Tim O'Malley (Limerick East, Progressive Democrats)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"notes the many initiatives undertaken by Government and by health service providers since 1998 aimed at reducing the incidence of suicidal behaviour including, for example:

—the placement of liaison psychiatric nurses in accident and emergency departments of general hospitals;

—the provision of training to relevant health care personnel in matters relating to suicidal behaviour;

—the development, in each health service area, of a directory of services, both statutory and voluntary, which are available to those concerned about or at risk of suicide;

—the introduction of restrictions in the availability of paracetamol, which can be harmful in overdose;

—the establishment of the national suicide review group and the appointment of suicide resource officers in each health service area;

—the provision of additional funding for research into suicidal behaviour and the prevention of deliberate self-harm;

and welcomes the development of a national strategy for action on suicide prevention, which will be published later this year."

I propose to share time with my colleague, the Minister of State at the Department of Health and Children, Deputy Seán Power.

I thank the Independent group for tabling this motion. As Minister of State with responsibility for mental health services, I believe that the more focus there is on this issue the better. As many of the speakers from the group have said, the whole area of suicide is very complex. The more we focus on it and can convey its seriousness to the public, the more effectively we can get to the heart of the problem in terms of putting the message across.

I stress at the outset that the Government shares the concern expressed on the opposite side of the House and among the public generally about the level of suicide. The problem of suicide has indeed become a serious one in Ireland. Suicide is in every case a tragedy, for the life that has ended and the family, friends and community left behind. It is a serious social problem. We cannot ignore or be complacent about the growing incidence of suicide and self-harm. Suicide prevention is an issue with which we must all be concerned. The challenge of preventing and reducing the rate of suicide is one of the most urgent issues facing Irish society at present and I welcome the opportunity this evening's debate presents for me to make a statement on the matter.

In 1998, the year in which the report of the task force on suicide was published, the number of deaths by suicide registered by the Central Statistics Office reached an all-time high of 504, reinforcing the need for sustained and co-ordinated action in response to the ongoing problem. Five years later in 2003, 444 deaths from suicide were registered. While this drop is encouraging, it is too soon to draw any firm conclusions from the reduction. What the figures indicate is that no effort can be spared to reduce what is still a major cause of death, particularly among young people. There has been a significant increase in the rate of suicide among young males in the past decade, with 305 such deaths in 1994, rising to 358 in 2003.

However, it is important to point out that, contrary to what is stated in the Opposition motion, youth suicide in Ireland is not the highest in the EU. The most recent analysis suggests it is fifth highest. In terms of the overall suicide rate, Ireland ranks 17th in the EU. Recent figures suggest that the rate has stopped rising, but we experienced probably the fastest rising rate in Europe during the 1980s and 1990s, albeit from a low base rate. These are all worrying trends which require further research so that better strategies are developed to help people who are particularly at risk.

The health strategy, Quality and Fairness — A Health System for You, included a commitment to intensify the existing suicide prevention programmes over the coming years. Work is now well under way on the preparation of a national strategy for action on suicide prevention. This strategy is being prepared by the project management unit of the HSE in partnership with the national suicide review group and supported by the Department of Health and Children. Work was initiated on the development of a national strategy for action on suicide prevention two years ago. Since that time, nearly 700 people have attended regional and national consultation meetings. Submissions were sought in the national press and 68 submissions were received. A national and international expert group of 16 people reviewed the strategy during the past two weeks of April and their analysis is currently being incorporated. The extent of consultation, the input of the external reviewers and a dedicated writing team will result in a high-quality, action focussed, evidence based strategy which will highlight immediate priority actions, targets for implementation in the medium term and longer term objectives for suicide prevention and mental health promotion in Ireland.

A fundamental aim of the new strategy will be to prevent suicidal behaviour, including deliberate self harm, and to increase awareness of the importance of good mental health among the general population. Ongoing multi-disciplinary research will be an essential strand of the strategy and findings will be of greatest value where they can inform and stimulate action and service development. The strategy will identify expected outcomes and set targets that can be measured, monitored and revised. Continuous quality control and ongoing modification and improvement of the strategy will be central to its implementation.

