Liz McManus (Wicklow, Labour)

I welcome this debate. It is probably the first time there has been a full debate in the House on suicide, despite the fact that all Members, in the course of their work, have encountered families whose lives have been blighted by the suicide of a loved one. Few of us have been trained in how to deal with that type of crisis so we can only imagine what is involved and empathise with and support those families as best we can. Indeed, many of us have family members who have committed suicide and have had to cope with that terrible crisis. Many parents never fully recover from the loss of a child who has died in this way.

This is an important debate. It is important that we know the extent of the problem. It is striking that in the past we thought Ireland had a low level of suicide. Certainly, the evidence is that the level was lower than it is now. In the 1960s there were approximately 164 suicides per annum; now the figure is approximately 450 per annum. That is a big increase. We can debate the reason for that but I suspect that in the past the figures were suppressed because of the stigma attached to suicide. I recall that there was general smugness in Ireland with regard to a country such as godless Sweden, which had a considerably higher level of suicide. The reality, of course, is that we often covered up cases of suicide, often for the benign reason of protecting people and minimising the damage.

It is better that we know the truth. It is healthier for the community to know the extent of the problem. I welcome the fact that there is better data collection now. Nevertheless, it is clear that we do not know the full extent of the incidence of suicide, and the Minister has used this as an excuse. There are hidden suicides, something we need to explore and study. There is circumstantial evidence that some car crashes are deliberate. We have seen instances of risky behaviour in cars, particularly by young men, and have learned to our cost in recent times where that can lead. There is a general view that some car crashes resulting in the death of young male drivers might in some cases be deliberate rather than accidental. Accurate research and accurate data collection is most important for getting to grips with this issue.

This is referred to in the report:

We have a body of statistics about suicide in Ireland that are likely to underestimate the true state of affairs. While accurate data collection is the ideal, avoiding unnecessary duplication of collecting information is also important. The best possible use of the existing data held by statutory and professional agencies relating to suicide deaths in Ireland supplemented when possible by information from the bereaved family and the deceased's social network would also help to build up a picture of the deceased. However, our relentless problem of suicide requires us to engage in preventative programmes and set targets for a reduction in self destructive behaviour in parallel as a matter of urgency.

The committee's report makes a key point, namely that while we collect this more accurate data we should not delay in setting targets. However, the Minister has just told the House that because we do not have accurate data and do not know the cause and effect of measures, targets will not be set. The report says that is the wrong way to proceed in tackling this issue. Perhaps the Minister will reconsider and have a little courage.

There is no lack of reports and information. There are two significant reports available, the Oireachtas joint committee report and the strategy report. These contain good information and proposals. The Oireachtas committee employed Dr. Siobhán Barry, an expert in psychiatric illness and suicide, and consulted with people and families who had been bereaved. The partnership between the expert and the people who are directly affected is fundamental to ensuring that we reach out to those at risk and to those who have lost loved ones.

The strategy outlined by the Minister lasts to 2014 but does not set clear targets. That is a key weakness in the Government's approach. Deputy Neville will probably discuss the example of Scotland. When the authorities in Scotland were tackling the high level of suicide they set out targets and were effective in reducing that level. On this morning's "Morning Ireland" a person in charge of dealing with the accident and emergency crisis stated that setting targets was crucial to tackling the problems in that area. If targets are not set, what are we working towards other than a series of aspirations that become more woolly as they become more ineffective? This is a crucial point.

This report and others point to the reasons for the increase in the incidence of suicide, apart from the fact that we have better knowledge about the problem. There is a loss of values and a loss of a sense of security among young people. We must take on board that Irish society has changed rapidly and become more unequal and divided. There is a greater sense of marginalisation as a result of our prosperity. Those who, for whatever reason, are left behind feel even more isolated. There is a raft of research to support the case that poverty and social exclusion have a detrimental effect on people's health, that social determinants of health are hugely significant and that poor people have shorter lives and, on average, are more liable to become ill than those who are better off and employed. The position is similar in respect of mental illness, which is a significant factor in suicide.

