Dan Neville (Limerick, Fine Gael) | Oireachtas source

I welcome the opportunity to contribute to the debate on the Bill, which deals with a very sensitive and complex issue. There is a wide range of views, which we earnestly respect, on this issue. Such views have been expressed both inside and outside the House. Members have received correspondence in respect of the legislation and I defend the right of people to express their views to us in any way possible. I would, however, have reservations about the small number who would put forward those views in a fashion that is more robust than just seeking to make a few strong points. A number of speakers indicated that they have been inundated with representations. However, I will defend the right of people to make such representations and I respect them for making them. Deputies have read very carefully the letters, e-mails and messages they have received with regard to this matter.

The legislation relates to saving lives, namely, those of the mother and the child, where possible. It upholds the equal rights of mothers and children as outlined in the Constitution. Termination is very difficult and there are intense ethical, religious, social, political and intimate personal issues surrounding it. Over 20 years have passed since judgment was handed down in the X case. That judgment allows for a child to have a termination in rare and difficult circumstances experienced by the 14 year old to which the case related. In 2009, the European Court of Human Rights found that an existing constitutional right was identified in the Supreme Court's decision in the X case and that it is legal and rational that this right should be available and enforceable.

I do not wish to repeat a great deal of what has already been stated by others. However, under the Constitution as interpreted by the Supreme Court, there is a right for termination in circumstances where a woman faces a real and substantial risk to her life and in circumstances where there is serious suicidal intent as a result of pregnancy. I use the word "intent" rather than that of "ideation". Deputy Lawlor expressed it well when he stated that, as psychiatrists will indicate, ideation is quite common. Ideation moving to intention is, however, a different journey altogether. We are, therefore, concerned with suicidal intent and not just suicidal ideation. Referenda held in 1992 and 2002 to remove suicide as a ground were both defeated. It has been stated that a difficulty could arise where, as a result of a tragic predicament, a termination on grounds of suicide might cause extreme controversy as a result of there not being a regulating case. The decision in the X case is the law of the State. That law was declared by the highest court in the land and it is binding on all lower courts.

I wish to deal now with the issue of suicide and I will then discuss the Bill. In that context, I refer to some research published in the British Medical Journal by Professor Louis Appleby in 1991 which indicates that the rate of suicide among pregnant women is lower than that among their non-pregnant counterparts. He also indicated that pregnancy protects against suicide but does not prevent it. US studies also show this trend in the context of levels of self-harm and suicide. However, these studies were undertaken in areas where relatively liberal abortion regimes exist and where termination is available for pregnant women in instances involving a real and substantial risk to their lives in the context of suicide. It is worth noting this research which indicates that there are lower levels of self-harm in pregnant women and that admissions to hospital for self-harming are lower among such women. This is international research and I am unaware of any such research which has been carried out in Ireland on this matter. I merely wish to draw attention to the research in question.

People have real concerns about this issue. The advice given to psychiatrists is that they should not make impulsive decisions. Some research shows that up to 50% of pregnancies are unplanned and that there is distress involved. However, these pregnancies are not unwanted. There is a difference between a pregnancy being unplanned and being unwanted. As one individual put it, a woman can move from saying, "Oh my God, I am pregnant" to being happy that the situation has arisen and being prepared to move on. Any decision in respect of someone's mental condition must be evaluated very carefully, particularly as people can change their minds. Professor Veronica O'Keane of Trinity College Dublin is on record as stating:

It is an accepted fact that suicide during pregnancy is a rare event in the western world. This is because maternal death during pregnancy is a rare event overall. Nonetheless, suicide is a leading cause of death during pregnancy. The causes of all maternal deaths in relation to childbirth are examined and published every three years in the UK. There were four deaths attributed to suicide in the latest report where it is stated that the last three inquiry reports found that maternal suicide was more common than previously thought and was a leading cause of maternal death. This indicates that suicide is an important cause of death during pregnancy, even where abortion is available.

A study conducted in Ireland for a similar period reports that there were two maternal deaths from suicide during the perinatal period similar to the deaths rate from cancer which was also two.