Since the publication of the report of the national task force on suicide in 1998, the Government has provided a cumulative total of more than €17.5 million towards suicide prevention programmes and for research. This includes funding to support the work of the health boards, the national suicide review group, the Irish Association of Suicidology and the National Suicide Research Foundation for its work in the development of a national parasuicide register. My Department also supports the ongoing work of many organisations such as Mental Health Ireland, GROW, AWARE and Schizophrenia Ireland in raising public awareness of mental health issues. The figure of €17.5 million does not encompass funding provided by other Departments such as the Departments of Education and Science, the Environment, Heritage and Local Government and Justice, Equality and Law Reform in addressing areas within their responsibility, as identified in the report of the national task force on suicide.

My Department has also made significant additional funding available in recent years to develop further mental health specialties such as liaison psychiatry, child and adolescent psychiatry, adult psychiatry and old age psychiatry services. These services can assist in the early identification of suicidal behaviour and provide the necessary support and treatment to individuals at risk. Figures recently published by Comhairle na nOspidéal indicate that a total of 87 additional consultant psychiatric posts have been approved since 1997.

The Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive is required to manage and deliver health and personal social services. In accordance with the legislation, the allocation of funding for suicide prevention and research is now a matter for the Health Service Executive. An additional €15 million revenue funding is being made available this year for the further development of mental health services including suicide prevention measures. Details of this allocation are being finalised by the Health Service Executive at the moment.

Since the publication of the report of the national task force on suicide in 1998, there has been a positive and committed response from both the statutory and voluntary sectors towards finding ways of tackling the tragic problem of suicide. The former health boards played a major role in coordinating efforts to help reduce the level of suicide and parasuicide here. Following the publication of the task force report, resource officers were appointed in all the former health board areas with specific responsibility for implementing the recommendations of the task force. The resource officers also engage in the promotion of positive mental health, the de-stigmatisation of suicide and provide information on suicide and parasuicide within their area. The health boards established the national suicide review group in 1999, in response to the recommendations of the task force report. Membership of this group includes experts in the areas of mental health, public health and research. Its main responsibilities are to review ongoing trends in suicide and parasuicide, to coordinate research into suicide and to make appropriate recommendations.

The annual report of the national suicide review group meets the requirement of the Health (Miscellaneous Provisions) Act 2001, that the Minister for Health and Children will report annually to this House on the measures taken to prevent suicides in the previous year. The report outlines the measures taken by health service providers and other agencies in the previous year to help prevent suicide and reduce the impact of suicidal behaviour. The aim of the report is to facilitate the sharing of information across the health and other sectors regarding suicide prevention projects and to provide accurate and current information on the patterns of death by suicide in Ireland. The report draws attention to the many initiatives being undertaken around the country in the area of suicide prevention.

Among the developments highlighted is the appointment of a liaison psychiatric nurse to the accident and emergency departments of many general hospitals to deal with people who present following attempted suicide. The provision of this type of service ensures that psychological problems in patients presenting to general hospitals are dealt with promptly and referred to the mental health services for further support if necessary. This benefits the patient but also ensures a more efficient use of medical and surgical services in accident and emergency departments. Other initiatives highlighted in the report include the provision of training to health service staff and public information campaigns.

The importance of exploring the causes and ways of dealing with suicide cannot be over emphasised. A suicide is a tragic and shattering occurrence that not only brings a life to an untimely end but has a devastating impact on family and friends. It is important to ensure that the public are informed about the high rates of suicide, especially among young people, as well as ways of preventing it. Preventing suicide means, in a corrective and constructive way, influencing a person's development and their own resources at different phases of life. An important aspect of suicide prevention is to promote self-esteem and self-confidence and to ensure that all young people develop personal and social skills. Children and young people need support in gaining control over their lives and coping with their problems. There are numerous regional initiatives currently being run by the Health Service Executive in conjunction with non-statutory organisations, which focus on mental health issues like stress management, depression, stigma reduction and suicide related matters. These are issues of paramount importance, which require further attention to ensure that positive mental health and the well-being of people is promoted.

