for Change, the implementation of which has been promised to the people for so long.
It must be borne in mind that the issue of suicide affects people of all ages. Perhaps in more recent times our attention has been drawn to the issue among young people by the Think Big campaign launched by Headstrong and, more recently, the Get on Board campaign to increase the awareness of mental health and push the issue to the fore of the political agenda among new and existing politicians.
Alarmingly, 60% of young people said they would not seek help from a health professional if they experienced mental health difficulties. This is testament to the old Irish attitude of not complaining and getting on with things. As a Government, we must support voluntary groups such as Headstrong, Aware, Amnesty International, Reach Out and the many other groups which exist to help to bring to an end the stigma attached to depression. Almost twice the number who die in road accidents die by suicide. As previous speakers said, the funding for the road safety campaign amounts to €20 million, while that provided for the suicide prevention campaign is €5 million. Therein lies a big problem. It is not my intention to make a comparison in the loss a family suffers in either case, but this illustrates the difference in the funding provided for the campaigns and the level of public awareness of the issues involved. This has to change.
Education on mental health must start in the community, particularly in schools by improving SPHE programmes; among support groups and voluntary organisations by improving their funding and facilities; and among GPs by strengthening their training to enable them to deal with issues that arise. Each one of us must take responsibility for the campaign to prevent death by suicide by ensuring we start at home and talking about it to our children, families, friends and work colleagues. Only when we remove the stigma from depression and the sense of failing and the lack of self-worth for those who suffer from it and replace these feelings with ones of security, hope and trust will it be more acceptable to ask for help.
Deputy Sandra McLellan: I congratulate the Minister of State and wish her well in her new position.
I have listened to the contributions of my fellow Deputies on the incidence of suicide in Ireland with sadness and dismay. It is an important issue and their contributions are valuable. However, we cannot afford mere posturing on the issue. We need action and effective measures to ensure that, as elected representatives, we will use our influence to create an environment in which there will be greater understanding and acceptance of people with mental health issues and a reduction in the stigma attached to them and the associated discrimination. I am lucky to have a platform to say my piece in the Chamber, but we need to remember that we have a responsibility to help to remove the stigma and discrimination associated with mental health problems. That goes for all of us.
The incidence of suicide in Ireland is at an all-time high. Ted Hughes once wrote a poem about Sylvia Plath who had taken her own life. It was entitled “Last Letter” in which he addressed the issue of her death. The opening line has always stayed with me: “What happened that night? Your final night.” I often think of it when I hear of suicides and what happened to the people concerned on their final day or night, as well as the loneliness and isolation they must have felt and their sheer desperation. The final night for many is the result of a combination of factors, including mental health issues, reduced self-esteem, discriminationand social stigma becoming a barrier in accessing services and a lack of support.
There may be a sum of €8.7 million available to support suicide prevention initiatives which is a good start, but more needs to be done. The strain imposed by financial difficulties is increasingly becoming a factor in suicides. It is one thing to give €8.7 million for a suicide prevention programme but another when people’s financial difficulties are being magnified tenfold by having to pay the universal social charge. While it is part of the Government’s responsibilities to address this issue, we have a collective responsibility to address it. Ní neart go cur le chéile.
It is estimated that 40% of undetermined deaths are suicides. A total of 527 people took their own lives in 2009, which is astonishing. It would make one’s heart break for the people who were driven to this, as well as their families and friends. When people attempt to access services, they are faced with an archaic mental health system. More than 20 years ago the Government ratified a legally binding international treaty guaranteeing everyone in Ireland fundamental human rights – the International Covenant on Economic, Social and Cultural Rights which Amnesty International has described as “one of the country’s best kept secrets”. I am not surprised it described it as such. Under the treaty, we are supposed to have a right to health care, but hundreds of children are detained in adult mental health facilities because there is insufficient child appropriate accommodation available.
The Minister for Health and Children has said a child should only be admitted as an inpatient to a psychiatric facility as a last resort. It would be preferable if no one had to be treated in a psychiatric facility and treatment was delivered within the community, but where that is an appropriate part of treatment, children should be treated in a facility suited to their needs. There is only a bed capacity of 52 within the child and adolescent mental health service infrastructure which the Government plans to increase to 58 by 2012. That means six additional beds will be provided in one year, which is inadequate. The Minister has said he envisages the plan bringing to an end the treatment of children in adult facilities. However, hundreds of children are in adult facilities. How, therefore, are we expected to believe this? Six additional beds are better than nothing, but they will not make the impact the Government believes they will. Service provision must be based on need. It is just plain wrong that people are not receiving the help and support they need because of the inadequacies of the health system and the inadequacies of a Government which will not recognise a person’s right to health care.
We must also be aware of those who are at higher risk of suicide and having mental health issues. BelongTo is a youth organisation which does great work with gay, lesbian, bisexual and transgender, LBGT, young people. In its submission on the national strategy for action on suicide prevention its officers quoted extensively from research that demonstrated the high levels of stress experienced by LGBT youth. According to one Dublin City University research paper, 94% of teachers were aware of verbal homophobic bullying in schools. The old adage of “sticks and stones may break my bones but names will never hurt me” is categorically untrue. LGBT young people are five times more likely to be medicated for depression, two and a half times more likely to self-harm and three times more likely to attempt suicide. They are at huge risk. However, 90% of teachers were not able to find a single mention of homophobic bullying in their schools’ policy statements on bullying.
Schools are harrowing places and life is grim for many gay teenagers. It is imperative, therefore, that action is taken to tackle this issue. We need to address the problem not only by directly funding suicide prevention programmes and strategies, but also by addressing the root causes of stress and depression This is not just the responsibility for the Minister of Health and Children. The Minister for Education and Skills also has a role to proactively work on the issue and ensure the development of programmes to positively endorse diverse sexual identities in schools and increase support for organisations supporting LGBT youth and their parents. If the State is not going to provide services, it is critical that the voluntary sector is supported in what it is doing. Our collective responsibility to address and prevent suicide means we must use our knowledge to propose meaningful and constructive solutions.
I support Amnesty International’s call to use the opportunity presented by the forthcoming review of the Mental Health Act to consider broader legislation to provide community-based mental health services. International evidence shows this not only improves mental health outcomes, but is also associated with lower suicide rates. Sinn Féin fully supports this position. It is an awful reflection on Fianna Fáil, its former Government partners and now the Labour Party and Fine Gael, as well as the HSE and the Department of Health and Children, that Amnesty International, a campaigning organisation for human rights, has to lobby for better mental health service provision because the service provided by successive Governments represents such an outrageous breach of people’s human rights; it is a scandal.
The National Office for Suicide Prevention has stated that the increase in suicide is linked to the current economic climate in this country, stating that it is likely to be a “result of the impact of the economic downturn with substantially more people unemployed and suffering from personal debt”.
Surely the Government can see now that its policies which are geared towards cutting the incomes of those who are lowest paid in society are increasing the level of suicide. It is hypocritical to speak in the Chamber of all the tragedies that have touched people’s lives – we all know of someone who has taken his or her own life – and then to ignore the evidence that is presented by a body such as the National Office for Suicide Prevention, which is a part of the HSE.
It is important that the Government, during the review of the Mental Health Act, looks at the evidence. Evidence-based policy should be based on need and not the minimum that Fine Gael thinks it can get away with providing. Mental health is a significant component in suicides. The EU consensus paper on Prevention of Depression and Suicide has stated that the “adequate treatment of major mental disorders… decreases the risk of suicide and is an effective way to prevent suicide in healthcare”.
Ireland still lacks a modern, adequately resourced community mental health service. Reform of mental health services must be part of a coherent response to suicide prevention. Better mental health services will mean fewer people dying by suicide. We need good community-based mental health services which have better outcomes when compared to traditional hospital treatment. The research proves that, yet four fifths of mental health service resources remain tied up in hospital-based treatment.
Implementation of the reform set out in A Vision for Change has been slow and uneven to date. Accountability for expenditure on mental health and transparent information on how such expenditure is used to reform the services in line with policy has been lacking. International human rights law demands that mental health services be continually improved in line with best practice in order to fulfil the right to the highest attainable standard of mental health and avoid social exclusion. As long as this country fails to implement reform, it will continue to fail to meet international human rights standards. These failings lead to enormous economic and human costs and needless individual suffering. The poor response to mental health is also contributing to high national suicide rates.
The forthcoming review of the Mental Health Act, as set out in the programme for Government, provides an excellent opportunity for the Government to change things for the better. We must examine what works. Everyone knows a family that has been devastated by suicide. Some families have been affected twice and others even three times. We must educate ourselves to recognise the signs. We must change things for the better. I call on the Government to listen to the evidence and it is being told by the people affected by suicide and to do something meaningful in order to address the problem.
Deputy Jerry Buttimer: Cuirim fíor fáilte roimh an Aire Stáit, Deputy Kathleen Lynch. Listening to Deputy McLellan I cannot help but wonder whether Sinn Féin seeks an increase in bed capacity and hospital facilities or a more community-based approach. Perhaps the party could indicate what it wants. This debate is probably the most important one we will have in this House because it deals with people, those we all know who live in our communities. At a time when more and more people are under pressure – tá siad faoi bhrú – it is important that the Government and everyone else would recognise the fact. It behoves all of us to work together to ensure that suicide and mental health problems do not escalate.
