Dáil debates

Thursday, 2 June 2005

1:00 pm

Tim O'Malley (Limerick East, Progressive Democrats)
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I welcome the opportunity to make a statement in this House concerning the level of suicide in Irish society. Suicide is a serious social problem in our country. In 2003, the number of registered deaths in Ireland attributed to suicide was 444. This high incidence of suicide in the population is not confined to Ireland but is a growing global problem. A disturbing feature is the male suicide rate which accounted for 80% of deaths from suicide in 2003. In particular, young males and older males aged 65 years and over have shown an increase in the rate of suicide. These are trends which require further research so that strategies can be developed to help people who are particularly at risk.

As the suicide figures began to increase back in the early 1990s, my Department became aware of the need for reliable and concrete information on which to build a national strategy to address the problem of suicide in Ireland. The national task force on suicide was therefore established in 1995 to address the growing prevalence of suicide in our society. The task force comprised 15 individuals from a range of backgrounds, including the coroner service, the Garda Síochána, nursing, psychiatry, psychology, public health and many voluntary organisations.

In September 1996, the task force published its interim report. It contained a detailed analysis of statistics relating to suicide and attempted suicide in Ireland and a preliminary analysis into the factors that could be associated with suicidal behaviour. The task force's final report was published in January 1998 and marked the completion of detailed examination of the incidence of suicide and attempted suicide and outlined a comprehensive strategy to reduce these in Ireland. The report outlined 86 areas where interventions should be targeted to reduce suicide levels. This highlights the complexity of the issue of suicide prevention. There are no simple solutions. The report also identified the various authorities with jurisdiction in suicide prevention strategies and their respective responsibilities.

While the level of suicide among our young people continues to give cause for concern, it is important to point out that youth suicide in Ireland is not the highest in the European Union. The most recent analysis suggests it is fifth highest. In terms of the overall suicide rate, Ireland ranks 17th in the European Union. Recent figures suggest that the rate has stopped rising, but it is correct that we probably experienced the fastest rising rate in Europe during the 1980s and 1990s, albeit from a low base rate.

The key components of the overall strategy recommended by the national task force in 1998 included the implementation of measures aimed at high risk groups, provision of information, training on suicide prevention for relevant professionals and organisations and the improvement of services which would benefit those at risk of suicide and those who attempt suicide. Since the publication of the report of the national task force, there has been a positive and committed response among both the statutory and voluntary sectors towards finding ways of tackling this tragic problem.

Significant progress has been made in a number of different areas, including the appointment of a suicide resource officer in each Health Service Executive area; the establishment of the national suicide review group, the National Suicide Research Foundation and the national parasuicide registry; the appointment of liaison psychiatric nurses to accident and emergency departments in many general hospitals; the provision of training for relevant health care personnel with regard to suicidal behaviour — this training is ongoing in all Health Service Executive regions; the enactment of legislation restricting the availability of medications which can be used to overdose; the development of a social and personal health education, SPHE, programme which is now compulsory for all junior cycle students in secondary schools; the publication of a directory of services in each Health Service Executive area for those who may be at risk of suicidal behaviour; and the development of a new form 104, which is the form on which the Central Statistics Office figures are based. A Garda inspector within each division has been nominated to oversee the use and completion of the form.

These are just some examples of the progress which has been made to date. Much more detail about various initiatives under way throughout the country can be found in the annual reports of the national suicide review group which are laid before the Houses of the Oireachtas each year. Many of the recommendations of the task force require continual development, particularly in the area of training and in the enhancement of our mental health services.

The Health Service Executive, in particular, has a major role to play in co-ordinating efforts to help reduce the level of suicide and attempted suicide. Resource officers have been appointed in all the health service regions with specific responsibility for implementing the task force's recommendations. Their responsibilities include the provision of staff training in risk assessment, production of information literature and events aimed at raising public awareness of suicide and parasuicide.

Another important aspect of suicide prevention has been the establishment of the national suicide review group. Membership of this group includes experts in the areas of mental health, public health and research. Its main responsibilities are to review ongoing trends in suicide and parasuicide, to co-ordinate research into suicide and to make appropriate recommendations. The group's researchers also collate existing research materials, both national and international, examine the effectiveness of intervention programmes and liaise with local co-ordinators.

Ongoing strategies and prevention programmes throughout the country are regularly reviewed by the national suicide review group and routinely commented on in its annual report. This report meets the requirement of the Health (Miscellaneous Provisions) Act 2001 which provides that the Minister for Health and Children will make a report each year to each House of the Oireachtas on the measures taken by health boards in the preceding year to address the problem of suicide.

The Department also allocates funding through the NSRG to voluntary and statutory groups engaged in prevention initiatives, many of which are aimed at improving the mental health of the younger age groups. These projects include life- skills courses for high-risk youth, school-based personal development modules and mental health promotion campaigns. A number of the projects have been positively evaluated and have been proven to enhance the coping skills of the participants. It is anticipated that such campaigns will lead to a reduction in youth suicidal behaviour over time.

The health strategy, Quality and Fairness — A Health System for You, included a commitment to intensify the existing suicide prevention programmes. I am pleased to report that work is well under way on the preparation of a national strategy for action on suicide prevention. The strategy, which is being prepared by the project management unit of the Health Service Executive in partnership with the national suicide review group, is supported by the Department of Health and Children. Work on the development of the strategy was initiated almost two years ago. Almost 700 people have attended regional and national consultation meetings since then and submissions have been sought in the national press. A national and international expert group of 16 people reviewed the strategy during the last two weeks of April and their analysis is being incorporated in the strategy.

The national strategy for action on suicide prevention that will emerge from the consultation process will take account of the input of external reviewers and the dedicated writing team. It will be of a high quality, it will focus on action and it will be based on evidence. It will highlight some actions which should be of immediate priority. The strategy will set targets for implementation over the next five years, as well as long-term objectives for suicide prevention and mental health promotion. I have met Dr. Rosaleen Corcoran, who is leading this process, on a number of occasions. I am pleased to inform the House that the strategy will be published in September of this year.

The national strategy's fundamental aims will be to prevent suicidal behaviour, including deliberate self-harm, and to increase awareness of the importance of good mental health among the general population. The strategy will emphasise the need for ongoing multidisciplinary research of a high quality. Research findings are of greatest value when they inform and stimulate action and service development. The strategy will identify expected outcomes and set targets which can be measured, monitored and revised. Continuous quality control and ongoing modification and improvement will be central to the implementation of the strategy.

Deputies may be aware that the President, Mrs. Mary McAleese, recently hosted a forum in Áras an Uachtaráin for groups and stakeholders working on suicide prevention. The theme for the gathering was integration and partnership, in acknowledgement of the increasing fragmentation in the suicide prevention field and the need for leadership and coherence at national level. Such issues will be addressed in the context of the new national strategy. A document that summarises the discussion at Áras an Uachtaráin, Suicide in Ireland — Everybody's Problem, was launched earlier this week. It was compiled by Dr. Tony Bates, who acted as rapporteur at the event. The theme of the report, as its title suggests, is that co-operation and involvement across the entire community is required if we are to reduce suicidal behaviour. The President has expressed her interest in continuing to support efforts in this regard. I welcome her involvement.

