Jerry Cowley (Mayo, Independent)

I am grateful for the opportunity to speak on this important motion. The Government's primary care strategy envisaged a comprehensive primary service which among other activities would help prevent suicide. However, the Government has failed miserably to invest in the primary care strategies promised, and the cost is the loss of young and old lives.

The primary care strategy promised €1.3 billion over ten years, or €130 million annually. That was to be a tenth of the overall health strategy budget. The Government recognised, correctly, the structural and human resource deficit in primary care and that funding of €1.3 billion was realistic. However, it only gave €18 million over three years compared with the €1.3 billion or €130 million every year for ten years that was proposed.

The primary care strategy envisaged a comprehensive primary care service whereby general practitioners would not act in isolation but as part of a team. Clinical psychologists and counsellors would be part of the primary care team within a primary care setting. This would act as a safety net or sentinel service to pick up people showing danger signs such as the desire to commit suicide.

Suicide in older people is a serious matter. Older people who say they will commit suicide are likely to be successful. They do not mess about but kill themselves. There is a terrible scarcity of psychiatric social workers, which is due to a lack of resources. I put down a parliamentary question on this issue and was horrified by the reply. There are few social workers for older people; they are as rare as hen's teeth. The cost is terrible.

General practitioners are catering for the majority of the population but funding deficits are costing lives, both young and old, through suicide. While communication between the general practitioner, the public health nurse and the community psychiatric nurse is well developed in rural areas, it is not so well developed in urban areas. There is insufficient access to counsellors. There is no direct general practitioner access as the GP must go through the psychiatric service. Try getting access to the psychiatric service on a Friday evening. These personnel should be part of the primary care scheme.

General practitioners and district nurses are under pressure from the large volume of work relating to chronic illness, due to earlier discharges from hospitals. They are trying to keep people at home to avoid the terrible calamity of trolley chaos in the hospitals. General practitioners need time to focus on the young, particularly young males, to identify those under pressure. These can be referred directly to a counsellor in the area. This would create a culture of caring, where people have time to care and to listen. However, that cannot happen when there is a lack of resources to enable general practitioners to carry out these tasks. It is important to have a system that allows access to paramedics for people under pressure.

We need resources but we are not getting them. We need an increased number of general practitioners, paramedics and allied health professionals, such as counsellors. When one looks at the graph showing the alarming increase in suicide incidence in Ireland, particularly among young people, from 1972 to 2000, as reported by the strategic task force on alcohol, it is exactly mirrored by a graph showing the increase in alcohol consumption. Alcohol abuse is a significant risk factor in suicide and compounds other risk factors.

There has been a sharp increase in male suicides, especially among the 15 to 29 years age group. Overall, it is the main cause of death in men from 15 to 35 years of age. Alcohol disorder continues to be the main cause of admissions to psychiatric hospitals, especially for males. If this upward trend in alcohol consumption continues, Ireland will have the highest rate of consumption in Europe and the suicide rate will go through the roof.

A coroner told me recently that in seven out of the ten recent inquests he had conducted on young people's suicides the deaths were alcohol related and many of the people had no history of depressive illness. They tended to be impulsive. Few of the deaths were anticipated and the relatives suspected nothing. Suicide often occurred after a disco when, after some late night drinking, the person threw himself over the bridge because he was refused a dance at a disco. That is what we are dealing with. The coroner also blamed extended licensing hours and exemptions. This is about buying time. Closing time was 11.30 p.m. but it is now 1.30 a.m. There must also be enforcement of the off-licence regulations relating to tracing drink sold to under age drinkers.

There are no longer any religious scruples about suicide. People drink at a younger age. When I was young, if a young man was drunk on a bus it was a sensation. We did not have the money for drink. These days, young people have the money.

We do not have the money we need to do the job that must be done in primary care to prevent suicide.

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