Dail Debate March 2011

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 friends of 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.

It continues:

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.