If we are to reduce the number of suicides, it is essential that people with life crises get appropriate support. In that context, expenditure on suicide prevention programmes has increased significantly in recent years. The Department of Health and Children has given special attention to the resourcing of suicide prevention initiatives in the last few years. The level of funding provided by the Department of Health and Children for suicide prevention is more than 20 times greater than it was in 1999. Since the publication of the report of the National Task Force on Suicide in 1998, more than €17.5 million has been provided for suicide prevention and research aimed at improving understanding of the issue. That figure does not include funding provided by other Departments, including the Departments of Education and Science, the Environment, Heritage and Local Government and Justice, Equality and Law Reform, which were identified in the National Task Force on Suicide's report as having a role to play in suicide prevention.

Additional funding has been given to the National Suicide Research Foundation, a multidisciplinary research centre that informs health service developments and policy formulation. The foundation, which was established in January 1995 by the late Dr. Michael Kelleher, consists of a multidisciplinary research team of professionals from a broad range of disciplines, including psychology, psychiatry and sociology. The primary aims of the foundation are to define the true extent of the problem of suicidal behaviour in Ireland, to identify and measure the factors which induce and protect against suicidal behaviour and to develop strategies aimed at preventing such behaviour.

To date, most of the National Suicide Research Foundation's work has involved the monitoring of parasuicide. Annualised data on every suicide and undetermined death registered in Ireland is sent to the foundation by the Central Statistics Office. The statistics are analysed to produce up-to-date age-specific and age-standardised suicide rates, with respect to demographic variables. Such information about suicide is provided in response to the numerous requests the foundation receives from professional bodies, students and the public.

The promotion of high levels of self-esteem and self-confidence among young people will take place as an important aspect of the suicide prevention programme. We need to ensure that such people develop personal and social skills. I welcome the debate on this issue. It is important for public representatives to discuss mental health issues and the incidence of suicide. That people are aware of the problems which exist is a sign of the wonderful advances which have taken place in our country. I compliment the many voluntary organisations throughout the country — I will not name them because there are so many of them — which contribute enormously to the positive mental health scene.

I was present in the Seanad for its recent comprehensive and constructive three-hour debate on mental health and suicide. I look forward to the contributions of my Dáil colleagues during this debate. It is healthy to discuss this matter, especially as the stigma and taboo which attached to suicide prevented people from talking about it in the past. If we work together to prevent suicide and promote positive mental health, we will make a greater collective contribution to ensuring that suicide levels stop increasing, as they have already done. When the expert group publishes the national strategy later this year, I hope it recommends measures which will ensure the levels of suicide decrease. There is a need for much more recognition of the importance of positive mental health in the community.

2:00 pm

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I am pleased to have an opportunity to speak on this important subject. I thank the Taoiseach for agreeing readily to the request made by the leader of Fine Gael, Deputy Kenny, for a debate on suicide during Government time. I hope it heralds a new and inclusive era of political debate and consensus and, more importantly, leads to positive action to stem the tide of the loss of so many lives, many of them young, in Ireland.

I convey my sympathy to the many people who have been bereaved by suicide. The families, friends and communities of those who are tragically visited by suicide have to endure a great deal of trauma. We should recognise the uniqueness of the bereavement suffered by such people.

The issue of suicide should unite the House, rather than divide it. No single party or person has a monopoly on concern or sympathy. Action must be taken by the Government because it controls the purse strings. Action costs money, but the cost of the loss of many lives is incalculable. Suicide, which is a compelling and personal tragedy, is a terrible, bleak and lonely end to a human life. It leaves family and friends bereaved, grieving, confused and bewildered. Every suicide leaves behind pain, desolation, outrage and unanswered questions. For many years, many of us seldom gave suicide a second thought. We may have had the illusion that it was something that happened to others and not to us. The increasing incidence of this tragedy now means that we are becoming all too familiar with the incidences of suicide in our families, among our friends and in our communities. I deeply regret such familiarity while welcoming the increased public debate. We must bring this issue out of the shadows and begin to take responsibility.

We must never forget that suicide is a terrible act against nature and must not be considered as a solution to any problem in any circumstances. Suicide prevention is everyone's responsibility. The tide can only be turned by concerted and co-ordinated actions by all sections of society. This is why this debate is so important. We in this House are all charged with the development of public policy and services. This is where action on a national level can and must begin. I understand the reluctance of some commentators and reporters to accept that suicide is a political as well as a personal issue. Many believe that politicians should not play a role in addressing what is a crucial social and health issue. Concern has been expressed that political debate on the subject may upset the bereaved relatives of suicide victims whose pain is characterised by agonised questioning and a search for some explanation of what happened. One of the problems with suicide is that we do not want to talk about a subject that has been taboo for so long.

International research has shown that between 80% and 90% of those who take their lives suffer from a psychiatric or emotional condition and, in many cases, this is unidentified depression. Recent research carried out in Kildare indicated that most of the young men who died had suffered from undiagnosed depression. The development of the psychiatric services has a key role in reducing suicide and in suicide prevention. The debate on the development of the psychiatric services is similar to the debate on suicide prevention.

I have repeatedly suggested to the Minister of State that there is an absolute need to invest heavily in the development of the psychiatric services, not just to prevent suicide but to deal with the issue of mental health. One in four people will at some stage suffer from a psychiatric health condition which will need intervention. We do not have community-based psychiatric services, which are needed. In 1997, 11% of the health budget went towards the psychiatric services. This year that budget is at just 7%. In England and Wales it is at 14%. Scotland has recognised it as a special difficulty, and 18% of its total health budget has been invested in the development of the psychiatric services.

The Minister of State said that €17 million has been spent on suicide prevention since 1997, which amounts to approximately €2 million a year. Surely this is unacceptable in the context of the total spending of the Government and the Department. I just attended a committee meeting dealing with the issue of the Travers report on which €1 billion or €2 billion will be spent, yet we are talking about just €2 million a year to deal with suicide prevention. It is totally inadequate. The Minister of State referred to €90 million for the development of the psychiatric services. The budget for this service is totally inadequate and indicates the Government's lack of interest in the area. It is worthwhile repeating these facts.

This time each year, I table a Dáil question on the amount of money spent on suicide prevention and I am informed by way of letter. In early April this year, I asked the Tánaiste and Minister for Health and Children what moneys were being spent on suicide prevention this year. She could not answer me because her Department did not know the answer. The query was referred to the Health Service Executive and I am still awaiting the information. In other years it took four days to receive a reply but after the Health Service Executive was set up, the Minister has no responsibility in this regard and, after waiting for two months, I still have not received the information. This is not fair to those of us who work in the area.

Most people who die by suicide do not want to die; they want to remove the pain rather than die. Suicide is not a diagnosis, it is a behaviour. Suicide has puzzled people down through the years. Parents, families and professionals are puzzled as to why it happens but there appears to be no answer. There is need for research to find out why it is happening. Some research is taking place but we must find out why suicide is happening. There are not sufficient psychological autopsies being carried out. How can we learn if more psychological autopsies are not carried out to get more information on people who take their lives?

The most difficult thing to accept when someone takes his or her life is that no one is to blame and that it is impossible, no matter what is done, to prevent all suicides. The acceptance of this may be the most difficult of all. It is inevitable that all parties, including schools, mental health professionals and families will feel guilt when a person commits suicide. It is also inevitable that all parties will try to shift the blame to others. The purpose of the blame is to remove personal guilt. It is also denying the fact that no one is to blame when a suicide takes place.

