Liz McManus (Wicklow, Labour)

I wish to share time with Deputies Costello and O'Sullivan.

We spend much time debating issues that have only limited relevance to people's lives in this House. However, in this case, no issue is more relevant to thousands of people and more disturbing to society generally so I warmly welcome the motion. I congratulate the framers of the motion for including all the key aspects that need to be addressed if we are to tackle the reality of suicide.

Directly the impact is obvious — the premature loss of life, often of a young person — but indirectly the impact is extensive. As Deputy Neville has written:

Suicide has a profound effect on the immediate family of the victim, his or her friends and on the immediate community. Bereavement by suicide is different from that resulting from other types of death. The intense reaction to the shock of learning of the tragedy produces a complexity of emotions including feeling angry with the victim, feeling rejected, a feeling of deep despair, being depressed, blaming oneself and a very deep sense of sadness. In many cases years after the event, the bereaved have not begun to deal with the trauma. In all cases the bereaved do not fully come to terms with it.

Recent research carried out in Denmark shows that suicide in one partner is so devastating that it significantly increases the risk of suicide in the other, particularly among men. The increased rate of suicide, therefore, is not of concern because of the victim alone. It matters because of the terrible suffering it causes to families and communities. It was once a hidden tragedy, criminalised and stigmatised but we acknowledge it nowadays, maintain a humane regime to mitigate its impact and ask ourselves why, in a prosperous and more tolerant society, is the rate of suicide rocketing to an unprecedented level.

On a day when he presided over seven inquests, five of which were of people who took their own lives, the County Offaly coroner talked about an epidemic. He is correct but what is highlighted in County Offaly is reflected in other counties to a greater or lesser degree. As the motion rightly points out, people who are poor are at a higher risk of suicide, as are unemployed people, those in prison, and those who are marginalised.

While the number of victims is increasing, the social factors are becoming more stark. Four times the number of people who died by suicide in the 1970s die each year. The extraordinary increase has been experienced in other societies, which have undergone drastic social change. That is one factor but the increase is also clearly linked to a growing inequality within our society. We must rely on British research to give us the hard evidence on this point but over the past 20 years the social difference in the rates of suicide in England and Wales has become significantly more marked. Suicide is on the increase and increasing proportionately among those living in poverty in countries where inequality has deepened over the past 20 years such as Ireland. A fairer society in many ways is a healthier society and that is nowhere more evident than in the area of mental health. The paradox is that clinical resources tend to be concentrated in the least deprived, rather than the most deprived areas.

A remarkable inequity in mental health services is documented in the report, The Stark Facts, prepared by the Irish Psychiatric Association. Not only are mental health services underfunded, the problem is further exacerbated by the way in which these funds are distributed. Funding allocations for different regions are based on historical factors such as the location of mental hospitals and not on current needs of the regions.

This has led to some regions spending five times as much per capita on mental health services as others. The 2003 inspector of mental hospitals report finds a 19-fold disparity in per capita spending. What is worrying about these imbalances is that the worst-off areas tend to spend the least. In other words funding is directed towards the areas that need it least. The most deprived areas have significantly fewer acute beds, larger sector sizes and a greater temporary to permanent consultant psychiatric staffing ratio.

Ireland has the worst suicide rate among young men of any developed country. It is strongly associated with alcohol and other substance abuse. The true extent of the level of suicide is unknown because so many deaths of drug abusers are impossible to determine. Was an overdose a deliberate effort to end an unbearable life or was it simply an accident? We will never know the full extent of the problem but we certainly should know about the young men at risk of suicide. However, only 20% of young males in Ireland who commit suicide were in contact with a health professional in the year prior to their death.

Parasuicide is the strongest identified risk factor for future completed suicide, yet when a person presents at a hospital's accident and emergency department following a suicide attempt he or she may be seen by a liaison mental health nurse or psychiatrist, but too often there are no referral services for this person. There are too few social workers, clinical psychologists and addiction counsellors, and community mental health teams are often only available between 9 a.m. and 5 p.m. The development of primary care teams and primary care networks would provide more accessible health professionals so that GPs and hospitals have support in managing 'at risk' clients. As things stand nearly 50% of the country's medical card holders do not have access to general counselling services. Three of the Health Service Executive areas covering 12 counties do not have any counsellors to deal with routine cases of anxiety and depression.

In our recently published policy document on mental health the Labour Party argues for a comprehensive strategy to tackle suicide, including addressing the epidemic abuse of alcohol in both social and medical areas, targeting of those at high risk such as those who present with parasuicide, addressing shortcomings in our education system on mental health issues, the provision of support services to those suffering from depression and the training of primary care health professionals, especially GPs and accident and emergency services, to enable the early detection of depression and suicidal tendencies.

This kind of strategy requires funding and resources, yet we have seen in recent years under this Government a steady proportionate decline of funding towards mental health services. In 1997, 13% of the total health budget was spent on mental health services. Now the figure is down to 6.9%. We argue strongly that a baseline of 10% should be set to guarantee a certain standard and evenness of care.

It is particularly important that the issue of funding be addressed. We live in a society that is more unequal than ever before, which I regret. It is the direct result of a Government ideology that has failed to resource public services and a quality of life for all our citizens. Inequality leads to greater ill-health and that is nowhere more evident than in the area of mental health and suicide. In a culture where there are only winners and losers, and where the pressures to achieve are so dominant, those who fail whether emotionally or socially often suffer the most terrible anguish.

For some the only way out is an end to life and far too many are taking that route. There is an onus on all of us to question the pressures that prey so heavily on vulnerable people, but there is a particular onus on us as policy makers to address the cause of those pressures where we can. It is clear that despite its unprecedented resources this Government has not seen fit to provide high quality accessible care and supports to people at risk of mental illness. For some that has meant the difference literally between life and death.

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