Triage Nurse Conference

Address by Dan Neville TD, President, Irish Association of Suicidology to the Opening of the Seventh Annual Conference of the Telephone Triage Nurses Section, Irish Nurses and Midwives Organisation at the Carlton Castletroy Park Hotel, Limerick on Tuesday 25th October 2011

Mental ill health is not only damaging to the sufferer, their family and community, it is damaging to the economy. In 2008, the Mental Health Commission published a Report which estimated the direct annual cost of mental health at a staggering €3bn in 2006! This is the cost to the taxpayer of decades of Government neglect and the isolation of services.

Mental Health is central in building a healthy, inclusive and productive society. Illness like depression and schizophrenia can be treated successfully for the vast majority of sufferers and with early intervention and treatment people can live healthy lives, fulfilling their individual potential.

In January 2006, the Government adopted A Vision for Change as the basis for the development of mental health services in Ireland. The policy framework set out in A Vision for Change, which built upon the recommendations of Planning for the Future 1984 , was greeted by near universal approval as the best model for a modern, comprehensive, world-class service to meet the mental health challenges facing our society almost universally accepted by all.

However, five years since its announcement, there is a lack of progress in implementing A Vision for Change and for the absence of leadership at a national level.

The Independent Monitoring Group reported in July of this year that specialist services promised as part of the strategy has not been developed. These include forensic mental healthcare services, rehabilitation and recovery, eating disorder services, psychiatric services for older people, services for co-morbid severe mental illness and substance abuse problems and intellectual disability services.

Progress on implementing reforms has been painfully slow. A Vision for Change set out a policy framework for the mental health of the whole population. In addition to recognising the importance of mental health promotion and primary care, it called for a person-centred, recovery orientated and holistic approach to mental health services. It also called for a shift from the current system, which is excessively reliant on institutional care and medication, to a system centred on community based care provided by multidisciplinary mental health teams. These teams would include psychologists, social workers, occupational therapists and service users who would work alongside psychiatrists, mental health nurses, psychotherapists and counsellors. It is important people with mental health problems are allowed access to the services and supports they choose while continuing to live and participate in their community, as is their right. Ireland is more reliant on institutional mental health care than any other country in Europe. While there are examples of good practice in certain areas, implementation of the plan to which I referred has been inadequate overall.

Services remain widely deficient with few complete multidisciplinary mental health teams in place and limited access to community care for a

full range of psychological supports that should be part of a modern mental health service.

In 2009, only one in five staff in the mental health service was working in a community setting. In patient facilities remain completely unsuitable, with 15 of the 63 approved in patient centres dating from the Victorian era or earlier. The Inspector of Mental Health Services has described some of these facilities as entirely unacceptable and inhumane. The position in respect of older people and people with intellectual disabilities is even worse as specialist mental health services in these areas are in need of comprehensive reform.

Non-capital expenditure on mental health services was cut radically from €1.1billion in 2008 to €770 million in 2009. These cuts continue an historical trend in which expenditure on mental health services declined from 13% of the overall health budget in 1986 to only 5.3% IN 2010. A Vision for Change recommends that 8.4% of health expenditure should be allocated to improving mental health services.

The public sector staffing moratorium has also disproportionately impacted on mental health services which account for just 9% of the health care workforce but for 20% of the 1,500 posts lost as a result of the moratorium.


Ireland has experienced one of the fastest rising suicide rates in the world. As a cause of death among young Irish people suicide exceeds both deaths due to cancer and road traffic accidents. Ireland has the fourth highest youth suicide rate in Europe. Recent research identified two suicides per month by children fewer than 15 years of age. Between 2003 and 2008 there was an increase in suicide of 40% for boys and 50% for girls

According to the recently published provisional figures on suicide rates for 2010, 486 people died by suicide that year. For every individual who died, ten people were directly traumatised. For the purpose of making accurate international comparisons, undetermined deaths are included in the suicide rates. The figure for undetermined deaths last year was 123. Chooselife, which is the Scottish programme for suicide prevention and is regarded as very progressive in this area, advises that “the inclusion of undetermined deaths protects against under-recording and provides more accurate figures for international and geographical comparisons”. If we take this formula into account 603 people died by suicide last year.

Research going back to the 1890’s demonstrates suicide and mental illness increase at times of recession. The World Health Organisation, WHO, stated earlier this year: “It should not come as a surprise that we continue to see more stresses, suicides and mental disorders”. The director of the WHO also stated: “There is clear evidence that suicide is linked to financial disasters. The potential psychological impact of economic recession on public health is severe. Job loss, job insecurity, job uncertainty, economic strain, loss of income, home repossession and restricted access to credit lead to a reduction in mental well-being, an increase in mental health problems and mental ill-health, increased substance misuse, especially alcohol and drugs, and intimate relationship breakdown and divorce.

There is a loss of purpose and daily structure, reduced social contacts and an increase in social isolation. An increased risk of suicidal behaviour occurs, both non-fatal self-harm and completed suicides.

People who are unemployed are two to three times more likely to die of suicide than those in employment. This high rate is partly because people with psychiatric illness are at a greater risk of losing their jobs. There is an association between unemployment and suicide. However, even among people with no record of serious mental illness, unemployment is associated with a 70% greater suicide risk. Prospective individual level studies show that unemployment has a causal influence on depression and suicidal thinking.

Job insecurity is associated with a 33% greater risk of common mental disorders, mainly anxiety and depression. People with mental disorder are more likely to be in debt than those who have no mental disorder. A United States research document indicates that a loss of income rather than low income was associated with suicidal ideation. In Hong Kong, 24% of all suicides in 2004 concerned people in debt.

Alcohol consumption rises during recessions, and this correlates with suicide. The figure for the 1990’s in this country was a 44% increase in alcohol consumption and a 41% increase in suicide.

In relation to attempted suicide and self harming there was an increase of 4% in presentation to hospitals with 11,966 by 9,630 patients. International research and the National Research Foundation point out that for each presentation of self-harm to A&E, 7 more are victims which conservatively places the annual figures for self-harming and attempted suicide at 70,000

Family has a key role to play in the recovery of a member in crisis including suicidal ideation. I am concerned that a large section of the psychiatric profession fails to recognise this. Too many professionals refuse to include family members in the recovery plan of their patients. In too many instances psychiatrists refuse to discuss the after care needs of a patient on discharge from a mental ill health residential service. This is unique in the health services where in general medicine, professionals see the family involvement as part of the recovery programme after discharge from hospital. Too often I have met families who are stressed due to lack of information on the treatment regime that best serves the convalescence of the patient. Patient confidentiality is quoted as the reason. Family members are key to identifying a member in danger of loosing their life. Too often, I receive complaints that the professionals do not listen and sadly the views of the family are bourn out and the person in crisis takes his/her life. This culture of exclusiveness of family in the recovery programme of a person with a mental ill health difficulty or suicide idieation must change