Professor O'Keeffe maintains that one of the established risks of suicide during pregnancy is an unwanted pregnancy. This is particularly true for teenagers. In the UK, teenagers are at an increased risk of suicide if pregnant. Overall, a pregnant compared to a non-pregnant teenager in the US is more than twice as likely to die by suicide. We have no statistics on pregnancy and suicide in Irish teenagers, although suicide is a cause of 20% of deaths in teenage girls.

I have been involved with and have knowledge of psychiatrists for more than 20 years since I was involved in campaigning to decriminalise suicide from 1990. I have great respect for the competency and the professionalism of the psychiatric profession. I have issues about psychiatry but not their competency and their professionalism. I have previously outlined those difficulties I had with some psychiatrists which relate to their involvement and communication with carers and their families. However, that is a separate issue from their competency in conducting a decision on the treatment of mental ill-health and suicide intent.

The chairman and secretary of the Irish Association of Suicidology are eminent psychiatrists and we have had eminent psychiatrists on the board in the past. My contact has been real and I am on the advisory board of the Irish Association of Suicidology. I wish, if I may, to say something about the competency and professionalism of the psychiatric profession. Psychiatrists are competent in conducting clinical practice within legislative structures. All consultant psychiatrists are trained in the operation of the Mental Health Act 2001. In this context they are practised in the assessment of medical problems and the legal restrictions within which they manage these problems. They attend tribunals for all patients detained under this legislation and present their rationale for treatment within a legal framework. Psychiatrists are accustomed to working with legal professionals.

Much has been said about suicide. I wish to dwell for some time on the issue of suicide. Recent figures published by the Central Statistics Office show that for 2012, some 507 people died by suicide, the majority of whom were men. However, there were a further 82 undetermined deaths. In other jurisdictions these would be included in the official statistics. There are also some unidentified deaths. We have heard about single occupancy vehicular road traffic accidents, some of which are suicide. I do not wish to overstate that but international research would suggest there are between eight and 12 such deaths. I do wish to overstate or exaggerate the numbers. Those figures combined suggest 600 people died by suicide last year while 161 people died on our roads. For comparative purposes I congratulate the Road Safety Authority for the excellent work it has done in this area.

Suicide is a very complex issue but we can easily identify two contributory factors, the neglect of the mental health services and the lack of suicide prevention programmes in past decades. Bearing in mind that up to 80% of those who die by suicide suffer from a mental health difficulty, the historical neglect of the mental health services is nothing short of scandalous. In the two recent budgets the Government allocated €70 million towards the development of the mental health services. It is vital that the allocation is spent as intended by developing community based multi-disciplinary services. Some 1,414 were allocated in 2012 and more than 400 in 2008. I do not wish to discuss this in detail but I would like the opportunity to do so because I have problems in regard to how it is implemented. Some €75 million was allocated this year but recruitment is only starting. For the first €35 million allocated, the first people were appointed towards the end of last year. I have been asking where did the other money go but that is a separate issue and is not one for debate on this Bill.

One in four will suffer a mental health problem at some stage of their lives. The demands, pressures and expectations of modern life can increase levels of anxiety and depression and it is felt even more intensely at times of recession. Suicide has affected too many families and communities across the country, yet a level of denial persists about the real and serious public issue. The stigma and lack of understanding around mental health problems and suicide must be overcome.

There are many misconceptions surrounding incidents of suicide. One of the hardest realities for the bereaved is the admission that a loved one found life too painful and came to the conclusion that suicide was the only option. People often say of some somebody who dies of cancer or heart disease that they really wanted to live but that the disease got the better of them, yet they wrongly say that somebody who dies by suicide wanted to die. Nothing could be further from the truth. People who complete suicide want to live as much as anyone else but living becomes too painful. Those who take their lives do not want to die, they just cannot bear the incredible pain their illness is causing them. It is very important for people to hear that message. Suicide is not a cop-out from life. People who complete suicide have reached the end of their tolerance. There is nothing shameful about someone dies by suicide. They have fought the valiant battle and they have lost the battle through their illness. Society's attitude must change and we must involve the State in comprehensive suicide policies. In a five year period, Australia reduced its death by suicide by 25%.

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