I want to deal with the area of gender and suicide. There is a contradiction in that male suicide and hopelessness has increased while Ireland has a booming economy. I have dealt with the medical side but this is the societal side of suicide. Professor Michael Fitzgerald, Chairman of the Irish Association of Suicidology, said that in Irish society in 2005, males find it harder to find a role and identity in society. Young males are often lost. If unemployed, they are unsuccessful. They feel discarded and there is an increased likelihood that they will consider suicide. They tend to use the strategy of the stiff upper lip. In some ways, females rearing children has not changed over the years, but the massive increase in working outside the home has changed for females. Nevertheless, in agricultural communities, women always worked on the farm, therefore, the new change in work practices may not be as radical as is often perceived. The institutions in which we put our faith, such as the Church, State agencies, the Garda and politicians have lost face in recent years and lost the trust of people to a greater or lesser extent. As these institutions have been declining in stature, the rate of suicide has been increasing. The people in Ireland who are valued in 2005 are males who are successful, who are winners, who are attending third level education and earning big bucks. People who are not in this category find it very difficult to find an identity, a position in which to earn respect, support or a place in society. Ireland is a place for winners. If one is not in that category, there is no place for one in current society.

The critical issue for male adolescents is to derive an identity, self-esteem and personal meaning from their position in society. People who are not winning are marginalised and devalued by society. There is no place for them. Those who fall out of education are the most vulnerable. All the studies that have been carried out, especially those carried out by the late Michael Kelleher, indicate that there is a higher level of suicide among people who leave education early. In the past, young Irish males could have gone to church, identified with God and the idea that there is something else beyond the euro. Nowadays there is nowhere for them to turn. There is also fragmentation of the family. There is an increase in marriage breakdown and the number of separations since 1986 has more than doubled. There is a fundamental breakdown in relationships between people and their socio-cultural setting. We do not know what our true value is. We have lost our way. The euro is worshipped and happiness emanates from the euro. We are told a private car is all we need. Many males are marooned, disconnected, alienated and lost. There is a lack of integration of the individual in society and there is a lack of solidarity among people, which solidarity came from attending mass with the same people in the same church every week. The religious festivals of the past are no more and they have been replaced by drinking festivals.

It is vital that the role of alcohol in suicide should be examined. Dr. John Connolly, secretary of the Irish Association of Suicidology, has done a great deal of good work in this area. There is a high incidence of suicide among alcoholics but suicide also occurs when people consume alcohol during crises, which interferes with their objectivity. The inhibitions of those contemplating suicide are also reduced.

The Minister of State referred to the national task force on suicide, which reported in 1998, and he highlighted that eight of its 86 recommendations have been implemented, which speaks for itself. The national suicide review group published its first report in 1999 and one of its chief objectives was to implement the recommendations of the task force, although it was the Department's responsibility. The review group was set up for that purpose but only eight of the recommendations have been implemented. A strategy group was established recently. Is the wheel being reinvented? Can the Minister of State not implement the remaining recommendations of the task force?

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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Hear, hear.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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The Department and the Government have failed to implement them. I have met psychiatrists who say nothing can be done about suicide. In the mid-1990s Australia identified young male suicide as a serious issue and the Government there introduced expensive measures to combat suicide. As a result, the incidence of suicide has reduced by 24% and the lowest incidence occurs in males aged between 15 and 20.

Suicide results in a cost to the State. That may be considered insensitive but every suicide costs the State. I refer to international calculations of the cost. A successful suicide strategy will generate significant economic benefits above and beyond the cost of a suicide. Three distinct economic factors are associated with suicide — the loss of production as a result of a suicide, the potential future contribution to the economy of the person who dies and the human cost the individuals place on their lives. If this international calculation is applied to the most recent suicide statistics in Ireland, which were published in 2003, the cost to the State was approximately €800 million. A calculation can also be made regarding the cost of deliberate self-harm, which is estimated at approximately €40 million annually. While this may be crude and insensitive, money is needed to address the incidence of suicide.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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It is unusual to revisit an issue so soon after it has been debated in Private Members' time but the issue of suicide deserves to be revisited. As Deputy Neville has stated on a number of occasions, suicide is a unique tragedy which has a lifelong impact on families and communities. The proliferation of support groups in recent years has helped families to cope with suicides and I hope the Government will bring about a small and modest improvement in this regard by encouraging and facilitating such groups. Families should always be focused on in debates on suicide as well as the tragic victims.

The House debated the issue of suicide shortly after the County Offaly coroner had described the incidence of suicide in his area as an epidemic. That was a shocking statement by somebody who is aware of the incidence of suicide in his community and it should be a wake-up call for those who doubt the seriousness of the problem.

Suicide is related to mental health and mental health services have been neglected. An increasing number of young suicide victims has focused long overdue attention on this problem. While advances have been made in recognising suicide as a major public health and social issue, suicide and mental health services in general have suffered sustained neglect in funding by the Government. For example, the slashing of the mental health budget to 6.9% of the overall health budget from 11% in 1997, despite the increased incidence of suicide annually, indicates the Government does not have its priorities right. Only 20 inpatient beds with specialised services for adolescents with mental health problems are in place, despite a Government commissioned report which recommended in 2000 that at least 120 of these beds were needed and should be provided.

The increasing incidence of suicide both internationally and in Ireland is a major public health problem, particularly among young men. The suicide rate among this group has increased fourfold since 1990 making it the most common cause of death among young people. The latest statistics reveal that suicide accounts for 50% more deaths annually than road accidents. Deaths resulting from overdoses or from lethal cocktails of drugs are sometimes not fully understood in terms of whether they were deliberate or accidental. I suspect the incidence of suicide is higher than official statistics record.

Suicide is the most common cause of death among 15 to 24 year olds and the rate in Ireland is increasing more quickly than in other countries. The incidence of suicide among young females has doubled since 1992. Young males comprise a particularly vulnerable group and a strategy must assess and target what can be done to facilitate them to deal with the pressures they face.

Parasuicide is also an issue. Significant numbers of parasuicides enter the health system and then disappear and this needs to be addressed. In 2003, 11,200 parasuicides presented at hospital accident and emergency departments and they must be tracked more effectively. We must ensure that supports come into play when someone presents as a parasuicide case. Otherwise, the likelihood is that some of these people will successfully kill themselves at some point in the future. There is a correlation between suicide and factors such as unemployment, poverty, bullying, relationship break-ups, legal and work related problems, alcohol and drug abuse, physical or sexual abuse in childhood and social exclusion. These are parts of the conditions that lead to suicide and must be addressed.

No debate on suicide can ignore mental health issues due to the correlation between suicide and mental illnesses, particularly depression. Emotional and mental distress can be as debilitating and life-threatening as physical illness at times. However, psychiatric illness does not receive the attention, investment and resources that go towards treating physical illness. It is time to change this mind set. Despite the passing into law of the long overdue Mental Health Act 2001, mental health remains the Cinderella of Ireland's health services as it has been receiving a smaller and smaller share of a cake that is not big enough to begin with. The area is under funded, unequally distributed, understaffed and lacking in essential specialist services. In short, it is as neglected and ignored as many of its clients. The most recent media coverage highlights the mental health tribunals we are still awaiting. The staffing requirement there is an indication of the Government's views on this whole issue.

