Liam Twomey (Wexford, Fine Gael)

Suicide is an emotional subject and every Member fully understands the trauma families suffer as a result of a death by suicide. It would be difficult to predict our own response if any of us received the call many families receive. To be informed of the sudden death of a father, mother, brother, sister, son or daughter is a terrible event and death by suicide is accompanied by raw emotion that can often be difficult to understand or discuss. All too often, a close family member discovers the victim of the suicide, something that will never leave him or her. Last week before the Joint Committee on Health and Children, we were told of a five year old child discovering his father hanging in the garage. That will never leave that young boy.

Those left behind often spend the rest of their lives asking questions of themselves, if something they said led to this catastrophic event for the family. Regrettably, sometimes angry words have been exchanged between parents and a child before this terrible occurrence.

As the Minister of State pointed out, the Oireachtas committee published a report on the high level of suicide in society and every Member of the Houses should read it. It gives important background information on suicide. It states:

Despite the disparity of backgrounds and experience of those who came before the Committee, a number of common opinions emerged from the evidence presented. These included the fact that:

1. Suicide, the act of voluntarily or intentionally taking one's own life, is a growing global problem. In itself, suicide is not an illness but rather it is a term used to describe the act of the taking of one's own life.

2. The causes of suicide are multi-faceted and entail an interaction of biological, psychological, social and environmental risk factors occurring in an individual who may have various socio-demographic vulnerabilities interfacing with life-long susceptibilities that are then usually subject to a precipitating event, with catastrophic consequences.

That might sound academic but it points out that there are social factors and vulnerabilities in an individual's life that can lead him or her to taking that life. The easy part to understand is that such an act has catastrophic consequences for the individual.

Suicide and suicidal behaviour are societal problems and society must alter social policy to deal with risk factors. Effective action to prevent suicide behaviour requires the co-operation of the whole community, with inputs from the Departments of Education and Science, Justice, Equality and Law Reform, Health and Children and Social and Family Affairs, as well as employers and voluntary agencies and organisations committed to positive health promotion.

It was recognised in 1897 that many suicides occur when the attachments between an individual and society are strained or fragmented. This association was made more than 100 years ago and Irish society, like the rest of the world, has changed dramatically in the period since, particularly in the past decade. Given that people have become much more detached from interactions in their communities, it should not come as a surprise to learn that the risk of suicide has increased significantly. New policies are needed to address the risk of suicide, especially among young people.

The report focuses on two further key issues, namely, suicide clusters and the role of alcohol. Suicide clusters are a well-known phenomenon. I had a shocking experience of it in my constituency of County Wexford where, over a brief period, the bodies of five victims of suicide were taken from the River Slaney. The media must take extreme care in reporting suicides. If vulnerable persons perceive that the reporting of a suicide appears to elevate the victim, a rash of copycat suicides may occur in the same area. Clusters of suicides will continue unless we can persuade the media to adopt a sensible policy on reporting suicides.

The second key issue is alcohol. Many people forget that alcohol is a depressant. As the report states, it produces a "significant fall in mood". It also notes that an "individual may not have a history of suffering from depression for this to come about", adding that alcohol is "disinhibiting". I have been made aware of cases in which individuals who had attempted to take their own lives were discovered and their lives saved. They may have been found hanging in a garage or shed. Usually, they had consumed a large quantity of alcohol and had no recollection of making preparations to take their lives. For reasons connected either to the disinhibiting or mood altering effects of alcohol or events in their lives, they took the decision to end their lives without being conscious of doing so. In other words, they did not start out with the intention of taking their lives.

Alcohol consumption has increased by 40% in the past decade. It may be coincidental but the increase in suicide over the same period was also roughly 40%. Given the significant contribution alcohol makes to the suicide rate, it must be a focus of attention because it is an area in which we can make a difference.

