Mr. John Meehan:

I am an assistant national director in the HSE and I am responsible for mental health strategy and planning. I am also the head of the HSE's National Office for Suicide Prevention. I am joined by Professor Philip Dodd, consultant psychiatrist, clinical professor and clinical adviser to the National Office for Suicide Prevention.

On behalf of Professor Dodd and myself, I thank the committee for the invitation to speak about the topic of youth mental health and suicide. We have submitted a briefing paper in advance of the meeting that gives greater detail on my remarks in my opening statement.

I will outline the strategic context for suicide prevention.

Connecting for Life, Ireland's national strategy to reduce suicide was launched in 2015 to run until 2020. The strategy was developed in line with the best national and international evidence available for effective suicide and self-harm prevention strategies. The strategy contains seven overarching goals and 69 targeted actions, each of which has a specific lead responsibility assigned to it. Along with the HSE, 22 Government Departments or agencies have made commitments to deliver on actions assigned to them under the strategy and over 28 charities or NGOs are receiving funding to deliver on work that supports these actions. While the NOSP carries lead responsibility for 16 of the 69 Connecting for Life actions, the role of the office also extends to driving the strategy, defining its milestones, monitoring its implementation and reporting progress across the multiple sectors and stakeholders.

The implementation of any strategy is a complex process. As such, one of the roles of the NOSP is to provide real-time visibility of how lead agencies are advancing their work and initiatives, across all Connecting for Life actions. In 2017, we developed a new monitoring system to track the implementation of Connecting for Life. The system was informed by the best implementation literature available. Monitoring dashboards are provided every quarter to the cross-sectoral steering group chaired by the Department of Health and are publically available online at. We also initiated in 2017 an independent interim strategy review in respect of Connecting for Life. The review was published this year and has provided a rigorous top-down assessment of progress across each Connecting for Life goal. The review has also made clear recommendations for the remainder of 2019, 2020, and beyond. The interim strategy review is also available at Connecting for Life, Ireland's national strategy to reduce suicide, was launched in 2015 to run until 2020. The strategy was developed in line with the best national and international evidence available for effective suicide and self-harm prevention strategies. The strategy contains seven overarching goals and 69 targeted actions, each of which has a specific lead responsibility assigned to it. Along with the HSE, 22 Departments or agencies have made commitments to deliver on actions assigned to them under the strategy, and more than 28 charities or NGOs are receiving funding to deliver on work that supports these actions. While the National Office for Suicide Prevention, NOSP, carries lead responsibility for 16 of the 69 Connecting for Life actions, the role of the office extends also to driving the strategy, defining its milestones, monitoring its implementation, and reporting progress across the multiple sectors and stakeholders.

The implementation of any strategy is a complex process. As such, one of the roles of the NOSP is to provide real-time visibility of how lead agencies are advancing their work and initiatives across all Connecting for Life actions. In 2017, we developed a new monitoring system to track the implementation of Connecting for Life. The system was informed by the best implementation literature available. Monitoring dashboards are provided every quarter to the cross-sectoral steering group chaired by the Department of Health and are publicly available online at.

We also initiated in 2017 an independent interim strategy review in respect of Connecting for Life. The review was published this year and has provided a rigorous top-down assessment of progress across each Connecting for Life goal. The review has also made clear recommendations for the remainder of 2019, 2020, and beyond. The interim strategy review is also available at .

Apart from the national strategy, 17 localised versions of Connecting for Life have been established nationally through the work of the NOSP team in collaboration with our operational colleagues in the HSE, the community healthcare organisation, CHO, chief officers and their teams, and the wider stakeholder group. Oversight is provided by local implementation teams working to national frameworks supported by the national office of NOSP. While each local version was developed over a different time period from 2015 to 2018, all are now in full implementation mode.

I turn to young people. While Connecting for Life adopted a whole-population approach, special consideration was given to priority groups at the development stage. These are groups that always require specialised or targeted initiatives because they are known to be particularly vulnerable to suicide or where evidence shows a potential greater risk of suicide. The priority groups identified in our strategy include stated demographic cohorts such as young people. In the context of today's meeting, I draw attention in particular to strategic goal 3 of Connecting for Life and the related objectives and actions under that goal. The overarching aim here is to target approaches to reduce suicidal behaviour and improve mental health among priority groups, including young people. The highlights of the initiatives related to young people and Connecting for Life actions are outlined in our submission document from page 8.

It is important to speak to our understanding of suicide and self-harm statistics among young people in Ireland as there are often mixed messages on this issue. Suicide data in Ireland are provided by the Central Statistics Office, CSO, and it is important to note that the only official decision as to whether someone has died by suicide is a legal decision made by a coroner, not a medical decision made by doctors or the HSE. There are many caveats attached to the information provided by the CSO and a significant time delay in receiving information on, for example, late registered deaths. Currently, we have full sets of data, which include late registered deaths, only up to 2014. Nevertheless, looking at provisional data for the most recent year available, which is 2018, we know that the highest rate of suicide in Ireland per 100,000 of population was among 45 to 64 year olds. Among males, the highest rate was among 55 to 64 year olds. Among females, the highest rate tends to be within younger groups, currently among 15 to 24 year olds.

Given that our European counterparts use varying systems to collect and report suicide data, it is not always advisable to compare countries on a like-for-like basis. That said, our best understanding of how we compare with other countries comes from EUROSTAT. The most recent comparisons from EUROSTAT show that in 2016, Ireland had the 11th lowest rate of suicide across 34 European countries among all age cohorts. In 2015, Ireland had the ninth highest rate of suicide across 33 European countries for young people age 15 to 19. This ranking has fluctuated widely in preceding years, from 12th lowest in 2014 to second highest in 2011.

Members can read further details of these statistics on page 14 of our submission but I would like to add that regardless of what the figures seem to indicate, we continue to be of the firm belief that co-ordinated, concerted, multi-sectoral approaches to suicide prevention must be in place across all sectors of society if a difference is to be made.

Data on self-harm presentations to emergency departments in Ireland is provided separately by the National Self-Harm Registry and the full data are in that. My office provides funding to the NSRF.

It is important to note that recent studies show similar increases in England. This coincided with the release of season two of the Netflix series "13 Reasons Why" and the high profile death of a DJ. They all had implications. We respond to self-harm through our emergency departments and we have clinical programmes related to young people which are set out on page 8 of our submission.

In regard to investment in suicide prevention, there also remains noticeable financial-----