In the past decade, there is not a single community or a single family in this country that has not been touched by the spectre of a death by suicide. Losing a loved one, friend, work colleague or neighbour leaves a thousand unanswered questions – the most common of which are, first, “Why?” and, second, “Could I have done something to prevent it?” Those questions shake us to the core of our being. The possibility of hope and of things improving lie at the essence of our humanity and spirituality. For many hundreds of people, at a time of deep emotional and psychological trauma in their lives, there does not seem to be a belief in life, there is a loss of hope and there is despair that things will not improve or get better. The reality is that it can. It is important that support is provided and that people talk, listen and reach out.
Recently, the Evening Echo reported on 202 deaths in Cork city and county over the past 30 months, as indicated by the Central Statistics Office of 170 men and 32 women. At times it appears as if suicide is a single, homogenous act that is becoming endemic across society. Reporting and presenting on suicide makes it seem as if it is beyond control, predictability or intervention. The analysis of the statistics and research suggests otherwise. Certain sections of communities are more vulnerable to death or harm from suicide. With careful screening and appropriate mental health and community training it is possible to become aware of potential precursors and triggers to some cases of suicide. It has been proven locally, nationally and internationally that appropriate intervention can and does reduce the number of fatalities from suicide.
For too long suicide has been a taboo subject which people have been afraid to talk about. It is important that we seek out reasons rather than seek to deny. Raising the issue and discussing suicide in this debate increases the opportunity for people to seek help and support. It is time for politicians and those involved in the mental health area to open the doors and pull back the veils of secrecy and denial so as to allow light and rational debate into this particularly difficult and sensitive subject. It is essential that we have an open and honest debate about the extent of fatal and attempted suicides and the response of the State at a national and local level.
According to WHO data, in 2009 Ireland was ranked 20th out of 26 European countries with a total suicide rate of 10.6 per 100,000 population. While significantly below that of Lithuania which had a rate of 30.4 per 100,000 we were significantly higher than our neighbours in the United Kingdom which had a rate of 6.4 per 100,000 and Greece which had a rate of 3.5 per 100,000. The same WHO data reveals that we have a youth suicide rate that is the 4th highest in Europe, which is a worry. Further analysis shows that in Ireland, over the period of 2002 to 2006 the highest rate of suicide was for young men in the 20 to 24 year age group. Those and other data clearly show that suicide and suicidal behaviour is a complex, multifaceted societal issue which while individual in focus appears to be responsive to societal and personal risk factors and indicators. The data also inform us that we must take an individualistic and holistic approach to suicide at a community, regional and national level.
I do not believe a one-size-fits-all solution can work. To be fair, neither does the Government. To be effective and meaningful, intervention must reduce both the level of attempted suicide and completed suicide. I agree with Deputy McLellan that there is a need for joined-up thinking between the various agencies, statutory and voluntary local bodies, education and social services, business and voluntary or community organisations and agencies committed to positive mental health promotion as well as participation by and acceptance of the role of the ordinary person who is often the first to become aware of the potential of risk or the likelihood of harm arising from suicide.
The establishment of the National Office for Suicide Prevention was an important advancement in the struggle to respond to the level of deliberate self-harm and completed suicide behaviour in society.
In Cork, we are fortunate to have a mental health resource officer who oversees and delivers valuable and essential community supports and training, helping develop skills in individuals, organisations and the community that enable them to respond to suicide. In addition to general and specific suicide helplines, peer support education programmes for young people in a community-based setting is provided so that young people can offer support to other young people. We also have the applied suicide intervention skills training, ASIST, which is a two-day skills building workshop in suicide first aid.
In essence, there are three basic elements to our strategy for dealing with suicide – at primary, secondary and tertiary places of education; in the workforce; and through local community, voluntary and statutory agencies. Our first strategy is to support positive mental health promotion; second, to respond in a supportive way when individuals are under stress or strain, for whatever reason, such as alcohol problems, bullying, gay or lesbian issues and money pressures; and, third, it is important to develop protocols of response when suicidal behaviour occurs, aimed at helping to minimise the negative impact.
It has been established, through both national and international research, that following a death by suicide, there is an increased probability that a family member or friend will attempt or complete an act of self-harm or suicide. This is known as a “clustering” effect. The Irish Association of Suicidology has reported that the media coverage of mental health issues and of suicide can be important determinants and influencers of possible behaviour. In general, the print and broadcast media have taken a responsible attitude and approach when dealing with these issues and I would like to take this opportunity to commend the work of the Irish Examiner in this regard. It has published an important booklet, entitled, Let’s Talk Suicide, which is a valuable asset and tool which should be available to every household. Perhaps the Minister of State will liaise with the Irish Examiner to arrange for that booklet to be made available to schools. The booklet forcefully and sensibly highlights the issue in a way that brings home the stark reality of suicide and its consequences. It also explores the options and supports for people contemplating suicide.
I would also like to pay tribute to Deputy Dan Neville, who through his sensitive work, commonsense approach and deep humanity has helped and influenced many people. As a public representative he has done the State a great service and should be complimented on that. Much of what he has done has been done quietly and below the radar, but he has helped and supported our fellow citizens.
The Internet is a source of much comment as its power and usefulness have transformed and shaped the lives of individuals, families and communities. Its influence is generally positive, but there is a potential dark side to the Internet that can manipulated by those who prey on the vulnerable and those in need of support. Some sites on the Internet actively promote and encourage self-harm. These sites are nihilistic and fatalistic and should be monitored or shut down. We have learned with child abuse that the Internet is difficult to police and to monitor on a 24-hour 365-day basis, but we must use it to channel positive and realistic messages on mental health and show that there are alternatives to suicide.
Reference has been made to Facebook, Twitter, Bebo and other social media sites, which are of huge importance with regard to the development of technological interventions to responding to suicide and in communicating positive messages about mental health. We must offer vulnerable people avenues of help which are accessible. I hope the Government will provide a strategy that will be immediate and offer interventions when people need them most. As we know, people who commit suicide do so deliberately at a time when helplines and out-of-hours supports are not available. Smart phones, mobile Internet access and Wifi must be used as a resource to reach out to people.
I understand there is not uniform availability of resources across or between HSE regional areas. Therefore, I call on the Minister of State to undertake a review of the implementation of the recommendations of the Reach Out strategy to ensure that all communities can be supported. I also call on the Minister of State to call on the HSE to undertake a rigorous review of best practice to determine what measures are most effective with regard to intervention and responding to suicide. We must do more than just respond to crises so that we feel better. We must do more than say we need more resources, beds and money. Given the current era of limited resources and reduced personnel, we must ensure that all interventions put in place are targeted, specific and effective. We must know what works and why it works. It is important that when we identify people at risk, they are supported. We must adopt a proactive and targeted approach to individuals deemed to be at high risk of suicide.
It is important to recognise the need for consistency in our response and intervention throughout the country. We must have flexibility in service provision to ensure interventions can be delivered where and when they are needed, rather than be restricted to office hours. We must also have a regular audit of statutory, community and voluntary groups that provide interventions in order to ensure quality control. I ask the Minister of State to follow up on this. We must look at the Internet as a way of promoting support and informing young people they are not alone. We must increase training and awareness among first responders, gardaí and social workers. We must also ensure we have a fast-track referral approach, from primary care services to community-based mental health services for those identified as being at risk.
I thank the Minister of State for her presence at this important debate. This debate is about people, not about a cold, calculated print-out of statistics. It is about our fellow citizens.
An Leas-Cheann Comhairle: I now call Deputy Nicky McFadden. I understand the Deputy is sharing her time with Deputy Brendan Griffin.
Deputy Nicky McFadden: I welcome the opportunity to speak on this serious matter. Like Deputy Buttimer, I would like to acknowledge the great work Deputy Dan Neville has done in this area and his sensitivity in dealing with people and the issues. I also acknowledge the positive approach the Minister of State is taking towards this issue. In talking about suicide, we should consider families throughout the country who have lost a member through suicide. I extend my condolences to all of those people. The facts and figures on suicide are sobering to say the least.
As the Minister of State, Deputy Kathleen Lynch, has stated previously, provisional figures for 2009 show an increase of 4% in suicide to 527 deaths. In this era of constant number crunching, it is easy to get bogged down in facts and figures, but 527 is not just a number. It is the death of 527 Irish men, women and young people who felt there was no other way out but to take their own lives. This is a sobering thought. Not only should we be troubled by this fact, we should also consider the families of those people and the profound effect these deaths have on them and the community.
The increase in suicide rates is mainly seen in men in the middle age group.
There is no doubt that unemployment and serious financial difficulties account for many of these deaths. The prevalence of suicide in middle aged men is a fact that needs to be addressed without a moment’s hesitancy.
Of course, younger and older people are included in these tragic figures. It is estimated that suicide rates have increased in the past two years by 24% and self-harm rates by 11%. Family difficulties, bullying, stress, anger and isolation are also serious contributory factors to suicide rates. The first step in decreasing suicide rates is to get rid of the stigma attached. Until quite recently, up to 1993, suicide was considered a crime. We must urgently remove the phrase “committing suicide” from our vocabulary. Mental illness should be discussed openly and frankly without any sense of sensationalism or scandal. Access to mental health services must be readily available to anyone who experiences mental health difficulties. Having worked in a GP practice, I believe the first port of call for people suffering from mental illness is their GP. It is important that GPs are readily accessible to people who are in trouble, and receive training on how to deal with suicidal thoughts and related issues.