We have had report after report that has highlighted the neglect and pointed out that the most deprived areas in the country receive the smallest mental health allocations. They have shown that the mentally ill in Ireland are still stigmatised and forgotten. They have also pointed out that despite the proliferation of previous reports and many commitments, we still do not have properly resourced community care for our mentally ill, properly constituted clinical teams to deal with those most vulnerable people and we do not have enough beds for certain specialties, notably child and adolescent, forensic services and services for eating disorders. At the same time, our system remains far too bed-based, with valuable resources tied up in bed provision rather than community-based services such as day hospitals, day centres, hospitals, half way houses, drop in centres and properly staffed community and mental health teams.

I take this opportunity to digress. My local hospital is St. Colmcille's in Loughlinstown, County Dublin, and it has the only centre in the country dealing with eating disorders. It was very disturbing to discover that 12 people died while waiting for treatment at that centre because it is simply incapable of meeting the huge growing need relating to obesity. Making this point is important even if it is not germane to this debate. We do not have enough psychiatrists, psychologists, social workers, therapists, nurses and back up staff. We do not intervene early enough to make a real difference for those who develop serious mental illnesses. We do not have an even near-adequate mental health service in place to deal with the one in four of us who will experience significant mental health difficulties in our lifetime.

The World Health Organisation sets out general principles for mental health legislation to protect the rights of the mentally ill, including respect for individuals and their social, cultural, ethnic or religious and philosophical values, taking into account individual needs, care and treatment provided in the least restrictive environment and a provision of care and treatment aimed at promoting each individual's self-determination and personal responsibility. Article 12 of the International Covenant on Economic, Social and Cultural Rights, which was ratified by Ireland, states that all persons have the right to the best available mental health care. In the Irish Celtic tiger economy of 2005, we are a long way from honouring our commitment under this convention and it is time we started to do so. These principles centring on the ideas of individual autonomy and respect have influenced new thinking about psychiatric illness. The ambition is now based on working out a road to recovery in partnership between the patient and the professionals rather than viewing recovery as something that is dispensed by one person to a compliant patient. This partnership is an important change but there are not enough staff to provide that type of secure support for people, which is something with which we must concern ourselves.

I made a point during Private Members' time that there are many societal influences on the suicide rate. Everyone agrees that, in countries experiencing rapid rates of change, levels of suicide have increased. No country has experienced as much change as Ireland over the past decades. However, it would be wrong and somewhat superficial to ignore the other feature that pertains to the influences of society on the well-being and good health of its population. Countries with the greatest inequalities are those with the greatest levels of ill health. A fair society is a healthier society. We depend to some extent on British data but what we are seeing is the increasing inequality leading to greater ill health and higher levels of suicide. We should take this information on board as politicians, not just as a matter of health policy but as a matter of our basic political perspective. If we continue to develop a society that is so unequal and is now second to the US in terms of inequality between the better off and the poor, we are not creating a better society. We are creating an unfair society where more and more people are being left behind. As Deputy Neville pointed out, the hopelessness and loss of self-esteem is considerable in a society where achievement is seen as central to individual well being.

In terms of analysing data on socio-economic classes, there is a whole cohort of people that is not known about. Such people do not fit into the modern categories of class and it is in this growing group of people that increasing numbers are committing suicide. This must not only be an issue of concern but of political initiative to ensure we develop a fair society in a way that will have an important impact on health and sense of well being. We will thereby ensure a reduction in suicide levels.

Currently our resources are often located in the areas that need them least when it comes to mental health services. We are all indebted to the Irish Psychiatric Association, which performed a magnificent job in producing its report The Stark Facts, which showed the extraordinary imbalance between affluent and better resourced mental health services and areas of deprivation, where not only were resources unavailable but where consultant psychiatrists or senior professionals were in temporary positions. This leads to instability in terms of treatment. That type of inequity is heaped upon a society already based on inequity. The two tiered nature of our health service is a reflection of the greater inequity that exists in our health service across the board. We are unique in Europe in our extraordinarily different approach, whereby someone with insurance can access care very rapidly but an uninsured person who is in need cannot. We need a new initiative in mental health services to ensure that equity exists and that in the areas of greatest need, the greatest effort is made to provide resources and facilities.

It is important to assess the potential impact of policy changes or legislation on the possibility of more young people committing suicide. I have grave concerns about the proposal of the Minister for Justice, Equality and Law Reform, Deputy McDowell, to deregulate the public house licensing system and to develop café bars. Dr. Joe Barry, president of the Irish Medical Organisation, has expressed strong and critical opposition to these measures and we should listen to him. If we do not deal with the binge drinking culture and alcohol abuse there will be no possibility of achieving a reduction in our suicide levels. If we do not wake up to that fact, we will be back in this House in one, five or ten years' time making the same points and facing worsened statistics and higher numbers of people committing suicide with the terrible, tragic loss of life that entails.

Paudge Connolly (Cavan-Monaghan, Independent)
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I propose to share time with Deputies Finian McGrath, Gogarty, Ferris and Cowley.

I welcome the opportunity to speak on this grave subject. Suicide is a major issue which affects all strata of society, irrespective of class. It particularly affects young males, among whom the rate of suicide is very high.

Suicide was a taboo subject at one time that was not discussed openly in any forum. Now, however, people are not afraid to use the word "suicide" and to call it what it is. People have seen that it is a tragedy and are prepared to speak openly about it. This has been evident at various seminars, one of which was held at Dromahair in County Leitrim. There was a large attendance at that event which was due to finish at 5 p.m. but continued until 7 p.m. In County Monaghan the vocational education committee and the Health Service Executive joined forces to host seminars at the Hillgrove Hotel in Monaghan town and the Nuremore Hotel, Carrickmacross. Both seminars were well attended with a high level of audience participation. People were looking for answers and action to be taken. People are afraid, particularly those who have lost loved ones or who fear that they might lose them.

In the context of possible solutions, a German model was put forward. A prevention programme was piloted in Nürnberg over a two-year period which resulted in a 26% reduction in suicide and self-harm. In Würzberg, where the programme was not piloted, there was a 24% increase in suicide and self-harm in the same period. The German programme will be piloted in Cork and Kerry and consists of four strands: liaising with general practitioners and organising GP workshops; targeting people who have engaged in self-harm, as it has been shown that such people are at a greater risk of committing suicide; targeting key professionals such as social workers and priests; and targeting the media, running advertising campaigns in cinemas and so forth.

If that pilot programme worked in Germany, there is no reason we should pilot it again to determine if it works here. I urge the Government to expand the scheme on an all-Ireland basis. It will save lives, is sensible and contains nothing harmful. The current situation is that we are adopting the German models and re-testing them to see if they are worthy of their reputation. I call on the Government to implement the prevention programme nationally.

References have been made to budgets. There must be some form of direct correlation between the reduction in the mental health budget and the increase in suicide. The mental health budget has decreased from 11% to 7% of total health spending, which is reflected in the level of resources locally. There are simply not enough resources to meet demand and money should be invested in the pilot project to which I have referred.

