Sandra McLellan (Cork East, Sinn Fein)

I congratulate the Minister of State and wish her well in her new position.

I have listened to the contributions of my fellow Deputies on the incidence of suicide in Ireland with sadness and dismay. It is an important issue and their contributions are valuable. However, we cannot afford mere posturing on the issue. We need action and effective measures to ensure that, as elected representatives, we will use our influence to create an environment in which there will be greater understanding and acceptance of people with mental health issues and a reduction in the stigma attached to them and the associated discrimination. I am lucky to have a platform to say my piece in the Chamber, but we need to remember that we have a responsibility to help to remove the stigma and discrimination associated with mental health problems. That goes for all of us.

The incidence of suicide in Ireland is at an all-time high. Ted Hughes once wrote a poem about Sylvia Plath who had taken her own life. It was entitled "Last Letter" in which he addressed the issue of her death. The opening line has always stayed with me: "What happened that night? Your final night." I often think of it when I hear of suicides and what happened to the people concerned on their final day or night, as well as the loneliness and isolation they must have felt and their sheer desperation. The final night for many is the result of a combination of factors, including mental health issues, reduced self-esteem, discriminationand social stigma becoming a barrier in accessing services and a lack of support.

There may be a sum of €8.7 million available to support suicide prevention initiatives which is a good start, but more needs to be done. The strain imposed by financial difficulties is increasingly becoming a factor in suicides. It is one thing to give €8.7 million for a suicide prevention programme but another when people's financial difficulties are being magnified tenfold by having to pay the universal social charge. While it is part of the Government's responsibilities to address this issue, we have a collective responsibility to address it. Ní neart go cur le chéile.

It is estimated that 40% of undetermined deaths are suicides. A total of 527 people took their own lives in 2009, which is astonishing. It would make one's heart break for the people who were driven to this, as well as their families and friends. When people attempt to access services, they are faced with an archaic mental health system. More than 20 years ago the Government ratified a legally binding international treaty guaranteeing everyone in Ireland fundamental human rights - the International Covenant on Economic, Social and Cultural Rights which Amnesty International has described as "one of the country's best kept secrets". I am not surprised it described it as such. Under the treaty, we are supposed to have a right to health care, but hundreds of children are detained in adult mental health facilities because there is insufficient child appropriate accommodation available.

The Minister for Health and Children has said a child should only be admitted as an inpatient to a psychiatric facility as a last resort. It would be preferable if no one had to be treated in a psychiatric facility and treatment was delivered within the community, but where that is an appropriate part of treatment, children should be treated in a facility suited to their needs. There is only a bed capacity of 52 within the child and adolescent mental health service infrastructure which the Government plans to increase to 58 by 2012. That means six additional beds will be provided in one year, which is inadequate. The Minister has said he envisages the plan bringing to an end the treatment of children in adult facilities. However, hundreds of children are in adult facilities. How, therefore, are we expected to believe this? Six additional beds are better than nothing, but they will not make the impact the Government believes they will. Service provision must be based on need. It is just plain wrong that people are not receiving the help and support they need because of the inadequacies of the health system and the inadequacies of a Government which will not recognise a person's right to health care.

We must also be aware of those who are at higher risk of suicide and having mental health issues. BelongTo is a youth organisation which does great work with gay, lesbian, bisexual and transgender, LBGT, young people. In its submission on the national strategy for action on suicide prevention its officers quoted extensively from research that demonstrated the high levels of stress experienced by LGBT youth. According to one Dublin City University research paper, 94% of teachers were aware of verbal homophobic bullying in schools. The old adage of "sticks and stones may break my bones but names will never hurt me" is categorically untrue. LGBT young people are five times more likely to be medicated for depression, two and a half times more likely to self-harm and three times more likely to attempt suicide. They are at huge risk. However, 90% of teachers were not able to find a single mention of homophobic bullying in their schools' policy statements on bullying.

Schools are harrowing places and life is grim for many gay teenagers. It is imperative, therefore, that action is taken to tackle this issue. We need to address the problem not only by directly funding suicide prevention programmes and strategies, but also by addressing the root causes of stress and depression This is not just the responsibility for the Minister of Health and Children. The Minister for Education and Skills also has a role to proactively work on the issue and ensure the development of programmes to positively endorse diverse sexual identities in schools and increase support for organisations supporting LGBT youth and their parents. If the State is not going to provide services, it is critical that the voluntary sector is supported in what it is doing. Our collective responsibility to address and prevent suicide means we must use our knowledge to propose meaningful and constructive solutions.

I support Amnesty International's call to use the opportunity presented by the forthcoming review of the Mental Health Act to consider broader legislation to provide community-based mental health services. International evidence shows this not only improves mental health outcomes, but is also associated with lower suicide rates. Sinn Féin fully supports this position. It is an awful reflection on Fianna Fáil, its former Government partners and now the Labour Party and Fine Gael, as well as the HSE and the Department of Health and Children, that Amnesty International, a campaigning organisation for human rights, has to lobby for better mental health service provision because the service provided by successive Governments represents such an outrageous breach of people's human rights; it is a scandal. The National Office for Suicide Prevention has stated that the increase in suicide is linked to the current economic climate in this country, stating that it is likely to be a "result of the impact of the economic downturn with substantially more people unemployed and suffering from personal debt".

Surely the Government can see now that its policies which are geared towards cutting the incomes of those who are lowest paid in society are increasing the level of suicide. It is hypocritical to speak in the Chamber of all the tragedies that have touched people's lives - we all know of someone who has taken his or her own life - and then to ignore the evidence that is presented by a body such as the National Office for Suicide Prevention, which is a part of the HSE.

It is important that the Government, during the review of the Mental Health Act, looks at the evidence. Evidence-based policy should be based on need and not the minimum that Fine Gael thinks it can get away with providing. Mental health is a significant component in suicides. The EU consensus paper on Prevention of Depression and Suicide has stated that the "adequate treatment of major mental disorders... decreases the risk of suicide and is an effective way to prevent suicide in healthcare".

Ireland still lacks a modern, adequately resourced community mental health service. Reform of mental health services must be part of a coherent response to suicide prevention. Better mental health services will mean fewer people dying by suicide. We need good community-based mental health services which have better outcomes when compared to traditional hospital treatment. The research proves that, yet four fifths of mental health service resources remain tied up in hospital-based treatment.

Implementation of the reform set out in A Vision for Change has been slow and uneven to date. Accountability for expenditure on mental health and transparent information on how such expenditure is used to reform the services in line with policy has been lacking. International human rights law demands that mental health services be continually improved in line with best practice in order to fulfil the right to the highest attainable standard of mental health and avoid social exclusion. As long as this country fails to implement reform, it will continue to fail to meet international human rights standards. These failings lead to enormous economic and human costs and needless individual suffering. The poor response to mental health is also contributing to high national suicide rates.

The forthcoming review of the Mental Health Act, as set out in the programme for Government, provides an excellent opportunity for the Government to change things for the better. We must examine what works. Everyone knows a family that has been devastated by suicide. Some families have been affected twice and others even three times. We must educate ourselves to recognise the signs. We must change things for the better. I call on the Government to listen to the evidence and it is being told by the people affected by suicide and to do something meaningful in order to address the problem.

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