It is not just in GP surgeries that this training should take place. Schools, youth clubs and other community organisations should be educated in this area. Discussion and open debate will create an environment where those who are depressed or having suicidal thoughts will be more inclined to talk openly about their feelings, thereby improving their chances of receiving the necessary help and advice. In schools there should be a greater focus on life skills education. Students should have access to self-esteem programmes, and learn assertiveness and resilience-building skills to equip them for the future.
We need a societal change in how we approach the issue of suicide. Openness, understanding and professionalism are needed to help those at risk. Greater observance is also needed and we need to know the telltale signs of depression or suicidal thoughts. I recommend that everyone should attend the suicide ASIST workshop. I did and it was probably one of the best things I have ever done. It outlines the telltale signs and gives participants the skills to deal with people at risk of suicide. Dr. Jacky Jones, a former regional manager of health promotion with the HSE, described the course as the mental health equivalent of neighbourhood watch.
I commend the National Office for Suicide Prevention website. To members of the media I recommend reading the media guidelines for reporting suicide and self-harm published by the Irish Association of Suicidology and the Samaritans. A number of organisations do great work in this area. Representatives of 1life campaigned outside Leinster House before Easter. It has a 24 hours a day, seven days a week dedicated suicide intervention and prevention helpline on 1800 24 7 100. That organisation helped 36,000 callers in its first year and receives more than 3,000 calls every month. I also recommend the organisation Suicide or Survive which can be contacted at 1890 577 577. Suicide or Survive provides a range of educational and therapeutic programmes that increase understanding of suicide and play an active role in its prevention in Ireland.
People should know that they are not alone and that help is available. On an individual basis, people should be aware of friends, family members or work colleagues who may be dealing with mental health difficulties. A simple action like just being a friend to somebody can be the most important thing in the world. I hope that all the contributions to this debate will help in tackling the risk of suicide.
Deputy Brendan Griffin: I appreciate the opportunity to speak on this issue. I acknowledge the many contributions to this debate made by Deputies from all sides of the House in recent weeks. I hope some of the very positive suggestions and ideas mentioned here over the course of the discussion can some day be implemented where possible. Unfortunately, like every Deputy, I have known many people who have died as a result of suicide. I recently considered the very shocking statistic that three out of 120 from my secondary school year group have died as a result of suicide and most of us have not reached the age of 30 yet. That is just one example and there are similar examples from throughout the country. It is a very sad and tragic situation. I hope that through these statements, along with the actions of the Government and various State agencies, this problem can be tackled and we can see an improvement. Unfortunately, each death is one too many and any improvement needs to be built on.
It is an issue that affects every part of the country, crossing geographical and social boundaries. It will take a very comprehensive approach to tackle the issue. Our approach to the problem of suicide needs to incorporate actions from every Department and is not simply a problem for the Department of Health and Children. Many aspects of the problem relate to other Departments and we need a comprehensive approach to the issue. For example the Department of Transport, Tourism and Sport has a major part to play. The links between physical activity and mental and physical well being have been well proven, and that needs to be improved and worked on. Sporting clubs and organisations that do fantastic work for their local communities have a role to play in helping to tackle this problem. The Department of Education and Skills has a major role to play in shaping attitudes to the problem, informing our young people and helping to eliminate the stigma that as many speakers have mentioned is still a large aspect of the problem.
As Deputy McFadden said, the media need to report suicide incidents in a very sensitive and appropriate manner at all times regardless of the individual involved. Unfortunately, when a celebrity or well known individual is involved, there seems to be a deviation from the best practice code, which needs to be tackled.
Even local government has a role to play. It has been proven that pet ownership can help to tackle the problem of depression and yet, according to the ISPCA, 30,000 dogs are put to sleep every year. Britain has a scheme offering those suffering from depression the opportunity to avail of dog ownership with the thinking that people will engage in more physical activity by simply walking the dog and that interaction between humans and dogs can be therapeutic and helpful.
This is only a very small suggestion but could perhaps be considered. It will not solve the problem but could certainly help. If but one life could be saved as a consequence, it should be considered.
I acknowledge the considerable contribution by Deputy Dan Neville, who has dedicated years to addressing this issue and who has done fantastic work on mental health. Much work on suicide and self-harm has already been done by the State and State agencies. When I asked a question about suicide statistics and the problem of suicide in the HSE south area at the regional health forum for that area in February, the response I received was very comprehensive and detailed. It proved that so much work has already been done in this area. Unfortunately, however, we seem to be losing the battle. We need to consider how best we can use our resources and the agencies of the State already working on this issue to try to improve circumstances overall.
Next Saturday morning I will be taking part in the Pieta House-sponsored Darkness into Light walk, which will take place at 4 a.m. in Killarney National Park. The walk symbolises the move from darkness into light and is in remembrance of a number of locals who died by suicide. The initiative and similar initiatives need to be welcomed and encouraged. They all help to eliminate the stigma that is, unfortunately, still associated with suicide in Ireland in 2011.
I will be delighted to attend the See Change campaign briefing on Wednesday, 11 May from 9.30 a.m. to 11 a.m. in the Oireachtas audiovisual room. I encourage all Deputies to attend. I know many will be attending, having spoken to them. The campaign is an example of a positive initiative that needs to be encouraged.
I sympathise with all those affected by suicide who may be watching this debate on the Internet or who may read the transcript thereof at some stage. Possibly every household in the country has been affected by suicide, a problem on which we all need to work together to solve.
Deputy Joan Collins: I wish to share my time with Deputy Seamus Healy.
An Leas-Cheann Comhairle: Is that agreed? Agreed.
Deputy Joan Collins: I join Deputy Griffin in sympathising with all those affected by suicide. We must address the nitty-gritty of the problem. There is a distinct link between the economic downturn, especially the rise in unemployment, and suicide. Amnesty International has made this very clear. It seems likely that the increase in the suicide rate is primarily a result of the impact of the economic downturn with substantially more people unemployed and suffering from personal debt.
One of the main problems with which the Dáil must deal is unemployment because doing so will give people more hope and income and allow them to put their children through college, etc. The Government is not really dealing with this and will not be able to do so because it has accepted the diktats of the IMF and European Union. While my point very much concerns economics, it is a key issue. The suicide rate will continue to escalate under the prevailing economic conditions unless the problem is addressed with real drive by creating jobs. People Before Profit and my fellow United Left Alliance Deputies believe this should be achieved by putting thousands of people back into the workforce in publicly funded jobs. I refer to the building of schools, as mentioned in the budget statement, the retrofitting of homes and addressing the water crisis associated with the condition of pipes all over the country. A national employment programme would make a big difference in preventing the worsening of people’s circumstances.
A key cause of suicide is the extremely poor quality of mental health services. I have experience of people having to rely on public health service psychiatrists, etc. What generally happens is that one receives an opportunity to sit with a psychiatrist once per month. The psychiatrist changes monthly, however, and there is no continuity. Many of the patients are older women and men. They may have to talk to young women doctors who are probably in the initial stages of training, and this does not help when dealing with the issue of depression.
Amnesty International has identified the poor quality of mental health services in Ireland as a key cause of suicide. Suicide is preventable and better mental health services would mean fewer people dying in this tragic manner. Amnesty International makes the point that adequate treatment of major mental disorders decreases the risk of suicide and is an effective way to prevent suicide in health care. Ireland still lacks a modern, adequately resourced community mental health service. The Government should address this. There is an absolute need to prevent suicide and this can only be done by investing in the appropriate services.
The need to move towards a well funded, properly resourced community-based mental health service is crucial. International evidence shows that good community-based services, by comparison with traditional hospital services, are linked to lower suicide rates. In Ireland, 80% of mental health resources remain tied up in hospital-based treatment. This is a model we must move away from. It represents another appalling failure of the HSE to carry out reform in this area. Amnesty International claims the failure to reform mental health services means Ireland continues to fail to meet international human rights standards. As a society, we must meet those standards, and this can only mean resourcing the appropriate services. How are we to resource the services in the current climate? The forthcoming review of the Mental Health Act 2001, committed to in the programme for Government, must result in legislation to force the HSE to implement urgent reforms.
Many of the people I have been meeting recently, particularly mothers and fathers of autistic children, who are trying to get their children into schools and have their disabilities assessed, are now being told there is no point in having them assessed because there are no special needs teachers to serve them. This is an absolute scandal. It is one of the economic and social issues we must address. We must be willing to step up to the mark in this regard, put resources where they are needed and impose taxes where we can. We know there is plenty of money within certain sections of society. The very wealthy in this country do not pay a cent in tax. If they were taxed and the money were invested where needed, we would have a way of moving forward. Until the Government meets this challenge, we will continue to experience the sorry economic circumstances we are experiencing at present and fail to step up to the mark with regard to suicide prevention.
E Deputy Seamus Healy: I congratulate the Minister of State with responsibility for mental health services on her appointment and wish her well in her new office.
I agree with previous speakers about the effects suicide has had on families throughout the country. I sympathise with the families and relatives who have been through this experience. Unfortunately, many families have had experience of suicide over the past number of years. Some families would have been aware of mental health difficulties but others have seen suicide occur almost out of the blue. It is a very important problem to be dealt with as it is a matter of real concern for many people in our community.
I thank the many voluntary organisations working in this area, such as the mental health organisation, GROW, Aware and others. There are also many local organisations who are doing exceptional work on this issue on behalf of families and persons with mental health difficulties. As Deputy Collins said, funding is undoubtedly a serious issue for many of these organisations. According to today’s newspapers, an organisation in Wicklow has indicated that unless its funding can be re-established it might have to close an important and energetic service it has been providing for many years.
