Jerry Buttimer (Cork South Central, Fine Gael)

Cuirim fíor fáilte roimh an Aire Stáit, Deputy Kathleen Lynch. Listening to Deputy McLellan I cannot help but wonder whether Sinn Féin seeks an increase in bed capacity and hospital facilities or a more community-based approach. Perhaps the party could indicate what it wants. This debate is probably the most important one we will have in this House because it deals with people, those we all know who live in our communities. At a time when more and more people are under pressure - tá siad faoi bhrú - it is important that the Government and everyone else would recognise the fact. It behoves all of us to work together to ensure that suicide and mental health problems do not escalate.

In the past decade, there is not a single community or a single family in this country that has not been touched by the spectre of a death by suicide. Losing a loved one, friend, work colleague or neighbour leaves a thousand unanswered questions - the most common of which are, first, "Why?" and, second, "Could I have done something to prevent it?" Those questions shake us to the core of our being. The possibility of hope and of things improving lie at the essence of our humanity and spirituality. For many hundreds of people, at a time of deep emotional and psychological trauma in their lives, there does not seem to be a belief in life, there is a loss of hope and there is despair that things will not improve or get better. The reality is that it can. It is important that support is provided and that people talk, listen and reach out.

Recently, the Evening Echo reported on 202 deaths in Cork city and county over the past 30 months, as indicated by the Central Statistics Office of 170 men and 32 women. At times it appears as if suicide is a single, homogenous act that is becoming endemic across society. Reporting and presenting on suicide makes it seem as if it is beyond control, predictability or intervention. The analysis of the statistics and research suggests otherwise. Certain sections of communities are more vulnerable to death or harm from suicide. With careful screening and appropriate mental health and community training it is possible to become aware of potential precursors and triggers to some cases of suicide. It has been proven locally, nationally and internationally that appropriate intervention can and does reduce the number of fatalities from suicide.

For too long suicide has been a taboo subject which people have been afraid to talk about. It is important that we seek out reasons rather than seek to deny. Raising the issue and discussing suicide in this debate increases the opportunity for people to seek help and support. It is time for politicians and those involved in the mental health area to open the doors and pull back the veils of secrecy and denial so as to allow light and rational debate into this particularly difficult and sensitive subject. It is essential that we have an open and honest debate about the extent of fatal and attempted suicides and the response of the State at a national and local level.

According to WHO data, in 2009 Ireland was ranked 20th out of 26 European countries with a total suicide rate of 10.6 per 100,000 population. While significantly below that of Lithuania which had a rate of 30.4 per 100,000 we were significantly higher than our neighbours in the United Kingdom which had a rate of 6.4 per 100,000 and Greece which had a rate of 3.5 per 100,000. The same WHO data reveals that we have a youth suicide rate that is the 4th highest in Europe, which is a worry. Further analysis shows that in Ireland, over the period of 2002 to 2006 the highest rate of suicide was for young men in the 20 to 24 year age group. Those and other data clearly show that suicide and suicidal behaviour is a complex, multifaceted societal issue which while individual in focus appears to be responsive to societal and personal risk factors and indicators. The data also inform us that we must take an individualistic and holistic approach to suicide at a community, regional and national level.

I do not believe a one-size-fits-all solution can work. To be fair, neither does the Government. To be effective and meaningful, intervention must reduce both the level of attempted suicide and completed suicide. I agree with Deputy McLellan that there is a need for joined-up thinking between the various agencies, statutory and voluntary local bodies, education and social services, business and voluntary or community organisations and agencies committed to positive mental health promotion as well as participation by and acceptance of the role of the ordinary person who is often the first to become aware of the potential of risk or the likelihood of harm arising from suicide.

The establishment of the National Office for Suicide Prevention was an important advancement in the struggle to respond to the level of deliberate self-harm and completed suicide behaviour in society. In Cork, we are fortunate to have a mental health resource officer who oversees and delivers valuable and essential community supports and training, helping develop skills in individuals, organisations and the community that enable them to respond to suicide. In addition to general and specific suicide helplines, peer support education programmes for young people in a community-based setting is provided so that young people can offer support to other young people. We also have the applied suicide intervention skills training, ASIST, which is a two-day skills building workshop in suicide first aid.