Many of the recommendations of the task force require continuous development particularly in the area of training and in the development of services relating to suicide and suicide prevention. The work to date in this area has been reviewed in the context of the preparation of the new national strategy.

Best international practice currently suggests that suicide prevention programmes should be developed on the basis of improving the mental health of the general population, in combination with developing strategies for known high-risk groups.

The new strategy for action on suicide prevention will provide specific recommendations for action in this area.

I would like to touch on the issue of support for those who are bereaved by suicide. We need to do all we can to make it as easy as possible for those people who are bereaved by suicide to confront and deal with the situation so that they can learn to get on with their lives. People often do not want to ask for help as they may feel that this will be perceived as a sign of weakness. Looking for and expecting practical help is not a sign of weakness, it is confronting one's problems. Everyone can learn to cope with a tragic loss, but for some people this can be a long and difficult process. The encouragement and support provided by the various organisations that work with those who suffer the intense trauma of bereavement through the suicide of a loved one is of immense importance. This has been recognised by the Government through the provision of financial support for groups active in this area.

The National Suicide Research Foundation was founded in January 1995 by the late Dr. Michael Kelleher. It consists of a multi-disciplinary research team with contributions from a broad range of disciplines, including psychology, psychiatry and sociology. The primary aims of the foundation are to define the true extent of the problem of suicidal behaviour in Ireland, to identify and measure the factors which protect against suicidal behaviour and to develop strategies aimed at preventing suicidal behaviour. Much of the foundation's work to date has involved the monitoring of parasuicide.

International studies have found parasuicide to be one of the most significant risk factors associated with suicide. Those who engage in parasuicide are 20 times more likely to eventually kill themselves. Studies have shown that at least one third of all suicides have a history of parasuicide. The National Parasuicide Registry is a national system of population monitoring for the occurrence of parasuicide. This important project is undertaken by the National Suicide Research Foundation, with funding from the Department of Health and Children. As a result of the National Suicide Research Foundation's reputation for high quality research, it has been invited to participate in several important international studies, among them the WHO-Euro multi-centre study of parasuicide.

In December last year I launched the third annual report of the National Parasuicide Registry. The findings in this report indicate that approximately 8,800 individuals presented to hospital due to deliberate self-harm in 2003. Some of these people presented more than once, accounting for the total figure of 11,200 presentations in 2003. The report indicates that, as in 2002, drug overdosing was the most common method of self-harm, representing more than 78% of all parasuicide acts registered in 2003. While it was common for several drugs to be taken in the same act, it is interesting to note that minor tranquilisers, paracetamol and anti-depressants were involved in almost all these cases.

Legislation restricting the sale of medicines containing paracetamol was phased in following enactment in October 2001. The registry has shown that paracetamol-containing medicines were involved in almost the same proportion of intentional drug overdose acts in 2003 — 31% — as in 2002 — 30%. However, the report notes that further detailed analyses are required to assess the effects of the Irish legislation on the use of paracetamol in deliberate overdose acts.

In Ireland, the level of discussion and openness on mental health issues, including deliberate self-harm and suicide, has increased in recent years. This is a welcome development. However, we need to ensure that public discussion and media coverage of suicide and deliberate self-harm remain measured, well informed and sensitive to the needs and well-being of psychologically vulnerable and distressed individuals in our society. In particular, we need to continue to work as a society to create a culture and environment where people in psychological distress feel able to seek help from family, friends and health professionals.

I reiterate that the Government shares the public concern about the levels of suicide. The national strategy for action on suicide prevention, to be published later this year, will provide us with a targeted, measurable action plan for tackling this serious social problem in a coherent and integrated fashion, involving all relevant stakeholders. I assure the House that the Government will support the implementation of that action plan and will work with all concerned in achieving the desired results.

See this speech in context