Like other Deputies, I regularly encounter people at my clinics who are experiencing unemployment for the first time. These are people whose families have no history of unemployment. It can be hugely distressing for people to find themselves in that situation. I have met people at my clinics who are completely frustrated, distressed and simply do not know what to do. They have always worked, either in good jobs or in self-employment, and suddenly find that they are dependent on the social welfare or community welfare services. It is distressing and frustrating for them that they are unable to look after themselves or their families. The problem of unemployment must be tackled. If it is, it would deal with at least one aspect of the suicide issue.
Another matter dealt with by Deputy Collins is young children with special needs and the difficulties they have. Unfortunately, it appears that the special needs area is being targeted for cuts in the education sector. Again, if this is allowed to progress, a growth in the suicide figures will become evident. Obviously, where young people are already experiencing difficulties in a school, social or family setting, those difficulties must be dealt with early or a situation will develop later that will give rise to many social ills, including suicide.
The number of suicides in the past number of years is a cause of concern. It opens our eyes and certainly suggests the issue must be dealt with seriously and tackled on an immediate and ongoing basis. There were 527 suicides in 2009. It is a terrifying figure. The breakdown of the figures shows that substantially more men than women take their own lives, with the rate for young men being significantly higher than that for young women. Young men in the 20 to 24 year old age group are particularly affected.
Implementation of the A Vision for Change document is hugely important in dealing with the issue of suicide. Certainly, the development of community-based services is vital to ensure that services are available on a family and local basis, and not just through the HSE but also through local community and voluntary organisations. Some people who have mental health issues prefer to deal with non-statutory organisations. The implementation of the community-based services proposed in A Vision for Change is very important.
As Deputy Collins said, there are huge resources available to be tapped. Numerous reports have suggested that approximately €250 billion in assets are in the hands of a small number of very wealthy people in this country. There is no assets tax on those assets. If those assets were targeted, there would be huge amounts of money available to deal not only with suicide, but also many other issues.
Deputy Joe Costello: I am delighted to have the opportunity to speak on this important issue. I congratulate the Minister of State, Deputy Kathleen Lynch. This is the first opportunity I have had to speak before her in the House. I acknowledge her commitment to dealing with this issue and what has been done already through the ASIST, applied suicide intervention skills training, programme and the See Change initiative. I also pay tribute to Deputy Dan Neville who, long before he became a Deputy, identified suicide as a major malaise in Irish society. I recall that as a Member of the Seanad he was one of the first, if not the first, to raise this issue and he has pursued it in the years since. Third, I pay tribute to all the voluntary organisations who are doing such good work, such as Pieta House, ASIST, Aware, the Samaritans and so forth.
Suicide is the silent killer in our society. It destroys lives, creates victims and causes devastation to many families in this country. As Members are aware, there are twice as many deaths by suicide as there are deaths on our roads. That is a dreadful statistic when one contemplates it. The two main causes of death among young people are either suicide or road traffic accidents.
Deputy Joe Costello: Suicide is a silent killer. In particular, it strikes many young men, so often without warning. Twice as many people die from suicide as in road deaths here. Combined, they are the two highest killers of young people. It is a hugely important issue. Road deaths have received enormous attention and was the subject of debate in the Chamber and in other fora. Scarcely a year has gone by without another Bill passing through the House to improve road safety and reduce road traffic deaths. I refer to permitted blood alcohol levels, speed cameras, road improvements and drug issues. Young people are those most at risk on the roads.
One could ask how often we have had a debate in the Chamber or in the public arena on deaths by suicide. I recall the previous debate we had lasting approximately two hours, which was hardly adequate to address the issue although it results in double the number of road deaths here annually.
I hope the debate that has been taking place for the past four weeks will change the situation and stimulate more activity in terms of the manner in which we approach the issue. More intervention and preventative measures are required. I hope also that we will bring to the attention of people the length and breadth of the country that there are voluntary and State facilities in terms of assistance and intervention.
I received a letter only yesterday from 1life suicide helpline which referred to the effects of the debate. It offered an update on the calls received over the Easter break in the light of the recent and forthcoming statements on suicide in the Dáil.
Some 705 callers rang the 1life suicide help line over Easter week alone and some 56% of those callers presented with serious suicidal ideation. Five calls were classed as ‘suicide in progress’. Some 59% of the callers were female and 40% were male. The number of male callers was much higher than the average for male callers, which is 20%. Young men do not come out into the open on this issue and do not use the help lines in the same way as young women. The number of female callers is quite high, at 59%, but young men are generally only one-third of that number. That we are having a debate on this issue and that the issue is being raised in the public arena through the media will have a desirable and beneficial effect in the broader community where some young people are subject to depression, have suicidal tendencies or suffer some form of mental illness that drives them to take extreme measures. While Dáil Deputies were enjoying the Easter break, calls to the help line numbered more than 1,000.
I hope this debate on the issue of suicide will bring ongoing benefits. The debate reflects the fact that many new Members, particularly younger Members, have a great awareness of the issue and we have had no shortage of Members wishing to speak on it. It is a growing concern that the largest increase in the number of suicides currently is among middle-aged men. This is unexpected as suicide was mainly a youth issue. There has been a sharp increase in the number of men in their 40s or 50s who die by suicide. Anecdotal and other evidence suggest that this is related to the prolonged recession we have had here over the past three years. Men who have been holding down stable, safe jobs and who have had a good career, now find themselves with mortgage difficulties and find it difficult to put bread on the table, educate their families and hold on to their jobs. They see little prospect of improvement. The result is enormous stress and trauma for people who did not have any problem with earning a living, rearing a family and buying a home. Now all of these issues are causing problems which are often overwhelming. Depression, stress, trauma and inability to cope are the result and these have given rise to the sharp increase in suicide in the middle-aged group.
In my constituency, Dublin Central, we have seen a new phenomenon of grandparents burying grandchildren. This has been going on for some time and is related to the scourge of drug addiction which has blighted so many young lives in the constituency and elsewhere. It is also related to the hopelessness and lack of purpose in these young lives, the shortcomings and frustrations of their environment, the emasculation of young men by a society which provides few job opportunities, the inadequate education services, the lack of facilities and the lack of a meaningful role in an environment which is often ghettoised. This environment undermines young people’s self belief and many of them turn to drugs and drink. This is the pattern in the deprived areas of the inner city of Dublin, other suburbs and other parts of the country. It has been a particular feature of my constituency in the north inner city. The fact that grandchildren are being buried by their grandparents is unnatural. This should not happen in any civilised society. It happens due to the stresses and trauma, particularly for young men, in an environment where they face hopelessness and lack purpose in their lives. This is an issue we must address. Suicide in this instance is a malaise of our lopsided and unequal society. It results from the degree of poverty and ghettoisation in certain sectors.
A long-term solution to the problem will only be found in redressing these inequalities and in providing hope, self respect and equality of opportunity for all. The Minister of State mentioned some good intervention and prevention policies in her address. She mentioned what she intends to do and what the previous Minister of State, Mr. John Moloney, put in place. The policies are there and much good work is being done by voluntary and State agencies throughout the country. There has been a stigma attached to the issue of suicide at individual, family and neighbourhood level. It is important the issue is more transparent and discussed more openly. That is the reason for this debate.
Some €8.7 million is to be spent on suicide prevention this year. This compares poorly with the amount of money being spent on road safety. It is most unlikely the amount will be increased significantly because it would be difficult to put policies in place that would be able to avail of an amount anywhere close to what is being spent on road safety in a short space of time. However, there should be a gradual increase in the amount allocated annually and that should be part and parcel of the policy to be adopted by the Minister of State for the duration of this Administration. Policies must be researched and put in place over the next years and the increased funding should only be put in place when those policies and the necessary legislation are implemented.
I compliment the Minister of State on the priority she has given to this issue and on the commitment she has given to dealing with it. I acknowledge that it is a priority issue for society, although it has been neglected for a variety of reasons, not all of which relate to the authorities. It is time we came to grips with the issue. I wish the Minister of State the best in the work she proposes to do to deal with the issue. I suggest that she should institute a debate on the issue in the House each year during which she can report on progress in dealing with this awful scandal of suicide in society.
Deputy Joe Carey: I welcome the opportunity to contribute to this important debate. It is encouraging that a debate on suicide prevention is getting priority in the 31st Dáil, with contributions from so many Members in recent weeks. I offer my congratulations to the new Minister of State with special responsibility for mental health, Deputy Kathleen Lynch and wish her well in her new role. I also acknowledge the years of work my colleague, Deputy Dan Neville, has put into the subject of suicide.
The tragic growth in the number of people taking their own lives is disturbing.
The 2009 statistics show that 527 people died by suicide, but experts believe the numbers were much higher. There is little doubt there is a direct correlation between the increased number of people taking their own lives and the economic situation the country is facing. The modern day pressures created by an economic situation with job opportunities hard to come by and increasing personal debt, in particular credit card debt and mortgage debt, are placing an enormous strain on people and, tragically, in some instances people are taking their own lives. There is now a well documented crisis in the number of suicides in Ireland each year. In reality the rate of suicide has been rising for many years prior to the economic downturn but the added pressures placed on individuals in recent years does not help.
People presenting with depression and anxiety must be seen in a prompt and timely manner with proper access to relevant medical and psychological treatments where required. There is not a town or village that has not been impacted by suicide. It is a classless and seemingly non-age specific affliction that leaves more questions than it gives answers. In some cases we do not know why people decide to take their own lives. The most striking figure is the shocking number of young men who take their own lives. Why is this the case and what strategy can be introduced to address this growing problem?
