Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to contribute on this sensitive and delicate subject. I commend the proposers for tabling the motion. The suicide epidemic is serious. The most recent statistic was that 444 people committed suicide in a year. The Ministers of State will accept that is a conservative figure and the true figure is higher. However, it is not as high as many people say. It is probably between 10% and 20% higher. Estimates have been made putting the figure at two and three times higher but that is not the case. There were 50 undetermined deaths in the same year. There are also suicides that cannot be recognised as such because of the circumstances of death. On a conservative estimate, 500 people take their lives annually. The road accident issue is important because it reflects the approach of the Government to road safety campaigns, which are under funded. A sum of €22 million is provided but on average only 10% is devoted to suicide prevention, according to the Minister of State.

Every suicide affects approximately ten people and 5,000 people are deeply traumatised by suicide each year. That is not an insignificant effect on the community as in a ten-year period more than 50,000 people will be directly and deeply traumatised by suicide. However, as the Minister of State hinted, we must put the issue in context. Each community, such as Wexford, refers to difficulties such as the contagion factor and there may be a cluster and copycats in many communities. Every community will state that it is a major crisis, and while that is true, we must remember that approximately 2% to 2.5% of deaths are from suicide — out of 30,000 deaths, 500 are from suicide. We must not take the issue out of proportion, but put it in the context of total deaths. Suicide is by far the most significant cause of death of young people. It is a crisis among young males — the ratio is 8:1. It is of urgent importance that the Government invests in suicide research and prevention.

I commend the President of Ireland, Mary McAleese, for her recent initiative in bringing together the organisations involved to discuss and co-ordinate their work. Most of these are non-governmental organisations. That had the effect of raising the profile of this concern and the interest of society and the media. The President has always been involved in this issue. One of the first actions she took after her election was to meet the Irish Association of Suicidology, of which I am a director, in its headquarters in Castlebar and spend several hours discussing this issue.

The Minister of State spoke on parasuicide figures which are of extreme concern — the latest figure shows that 11,200 people presented at accident and emergency units. We do not know the figures for those who presented at their GPs or who did not present for assistance. It is conservatively felt that the true figure for attempted suicide is approximately 60,000, which is a serious issue. It is significant that among young people more girls than boys attempt suicide, as the most recent figures show that approximately 57% are female and approximately 43% are male.

Urgent research into attempted suicide is necessary because, as the Minister of State rightly stated, approximately one third of people who committed suicide had previously attempted suicide. That is a significant risk factor. The work of the National Suicide Research Foundation has been commended and I also recognise it. Since it was founded by Dr. Michael Kelleher it has done excellent work and it has much expertise.

Psychiatric patients are ten times more likely to take their lives than the community average. In the four weeks after discharge from a psychiatric hospital, people are between 100 and 200 times more at risk of suicide. Psychiatric services are crucial in the prevention of suicide. Some 80% to 90% of the people who take their own lives suffer from a psychiatric or emotional condition requiring intervention. In young people, it is often undiagnosed depression and we must encourage, promote and educate them to recognise when they are in crisis, despair and trouble because sometimes they do not do so. They see it as failure, that life is against them or things are going wrong and they are unable to cope, but they are suffering from depression and intervention is needed.

It is important that we destigmatise psychiatric illness so that parents do not tell their children who have attempted suicide not to tell anyone about it, to keep it quiet and let nobody know, as I have seen. Parents still do that because of fear of stigma. We should be more open and accepting as one in four people will suffer psychiatric illness at some stage of their lives. To destigmatise psychiatric illness is a long and difficult road, and I will return to this issue later if time permits.

The reduction in the level of investment in our psychiatric services has been pointed out. In 1997, 13% of the total health budget was spent on psychiatric services and that is now down to6.9%. In 1960, up to 20% of the health budget was spent on psychiatric services. It was correct to reduce the numbers of people in psychiatric hospitals as many were there for social reasons, but we did not reinvest that money in community services. The figure should still be 20%, but the money should be put into community services. We do not have a community based psychiatric service and it is internationally recognised that to deal with psychiatric services in the community we need multi-disciplined psychiatric services. Investment is required to have a team of psychologists, psychotherapists, occupational therapists and other therapists in the community as a visible and immediate support to people in crisis.

The Minister of State mentioned an investment of €15 million in psychiatric services this year, but with all due respect — perhaps the Minister for Health and Children does not support him in such spending — that figure is derisory. It is less than what was spent on Punchestown last year. The total spent on electronic voting was €60 million, and a quarter of that has been spent on developing psychiatric services. The Minister of State often quotes that approximately €90 million has been spent since 1997, but that is derisory in the context of what is required. The Irish College of Psychiatry informed the Oireachtas Joint Committee on Health and Children that 70% of psychiatrists do not have a psychotherapist available to them and 30% do not have the support of an occupational therapist. We need investment in the professions.

The Minister of State also referred to the fact that there has been some expansion in psychiatric services and in the number of psychiatrists. We need quality psychiatrists but we also need support. It is recognised that we do not have sufficient numbers in the support disciplines. Psychiatrists have stated clearly that proper management and a range of therapy services are required.

The Minister of State mentioned that €17.5 million has been spent on suicide prevention since 1998, but €22 million is been spent on road accidents each year. The figure of €17.5 million represents less than €2 million per year. It is difficult to be critical in such a sensitive area, but how does one justify the spending of only €2 million each year on suicide prevention out of a total health service budget of €1 billion? We are informed that much of that €2 million is being invested in the psychiatric services. It is not directly invested in suicide prevention. I put down questions on that comparing it to the year when we got €600,000 — the Minister referred to €2.6 million or some such figure — and the reply was to the effect that the same activities took place in every health service, that there were no new initiatives and that there was no difference in the allocation. It was just a different amount of money. Much of that money has been hived off into the general psychiatric services, and the Minister is probably aware of that.

