Pat Carey (Dublin North West, Fianna Fail)

I welcome the opportunity to say a few words on suicide and suicide prevention, which are extremely important issues. It is important that suicide is addressed in this House and it is probably a healthy sign of our development that we can talk about it and acknowledge that a problem exists. In doing so, I pay a particular tribute to Deputy Neville for the pioneering work he has carried out over recent years and organisations like the Bethany bereavement groups, which have carried out tremendous work throughout the country.

Suicide is always a tragedy, for the person whose life has ended and for the family, friends and community that have been left behind. Suicide has an intensely devastating effect. I know of many families in my constituency, some of them very close friends, who have had to bear this intense loss. It is always difficult to accept and understand. The resulting pain, anguish and sometimes anger affects not only the family of the deceased but the entire community in which he or she lived. Over the past 20 years the suicide rate in Ireland has increased at an alarming rate. During the 1980s and 1990s, we experienced the fastest increase in Europe, albeit from a low base. In 2003, the Central Statistics Office recorded the number of registered suicides as 444. Today, every 45 minutes at least one Irish person will attempt to die by suicide. These figures are shocking. There probably is not a family in the State which has not been affected or touched in some way by suicide.

What concerns me further about the statistics are the specific groups that are affected by the trend. More than four times as many men as women died by suicide in 2003 — 358 males and 86 females. There is a statistical link between unemployment and suicide, especially in young men, and rates of suicidal behaviour are higher among manual occupation groups. Research shows that suicide rates in the lowest social class are almost four times as high as in the highest earning brackets. Most frightening is that our rate of youth suicide is very high. A total of 30% of all deaths in the 15 to 24 year old age group in 2003 were recorded as suicide. In the 25 to 34 year old age group, the figure was 23%, making it the largest cause of death in both groups. Ireland now has the second highest youth suicide rate of the 30 OECD countries.

What are the reasons for this dramatic increase in suicides in this country? Is it even that straightforward just to point to the causes? After all, most people do not understand suicide — I do not understand it. However, by examining the research we can gain some knowledge and understanding of this alarming trend.

Between 40% and 60% of those who die through suicide have made previous attempts. Psychiatric disorders or addiction problems are present in 90% of people who take their own lives. With the increasing mental distress, a person's ability to find solutions to their problems, or even to imagine there could be solutions, diminishes. It is at this stage that suicide can be seen as a meaningful alternative. This thought seems to occur more readily to men, those living alone and people who feel alienated from society.

Not everyone with depression attempts suicide so it is clear that other factors are relevant. A culture of alcohol abuse is a factor in these high numbers. In young people in particular, the sequence of events leading to suicide may start with alcohol or illicit drug use. There has also been reference to the decline in traditional religious belief systems, which occurred at the same time as rapid social and economic change in this country. I am not qualified to state whether there is a causal link between the two.

In an effort to address these issues and the increase in suicide, the report of the national task force on suicide in 1998 made a total of 86 recommendations under various headings, such as the provision of services, prevention, intervention and after care. Since 1998, significant progress has been made in implementing the report. A suicide resource officer has been appointed in each HSE area and liaison psychiatric nurses have been appointed to accident and emergency departments in general hospitals. Provision has also been made for training relevant health care personnel in regard to suicidal behaviour and such training is ongoing in all HSE regions. In addition, the national suicide review group, the National Suicide Research Foundation and the national parasuicide registry have been established to research further the causes behind this trend.

Legislation has been enacted restricting the availability of medication which can be used to overdose. A social and personal health education programme has been developed and is now compulsory for all junior cycle students in secondary schools. However, more can always be done and, although statistics show that the growth in the numbers attempting suicide has slowed recently, we must strive to reduce the figure entirely.

An interesting point was made during a previous debate on suicide in the House. It was that suicide is not chosen but happens when the pain one feels exceeds the resources for coping with that pain. We all experience real pain at some stage in our lives but dealing with the pain is crucial. It is the resources available to us to deal with it that can make the difference.

The most effective way to tackle suicide is to provide early support and intervention and to provide the most effective resources for people to cope with events in their lives before all hope is lost. Looking at the policies of our European counterparts, the Finnish strategy is particularly comprehensive and well developed. It is the only national strategy that has a framework with a clear definition of suicide prevention. This prevention strategy is at several levels. Primary prevention aims to enhance every individual's inner resources and living conditions. Secondary prevention attempts to eliminate or reduce conditions such as mental illness, intoxicant problems, physical illness and life crises which, under certain circumstances, can lead to suicide. Tertiary prevention focuses on those who have attempted or planned suicide and the methods they use.

A range of supports and interventions needs to be introduced where the focus is on enhancing coping skills, creative options and problem solving approaches to crises. Major emphasis must be placed on addressing public attitudes to depressive and other psychiatric disorders. We should seek to enhance further awareness of depression and its recognition and treatment in general practice. We must improve access to the psychiatric services. We must also examine ways to reduce the impact of life crises, including unemployment, marital breakdown and alcohol related problems. There is a need to provide improved training for our front line workers so situations can be identified early. Most importantly, we must seriously target suicide among our youth, especially young men, for special attention. Emphasis should be placed on the need to build self-esteem, to detect anger management issues and to diminish the sense of alienation that many teenagers feel.

While suicide rates are higher in young adults, many of the risk facts and associated behaviour problems are established in adolescence. If we can target this behaviour early, we can really make a difference to their lives. Teenagers need somebody to talk to, particularly at critical times. It is important that we understand the particular needs in that regard and provide adequate counselling and psychiatric services for them. We appear to have a growing development of services for children and adults but young adolescents appear to be falling between the two, with fatal consequences.

Tackling suicide as a single issue will never bring success. Suicide prevention measures must take account of broader socioeconomic and environmental issues, particularly those associated with social justice, education, health, inequality and community affairs. I urge the Government to continue its work in this regard. There is a job to be done and, as legislators, we have a responsibility to deal with suicide and to reduce the risk of suicide.

Over the last few decades, dramatic medical and scientific advances have occurred with regard to many killer diseases such as cancer, diabetes and heart disease. These advances came about through dedication and determination from statutory and powerful agencies and from relentless advocates who, together, have advanced the health of the Irish nation. Now, suicide represents the new age killer. If we are to stamp it out once and for all, the same dedication and determination must be shown by all.

See this speech in context