It is clear that when it comes to suicide, young males are the most vulnerable section of society and policy on suicide prevention must reflect this fact. In the second quarter of 2010, there were 127 recorded deaths by suicide in Ireland. Of these 102 were male, which reflected a slight increase in the same period in the previous year. In 2009, some 527 people took their own lives, which is significantly higher then the number of people killed on our roads in the same period. We must divert the same level of resources and political action to the issue of suicide as is currently given to tackling road deaths. We also need to try to understand why so many Irish people, particularly males, take their own lives.
I commend a recent RTE television programme on the issue and I also commend Carl O’Brien of The Irish Times who wrote a series of articles on suicide. He dealt with it very sensitively and candidly, and did a good job in raising awareness of suicide. Creating awareness and highlighting the terrible emotional legacy it leaves are important for society. We know that links between alcohol and drug abuse and suicide is quite high, and further studies of the area are needed to get a more comprehensive picture. For too long issues such as suicide in Ireland have been taboo, to be contained within private grief and not for national discourse. We need to change that in a sensitive way.
I compliment the work of organisations such as the Samaritans and Living Links, which do tremendous work. Support groups also play a very important role in offering vital counselling services to those who have been bereaved by suicide. One such group, Solas, is based in Ennis in my constituency. This group was established in 2005 and does very valuable work.
If we are to make a dramatic reduction in the number of people we lose through suicide each year, the solution must lie in a community-led approach. Local community groups, youth clubs, the GAA, soccer clubs and other organisations can play a key role. Some of these clubs and organisations are already doing this in that they are rolling out different programmes. There are outstanding people who are active members of these clubs and want to play a part in preventing suicide. These clubs need resources and supports.
The issue of suicide awareness and prevention is a complex and difficult one. If a community-led approach to suicide prevention is to work, clubs will need help and encouragement to establish suicide awareness and prevention programmes that can be delivered through their clubs. Funding for mental health issues needs to be protected and channelled through primary mental health care and communities. Understanding suicidal behaviour is not enough if we as a society do not change and look at the issues behind suicide and in doing so develop the skills needed to deal with them.
I wish the Minister of State, Deputy Kathleen Lynch, well in her new role and I hope she takes on board some of the positive proposals made my Members on all sides of the House during this very worthwhile debate. I concur with Deputy Costello who proposed that we should have a debate on the issue every year and get an update from the Minister of State as to progress on the measures she hopes to introduce to reduce the number of people who die through suicide.
Deputy Aengus Ó Snodaigh: Cosúil le daoine eile, gabhaim comhghairdeas leis an Aire Stáit, an Teachta Kathleen Lynch, as ucht an post nua atá faighte aici. Ní bhfuair mé seans é sin a rá go dtí seo. Tá a fhios agam, ón obair a dhein sí roimhe seo, gur duine maith í. Tá súil agam go mbeidh sí in ann obair de réir a mbriathar nuair a bhí sí ar an taobh seo den Teach.
Baineann an díospóireacht seo le ceist ríthábhachtach don tsochaí. Níl an ghné seo gafa le polaitíocht páirtí, ach leis an bpolaitíocht agus leis an sochaí. Ní chóir go mbeimid in adharca a chéile faoi. Sa deireadh thiar thall, tá an díospóireacht seo sé níos tábhachtaí ná aon rud eile a tharlaíonn anseo. Baineann an ábhar seo le beatha na ndaoine. Mar a dúirt an dá Theachta a labhair romhaim, más féidir linn díriú isteach ar an ní seo uair sa bhliain, b’fhéidir go gcuideoidh sé le duine éigin a shábháil ó féinmharú. Measaim gur fiú é sin. É sin ráite, caithfimid díriú isteach ar cén fáth ar tharla méadú chomh mór ar ráta féinmharaithe na tíre seo le blianta beaga anuas. Ní leor a rá go bhfuil níos mó taifead á dhéanamh ar seo.
It is not just that there is now greater recording of suicides than there was in the past. That accounts for some of the increase in recent years, but it does not explain why our society is suffering the current level of suicide. The previous speaker said that 527 suicides were recorded in 2009, which was a substantial increase on the previous year – that is not even the full figure.
That gives a sense of the scale of the problem we have. It is not a party political issue but is a political issue because we as a society must ensure that the appropriate resources are dedicated to addressing this issue. The services and supports need to be in place, whether it is at a local community level or at a national level. The HSE should give a greater priority to dealing with mental health issues than it has given in the past. In our schools and clubs those who are mentors, leaders and teachers need to understand how to identify the signs. Not everybody who has committed or attempted suicide projects the signs but quite a number of people do so.
I am no expert in this field but realise there are signs that need to be spotted and that people need to be listened to. The problems need to be addressed in as comradely and helpful a fashion as possible. It is partly a question of resources. The various groups who help those who are suffering from distress or depression, or who are contemplating suicide, have set out in some detail the steps one can take. We need to consider these.
A harrowing statistic I read in recent months is that over 74% of citizens know somebody who has died by suicide. This shows the scale of the problem. It is only one step removed from us. How many Members have attended funerals of suicide victims and noted the absolute grief of their bereaved families? We have noted the harrowing scenes and distress.
Families of suicide victims often feel guilty. They ask whether the suicide would have happened had they taken a certain course of action. They sometimes blame themselves not realising that the suicide might have happened in any case. In many cases, families do not know the reason for the suicide, even years later. “Why” is the big question for families. Families and associates of victims often need help.
Not so long ago I attended a funeral of a young man who had committed suicide. I met his parents again last week and discovered they still ask why it happened. There were no signals. Perhaps the family will never know why it happened. At the man’s wake, there was considerable anger among his friends. I could not figure out whom they were angry with. Was it with themselves, society or the young victim? I talked to some of the men and met some of them since in various locations, including the local club and pub, and noted the conversation always returns to the question of why the suicide occurred. The anger of some of the men was associated with their belief that there is nothing for them and no hope. Some asked why the victim had not talked to them. I have had similar conversations at one or two other funerals I attended.
Suicide does not affect just one group of people. While it is most prevalent among young men, which in itself is scary, it is a problem right across society. Quite successful people have committed or contemplated suicide because of a collapse of their business or relationship, for example. Some have attempted suicide and have not been successful. The problem arises right across society. It is partly a question of education. That we in the House are willing to talk about suicide is very important. Twenty years ago, the Dáil would not have discussed suicide to the extent we have discussed it. It was a taboo subject and people did not mention it, pretending it was not really happening. We now have a more enlightened society and this alone will help dissuade some people from committing suicide and bereaving their families.
The main step we need to take as a society is to listen a little more. In the past ten or 15 years, we have become inward-looking. We are too busy rushing here, there and everywhere and sometimes do not take the time to stop and listen to friends and those around us. If this message, which is
A group I met recently is involved in online counselling. Not everybody wants to discuss problems over the telephone or on a face-to-face basis; some want to put their thoughts on paper. We should support every organisation that can help people. I congratulate all those who are involved in offering support. In many ways, theirs is a thankless task. Sometimes they come home distressed after having spent a few hours manning a telephone line. Every Member of the House ought to praise those who give up their time voluntarily to help people they have never met, and we ought to praise everybody else involved also.
There is a range of steps that the Government should take urgently. There should be a properly resourced suicide prevention strategy, which strategy might involve determining whether the time of all the relevant organisations has been put to the most effective use. There is a wide range of groups. They should be properly resourced and should have the skills and staff required to deliver the services they are advertising, such that the services of Teen-Line and Samaritans, for example, would be available morning, noon and night. Every group is struggling to raise money and to operate with existing resources.
The modernisation of the mental health legislation in line with the new convention on the rights of persons with disabilities is required. I hope the Minister of State, Deputy Kathleen Lynch, will be able to introduce legislation in this regard in the near future. I am not expecting it to be introduced in her first couple of days in office. We need to promote a cross-departmental action group to combat social exclusion, prejudice and discrimination against people with mental health problems. We should ring-fence a certain proportion of the budget of the Department of Health and Children for mental health services in line with the recommendations of the World Health Organisation. The required child and adolescent community-based mental health service must be provided. The placement of children in adult inpatient facilities must cease, which means facilities must be created that are more appropriate to children than the facilities that were made available heretofore. It is disgraceful that some young people to whom I have spoken have ended up in inappropriate wards in hospitals and did not receive proper care because of a disconnect in the HSE over the years. There has been a failure to address the issue of suicide attempts, particularly among young people with suicidal tendencies. Many organisations are doing great work in the field of suicide prevention and counselling and they must be resourced properly.
The week before Easter, a group contacted me with a view to abolishing the stigma that surrounds mental illness. This is a useful goal. The organisation outlined certain stigmatising words that should not be used and which can lead to isolation among those who are trying to deal with mental illness. As a society, we are all responsible for the prevailing culture and need, as individuals, to make a conscious decision not to use certain words, such as “mad”, “crazy”, “bonkers”, “psycho” and “schizo”. There is a range of such words. I have heard my children and other children using them, albeit not understanding the consequences for those with mental health issues or those who may be struggling in life.
First and foremost, we must save lives. It is that simple. We must seek to prevent suicide in whatever steps we take. We do not wish to be attending funerals and consoling friends and families who have lost a loved one due to this society not being caring. For many years Ireland was known as Ireland of the welcomes. That welcome should not just extend to people from abroad but to everybody, including those with mental health problems. That means taking the time and making the space in our lives to address it.