In every case of suicide, a full audit should be performed. All the circumstances of the case should be examined. We must determine if the person was in contact with the mental health services, whether the services responded, how well and whether they failed the individual. We also need to ask if the person confided in a friend or loved one and, if so, whether the confidant was equipped to deal with the situation.

Sometimes people do not know where to go for help. If one rings the Department of Health and Children, the response one receives is not good. I would like to think that the quality of response would improve. We also need to examine whether there was a trigger factor in the suicide, whether there were clusters of suicides in an area and the age profile of the deceased. If we get a better and fuller understanding of suicide and those most likely to take their lives, we will have a better quality of response and will be better equipped to deal with the problem.

We should review suicide figures monthly because this will make it more likely that someone will have to answer questions. Annual reviews are inadequate. It is 2005 and we are analysing the suicide figures for 2003. That is not good enough. Another issue is bed shortages. I called for media coverage of this debate, not to name people but to keep the issue alive.

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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I welcome the opportunity to speak on the important matter of suicide. This issue must be dealt with in a well thought-out, caring and professional manner. We must face up to the problem in our society and move on to resolve it.

The Government and the broader community must accept that suicide is a major crisis in the State. We must face that reality and accept that the latest statistics reveal that suicide accounts for 50% more deaths annually than road traffic accidents. A total of 444 people committed suicide last year while 293 people died on the roads. Suicide is the most common cause of death in Ireland among those aged between 15 and 24 and our rate in this age group is the highest of all 25 EU states. The suicide rate in Ireland is rising more quickly than in any other EU country and the rate among young females doubled between 1992 and 2000. The highest rate of suicide in the past five years is among men aged between 20 and 29. In 2003, 11,200 para-suicides or attempted suicides presented to hospital accident and emergency departments.

There is a correlation between suicide and factors such as unemployment, living in poverty, bullying, relationship breakdown, legal and work related problems, alcohol and drug abuse, physical or sexual abuse in childhood and social exclusion. We have witnessed the slashing of the mental health budget from 11% of the total health budget in 1997 to 6.8% this year, despite the fact that suicide is claiming more lives annually. Another reality that must be faced is that there are only 20 inpatient beds with specialised services for adolescents with mental health problems.

This is the reality for many of our citizens. However, suicide is also a community and family issue. We must all slow down and listen to the needs and feelings of others. The modern society of rush and go, competition and pressure leads to a situation where people are not listening to one another and vulnerable people fall through the net. Every citizen of this State should be the eyes and ears of a public health strategy. We must become a community that listens.

I have a number of proposals to deal with suicide, including developing an effective strategic action plan for both prevention and reduction of suicide as an urgent, national priority; implementing all 86 recommendations of the 1998 report of the national task force on suicide on ways to prevent and reduce the incidence of suicide; establishing a national suicide prevention agency; providing a comprehensive programme of multidisciplinary research and investment in suicide prevention strategies; and improving awareness of suicide by investing resources in education programmes and mental health services. When the Government carries out such actions, then we can say we are taking the issue of suicide seriously. I urge all Deputies to reflect on these important matters.

Photo of Paul GogartyPaul Gogarty (Dublin Mid West, Green Party)
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I concur with many of the comments from previous contributors. There is little one can say in two and a half minutes except for every family that has been touched by suicide, words cannot express anything. One can only try to empathise with families affected by suicide because in many cases, people will blame themselves for the suicide of their loved ones. Unfortunately, there are practicalities that impinge on this personal tragedy. For example, the UK spends four times as much on mental health services as Ireland. There is a greater drink culture here than in continental Europe. These factors contribute to our high suicide rate.

Deputy Neville, who made a very telling contribution, pointed out that the majority of suicides are caused by mental health problems. I agree with Deputy Neville's point but I would like to use the short time available to focus on alcohol and young people, an issue that is closer to my heart. In some instances, alcohol is a contributing factor in the suicides caused by psychiatric or mental health problems. In a study by the Samaritans in 2003, a number of adolescents who had contacted the Samaritans were asked how many times they had been drunk in the previous year. Those who had contacted the Samaritans reported being drunk ten times more than those who had not contacted the Samaritans, which is telling. Between 400 and 500 young people commit suicide every year in Ireland. This represents one in three of all deaths of those between the ages of 15 and 24. The figure could be higher because the incidence of single-car accidents among male drivers is disproportionately high and we do not know how many people take their lives in this context.

We need to focus on alcohol and responsible drinking in this debate. Deputy McManus made a point regarding inequality, with which I concur.

I would also like to address the issues of community and family values. As we have prospered, the values and the respect we had for each other, the environment around us and our family and community have disappeared. There must be some collective way that we, as politicians, can try to encourage the restoration of those values without returning to the era of the squinting windows.

Photo of Martin FerrisMartin Ferris (Kerry North, Sinn Fein)
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Ireland has the second highest incidence of suicide in Europe. In 2003, 577 people took their own lives, the majority being young men. We need to look at the reasons behind this. What is the reason behind the rising suicide rate? I think there has been a 25% rise in suicides over the last ten years, particularly in young males. We need to examine the social deprivation and inequalities in our society if we are to find a remedy for this enormous tragedy that is inflicted on many families each year.

Suicide touches the life of every Deputy numerous times each year when their constituents endure the pain of suicide. The enormous pressures facing young people, particularly within the education system, are a major contributing factor in suicides. We grade children like cattle on a points system. Children are expected to obtain a certain amount of points in examinations. When certain people are unable to obtain this amount, they find it very difficult to come to terms with it.

We also need to examine the structures that are there to help people, particularly young people, who are experiencing trauma. It is fair to say that the pain of mental and emotional trauma is far worse than any physical pain. We must also look at the mistakes of the past. At one time, there was a considerable stigma associated with the tragedy of a person taking his or her life, which was largely due to the attitude of the institutional churches. This stigma added to the pain of surviving family members. There is a need for structures and caring preventative measures to be put in place and resources to implement them. We need a national suicide strategy as a priority and we need the resources to implement it on an all-Ireland basis.

Jerry Cowley (Mayo, Independent)
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My first real exposure to suicide was as a young trainee GP in Swinford, County Mayo, when I saw two elderly men both laid out side by side on a slab in the mortuary in Swinford Hospital. The sight of two men lying side by side with the track of a rope on their necks is one that will stay with me for the rest of my life. These two men did not know one another but one heard about the other committing suicide and decided to end his life as well. It appeared to me to be a terrible waste of life. I looked at the men's situations and discovered they had families. Yet they felt so lonely and depressed they decided to end it all.

The situation has grown even sadder since then because we have seen the alarming rate of increase in young people taking their own lives. This has happened over the years since I was a young GP in Swinford. Many things have changed since then. Society has changed and become more Americanised and more orientated towards profit and money. God has been replaced by the god of money. It is all about having it all and getting on with it. If a person cannot get on with it, he or she is pushed to the side.

People face pressures from all sides, including the media. People face pressures to perform, to be the smartest, the most beautiful, the most slender, the most successful or the person who gets laid every night. These are terrible messages that are being directed at people all the time. These messages are forms of pure propaganda by people who are just trying to make money out of young people and society in general. We see it in the care of the elderly, which we debated yesterday in the House. The Government is aiding and abetting a situation that is all about profit. We should all take part in looking after older people but we have given it over totally to private operators who, in the absence of anything else, are doing the best job they can. However, it is still private enterprise and operators who have to turn a profit. Why do we not look after older people ourselves? Why are communities not doing it? Communities could look after older people. Why should care of the elderly be profit-driven and not community based? We can look after older people in our communities and some communities are doing it.

