Mr. Dominic Layden:

An omnibus survey was conducted by Amárach Research in February and it showed Aware is the organisation most widely spontaneously associated with depression and mental ill health in Ireland, at 31%, followed closely by the Samaritans, at 28%. A wide range of other organisations was recalled although these were listed as having significantly lower levels, including the State and HSE, at 12%. This points to the fact that where mental health is concerned, people think of Aware and the Samaritans before they think of the public sector, the HSE and other organisations.
This prompts two questions. Why does the public think of Aware and the Samaritans before any other body? What are they looking for when they come to our organisation? Aware has longevity, trust and brand awareness. The organisation has been in existence for just over 29 years. All our services are independently evaluated. A clinical sub-committee of our board oversees all the services we provide. We appointed a clinical director and a full-time training and recruitment officer in recent years. The independent evaluation of services for any organisation is a major challenge. Within the voluntary sector, it poses even more challenges because, obviously, most of our services are provided by highly trained, active and committed volunteers.
We have a very strong and committed volunteer base nationwide. More than 345 active and highly-trained volunteers are involved in our service delivery and each receives a minimum ten hours’ training. We have a wide range of volunteer policies and procedures, from confidentiality policies to procedures in dealing with individuals attending our support groups or helpline. We have a well-trained organisation.
The public, when it approaches Aware, comes for information in the first instance, then for support and education. The public is now coming to us for wellness training programmes at work. The primary source of information on depression stress and other mental health mood-related disorders is our website. We get approximately 260,000 unique hits on our website every day, which amounts to approximately two hits every two minutes. We hold a monthly lecture in St. Patrick’s. We video them and have published them online in the past year and a half. Over 39,000 people have downloaded the monthly lectures. A range of experts in the field, namely, experts in depression, mood-related disorders and suicide, are invited to deliver the lectures.
We have three support mechanisms. We have a helpline and just over 50,000 calls have been answered in past three years. We have an encrypted e-mail service, which means a volunteer will not know whom an e-mail has been sent from. The transcript of the response is read by another volunteer before it is sent back to the person who sent the e-mail. Finally, we have support groups. We have 45 locations nationwide. Some groups meet weekly and sometimes bimonthly or monthly. In the past 29 years, many people have remained alive because of the services attendees at the support groups have been able to receive.
Beyond the provision of information and support, the third area is education. We have three educational programmes. The first, Beat the Blues, is delivered by professional trainers to students aged from 15 to 18 in all secondary schools. In the past two years, we have delivered the programme to over 60,000 students. Approximately half of all secondary schools have received our programme to date. This programme helps young people to learn coping skills for dealing with concerns, in addition to tips for looking after mental health and building resilience. It costs approximately €7 to deliver the programme to each child. This is excellent value for money.
Our second education programme is a lifeskills group programme, which is available for adults of 18 and over. It is delivered to groups of up to 25 people over six weekly 90-minute sessions and it is based on the principles of cognitive behavioural therapy. Launched in May 2012, the programme has now been delivered to 3,000 people across most counties, with several more phases planned between now and the end of the year. The programme is independently evaluated. We have seen significant improvements in self-reported depression and anxiety, using standardised clinical measures. Crucially, these results are sustained at 12-month follow-up, as shown in evaluations by Dr. Katrina Collins. With private one-to-one cognitive behavioural therapy sessions costing approximately €100 each, the real value of Aware’s free programmes could be estimated at just under €2 million.
The third education programme is Life Skills Online. It offers a unique option for service users to access a programme based on cognitive behavioural therapy from the comfort of their own home, with the added benefit of encouragement from a trained supporter, equivalent to a personal trainer in a gym. Launched in 2012, the eight-module programme has been completed by over 800 to date, and we are currently involved in a randomised controlled trial with Trinity College Dublin and SilverCloud technology company. All these services are free to the public. We recently launched wellness-at-work training programmes that provide talks for employees and half and full-day training programmes for managers in the workplace.
Aware welcomes the report on suicide by the rapporteur to this committee, Senator John Gilroy, and has a number of observations and comments. First, as referenced in the report, there are a large number of organisations working in the area of mental health, and their services are provided in addition to the services provided by the State. We welcome the suggestion that there should be a national registry of all organisations working in this area. We believe such a registry would be helpful for all stakeholders and that, in addition, the publishing of information on how and why organisations or projects are funded is important for transparency and accountability.
Second, Aware has significant concerns about the use of the word “suicide” and the focus, particularly in media circles, on the issue. Suicide has become an everyday word, and to a vulnerable person, particularly a younger person, the common, almost casual, manner of speaking about such a serious issue can mean suicide is in some way perceived as a real option in life.
Aware would like people to understand that just because someone has thoughts of taking his or her own life does not mean he or she has to do it; there are always alternative options. Just because someone has depression does not mean that he or she will inevitably take his or her own life as many people experience depression and make a full recovery.
Third, the recession over recent years has made many people feel more vulnerable. There have been continuing conversations about austerity and a sense that there will be many years of battle before things begin to show signs of recovery. There is a real need for people to understand what they can do to maintain their mental health in the face of such challenges, and how to build and develop resilience to lessen the impact on their mental well-being.
Fourth, alcohol is a significant factor in influencing mental health but there seems to be reluctance to acknowledge this. The rapporteur has included detail in his report about the link seen between the increase in the suicide rate in the late 1990s and the increase in the per capitaalcohol consumption rate. Research commissioned by Aware in 2004, carried out by Dr. Conor Farren, noted that in Ireland, being unique among European countries, there was a 41% increase in alcohol consumption per head of population over the ten years to 2000, and this mirrored a parallel increase in the national suicide rate.
Fifth, in addition to the need to provide services that focus on helping people who are in acute suicidal crisis, there is a real need for everyone to understand suicide prevention is not just about acute crises.

It begins at a much earlier point in the journey. If this were understood and acted on, so many lives and so much distress could be prevented. If we look at how cancer is dealt with, people are encouraged to check themselves regularly for symptoms of some of the more common types of cancer, such as breast cancer or testicular cancer. There are also a number of screening options which people are actively encouraged to take advantage of such as cervical cancer screenings. These seem to be showing real results in terms of identifying people who are at risk at an earlier stage and improving outcomes.

Aware is trying to encourage people to take more responsibility for their mental health and monitor how they are doing through its positive mental health programmes. It is helping people to understand that mental health is something that we all have but there are ways that we can look after it to prevent issues from developing.

Aware believes education is the key to bringing about a fundamental shift in society’s attitude to mental health and, ultimately, suicide. Aware has delivered its Beat the Blues positive mental health programme to 60,000 senior cycle students in over half of the secondary schools in the past two years. We recommend the State and Department of Education and Skills encourage all secondary schools to avail of this free programme, as there is nothing else there for young students at this pivotal stage in their lives.

We also recommend that mental health education and resilience development should be part of the curriculum, including at primary level. We should all aspire to create a well society with young men and women resilient and adaptable no matter what the challenges they face.