In essence, there are three basic elements to our strategy for dealing with suicide - at primary, secondary and tertiary places of education; in the workforce; and through local community, voluntary and statutory agencies. Our first strategy is to support positive mental health promotion; second, to respond in a supportive way when individuals are under stress or strain, for whatever reason, such as alcohol problems, bullying, gay or lesbian issues and money pressures; and, third, it is important to develop protocols of response when suicidal behaviour occurs, aimed at helping to minimise the negative impact.

It has been established, through both national and international research, that following a death by suicide, there is an increased probability that a family member or friend will attempt or complete an act of self-harm or suicide. This is known as a "clustering" effect. The Irish Association of Suicidology has reported that the media coverage of mental health issues and of suicide can be important determinants and influencers of possible behaviour. In general, the print and broadcast media have taken a responsible attitude and approach when dealing with these issues and I would like to take this opportunity to commend the work of the Irish Examiner in this regard. It has published an important booklet, entitled, Let's Talk Suicide, which is a valuable asset and tool which should be available to every household. Perhaps the Minister of State will liaise with the Irish Examiner to arrange for that booklet to be made available to schools. The booklet forcefully and sensibly highlights the issue in a way that brings home the stark reality of suicide and its consequences. It also explores the options and supports for people contemplating suicide.

I would also like to pay tribute to Deputy Dan Neville, who through his sensitive work, commonsense approach and deep humanity has helped and influenced many people. As a public representative he has done the State a great service and should be complimented on that. Much of what he has done has been done quietly and below the radar, but he has helped and supported our fellow citizens.

The Internet is a source of much comment as its power and usefulness have transformed and shaped the lives of individuals, families and communities. Its influence is generally positive, but there is a potential dark side to the Internet that can manipulated by those who prey on the vulnerable and those in need of support. Some sites on the Internet actively promote and encourage self-harm. These sites are nihilistic and fatalistic and should be monitored or shut down. We have learned with child abuse that the Internet is difficult to police and to monitor on a 24-hour 365-day basis, but we must use it to channel positive and realistic messages on mental health and show that there are alternatives to suicide.

Reference has been made to Facebook, Twitter, Bebo and other social media sites, which are of huge importance with regard to the development of technological interventions to responding to suicide and in communicating positive messages about mental health. We must offer vulnerable people avenues of help which are accessible. I hope the Government will provide a strategy that will be immediate and offer interventions when people need them most. As we know, people who commit suicide do so deliberately at a time when helplines and out-of-hours supports are not available. Smart phones, mobile Internet access and Wifi must be used as a resource to reach out to people.

I understand there is not uniform availability of resources across or between HSE regional areas. Therefore, I call on the Minister of State to undertake a review of the implementation of the recommendations of the Reach Out strategy to ensure that all communities can be supported. I also call on the Minister of State to call on the HSE to undertake a rigorous review of best practice to determine what measures are most effective with regard to intervention and responding to suicide. We must do more than just respond to crises so that we feel better. We must do more than say we need more resources, beds and money. Given the current era of limited resources and reduced personnel, we must ensure that all interventions put in place are targeted, specific and effective. We must know what works and why it works. It is important that when we identify people at risk, they are supported. We must adopt a proactive and targeted approach to individuals deemed to be at high risk of suicide.

It is important to recognise the need for consistency in our response and intervention throughout the country. We must have flexibility in service provision to ensure interventions can be delivered where and when they are needed, rather than be restricted to office hours. We must also have a regular audit of statutory, community and voluntary groups that provide interventions in order to ensure quality control. I ask the Minister of State to follow up on this. We must look at the Internet as a way of promoting support and informing young people they are not alone.We must increase training and awareness among first responders, gardaí and social workers. We must also ensure we have a fast-track referral approach, from primary care services to community-based mental health services for those identified as being at risk.

I thank the Minister of State for her presence at this important debate. This debate is about people, not about a cold, calculated print-out of statistics. It is about our fellow citizens.

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