We have made a god of money and put these terrible pressures on our young people. They are born, through no fault of their own, into a society which has these pressures. It is time we examined these pressures. Where is Government money being spent? It is being spent on so many silly, difficult, rotten things that really do not matter. The money should be spent on psychiatric services. We know the graph for alcohol consumption goes way up, together with the binge drinking of our young people. We also know that the money that needs to go into psychiatric services is not available. These are things we know for certain.

I also know for certain, as a GP, that supports are not available. So many people — one quarter — come to their GP before committing suicide yet I think that sometimes GPs do not have the resources to deal with this. The answers are obvious. There is an onus on us to work towards a better society. This means putting the resources in place to support the things that matter.

Photo of Pat CareyPat Carey (Dublin North West, Fianna Fail)
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I welcome the opportunity to say a few words on suicide and suicide prevention, which are extremely important issues. It is important that suicide is addressed in this House and it is probably a healthy sign of our development that we can talk about it and acknowledge that a problem exists. In doing so, I pay a particular tribute to Deputy Neville for the pioneering work he has carried out over recent years and organisations like the Bethany bereavement groups, which have carried out tremendous work throughout the country.

Suicide is always a tragedy, for the person whose life has ended and for the family, friends and community that have been left behind. Suicide has an intensely devastating effect. I know of many families in my constituency, some of them very close friends, who have had to bear this intense loss. It is always difficult to accept and understand. The resulting pain, anguish and sometimes anger affects not only the family of the deceased but the entire community in which he or she lived. Over the past 20 years the suicide rate in Ireland has increased at an alarming rate. During the 1980s and 1990s, we experienced the fastest increase in Europe, albeit from a low base. In 2003, the Central Statistics Office recorded the number of registered suicides as 444. Today, every 45 minutes at least one Irish person will attempt to die by suicide. These figures are shocking. There probably is not a family in the State which has not been affected or touched in some way by suicide.

What concerns me further about the statistics are the specific groups that are affected by the trend. More than four times as many men as women died by suicide in 2003 — 358 males and 86 females. There is a statistical link between unemployment and suicide, especially in young men, and rates of suicidal behaviour are higher among manual occupation groups. Research shows that suicide rates in the lowest social class are almost four times as high as in the highest earning brackets. Most frightening is that our rate of youth suicide is very high. A total of 30% of all deaths in the 15 to 24 year old age group in 2003 were recorded as suicide. In the 25 to 34 year old age group, the figure was 23%, making it the largest cause of death in both groups. Ireland now has the second highest youth suicide rate of the 30 OECD countries.

What are the reasons for this dramatic increase in suicides in this country? Is it even that straightforward just to point to the causes? After all, most people do not understand suicide — I do not understand it. However, by examining the research we can gain some knowledge and understanding of this alarming trend.

Between 40% and 60% of those who die through suicide have made previous attempts. Psychiatric disorders or addiction problems are present in 90% of people who take their own lives. With the increasing mental distress, a person's ability to find solutions to their problems, or even to imagine there could be solutions, diminishes. It is at this stage that suicide can be seen as a meaningful alternative. This thought seems to occur more readily to men, those living alone and people who feel alienated from society.

Not everyone with depression attempts suicide so it is clear that other factors are relevant. A culture of alcohol abuse is a factor in these high numbers. In young people in particular, the sequence of events leading to suicide may start with alcohol or illicit drug use. There has also been reference to the decline in traditional religious belief systems, which occurred at the same time as rapid social and economic change in this country. I am not qualified to state whether there is a causal link between the two.

In an effort to address these issues and the increase in suicide, the report of the national task force on suicide in 1998 made a total of 86 recommendations under various headings, such as the provision of services, prevention, intervention and after care. Since 1998, significant progress has been made in implementing the report. A suicide resource officer has been appointed in each HSE area and liaison psychiatric nurses have been appointed to accident and emergency departments in general hospitals. Provision has also been made for training relevant health care personnel in regard to suicidal behaviour and such training is ongoing in all HSE regions. In addition, the national suicide review group, the National Suicide Research Foundation and the national parasuicide registry have been established to research further the causes behind this trend.

Legislation has been enacted restricting the availability of medication which can be used to overdose. A social and personal health education programme has been developed and is now compulsory for all junior cycle students in secondary schools. However, more can always be done and, although statistics show that the growth in the numbers attempting suicide has slowed recently, we must strive to reduce the figure entirely.

An interesting point was made during a previous debate on suicide in the House. It was that suicide is not chosen but happens when the pain one feels exceeds the resources for coping with that pain. We all experience real pain at some stage in our lives but dealing with the pain is crucial. It is the resources available to us to deal with it that can make the difference.

The most effective way to tackle suicide is to provide early support and intervention and to provide the most effective resources for people to cope with events in their lives before all hope is lost. Looking at the policies of our European counterparts, the Finnish strategy is particularly comprehensive and well developed. It is the only national strategy that has a framework with a clear definition of suicide prevention. This prevention strategy is at several levels. Primary prevention aims to enhance every individual's inner resources and living conditions. Secondary prevention attempts to eliminate or reduce conditions such as mental illness, intoxicant problems, physical illness and life crises which, under certain circumstances, can lead to suicide. Tertiary prevention focuses on those who have attempted or planned suicide and the methods they use.

A range of supports and interventions needs to be introduced where the focus is on enhancing coping skills, creative options and problem solving approaches to crises. Major emphasis must be placed on addressing public attitudes to depressive and other psychiatric disorders. We should seek to enhance further awareness of depression and its recognition and treatment in general practice. We must improve access to the psychiatric services. We must also examine ways to reduce the impact of life crises, including unemployment, marital breakdown and alcohol related problems. There is a need to provide improved training for our front line workers so situations can be identified early. Most importantly, we must seriously target suicide among our youth, especially young men, for special attention. Emphasis should be placed on the need to build self-esteem, to detect anger management issues and to diminish the sense of alienation that many teenagers feel.

While suicide rates are higher in young adults, many of the risk facts and associated behaviour problems are established in adolescence. If we can target this behaviour early, we can really make a difference to their lives. Teenagers need somebody to talk to, particularly at critical times. It is important that we understand the particular needs in that regard and provide adequate counselling and psychiatric services for them. We appear to have a growing development of services for children and adults but young adolescents appear to be falling between the two, with fatal consequences.

Tackling suicide as a single issue will never bring success. Suicide prevention measures must take account of broader socioeconomic and environmental issues, particularly those associated with social justice, education, health, inequality and community affairs. I urge the Government to continue its work in this regard. There is a job to be done and, as legislators, we have a responsibility to deal with suicide and to reduce the risk of suicide.

Over the last few decades, dramatic medical and scientific advances have occurred with regard to many killer diseases such as cancer, diabetes and heart disease. These advances came about through dedication and determination from statutory and powerful agencies and from relentless advocates who, together, have advanced the health of the Irish nation. Now, suicide represents the new age killer. If we are to stamp it out once and for all, the same dedication and determination must be shown by all.