I have dealt with the medical aspect but there is a danger of "over-medicalising" the response to the rising levels of suicide and basing all our arguments on the need for additional personnel, resources, hospital places and early intervention services. Those are vital but we miss the point about the societal influences that engender suicidal thought and actions. Leadership in identifying and addressing those societal influences is the duty of the State and, by extension, the Government. We must focus on the wider sphere. The pressure points in Irish society must be taken into account when examining the human tragedy of suicide. It is also a societal tragedy.

There is merit in the argument that we must examine and debate the way the cultural and economic changes that have taken place in Ireland over the past decade may disorient people and detach them from traditional values and supports that may never have had any formal link with mental health or suicidal behaviour. Ultimately, influencing the way individuals react to changes in their social life will be central to the prevention of suicide. The changes in society have been extremely dramatic in the past two decades, and we have all lived through that. To quote George Bernard Shaw:

Youth, which is forgiven everything, forgives itself nothing.

Age, which is forgiven nothing, forgives itself everything.

Youths are very hard on themselves. Success is an increasingly important goal in society. In previous times the way we interacted with and supported each other was important but individual success has become important. There is a belief that anything can be achieved if we work hard and are smart and attractive enough but over-reliance on the individual as the arbiter of success or failure and reliance on the subjective judgment has clear implications. If I am in control of the elements that dictate success or failure, when successful the glory is mine but when there is failure it is my failure and I must take responsibility. Society no longer helps those who fail or those who perceive themselves as failures.

That is evident in the era of the Celtic tiger. Perhaps there are more margins to live on than previously and the core is getting weaker. The uncertainties of life are increasing. Who we are? The core of life and being is dictated by what we can own and what we can buy. One is only as good as what one can own and the brands one wears. In a world where there are fewer certainties, young people are faced with choices that would have been unthinkable in previous generations. At the same time many of the cultural icons of the past are debased in the eyes of the young, such as the church and our own political establishment.

Are adolescents more vulnerable to perceived failure today or is it just that they are less likely to ask for help? The Exploring Masculinity programme of 2000 clearly recognised that the cultural, social and psychological impacts of change demand careful attention and analysis. These are important factors in reducing suicide yet the rate has continued to increase. Are we making best use of programmes such as these? Are we supporting teachers who deal with these issues or are we losing it all in the points race and the pressure to succeed academically at all costs? In that respect I hope we will hear tomorrow from the Minister for Education and Science and the Minister for the Environment, Heritage and Local Government, who have key roles to play in suicide prevention. Suicide prevention is not just a health issue, it is an educational and an environmental issue.

Research, understanding and analysis of the pressures on young people are vital if we are to address the epidemic of suicide. That must not be shirked by the Minister or the Government but run parallel to the resourcing and development of these services. We must regard suicide prevention as a multi-dimensional area that requires promotion and investment.

The relationship between alcohol consumption and suicidal behaviour has been well established by robust research internationally. There is a clear association between the per capita consumption of alcohol and the suicide rate in any country. The higher the level of consumption of alcohol, the higher the suicide rate. Alcohol consumption levels can explain the difference in suicide rates between countries and between different areas in each country.

Alcohol impacts on suicide rates in a number of ways. Alcohol consumption leads to depression, which is a major factor in suicide and suicidal behaviour. In addition, depressed persons frequently turn to alcohol in the mistaken belief it will improve their mood. In many people alcohol has a biphacic effect, initially causing a feeling of well-being but soon to be followed by dysphoria. Traditionally, the lifetime risk for suicide in alcoholism is thought to be between 3% and 7% and the risk for major depressive illness is approximately 15%, although the latter figure is now believed to be somewhat over-estimated. The core morbidity of depression on alcohol abuse greatly increases the risk of suicide and suicidal behaviour.

A third factor is that alcohol impairs judgment, reduces inhibition, increases risk-taking behaviour and may result in impulsive suicide and suicidal behaviour, most frequently in the young. Alcohol causes cognitive constriction and reduces problem-solving abilities. There is a direct relationship between the increase in alcohol consumption in Irish society and the levels of suicide. A campaign about alcoholism is very important in respect of many of the societal difficulties we are facing, including violence and so on, but alcoholism also has an impact in terms of psychiatric illness, suicide and related matters.

The National Suicide Review Group was set up in 1998 following the report of the national task force on suicide. The job of the review group was to oversee the implementation of the recommendations of the national task force on suicide. The Minister's amendment contains six of the 86 recommendations of the national task force on suicide that have been implemented. That is a fair representation of the position.

Seven years after the national review group was to oversee the implementation of the recommendations, a national strategy group was set up which was to report this April. Three weeks ago, in his reply to my question on what was happening in terms of the implementation of those recommendations, the Minister said he was awaiting the report of the strategy group. There are 86 recommendations. It is extremely frustrating that we have had mental health reports and now a strategy group report, which will have to be examined and on which there will have to be consultation. When will we see action in this area?

I am a director of the Irish Association of Suicidology. We have an excellent board made up of three professors of psychiatry, two consultant psychiatrists, including a former chairman of the college of psychiatry, a bereaved person, a lecturer in sociology, a counsellor for the bereaved, a member of the Samaritans and a member of the national task force on suicide. It is a diverse and very experienced 32-county group.

The Minister spoke about his contribution to our organisation. He gave us €75,000, for which we are extremely thankful. We asked the Minister of State for a meeting this year but he failed to meet us to ask about our level of experience and the ways we could contribute. I was reluctant to raise the matter in the House previously as we wished to progress matters otherwise, but we are very disappointed.

See this speech in context