I am a member of the Ballyfermot drugs task force and one of its initiatives is to train local people to spot the signs of possible suicide. It is a cost-effective programme and now 200 people have the training to watch out for signs that people, particularly young people, are contemplating or actively planning suicide and to know what steps to take. It is not that they interfere but they know where to direct the people concerned. Many of the problems in our society are due to the huge change whereby alcohol and drugs have taken a greater role in people’s lives, particularly in the case of young people. That feeds into the national drugs strategy which will take on the alcohol issue when it is fully implemented and resourced.
It is useful and correct to address this issue in the House. As we give more attention to it hopefully the numbers will stabilise and start to reduce as quickly as possible. Ultimately, we must have a society in which people who feel under pressure, particularly young people, know they can talk to somebody, be it a relative, friend or somebody anonymous through a helpline or website. We should do whatever we can in this House.
Deputy Robert Dowds: I wish to share time with Deputy Kenny. I congratulate Deputy Kathleen Lynch on her appointment. She is a very down-to-earth woman and I hope she has much success in her office. I believe she will be on top of the issues with which she must deal.
I am conscious of the huge sadness and trauma surrounding suicide and the terrible impact it has on the friends and families of the individuals concerned. I wish to record my appreciation of the work done by many organisations and individuals who tackle the issue of suicide and the heroic efforts of priests and clergy who are in the difficult position of conducting the funerals of suicide victims. I witnessed one priest manage to maintain the very fine balance between honouring the person who had taken their own life and ensuring that suicide was not painted in any type of glamorous way. That was particularly difficult and the more people who can do it, the better when it comes to tackling this issue.
I will focus on the links between alcohol and suicide. The data from the World Health Organisation regarding suicide are striking. The 2009 figures show Ireland in a reasonably good light with 9.2 deaths per 100,000 people. That puts Ireland close to the bottom of the table, in contrast with countries such as Estonia and Lithuania where the incidence is up to over 30 per 100,000. However, when one examines the suicide figures for the 15 to 24 year old category, the situation is considerably different. In that context Ireland’s figure is 14.4 per 100,000 people, which puts it fourth from the top. This contrasts with the rate for countries such as Portugal, with 3.7 per 100,000, and Greece, with 1.9 per 100,000. This is a considerable contrast to the overall figure in Ireland. While we must focus on the general issue of suicide, we must also examine why there is a higher incidence at that stage in life. That incidence is not necessarily reflected in other countries.
I strongly believe that alcohol plays a considerable role in many suicides, most especially in those that occur in the 15 to 24 year old age group. Although pure alcohol consumption reduced from a peak of 14.2 litres in 2002 to 12.4 litres in 2008, Ireland still has the third highest rate of alcohol consumption in Europe after Estonia and Austria according to European figures. The starkness of these figures is worsened by the fact that the European Union survey indicates that one quarter of Irish people had not drunk alcohol in the previous year. This means that those who are drinking are consuming considerable amounts.
I recently asked the Oireachtas Library & Research Service to look into the research on this matter. The evidence on the connection between alcohol and suicide is quite frightening. A 2006 study of the emergency department at Cork University Hospital looked at patients who attended the emergency department during three periods between December 2002 and January 2004. The study reported that 50% of people attending the emergency department with acute intoxication had also consumed large amounts of prescription medication and-or had over-medicated in an attempt to harm themselves. Almost all the participants were young, male and from lower socioeconomic backgrounds. The authors state that “the results of this study suggest that excessive alcohol consumption is closely related with suicide and deliberate self-harm”.
Another study, conducted by Bedford et al in 2006, reviewed coroners’ reports in Cavan, Monaghan and Louth in 2001 and 2002. The study was undertaken to identify the blood alcohol concentrations, BACs, in persons who died as a result of accidental death or suicide. All cases where the person died as a result of injury or suicide in 2001 and 2002 were included. There were 129 deaths eligible for inclusion, of which the majority were male, at just over three quarters, and 113 were adults aged 18 years and over. Blood alcohol concentration levels were tested for the majority, 105 or 81%, and 55% tested positive for alcohol. The key findings were that 31 or 24% of the deaths were suicides, of which 90% were male. Blood alcohol concentrations were recorded for 29 of these suicides and, of these, 16 or 56% had alcohol detected in their blood.
Persons aged less than 30 years of age were significantly more likely to have alcohol in their blood. Over half of those aged less than 30 years had blood alcohol concentrations in excess of 160 mg per 100 ml, twice the legal drinking limit. The blood alcohol concentration findings in the study, particularly for the under 30s, are among the highest reported in the international literature. From these findings the authors conclude that the high blood alcohol concentrations in those who died as a result of suicide or injury reflect the high level of alcohol consumption and binge drinking in Ireland. Another study, which I will not have time to deal with in detail is the national report, “Suicide in Ireland: A National Study”, in 2001. It had somewhat similar findings.
The World Health Organisation has estimated that the risk of suicide where a person is currently abusing alcohol is eight times greater than if he or she was not abusing alcohol.
A report from the UK Mental Health Foundation also states that as many as 65% of suicides were related to excessive drinking and identifies alcohol problems as one of the highest risk factors for suicide. This report also identifies a strong link between alcohol use and thoughts of suicide, suicide attempts and completed suicides among young people under the age of 24.
These studies clearly outline a connection between alcohol and suicide. It seems obvious that high alcohol consumption can induce depression, which might cause suicide or which might lead to someone with a suicidal intent drinking in order to gain the courage to commit suicide. Groups such as Alcohol Action Ireland believe that the connection between alcohol and suicide is strong and argue that alcohol use can act as a factor in suicide. This view is also supported by Ann Hope who, in a research report compiled for the HSE in 2008, argued that alcohol is an important contributory factor in suicide and concluded that “Alcohol can facilitate suicide by increasing impulsivity, changing mood and deepening depression”.
A problem which has also been highlighted is that there is insufficient evidence to examine whether a link exists between single vehicle road accidents and suicide. Professor Denis Cusack made a call in respect of this matter and I wonder whether there have been any developments in this regard. It would be useful if material relating to whether their is a link between such accidents and suicide could be made available because it would be of assistance in examining the overall position.
I ask the Government to seriously consider banning advertising which relates to alcohol. Such advertising always glamorises alcohol and usually links it with something such as sport. While alcohol does have a positive function, if not used properly it can have hugely negative effects. It would certainly be worthwhile for the Government actively to consider banning the type of advertising to which I refer. I accept that such a move would probably lead to quite an aggressive debate. However, I am of the view that it would ultimately be of major benefit, particularly in the context of allowing us to confront the issue of alcohol consumption.
I appreciate that this debate primarily relates to suicide. If, however, the advertising of alcohol was banned, this would have a positive impact not only in respect of alcohol consumption, but also in the context of suicide. A ban on advertising might give rise to a situation where younger people might tend not to start drinking until they reach a more mature age. This would certainly be beneficial in the context of the issue of suicide.
Deputy Seán Kenny: I congratulate the Minister of State, Deputy Kathleen Lynch, on her appointment. I wish her every success in her new position.
Suicide is a global issue. The WHO has indicated that it is a significant public health problem worldwide and that each year more people die as a result of suicide each year than die in armed conflict. That fact places the matter in perspective. It is possible for everyone, whether inside the House or outside it, to be in a position to take steps to prevent suicide and to inform others of those steps. The key to preventing suicide is to take it seriously. I wish to outline some of the steps to which I refer in the hope that the information I will provide will be of use.
Suicidal behaviour is a cry for help. Most people have suicidal thoughts or feelings at some point in their lives. Almost all suicidal people suffer from conditions that will pass with time or with the assistance of a recovery programme. There are modest steps we can take to improve our response to those who are suicidal and to make it easier for them to seek help. It is a myth to state that people who talk about committing suicide do not do it. However, studies have found that more than 75% of all those who commit suicide did things in the weeks or months prior to their deaths to indicate to others that they were in deep despair and in need of help. Anyone who expresses suicidal feelings requires immediate attention.
It is also a myth that individuals who attempt suicide are insane. It has been stated only 10% of all suicidal people are psychotic or have delusional beliefs about reality. Most suicidal people suffer from the recognised mental illness of depression but many depressed people adequately manage their daily affairs. The absence of insanity does not mean the absence of suicide risk.
On average, a single suicide intimately affects at least six people. Sometimes people who know someone who ended their own life can say that the problems that person was experiencing were not enough to prompt him or her to commit suicide. It is a mistake for people to assume that because they may feel something is not worth feeling suicidal about that others feel the same way. It is not a matter of how bad is the problem, rather it is how badly it is hurting the person who is experiencing it.
Another myth is the suggestion that nothing can stop a person from committing suicide once he or she has made a decision to do so. An individual who is suicidal can be ambivalent. In other words, there is a partial desire to live. The other part of the person does not want death – it wants the pain to end but not necessarily to die. It is the part of the individual that wishes to live which seeks to say to another person “I feel suicidal”. If a suicidal person turns to us it is likely that he or she believes that we are more caring or more informed in respect of coping with misfortune and are more willing to protect his or her confidentiality. No matter how negative the manner and content of what such a person says, he or she is doing an extremely positive thing. We should all be willing to give or receive help. In addition, we should be prepared to do so sooner rather than later.