Gay Mitchell (Dublin South Central, Fine Gael)
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I feel somewhat inadequate contributing to this debate in the presence of Deputy Neville, having listened to his contribution. I join Deputy Carey in praising Deputy Neville and others who have done so much work on this issue.

Suicide in Ireland is now at unprecedented levels. The reasons for this are complex. To reduce the rate of suicide we need integrated comprehensive plans. I am aware that recommendations have been made. I wish to raise one issue in the time available to me. Teachings on the excessive use of alcohol, drug abuse, what we value, what we do not value, self-restraint, self-denial and mercy are messages carried by organised religious groups such as Christians, the Jewish community, Muslims and others. If, for young people in particular, this teaching is replaced by "anything goes" and what feels good, despair cannot be too far behind.

As a young Muslim man who worked for me last year put it, the term "jihad" is much misunderstood. Jihad is what we each face daily, the struggle between what is right and wrong. We all do wrong but if we recognise the wrong, because there are some beliefs or a moral system guiding us, we can make amends and strive for what is right. If we do not know that internal jihad, confusion and despair can easily follow. For many of us, the teaching that equipped us to handle this jihad came in the main from religious sources, with all its faults and human failings. Can we actually create an environment where religious practice is respected and encouraged, although not forced? Should we do so?

Religious practice is as much part of who we are as a people as is culture, language or, for example, hurling. If hurling or art were to be threatened we would act. In the case of religion, some of us seem to rejoice in its apparent decline. Some of this is due to abuse that has been perpetuated, some because of the harshness with which some religious leaders behaved in the past.

Rev. Dr. Eoin Cassidy, in his book The Search for Meaning and Values, published by Veritas in 2004, refers to the philosopher Alistair MacIntyre of the University of Notre Dame in Indiana. If MacIntyre is correct, liberal individualist culture provides neither a basis for moral discourse nor a context for rationally securing agreement on any moral issue because it cannot sustain the wherewithal to create a moral community. What is necessary for a moral community to exist is some shared sense that there is a purpose to existence and some level of agreement as to what that purpose might entail. MacIntyre's view is that western culture has lost connection to the idea of virtue and what it means to be a virtuous person, or even what it means to aspire to be a virtuous person.

In his opinion we possess only the fragments of a former conceptual scheme; we possess such words as goodness, virtue, a virtuous life, and so on, but we have lost our comprehension, both theoretical and practical, of morality. He states:

In this context, there is no rational way to gain moral agreement, hence, for all practical purposes, we are living in what might be called an emotivist culture, one which proclaims that all judgements are nothing but expressions of preference, attitude or feeling.

This may be a pessimistic appraisal but if we are to make a start to creating a society where the despair or indifference which leads to suicide is less prevalent, we must begin with a thoughtful re-appraisal of some of the philosophies which have helped bring us to this point.

Iris Murdoch, the Irish-born, Oxford-based novelist and philosopher, who died in 1999, was the recipient of numerous awards and accolades. Rather than the empty external freedom of existentialism, Murdoch looks to an alternative view that places emphasis on the growth of freedom that accompanies a growth in the person, and one that shifts the emphasis in morality from the world of action to that of vision. According to Murdoch, modern ethical theories such as behaviourism, utilitarianism or existentialism cannot account adequately for either moral progress or moral failure because they have no sense of the existence of an appropriate goal towards which they ought to strive and which does justice to the seriousness of the ethical project.

As Rev. Dr. Eoin Cassidy states, Christians believe it is by reflecting on mystery, truth, goodness, beauty and love that one can begin to explore the mystery of God and the manner in which God is revealed in the world. These privileged dimensions of creation and, in particular, human existence can be described as the four footprints of God in the world, according to Dr. Cassidy. However, in the search for meaning and value, it is not only the Christian churches which can contribute. In October 1965 under the title Nostra Aetate— In Our Time — a short declaration, inspired by Vatican II, on religious and spiritual interpretations of experience was issued. This vision is well articulated in the following passage from Nostra Aetate:

Human beings look to their different religions for an answer to the unsolved riddles of human existence. The problems that weigh heavily on the hearts of human beings are the same today as in the ages past. What is the person? What is the meaning and purpose of life? What is upright behaviour, and what is sinful? Where does suffering originate, and what end does it serve? How can genuine happiness be found? What happens at death? What is judgement? What reward follows death? And finally, what is the ultimate mystery, beyond human explanation that embraces our entire existence, from which we take our origin and towards which we tend?

All this might seem a very strange contribution on the subject of suicide. We need better youth service facilities, more education on the abuse of alcohol and early warning systems. However, on their own, these will not go to the heart of the ills in society which have given rise to such a high rate of suicide.

Politicians can no more reverse the trends in suicide than we can create jobs, for example. However, we can create the environment in which employment will have the opportunity to flourish. We can also help create the environment which contributes to the search for meaning and value that leads people away from despair. To do that, we must start talking more about the value of religious teaching and belief. We must respect those who hold religious beliefs, as well as those who do not. The trend towards only one type of society, an assimilated society, where secularism is almost a universal religion and the only one to be respected, is a recipe for despair. Our society must be about integration not assimilation. Have we learned nothing from the birth of the European Union or the Troubles of Northern Ireland?

The essential point I want to make is as follows. If we are to lead young people away from despair and hopelessness, they must be given hope, vision and leadership. They will not hear this message of hope exclusively in the home or exclusively from the tongues of other leaders like politicians or trade unionists, and they are unlikely to get it from the business class. One sector of our society, with all its excesses and abuses, has in the past tried to imbue a sense of moral values. That sector is the religious, largely Christian, sector. It is now a very much more mixed sector with different Christian religions, a strong Muslim community and, sadly, a declining Jewish community.

One aspect those groups have in common is a wish to try to imbue people with a sense of what is right and wrong. I do not want to return to the excesses of religious leadership, or anything akin to a shadow-state within a state. I do not want a society where the parish priest controls who uses the local community hall or where the Muslim teacher imbues intolerance. However, I do want a society where sport, culture, art, politics and religion co-exist. Organised religion has a contribution to make in leading people away from despair and in seeking to equip society with a value system that helps when trying times are present. The new Roman Catholic Archbishop of Dublin, Dr. Diarmuid Martin, has stated his Church must find new ways of evangelising. I fully support and encourage that, and believe it would help if women and married people were allowed a full role in that new model.

The Beatitudes tells us that blessed are the merciful for they shall be shown mercy. One of the less palatable manifestations of the wrongs of Ireland's society is the absence of mercy. We are all at it — journalists, businessmen and politicians. Has our inability to show mercy created an atmosphere or attitude in which suicide can thrive? This is a question worthy of consideration and debate. Would it be unthinkable to have a White Paper on the role of religion in society? Foreign policy and education are not the only important areas which should receive such consideration and analysis. To turn society around and to reduce the number of suicides requires a multifaceted approach.

Photo of Máire HoctorMáire Hoctor (Tipperary North, Fianna Fail)
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Tá mé buíoch as an deis seo a labhairt ar an bhfadhb mhór chonspóideach seo, féinmharú. I welcome the opportunity to address the House on the issue of suicide, particularly in light of the recent statistics showing that north Tipperary had the distinction of the worst figures for completed self-terminations in the Republic. I share the public concern about the level of suicide nationally and welcome the earlier statement to the House by the Minister of State, Deputy Tim O'Malley. I am aware also, as laid out by the Minister, of the progress made at a national level by the Government, the health services and the voluntary sector since the national task force on suicide in 1998.

