Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

Cuirim fáilte roimh an Aire Stáit. By far the greatest tragedies in this economic crisis are the tragedies of people taking their own lives. That is an appalling reality that I have encountered directly. We can never fully answer the question of why individuals choose suicide but I know of cases where financial pressure pushed vulnerable people to the ultimate extreme of suicide.

These personal experiences are borne out by the figures. The Central Statistics Office states that registered deaths from suicide in 2009 reached a record figure of 527, a 24% increase on the previous year. That is a very significant increase. At the end of January this year the Central Statistics Office stated there were 127 deaths from suicide registered in the second quarter of 2010. Of those, 102 were male and 25 female. In the same period in 2009, 122 deaths were registered, 94 male and 28 female.

Geoff Day, Director of the National Office for Suicide Prevention, states in his preface to the office's 2009 annual report:

International research would indicate that during an economic downturn suicide numbers increase, however, the size of the increase based on the provisional figures is extremely worrying... The impact of the economic downturn in 2008, and particularly in 2009, has led to substantial increases in both self harm and suicide numbers.

Elsewhere it is stated in the annual report:

It seems likely that the increase is primarily a result of the impact of the economic downturn with substantially more people unemployed and suffering from personal debt.

Clearly, the recession is making a severe problem even worse but this problem is not, of course, primarily related to recessionary conditions. Greater awareness of the reality of suicide in our society, and initial steps to address it in a more effective way, began at the height of the economic boom. In 2006 the Oireachtas Committee on Health and Children published its report on the high level of suicide in Irish society. The report was especially critical of the state of our mental health services. It pointed out that people with mental illness are known to be at greater risk of death by suicide but "the type of mental health service one can access is a matter of luck". Those who were members of the committee will remember that sentence. The report went on to say that funding for mental health services is "allocated in a random manner with scant regard for need". Perhaps most damning of all in the context of suicide the report asserted: "The provision of mental health services for adolescents is high on aspiration but low on action."

I regret to say that the situation in terms of mental health services has improved little since the publication of that report in 2006. On the other hand much good work has been done in raising awareness of mental health by the HSE and by the Office for Suicide Prevention.

Sinn Féin has identified suicide as a distinct priority area requiring concerted co-operation between Government, the health services, the voluntary sector and communities. Our youth section, Ógra Shinn Féin, has campaigned on this issue and we organised a seminar on suicide in Stormont in 2007 which I attended and addressed. On his own initiative, my colleague, Deputy Aengus Ó Snodaigh, published an information booklet on this issue for distribution in his constituency during the last Dáil.

Sinn Féin has included suicide prevention as a key element in the policy document, Healthcare in an Ireland of Equals, which I published in 2006. Among our key proposals were: to make suicide prevention an area of co-operation under the North-South Ministerial Council to give the issue the strategic co-ordination it requires; to frame and implement a fully resourced, comprehensive all-Ireland suicide prevention strategy, including actions to promote mental health among the general population, delivered through schools, youth services, workplaces and the media; mental health promotion actions targeting specific sections of the population, incorporating their diverse needs into tailored suicide prevention sub-strategies; mental health promotion and suicide prevention actions targeting groups identified as at higher risk of suicide; actions to assist individuals identified as at risk of suicide; actions to assist people who are bereaved through suicide; to invest in further clinical and community-based research on suicide prevention; to develop national mental health awareness and anti-stigma campaigns to help tackle the issue of suicide; and to include parasuicides, people at risk of suicide, families bereaved by suicide and families of people at risk of suicide in policy-making on this issue, that is to say, the widest possible consultation.

We agree with the Joint Committee on Health and Children and its report calling for targets to be set for the reduction of the rates of suicide in the country. Targets help; they focus each and every one of us. I commend the Irish section of Amnesty International on its work on mental health and suicide. In particular, Mr. Barry Johnston has been focused and exercised on this issue in recent years and I commend him personally on his efforts. Amnesty International has played an important role in raising awareness, especially in lobbying for more effective and rights-based mental health legislation and mental health services. As Amnesty International has stated simply and clearly, better mental health services mean fewer people dying by suicide.