The Minister of State indicated that more information would be sought and baselines established before the Department would set reduction targets. Other countries have successfully reduced suicide rates through targeted programmes, particularly those focused on young people. Apart from young people, the other group most vulnerable to suicide is elderly people, particularly those living alone. Of the 500 suicides per annum, at least half involve young people. When one adds a further 250 young people who lose their lives on the roads each year, one finds that every year 500 young people are killed in two areas where prevention measures are required.

Between 50,000 and 60,000 young people sit their junior certificate every year. Statistically, by the time a class of 15 year olds reaches the age of 25 years, one tenth of its number will have died either in road traffic accidents or as a result of suicide. It is shocking that we are not tackling these two key causes of death among young people. Rather than waiting to set baselines, we should take immediate action.

To return to the issue of alcohol, young people's alcohol consumption has changed dramatically in the past 15 or 20 years. They consume much larger amounts of spirits and aim to get intoxicated quicker. This could have a significant knock-on effect on the two growing trends of suicidal and parasuicidal behaviour. Many of those who engage in parasuicidal behaviour do not realise that while they did not set out to kill themselves, their actions may have serious consequences. I have worked in accident and emergency departments in Dublin and Cork. Frequently, young people would tell me on admission that they had taken 20 or 30 paracetamol tablets. They would be dismissive at first but would become anxious when they learned that paracetamol could potentially kill them as it would cause their liver to shut down. They thought paracetamol was relatively safe and would not result in death. While technically parasuicidal, their behaviour could have serious consequences. In many cases, young people who did not intend to kill themselves have been discovered dead.

We need to be alert to parasuicidal behaviour, which frequently occurs when young people consume large amounts of alcohol and row with their friends. Many 15 and 16 year olds are not psychologically prepared for the emotional relationships they enter and may, when they drink too much, make a cry for help by taking paracetamol with devastating results. The Minister can no longer sit on this issue because far too many young people are losing their lives.

The all-party report of the national task force on suicide was published in January 1998 when Deputy Cowen was Minister for Health and Children. The seventh report on the high levels of suicide notes that one of the reasons the task force report failed to have an impact on suicide rates was that resources were not allocated to target them. Two years after the publication of the task force report, suicide rates peaked and continued at high levels for a further three years. If the necessary resources had been forthcoming in 1998, how many of the lives lost in subsequent years could have been saved?

We can no longer sit on the fence. It is unacceptable for the Minister of State to indicate action will be taken when suicide rates have been accurately determined. Suicide rates are too high to take a bookkeeper's attitude on the need to have precise figures. Cross-departmental action is required to dramatically reduce the suicide rate. The Department of Education and Science must establish suicide prevention programmes in schools. I do not know what age children should be involved in these programmes. Ten years ago, we probably would have favoured starting with transition year students but these students have become much more aware of what is happening in the wider world. For this reason, it may be necessary to move the goalposts and focus suicide prevention efforts on 12 and 13 year olds.

The recommendations of the task force on alcohol have been ignored by the Government. This is something for which it must take responsibility. If the huge increase in the consumption of alcohol by young people is a contributing factor to the incidence of suicide, the Minister should take that on board and implement the strategies required immediately. The Opposition wants the Government to do its job in this regard. It is not good enough just to list what is being done when it is clear that despite all the programmes, not enough is being done to protect people.

The statistic I mentioned earlier might not be 100% accurate but it is the case that in every classroom of 30 or 40 students who are about to sit their junior certificate examination, at least two or three of those students will not see their 25th birthday because of death either by suicide or in a road traffic accident. These are the two main crises for young people at present. The Government has all the reports it needs on these issues. It is now time for it to do its job by tackling these problems and really making a difference to people's lives.

The issues surrounding death by suicide among elderly people are far different. It is usually caused by loneliness, where people are living alone and have become detached from society. They no longer feel wanted by society. It is a separate issue. Society has changed dramatically; there is not the same respect for elderly people and they are not valued as much. In some respects we have sidelined the elderly from involvement in their communities and in family life over the past decade due to the fast pace of modern life. This is the next issue on which the Minister must focus his attention. Again, however, it must be dealt with across all Departments, not just the Department of Health and Children.

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