Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to contribute to this debate. I welcome the report of the Joint Committee on Health and Children on high levels of suicide. The report made a thorough examination of the issue. I thank those who presented to the joint committee and I commend the expertise and work of the committee itself.

Suicide is a difficult issue for communities and families but especially for families who suffer a bereavement by suicide. No words can ever console or begin to explain to a family who suffer such a bereavement. The question most often asked is "Why?", and it is the hardest question to answer because the reason is different for every case of suicide. Different aspects of life, experience, pressure, difficulty or the state of a mental illness come to impact on a victim of suicide. It is always difficult to persuade families bereaved by suicide to accept that no one is to blame when a suicide occurs. No blame attaches to anyone in a case of suicide. People who take their own lives are not intent on ending their lives so much as ending the pain they are suffering. They see no other way out of their suffering than to take their own lives.

Much of what has been said today touches on the need to intervene in the lives of people in crisis and to promote the view that to recognise one's difficulties and despair and obtain help is to take a positive approach. A young person labelled with a psychiatric difficulty, depression or a need for counselling often loses status among his peers. If a young person goes from the midlands to speak to a counsellor in Dublin, for example, others will not know about his problem but the young person will label himself. He will self-label and know he is in trouble. The key to dealing with mental ill health and suicide is to destigmatise these areas. Programmes are needed to destigmatise suicide and mental ill health.

International experts say more than 80% — one study says as many as 87% — of people who take their lives suffer from a psychiatric illness. Young people who commit suicide are often suffering from undiagnosed depression. They feel depressed and suffer from a sense of failure and low self-esteem. They do not put a label on their condition or understand what is happening, but they need assistance. Much of the assistance needed by young people is psychotherapeutic rather than psychiatric, although psychiatric treatment is often necessary. I do not subscribe to the view that drugs can be eliminated. They are important in the treatment of mental illness. I accept that they are over-prescribed because we do not have the multi-disciplinary teams of psychotherapists and other therapists who are required to deal with suicidal tendencies. We must destigmatise suicide so that people do not feel ashamed if someone in their family has attempted suicide or has a psychiatric illness.

The report mentions deliberate self-harm. The treatment of deliberate self-harm in our hospitals is patchy. In the former Eastern Health Board area, 47% of those who deliberately self-harm are admitted to hospital but only 9% are admitted in the former South Eastern Health Board region. There is no uniformity in our understanding of deliberate self-harm. Some 10% of those who deliberately self-harm go on to take their lives. Treating deliberate self-harm and attempted suicide is a key issue in reducing suicide.

There is a need for research in all areas of suicide but there is urgent need to research the level of deliberate self-harm. Each year, over 11,000 such people present at accident and emergency units. We do not know how many people who deliberately harm themselves visit their GPs and are treated at that level. Neither do we know how many do not seek treatment at all but simply hide the failed attempt to take their own lives. Some may not even tell their families what has occurred. It comes back to the stigma surrounding suicide. Because families do not want it known that a relative is in crisis, they often do not seek assistance, including a psychiatric assessment for those who commit self harm. If suicide is de-stigmatised more people will seek the necessary help.

During the course of our discussions on this document, the relationship between alcohol abuse and suicide became evident. The report shows that in the 1990s there was an increase of 41% in alcohol consumption and 44% in suicide. There is a correlation between alcohol consumption levels and suicide. It would not be correct, however, to say that alcohol is the cause of suicide because many factors are involved, including changes in society.

Much concern has been expressed about binge drinking by young people. A person suffering from mild depression or any mild psychiatric illness who consumes alcohol, which is a depressant, can become chronically depressed as a result. Another big issue surrounding alcohol is that it can reduce inhibitions in those who may have suicidal tendencies. We need to understand the role of alcohol in causing mood changes in people who are already experiencing difficulties. Such people may reach a moment of deep crisis brought on by a combination of alcohol abuse and the personal difficulties they are facing.

Eating disorders cause higher mortality levels than any other illness in Ireland. There is some debate over whether such disorders constitute psychiatric illness but a certain psychiatric element is involved. We have no proper services to deal with eating disorders, although good models exist for treating and curing such disorders. Yesterday, I had a long discussion with the Marino therapy centre which undertakes excellent work in this area. The Minister of State should examine the successful model employed by that centre with a view to evaluating how it can be used elsewhere. It should be introduced in each HSE region because eating disorders such as bulemia, anorexia nervosa and binge eating are on the increase.

A key to reducing suicide and mental illness is the provision of modern, world-standard psychiatric services for children and adolescents. I could spend the next 30 minutes telling the Minister of State what is wrong but we know what is required. If we had such services we could reduce the levels of suicide through early intervention. We could also reduce psychiatric illness from occurring later in life because such intervention provides a better chance of curing it. According to Professor Patricia Casey, 90% of depressed young people can recover as a result of early intervention. Delayed intervention, however, allows depression to become chronic, thus causing severe problems for those involved. I cannot overstate the vital need for early intervention to cure psychiatric illness in children and young people generally.

Two weeks ago, a child and adolescent psychiatric service gave us a presentation. The officials told us that in parts of the country young people are waiting three years for a consultation. I did not think the delays were that long. Last April, the Minister of State informed me that while there were no waiting lists in some areas, in others the delays ranged from six to 12 months, and two years in Kerry. I accept the Minister of State's word but I think immediate intervention is now required to cope with these delays.

The Government has facilitated several Dáil debates on suicide. In addition, Fine Gael and the Technical Group have introduced such debates in Private Members' time. Some people are of the view that in previous years the statistics on suicide were incorrect but I do not accept that for several reasons. First, our system of collecting such statistics, on form 104, is more accurate than in most other countries. Second, very low levels of suicide were recorded among Irish emigrants abroad. Third, there was a low level of suicide in Ireland also and the figures from the 1960s are quite accurate.

There is under-reporting of suicide but that is unavoidable because we do not know about every case. Car crashes were mentioned in this regard and internationally it is accepted that between 6% and 12% of all single-occupancy car crashes are suicides. We are talking of perhaps 10% to 20% in Ireland but while we recognise the problem it should not be overstated. It is accepted that the level of under-reporting of suicide ranges from 10% to 15%, which would mean we are averaging approximately 500 suicides a year. The National Suicide Prevention Office has an annual budget of €1.2 million and the National Safety Council, which promotes road safety, receives €29.4 million, yet there are more suicides than road deaths. That tells a tale concerning the level of investment in suicide prevention.

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