The Minister of State is a member of a party which believes that inequality is a good thing. His party's new leader has espoused the cause of inequality but when it comes to health, that is a load of baloney. Inequality is anything but good. In circumstances where good measures are in place in societies where the divide is not so wide, health outcomes are generally much better. In the US, of which the Minister for Health and Children is so fond and with which she is besotted, the health service spends enormous amounts of money but does not deliver better health outcomes. This is largely because US society is so unequal. Those at the bottom of the ladder in America cannot access health care and suffer much greater ill health.

Consideration must be given to societal issues. A fair society is a healthier society. Until we grasp that concept and begin to promote the principle of a fair society, we will continue to be obliged to climb the hill with a burden on our backs.

Another issue to which I wish to refer is that of the victims of abuse. It is part of a painful legacy that is also coming to the surface that there is a higher level of suicide among victims of abuse. We must ensure that full counselling and psychotherapy services are put in place to try to ameliorate the damage and destruction done to people's psyches by abuse. This gives rise to a general point regarding counselling and psychotherapy, namely, that it is difficult for people facing emotional crises in their lives, particularly if they do not possess adequate financial resources, to seek help of the kind to which I refer. Such help is not incorporated into our health service in the way it should be and it is not accessible via the medical card system. There are many voluntary organisations which are trying to meet the huge need for counselling. For many people, counselling can open a door to happiness and relieve them of enormous emotional burdens that they often carry in isolation. Whether we can rely on counsellors' judgment and evaluate whether they are good at what they do is another matter. In my opinion, this area should be professionalised. However, that is a matter for another debate.

I welcome any beneficial moves in respect of mental health that the Minister of State intends to make. I will not begrudge anything being done by the Mental Health Commission, the establishment of which was an extremely positive development. It is vital that mental health should be given higher priority within the health service.

I wish now to deal with the issue of alcohol abuse, to which the requisite attention has not been paid. The Government has at its disposal all the information it needs in the form of the second report of the strategic task force on alcohol. We are aware that there is a strong link between alcohol and some suicides. Members raise issues in the Dáil and table questions about, for example, the alcohol products (control of advertising, sponsorship and marketing practices/sales promotions) Bill. I inquired about the latter in 2003 and I was informed that publication was expected in early 2004. The legislation has disappeared from the horizon. The reason for this is that the Minister for Health and Children capitulated to the alcohol industry.

The second report of the strategic task force on alcohol indicates that Ireland has a major problem in respect of alcohol abuse. Chapter 2.21 of the report states:

A recent study showed that adults in Ireland had the highest reported consumption per drinker and the highest level of binge drinking in comparison to adults in other European countries... The study showed that binge drinking is the norm among Irish men; out of every 100 drinking occasions, 58 end up in binge drinking. Among women, 30 occasions out of 100 end up in binge drinking. Binge drinking was conservatively defined in this study as drinking at least one bottle of wine, or 7 measures of spirits, or 4 pints of beer or more, during one drinking occasion... While young Irish men reported the highest consumption of alcohol and had more binge drinkers than any other group in the population, binge drinking was common in all age groups up to 64 years.

There are two points to be made. First, we have a real problem as regards the abuse of alcohol and, second, it is clear from the research that this problem does not merely exist among young people. We espouse a culture which ensures that practically every part of our social lives revolves around the pub and that the young are educated into the culture of alcohol abuse by older people. We are creating a range of problems, including those which relate to liver damage and mental conditions.

We are aware that there are many problems associated with the abuse of alcohol but the Government is not dealing with this matter. That is disturbing, particularly because the link between alcohol and suicide is well known. However, it is also disturbing because young people are being exposed to the opportunity to suffer great ill health, such as that caused by liver damage, in the future by a culture that we do not seem to be able to control or redirect in any way.

The summary of recommendations in the report of the task force is extremely clear and states that we should increase taxes, restrict greater availability, deal with advertising, reduce exposure of children to alcohol, etc. Regrettably, however, the recommendations remain in the report and have not been taken on board elsewhere. That is one of the examples of the Government's acute failure to deal with this issue.

Everyone understands that difficult decisions must be made. When the Government introduced the smoking ban, I found myself in the extraordinary position, at public meetings in my constituency, of defending it against a Minister who also represents the constituency and who was highly critical of the ban. However, that was my choice and I would make it again.

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