Liz McManus (Wicklow, Labour)

It is unusual to revisit an issue so soon after it has been debated in Private Members' time but the issue of suicide deserves to be revisited. As Deputy Neville has stated on a number of occasions, suicide is a unique tragedy which has a lifelong impact on families and communities. The proliferation of support groups in recent years has helped families to cope with suicides and I hope the Government will bring about a small and modest improvement in this regard by encouraging and facilitating such groups. Families should always be focused on in debates on suicide as well as the tragic victims.

The House debated the issue of suicide shortly after the County Offaly coroner had described the incidence of suicide in his area as an epidemic. That was a shocking statement by somebody who is aware of the incidence of suicide in his community and it should be a wake-up call for those who doubt the seriousness of the problem.

Suicide is related to mental health and mental health services have been neglected. An increasing number of young suicide victims has focused long overdue attention on this problem. While advances have been made in recognising suicide as a major public health and social issue, suicide and mental health services in general have suffered sustained neglect in funding by the Government. For example, the slashing of the mental health budget to 6.9% of the overall health budget from 11% in 1997, despite the increased incidence of suicide annually, indicates the Government does not have its priorities right. Only 20 inpatient beds with specialised services for adolescents with mental health problems are in place, despite a Government commissioned report which recommended in 2000 that at least 120 of these beds were needed and should be provided.

The increasing incidence of suicide both internationally and in Ireland is a major public health problem, particularly among young men. The suicide rate among this group has increased fourfold since 1990 making it the most common cause of death among young people. The latest statistics reveal that suicide accounts for 50% more deaths annually than road accidents. Deaths resulting from overdoses or from lethal cocktails of drugs are sometimes not fully understood in terms of whether they were deliberate or accidental. I suspect the incidence of suicide is higher than official statistics record.

Suicide is the most common cause of death among 15 to 24 year olds and the rate in Ireland is increasing more quickly than in other countries. The incidence of suicide among young females has doubled since 1992. Young males comprise a particularly vulnerable group and a strategy must assess and target what can be done to facilitate them to deal with the pressures they face.

Parasuicide is also an issue. Significant numbers of parasuicides enter the health system and then disappear and this needs to be addressed. In 2003, 11,200 parasuicides presented at hospital accident and emergency departments and they must be tracked more effectively. We must ensure that supports come into play when someone presents as a parasuicide case. Otherwise, the likelihood is that some of these people will successfully kill themselves at some point in the future. There is a correlation between suicide and factors such as unemployment, poverty, bullying, relationship break-ups, legal and work related problems, alcohol and drug abuse, physical or sexual abuse in childhood and social exclusion. These are parts of the conditions that lead to suicide and must be addressed.

No debate on suicide can ignore mental health issues due to the correlation between suicide and mental illnesses, particularly depression. Emotional and mental distress can be as debilitating and life-threatening as physical illness at times. However, psychiatric illness does not receive the attention, investment and resources that go towards treating physical illness. It is time to change this mind set. Despite the passing into law of the long overdue Mental Health Act 2001, mental health remains the Cinderella of Ireland's health services as it has been receiving a smaller and smaller share of a cake that is not big enough to begin with. The area is under funded, unequally distributed, understaffed and lacking in essential specialist services. In short, it is as neglected and ignored as many of its clients. The most recent media coverage highlights the mental health tribunals we are still awaiting. The staffing requirement there is an indication of the Government's views on this whole issue.

We have had report after report that has highlighted the neglect and pointed out that the most deprived areas in the country receive the smallest mental health allocations. They have shown that the mentally ill in Ireland are still stigmatised and forgotten. They have also pointed out that despite the proliferation of previous reports and many commitments, we still do not have properly resourced community care for our mentally ill, properly constituted clinical teams to deal with those most vulnerable people and we do not have enough beds for certain specialties, notably child and adolescent, forensic services and services for eating disorders. At the same time, our system remains far too bed-based, with valuable resources tied up in bed provision rather than community-based services such as day hospitals, day centres, hospitals, half way houses, drop in centres and properly staffed community and mental health teams.

