Kathleen Lynch (Cork North Central, Labour)
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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 Changeis 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 Changeis developing the Make a Ripplecampaign 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 Healthawareness 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 ASISTprogramme, 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 Outand 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.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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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.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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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 a 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.

Joanna Tuffy (Dublin Mid West, Labour)
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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?

Maureen O'Sullivan (Dublin Central, Independent)
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Yes.

Joanna Tuffy (Dublin Mid West, Labour)
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Is that agreed? Agreed.

Maureen O'Sullivan (Dublin Central, Independent)
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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.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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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.

Finian McGrath (Dublin North Central, Independent)
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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.

Dan Neville (Limerick, Fine Gael)
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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.

Robert Troy (Longford-Westmeath, Fianna Fail)
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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 peoplewho 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.

Charlie McConalogue (Donegal North East, Fianna Fail)
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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.

Dominic Hannigan (Meath East, Labour)
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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.

Derek Keating (Dublin Mid West, Fine Gael)
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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.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I congratulate Deputies Hannigan and Keating on their maiden speeches.

Gerry Adams (Louth, Sinn Fein)
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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.

Andrew Doyle (Wicklow, Fine Gael)
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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.