Mr. Gerry Raleigh:

The highest recorded figures were in 1998, but there has been a downward trend. A strategy was developed in 2004 and then Reach Out began and this saw a decrease in the trend. However, the figures then moved in the wrong direction and in recent years the highest rates came in 2009. As the Minister of State has said, these higher figures raised particular concerns around young and middle-aged men. While it is a small comfort, we are seeing a stabilisation in suicide rates across these age groups in the past couple of years. The most recent official figures we have are for 2010. We suspect, on the basis of the provisional figures, there will be a slight increase in the figures in 2011 and a slight fall again in 2012.

There is a modest parallel reduction in the rates of self harm being reported in our accident and emergency units. Over the past couple of years we have seen a stabilisation of the figures and some reduction. We take no comfort from these figures because they are still too high.

On the question of a national strategy, a recent WHO document begins on a positive note and states that suicide is largely preventable. The document speaks about the international evidence regarding the importance of community. One factor we have seen in recent times, arising perhaps from the economic situation, is the strengthening of communities. From my perspective, the community is one of the key positive tools we can use to support vulnerable people and help them get over the crisis they face.

As the Minister of State noted, we are in the process of reviewing Reach Out which, in its time, was a visionary document. There is nothing in it, or nothing omitted from it, that does not appear in the German, Scottish or New Zealand strategies. I have taken time in recent weeks and months to try to see what is working well for us. We will evaluate the document before it expires and are looking to develop a framework for a thorough evaluation. In comparison with Scotland's Choose Life programme, and the German programme in particular, weight is given to implementation planning. One thing we are examining in the office is how, at local level, in an effort to reduce the level of fragmentation and ensure services are evidence based, there will be standards of safety around what actually happens when a person looks for help. That is framed in the context of a local plan. Defining "local" is a challenge we must get to, but it should be as local as local needs be. We must base our service planning for the future on that basis, on a bottom-up, top-down approach which reflects local needs but has a framework that allows for the commissioning of services that are safe and are evidence-based in the community. Behind that we must support local communities so that people are clear about where to go when they need help. There must be a very strong and robust communication strategy.

One of the challenges we face in the office is a call from the political system and from society and communities. We understand this; it is a very strong campaign. We will act but the actual campaign needs to signpost people in the right direction, where help exists and is readily available. That is the challenge. There are three pillars to what we are considering. One is around help seeking. We must do this in the context of understanding our mental well-being, as individuals and as a community. What does our mental health look like? When it is compromised how might we feel? Where do we go to look for help? It may be that some people do not have the capacity to make that call for themselves. We must have people in the community who can put their hand on their neighbour's shoulder and say, "I think you're struggling and you need help". That is why the importance of programmes like Assist and Safe Talk are so relevant when they are used appropriately and are available.

Help seeking is about encouraging people to ask for help when they are compromised. There is a second aspect but I will jump to the third, which is about health giving. This is about when people knock on the door and seek help, ensuring the help is there in a co-ordinated way. This could be going to one's GP and saying one is feeling a bit off, asking what one should do. The GP must have the time and the capacity to understand this. GPs are excellent. They see the majority of people who are in distress or coming into stress, much more so than any of the second level services. They must be equipped and supported to signpost and assist people along the way. It goes on. The continuum of services develops in an integrated way. Although there may be a lot of fragmentation in the system, I believe everybody has a role to play, be it in the help-seeking domain or in help giving.

The third frame, mentioned by one of the voluntary service providers in the context of our developing our communications strategy, is around help taking, or receiving help. For men in Irish society that is a particular challenge. Much academic research has been done on masculinity and the preservation of the self. There are different catch phrases. It is about how to access the male population, young or old, in a way which allows people to ask, comfortably, for help. There are two straplines that appeal. One is about face to face communication, which many men do not do well. They do side to side, or shoulder to shoulder. These may be clichés but they are important. The use of community and the development of community groups must be used. I refer to sporting clubs, the GAA and different community groups where men interact. I do not wish this to predominate as a male issue, because it is not one, but there are challenges in how we present services to people so that they will be comfortable in accessing them. We will try to build a new national strategy around those three platforms.