I take this opportunity to digress. My local hospital is St. Colmcille's in Loughlinstown, County Dublin, and it has the only centre in the country dealing with eating disorders. It was very disturbing to discover that 12 people died while waiting for treatment at that centre because it is simply incapable of meeting the huge growing need relating to obesity. Making this point is important even if it is not germane to this debate. We do not have enough psychiatrists, psychologists, social workers, therapists, nurses and back up staff. We do not intervene early enough to make a real difference for those who develop serious mental illnesses. We do not have an even near-adequate mental health service in place to deal with the one in four of us who will experience significant mental health difficulties in our lifetime.

The World Health Organisation sets out general principles for mental health legislation to protect the rights of the mentally ill, including respect for individuals and their social, cultural, ethnic or religious and philosophical values, taking into account individual needs, care and treatment provided in the least restrictive environment and a provision of care and treatment aimed at promoting each individual's self-determination and personal responsibility. Article 12 of the International Covenant on Economic, Social and Cultural Rights, which was ratified by Ireland, states that all persons have the right to the best available mental health care. In the Irish Celtic tiger economy of 2005, we are a long way from honouring our commitment under this convention and it is time we started to do so. These principles centring on the ideas of individual autonomy and respect have influenced new thinking about psychiatric illness. The ambition is now based on working out a road to recovery in partnership between the patient and the professionals rather than viewing recovery as something that is dispensed by one person to a compliant patient. This partnership is an important change but there are not enough staff to provide that type of secure support for people, which is something with which we must concern ourselves.

I made a point during Private Members' time that there are many societal influences on the suicide rate. Everyone agrees that, in countries experiencing rapid rates of change, levels of suicide have increased. No country has experienced as much change as Ireland over the past decades. However, it would be wrong and somewhat superficial to ignore the other feature that pertains to the influences of society on the well-being and good health of its population. Countries with the greatest inequalities are those with the greatest levels of ill health. A fair society is a healthier society. We depend to some extent on British data but what we are seeing is the increasing inequality leading to greater ill health and higher levels of suicide. We should take this information on board as politicians, not just as a matter of health policy but as a matter of our basic political perspective. If we continue to develop a society that is so unequal and is now second to the US in terms of inequality between the better off and the poor, we are not creating a better society. We are creating an unfair society where more and more people are being left behind. As Deputy Neville pointed out, the hopelessness and loss of self-esteem is considerable in a society where achievement is seen as central to individual well being.

In terms of analysing data on socio-economic classes, there is a whole cohort of people that is not known about. Such people do not fit into the modern categories of class and it is in this growing group of people that increasing numbers are committing suicide. This must not only be an issue of concern but of political initiative to ensure we develop a fair society in a way that will have an important impact on health and sense of well being. We will thereby ensure a reduction in suicide levels.

Currently our resources are often located in the areas that need them least when it comes to mental health services. We are all indebted to the Irish Psychiatric Association, which performed a magnificent job in producing its report The Stark Facts, which showed the extraordinary imbalance between affluent and better resourced mental health services and areas of deprivation, where not only were resources unavailable but where consultant psychiatrists or senior professionals were in temporary positions. This leads to instability in terms of treatment. That type of inequity is heaped upon a society already based on inequity. The two tiered nature of our health service is a reflection of the greater inequity that exists in our health service across the board. We are unique in Europe in our extraordinarily different approach, whereby someone with insurance can access care very rapidly but an uninsured person who is in need cannot. We need a new initiative in mental health services to ensure that equity exists and that in the areas of greatest need, the greatest effort is made to provide resources and facilities.

It is important to assess the potential impact of policy changes or legislation on the possibility of more young people committing suicide. I have grave concerns about the proposal of the Minister for Justice, Equality and Law Reform, Deputy McDowell, to deregulate the public house licensing system and to develop café bars. Dr. Joe Barry, president of the Irish Medical Organisation, has expressed strong and critical opposition to these measures and we should listen to him. If we do not deal with the binge drinking culture and alcohol abuse there will be no possibility of achieving a reduction in our suicide levels. If we do not wake up to that fact, we will be back in this House in one, five or ten years' time making the same points and facing worsened statistics and higher numbers of people committing suicide with the terrible, tragic loss of life that entails.

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