The prevention of suicide is not something to be undertaken as a last minute activity. Text books on depression indicate that it should be reached as soon as possible. Unfortunately, individuals with suicidal tendencies can fear attempting to get help. They are concerned that help may bring them more pain and result in their being informed that they are stupid, foolish, or manipulative. These individuals may fear rejection, punishment, suspension from school or work or written records of their condition or their involuntary commitment to a psychiatric hospital being recorded.
We must do everything in our power to reduce the pain experienced by a person who is feeling suicidal, rather than increasing or prolonging it. We should give that person every opportunity to unburden himself or herself of his or her troubles and to ventilate his or her feelings. Not much needs be said and there are no magic solutions. We should not judge people. In addition, we should avoid arguments.
Yet another myth is the idea that discussing suicide may give someone the idea of committing it. Individuals at risk of suicide are already aware of the idea, particularly in light of the wide coverage relating to it in the media. People already have the idea because suicide is constantly in the news. Asking a person whether they feel suicidal is a good thing – we are showing that we care about him or her, that we take him or her seriously and that we are willing to share his or her pain and be of assistance. Persistence and patience are needed in order to seek and pursue as many options as possible to ensure that a suicidal person is able to obtain the help he or she needs.
I previously served as a member of the HSE Dublin north-east regional health forum and last year I was in attendance when Mr. Geoff Day, director of the National Office for Suicide Prevention, made a presentation to it. Mr. Day identified solutions that work in the area of suicide prevention. These include GP education, skills and problem-solving programmes, education of community gatekeepers, restriction on access to the means of suicide, treatment of mental illness, follow up after self-harm and responsible media reporting.
There is a need for better and more rigorous controls in respect of the sale of non-prescription drugs. Paracetamol is just one example of a non-prescription drug. Such controls would provide a way to restricting access to the means of committing suicide. Non-prescription drugs are freely available in shops and supermarkets and if they are mixed with alcohol they can cause accidental death, which can often be categorised as suicide. It is possible to purchase these and other life-threatening drugs on the Internet, over which it is extremely difficulty to exert control in the context of the sale of products.
I will conclude by quoting comments by President McAleese at the world congress on suicide prevention in Killarney in 2007.
Reducing suicide rates requires a collective, concerted effort from all groups in society: health, social services, other professionals, communities and community leaders, voluntary and statutory agencies and organisations, parents, friends, neighbours and individuals. It also requires the careful nurturing of a culture in which people in psychological distress don’t hesitate to seek help.
I would like to express my gratitude to all the groups and organisations who help people to deal with suicide and its after effects.
Deputy Denis Naughten: I welcome the opportunity to speak on this debate today. I wish the new Minister of State the best of luck in her role. I know that she will do an excellent job because she has a great interest in this area. I specifically want to acknowledge the tremendous work that has been done by my colleague, Deputy Neville, over a long number of years in both Houses. We would not be debating this issue today but for the Trojan work he has done over a long period of time.
The first thing we must acknowledge is the scale of suicide. People do not talk about it. They are afraid to talk about it and it has not received the same level of debate as issues such as road traffic accidents and road safety. Deputy Neville’s own organisation, the Irish Association of Suicidology, carried out a study which indicated that three out of four respondents in a survey knew somebody who had died by suicide. Every one of us has personal experience of this. I am aware of family members, friends and neighbours who have all died by suicide. It is important that we talk about the issue, but it is also important that we deal with some of the myths on suicide and mental health.
Huge stigma is associated with mental health in Ireland. Addressing the perception of mental health will go a long way towards ensuring that people who have a risk of committing suicide get the help they need. Between 80% and 90% of those who take their own lives are suffering from some type of psychiatric condition. For those who are young people, it has often been unidentified depression. We need to look at the stigma associated with mental health in this country. It has been ingrained into us as a society. Everybody will talk about someone who is diagnosed with cancer. Somebody with cancer has no difficulty talking about their diagnosis and their treatment, be it in the pub, outside the church or in the local community. However, if it is mental illness and somebody is on medication for it, that person closes down, the family closes down, and they try to ensure that nobody finds out about it. That typifies the public perception and the attitude in society to mental health issues. If we look at the number of people who have a diagnosed mental health issue and the number of people with an undiagnosed mental health issue, then a significant proportion of the population will be affected. It will cross every single home in this country at some stage in everybody’s life. The concealment of depression and other mental health problems is a serious concern and is a significant part of the problem of addressing suicide in society.
One in three people have experienced depression either personally or among family members. In the vast majority of cases, that particular experience is concealed from immediate family members and from friends. It is interesting to note that around 400,000 people suffer from depression, yet do not feel comfortable talking about it. It was interesting to listen to Mary McEvoy on the television recently telling her own story about depression. She finished up by saying that she had not beaten depression, but she was able to function in society, still suffering from depression and still on medication for the condition. We need more people like that who are prepared to come out and talk about their own personal experiences of depression.
We need more debates like this. When I was doing research on this issue, I found out that 60,000 people attempt to take their own life every year. I did not believe the figure and I had to double check it. One person attempts to take his or her own life or do some form of self-harm every nine minutes in this country. It is far greater than the statistics on road traffic accidents, yet it is being brushed under the carpet every day.
Everything these days is about economics and mathematics. We have to listen to the expert economists who tell us how to run our economy and what we should and should not do. However, if we look at the economics of two mental health issues, about €3 billion per annum is being lost to Irish business due to bullying. Another €1 billion per annum is lost due to suicide. These two issues cost about €4 billion per annum, not to mind the impact of people who try to commit suicide or self-harm. This is roughly the amount of money that the Government will have to save for the budget in 2012. From a purely economic perspective, it makes sense to put further resources into mental health issues, as well as bringing in a change of attitude.
We need to be able to talk openly about mental health. There is much sympathy for people diagnosed with cancer. The community rallies behind them and their families, yet people tend to steer clear of those diagnosed with something as common as depression.
I want to raise the issue of school and work place bullying. Anyone who saw the headlines in the newspapers today on Phoebe Prince would have to acknowledge that it is a massive issue both in the workplace and in schools.
No doubt it is a significant contributing factor in suicide rates. As I pointed out purely from an economic point of view, €3 billion per annum is being lost to Irish business solely in the associated costs of workplace bullying. We need to take it back a step and deal with this issue at school level.
I am also conscious that we tend to try to dump everything on schools and on teachers and get them to solve everything. It is important that we deal with this issue in terms of not only the victims of bullying, but the bullies themselves, both at primary school and at secondary school, and to eradicate the problem before it goes into wider society. In many cases, the bullies themselves have other issues, including family issues, that need to be dealt with. It is indicative of some other problem. It is crucial that there are anti-bullying strategies within the school environment because they have been proven to work successfully.
A proper co-ordinated national structure on the issue of anti-bullying strategies in the school system is needed because each of us has come across stories of parents who have encountered significant difficulties getting a bullying issue addressed in their local schools, either at primary or post-primary level. There needs to be a far greater awareness of it within communities and the school setting so that it is nipped in the bud when it arises in the first place. School-yard bullying cannot be tolerated in any circumstance. If one can deal with the issue in the school setting, there will be not only the immediate impact, but also a longer term positive impact in cutting down workplace bullying and anti-social behaviour.
Bullying has profoundly negative consequences, both short term and longer term, for the children concerned. They become isolated and withdrawn and they suffer from anxiety and low self-esteem. It has an impact on their school performance and, sadly, there are tragic incidents where it also leads to suicide. The Phoebe Prince story highlights that. It is happening in schools and communities and it is an issue we cannot continue to ignore.
The final point I want to make relates to the economy. When one turns on radio or television, news of the economy is all doom and gloom. It is all negative. Economic strain and personal financial crises for families precipitate events that can lead to deaths by suicide and problems with mental health, and we must look seriously at this issue. It is worth noting that despite all the doom and gloom due to the problems of the banking crisis and the way the bankers have got away with blue murder, which is sickening and forms part of the problem of public perception, we have not ended up in difficulties such as those experienced by the Japanese due to the earthquake and the subsequent nuclear disaster in that we have not had any physical disaster in this country. People do not have money and are in serious financial difficulty, but it is important that we put it in some sort of perspective.
It also is important that we start talking ourselves up because we, as a race, are good at knocking people and looking for the negative in everything. It is about time we started looking at the positive. Listening to the radio last week, I heard two good stories on “Morning Ireland” about communities that are starting to turn around the economy. In a community in south Galway, the parishes are coming together to develop tourism by bringing second, third and fourth generation Americans back to Ireland to visit their ancestral roots. This stimulates the local economy as a result. In Longford, the business community has come together and put a fund of €1 million in place to invest in small businesses to get them off the ground. There is much good news out there but the sad part is that it does not travel. We, as public representatives, need to start selling the good news stories. Leaving aside the political debate that we can have here on whether the Government is taking the right decisions, there is an onus on each of the 166 Members of this House and the 60 Members of the Upper House to start talking about some of the positive stories and to see how we can support those businesses. It may not be a matter of providing funding but of providing advice or encouragement to individuals who do not believe that they have anything to look forward to.
Acting Chairman (Deputy Thomas P. Broughan): The Deputy has one minute left.
Deputy Denis Naughten: The position is not as bad as it is being spun at present. We will get out of this recession. In the past, we as a society have got out of difficulties far greater than the one we are in. If we start picking ourselves up, dusting ourselves off, and looking to the positive and what we can do well in this country, then we can drive the economy forward and deal with some of the negative impacts of the recession. One step that can be taken quickly, and which will not cost one cent, is to deal with that issue of perception of mental health and to start openly talking about it. If we could even take that one small step forward as a society, it would have a significant impact on the rates of suicide and those seeking the professional help. People do not have to suffer in silence.