More work is needed to target those people in our society most at risk of mental illness and suicide. Sadly, it is a fact that the example I cite relates to lesbian, gay and bisexual people. The Gay and Lesbian Equality Network, GLEN, has stated that despite the progress in Ireland in recent times, lesbian, gay and bisexual people can still experience discrimination, harassment and exclusion in their everyday lives. Many years of research supports the view that a lesbian, gay or bisexual orientation per se is not linked with mental health problems. However, given the stresses created by inequality, marginalisation and harassment, lesbian, gay or bisexual people are at an increased risk of psychological distress because of these experiences. This is often referred to as minority stress, a term used to describe the mental health consequences of stigmatisation, social exclusion, discrimination and harassment of minority groups.

It is important and I have every confidence that the Minister of State in her new role and with her new responsibilities will reflect this area of need of address in all that she will pursue in the time ahead. In our health manifesto, a shortened document on our overall health policy position that I launched in the recent general election, Healthcare in Ireland - There is a Better Way, we called for the following: the development of mental health services on an all-Ireland basis - a proposal I commend to the Minister of State - progressing from increased co-operation to integration of services on the island; improved accountability and transparency in planning and financing mental health service reform; modernised mental health legislation in line with the new Convention on the Rights of Persons with Disabilities; the promotion of cross-departmental action to combat social exclusion, prejudice and discrimination against people with mental health problems; the ring-fencing, in accordance with the World Health Organisation recommendation, of 12% of the annual Department of Health and Children budget for mental health services; the development and promotion of suicide prevention strategies; and the provision of required child and adolescent community-based mental health services and ending the placement of children in adult in-patient facilities. Sadly, as the Minister of State is aware, there are still several of these. Progress has been made in some of these areas and more is promised in the programme for Government. For our part, Sinn Féin will continue to press these demands in the 31st Dáil and as a campaigning party.

Effective community-based mental health care is essential. My constituency of Cavan-Monaghan was the forerunner where the template was developed over many years and those at the helm deserve to be congratulated. There must be continuing care of people with mental illness. Too often, we hear of people treated in hospital emergency departments after incidents of self-harm or even attempted suicide and discharged with no immediate plan for follow-up care. If one gets a gash in one's leg and receives stitches, one would get an immediate follow-up appointment, yet people with mental illness are too often not regarded as being in need of ongoing monitoring and early follow-up, an issue which must be addressed. The attitudes behind this must change but this will only happen as a result of leadership from Government, all elected voices and our public health services.

The Government review of mental health legislation is especially important. Health legislation should be strengthened to ensure that it is firmly based on the rights of patients to adequate care and that the obligation on public health services to provide care is clear and based firmly on laws and regulations that can be implemented effectively. I urge the Minister and the Minister of State to set out, at an early date, how mental health care fits into the proposed health reform programme of the Government. Elsewhere, I have set out Sinn Féin's concerns about the many shortcomings of an insurance-based model of health care. I will continue to express concern about the model the current Government appears to be intent on pursuing.

I am especially concerned that mental health, which must be a priority in terms of public health care provision, could be neglected in the model of delivery based on the insurance sector now being contemplated. We must see the Minister's plans as soon as possible not only in outline form, but at the earliest time in respect of the detail of what is intended. While we will debate these issues and deliberate on the way forward we have an obligation to work together, which we have demonstrated in our collective welcome and declared support for A Vision for Change. Such constructive opposition was demonstrated by all parties, including both parties now in Government. The sane and balanced position which we all took, and which I shared with the current Government, will continue in respect of what the Government does well and right in the interests of health care needs, in particular those of mental health. This will continue to be the disposition that Sinn Féin and I hold. We all have a responsibility and those of us in the Opposition will continue to play a responsible role. We have an obligation as citizens to play our part in raising awareness and in making people at risk aware that they are not alone, that help is available, there is light after darkness and that together we can properly and rightly remove for now and all time the stigma that associates with mental health issues.

I conclude with a quotation from the National Office for Suicide Prevention which states in its declared work programme: "Even in these difficult times our individual and collective efforts will make a difference."

I hope the Government and Opposition will work together in this House to make a difference and regardless of whatever will separate us on this, which will allow for intense debate, that in the time ahead we will look back on 31st Dáil as a time when real progress was made together on the issue of mental health and real suicide prevention measures.

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