Deputy Pat Deering: Since this is my first opportunity to speak in this Chamber, I thank the people of Carlow-Kilkenny, particularly the people of Carlow, for entrusting their confidence in me to represent them in the 31st Dáil. I thank my family, my party and my party workers for their help and support during the recent election campaign.
Like every other speaker, I am delighted to get the opportunity to make a few brief points in this important debate. Suicide affects every town and village in this country. Ironically, since this debate started three to four weeks ago, in my county four young people under the age of 25 have taken their own life. Like previous speakers, I have found going to those funerals very difficult. Suicide is an area that we need to tackle immediately.
A number of years ago, road safety was a big issue. I do not mean to downgrade that important issue, but it was a national emergency over the past five or ten years and we tackled it strongly. We need to go down the same road now to tackle this important issue.
There are three main categories of which we all know. There are young males, males in the 30 to 45 age bracket and then there are females, who are more affected than anybody else. Two main areas should be looked at and bearing in mind the old adage that prevention is better than cure, education is the first step we should take. Young males in the 15 to 20 age bracket are vulnerable.
Once somebody in that particular age bracket takes his or her own life, friends in the same age group might think they may be better off going down the same road. We need to tackle this and ensure they are more aware of the better services that are available and that better options exist than taking one’s life. We need to have a structure in place at secondary school level, perhaps during transition year, to ensure they are more knowledgeable and not as vulnerable.
Media campaigns are very important and have been very effective in road safety. We spent a great deal of money on media campaigns in recent years and it was money well spent. We need to go down this road with regard to suicide prevention to ensure we are successful. While suicide will never become a thing of the past, the current figures are frightening. We need to bring on board people who are looked up to by young people, such as sporting heroes and TV personalities, to make young people aware of the options that exist and the fact that taking one’s life is not the way to go.
Funding is also very important and we need to ring-fence a certain amount of money every year to try to reduce the figures. In the past, we set targets for road safety and we should go down the same road for this.
I thank my colleague, Deputy Neville, for his work over the years, for ensuring we have had this debate, and for ensuring this issue has come to the forefront rather than being kept in the dark as it was in the past. As we know, suicide was something about which people did not want to speak but because of Deputy Neville’s work, we are having a national debate on it. It is something about which we should speak more openly. I wish the Minister of State, Deputy Kathleen Lynch, well in her new role. I know she takes it very seriously and I wish her every success.
Acting Chairman (Deputy Thomas P. Broughan): I thank Deputy Deering and I congratulate him on his first speech in the Dáil. As Acting Chairman, I wish to be associated with the remarks of commendation for Deputy Dan Neville on the heroic work he has done on this matter for many years. I warmly commend him.
Minister of State at the Department of Health and Children (Deputy Kathleen Lynch): I also wish to be associated with the remarks made about Deputy Dan Neville. My first experience of Deputy Neville with regard to this issue was many years ago when someone who was unsuccessful in a suicide attempt came to Cork. Deputy Neville contacted me and between the two of us we befriended the person and did a little socialisation. Dan’s record is not only with regard to prevention or public information, but it also stands with regards to people who are not successful in their attempt as he has talked many of them and their families through very difficult situations. It is for this that we should be most grateful.
It is also appropriate that I recognise the contribution made by my predecessor, John Moloney. He was also very dedicated and put in place many of the initiatives on which we are now following through. If we constantly state that if more women were involved in decision-making in society that things would be different, then it is incumbent on us as women to act differently when we get there, and acknowledging what others have done is very important.
I thank all of the Deputies who contributed in a very sincere manner. Clearly, they know the subject, and I suppose this is on the basis of personal experience, which is a sad way to find out about something such as suicide. It strikes me that according to the most recent statistics, the number of people who have taken their own lives would fill this Chamber more than three times over. We need to keep this in mind always.
We may attend an individual funeral or we hear about a cluster of three, four or five suicides in an area but it is very difficult to envisage the total of more than 500 people. If one closes one’s eyes, it is virtually a small village. If that number of deaths happened as a single tragedy any year, our response would be far more immediate and urgent. This is what we need to do; we need to keep in mind the number of people we are speaking about and the devastation each death leaves after it not only for the family, but for friends and the community, and also the terror it sends through each house in the immediate area. What this is really about is this sense of terror, which perhaps makes us not want to speak about it because if we do not speak about it then somehow it will not happen again. We know this is not true because it has gone on for so long.
It was interesting to hear almost every speaker compare funding for suicide prevention with funding for the Road Safety Authority. A comparison can be made on funding, but I am not certain a comparison can be made on the manner in which people die. I must admit I am not into this; I can understand it is an easy argument to make but I do not think it is a comparison of like with like. Every evening, on the six o’clock news one can see the carnage of road accidents but we do not see this with regard to suicide and I am not certain we want to do so.
People who decide to take their life by suicide do not make an immediate decision to do so; it is something they have thought about. What is important is to say to those people who are listening and who are contemplating suicide that they should speak to someone. The old adage that talk is good is vital. If they cannot speak to someone nearby they should pick up the telephone. They should speak to the various helplines or their GP. They should speak to their sisters or brothers or someone, because it is important that we recognise that people who have taken this course of action need someone to talk to. They need help and that help is there. When that help is given, it can divert people away from this path and this is very important. We are not speaking about strangers on the street; we are speaking about fathers, mothers, sisters, brothers and a beloved son.
In the argument about where we are going with regard to mental health, the stigma attaching to mental health is probably the greatest preventer of people seeking help in the first instance. Why is this stigma attached to mental health? Surely it is no different from having cancer. I remember a number of years ago one did not say the word “cancer” in public. One would say “the big C” or “she has been diagnosed with the other thing”. We have got past this because we recognise that it is a disease, and one which not alone is preventable but curable and treatable. So is mental illness and we need to get our heads around this. We need to start saying it out loud and exploding the picture.
Last night, I attended the launch of Make a Ripple, which is an excellent new intranet campaign for people feeling down and unwell with regard to their mental health. They can go online and share their stories and read other people’s stories. Amazingly, one of the people headlining the Make a Ripple campaign is Alastair Campbell, someone with whom all of us here would have an affinity. He is hugely successful in politics, writing and his contribution to society, and he suffers from depression. He speaks about it. Some days he feels very good, some days it is a little bit mild and other days he stares into the abyss.
He talks about it and we need to start doing the same. We need people to come out and to start talking about the very bad days they have had but which they have left in the past. I worry that we are not allowing young men and not so young men the opportunity to speak and the opportunity to tell us that they are feeling vulnerable. I am a great believer in balance. I have spent my life trying to achieve the type of balance necessary in society so that women can be treated equally. Sometimes by creating balance in one area, something else is put out of kilter. We need to start telling men, both young and middle aged, that they are not just valued as being providers but that they are valued as fathers, as brothers and as contributors to society. They need to know we value them. I can understand the type of humiliation men feel when they lose their jobs or businesses because they can no longer provide what they provided in the past. I say to them that is not what we value in you but we value your contribution to your family, to society; we value you. We need to get that message out there.
Deputy Naughten told the House about the cost to the economy of the effects of depression and of suicide. How do we judge whether a person has been successful in life? I hope that not everything is judged in economic terms based on the size of a person’s car or house. We need to reconstruct how we regard people, how we value success and how we monitor that success.
It is good that people will praise a man who is a good father and regard this as a very honourable role. We need to start thinking outside the box about how we view people who take their own lives and people who suffer from depression. We need to start speaking out about stigma and we need to tell people that it is not the shameful thing they think it is. A total of 75% of mental illness emerges during childhood and adolescence and early intervention is essential so that such illness does not bring with it a lifetime of pain and misery. I refer to projects which provide such intervention and the very successful work of voluntary agencies such as Jigsaw and Headstrong. Such projects must be rolled out in all parts of the country so people can access the assistance of individual people as well as agencies.
Deputy Dowds suggested a ban on alcohol advertising. In my view, the day is fast approaching when alcohol needs to be included in the bundle of what we consider to be harmful drugs. This needs to happen. It is known that alcohol has the same destructive effect on health as do cigarettes but yet we still maintain that it is permissible to advertise alcohol. However, any ban on advertising must be a European-wide ban. It would be pointless for RTE to ban the advertising of alcohol if it is advertised on UTV and other stations. We must put across the message that success in life is not automatically regarded in terms of economic success as success must be measured in how a person contributes to society.
Children in primary school should be included in programmes which encourage them to talk about their feelings rather than about their mental health. Very young children can very quickly identify and name a bully but as they get older they will not do so because it is considered less manly to do so at second and third level. Just as in industry there is a Safe Pass system and legislation provides for health and safety instruction we need a similar system for dealing with mental health and it should be provided for in legislation. We need to start talking the talk and to start breaking the silence. Safe Talk and Assist need to be part and parcel of induction courses in all employment. It is only by adopting such a holistic approach to mental health and only when we all start to talk about it that people will feel safe and secure in approaching others.
Neither the previous Government, this Government nor the next Government can do this work on its own. It is a societal issue and society has to take ownership of it. The Government must put the structures in place so people can approach a service and receive assistance. We must all recognise the signs so that when someone feels threatened we can ask them how they are doing today. We may be a friend, a neighbour or a family member but we can then help them. If it is the case that according to the latest statistics this Chamber could be filled three times over with the number of people who have taken their own lives, then we need to deal with it.
An Leas-Cheann Comhairle: That concludes statements on suicide.