Suicide is a difficult subject for governments and health services to grapple with. One cannot legislate out of existence the diverse and complex pressures and stresses that lead people to take the drastic action of ending or attempting to end their lives. Social or economic and personal regulation by the Government cannot ever entirely hope to eradicate this phenomenon. However, the State has a duty of care to do all it can to set in place systems and procedures to guide our public servants in the general health services, mental health services, social welfare and educational sectors to best prevent self-destruction. In 2003 north Tipperary suffered twice the national average number of suicides.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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North Tipperary has the highest rate of suicide in the country.

3:00 pm

Photo of Máire HoctorMáire Hoctor (Tipperary North, Fianna Fail)
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North Tipperary has the highest rate in Europe. The mid-west region which Deputy Neville, the Minister of State, Deputy Tim O'Malley, and I represent, has high suicide figures, which is very saddening. This is a huge social concern and we cannot understand why so many take their own lives. Suicide defies the application of any hard and fast certainties arising from research into the phenomenon.

Some 96% of Irish suicides are related to mental illnesses, ranging from depression to schizophrenia. I am particularly concerned for north Tipperary in this regard. GPs and nurses have been campaigning for improved mental health services in the area for some time and have been supported by Deputies from every party. The current north Tipperary team consists of one consultant psychiatrist, one clinical psychologist, one addiction counsellor and one social worker. The team, which provides general practitioner contact and support, day hospital interventions, outpatient clinics, day centre services and domiciliary interventions, serves a growing population of 70,000 people. There are no weekend services for psychiatric or mental health care in north Tipperary at the present time. If an emergency is clearly identified, the person must be referred to St. Michael's in Clonmel which is 50 miles from Nenagh and 70-miles from Lorrha, the most northerly parish in Tipperary. This is unacceptable. There is no public transport system in place to accommodate people who must travel to Clonmel under such circumstances.

After-hours psychiatric posts advertised in October 2002 have not been filled and seem to have evaporated. The Minister of State should investigate the matter. There are plenty of psychiatric nurses qualified for such positions but a shroud of mystery covers the health services in the mid-west region. Responses are poor and contact is not up to the expected standards. Where did the jobs go? Were they adequately advertised? There is a great need in north Tipperary and the greater mid-west region for these posts to be filled and services to be provided.

I pay tribute to the voluntary sector, particularly the Living Links programme for which north Tipperary has again received funding this afternoon through the Department of Social and Family Affairs. The programme involves volunteers who engage in very rewarding and valuable work in north Tipperary and other areas. The Rainbows programme is aimed at school-going children, from primary to secondary level. Within parishes, it is targeted towards children who have been bereaved. Unfortunately the service is only provided once the bereavement has taken place. It is increasingly important that supports be put in place so that there is less need for them. We must address the issue early on and not after the event.

I wish to highlight the deficit of weekend services and the supports in place in Limerick. The Minister of State, Deputy O'Malley, will be familiar with these schemes. The scheme to which I refer is based in Limerick Regional Hospital and has been running for four years. The services are provided until 3 a.m. at weekends. If only north Tipperary had the same support in place. I pay tribute to the staff at Glenroyd in Tyone, Nenagh who provide mental health services for the greater north Tipperary area. However, they are in dire need of increased services and support. This issue must be urgently addressed and I have been pushing the Department of Health and Children for these services to be improved.

It is difficult to legislate for an issue such as this. We can, through our education system, help young people to become better communicators. It is no coincidence that the national rate of suicides has risen greatly as our society has become modernised and detached from traditional community life. We need to do more than simply provide a troupe of mental health professionals. This country takes pride in the fact that we are the greatest exporter of software and excel in the area of information technology. Technology means greater communication but there is a greater need for parent-child interaction in the family home. People must be facilitated with flexible working hours so that they have more time with their children during the precious childhood years.

The development of interpersonal skills in schools, sports clubs and playgrounds has been damaged by the increasing isolation experienced by the population as a result of the daily stresses and pace of life. In rural communities such as north Tipperary the mechanisms for dealing with these changes are only being developed. Irish society has had to modernise quickly and, for the most part, it is doing well. However, we cannot become complacent and ignore those struggling in the wake of this transition.

Two weeks ago the Sunday Independent rather cruelly described many of today's suicides as emotional tantrums; the result of traumas such as discovering one is homosexual, the dissolution of a romantic relationship, parent-child conflicts and dashed expectations for a perfect life. However the article made a good point when it stated that we are not furnishing young people with the emotional tools to deal with life's downside, something that no Government can prevent.

I welcome Deputy Gay Mitchell's comment with regard to the need for greater spiritual awareness and renewal. It is a controversial issue within our schools. However, as Ireland has become more secular, the supports of a growing spiritual life have been challenged. Spirituality is a vital support for people who have experienced trauma and are therefore prone to depression. The education system has much room for improvement in this regard.

A double approach to general mental health and awareness must be developed. Greater social justice and access to educational opportunities have greatly improved the lives of many in north Tipperary, but not in every case. There are people for whom the Celtic tiger never happened and whose community life has altered so much as to be unrecognisable from that which existed in 1990. Unprecedented debt and addiction to new substances have challenged many. The growing belief that success and happiness can be measured in terms of material wealth will bankrupt the very people who are least prepared to navigate the new economic landscape of the nation. Suicide is a product of these and many other factors, although it would be an insult to the dead to attempt to list them all.

The Offaly County Coroner, Mr. Brian Mahon, noted that most suicide cases are completely different but have a common thread, such as mental illness and alcohol and substance abuse. The Government must aid nurses, doctors and teachers in providing an accessible and caring holistic approach to those who contemplate suicide. We must combat it with life skills, emotional awareness and communication. Suicide is a permanent solution to a temporary problem.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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I wish to share time with Deputy Stanton.

I welcome this opportunity to make a statement regarding the serious problem of suicide, especially among young males. I commend Deputy Neville on his positive activity in the area at national level at a time when open discussion on this tragic issue is often despised.

Some 444 deaths were registered as suicide in 2003 which is a serious indictment of our society. There may be more than that registered figure. Eight of the 86 proposals made by the national task force on suicide have been implemented. That is unacceptable and it questions the relevance of setting up groups to propose strategies if they are to be virtually ignored.

I want to raise a specific case that has caused great anxiety to me personally as well as to many other people. The man involved in this particular case was at the older end of the age spectrum. Fred Williamson, at 70 years of age and recovering from a serious illness, found himself without family back-up and in serious depression. He begged the authorities to take him into care for a few weeks at least, or longer if necessary, to see if he could benefit from such care. However, they insisted that he was a patient suitable for home care and not in-house accommodation. That care was tried for a number of weeks and, once again, through my office, I begged the authorities on his behalf to re-examine his situation, taking into account his home difficulties. I was assured they were fully aware of those difficulties but that he should be either treated at home or in a home for the elderly. His two sisters lived in England and were not in a position to look after him.

On the last day I was in consultation with him, I spent two hours on a Monday evening on the phone to the psychiatric services without success. I had to leave the country on business that night and did not arrive back until Friday. I did not get further information from the psychiatric services but I got a phone call at 12 o'clock on Saturday to advise me of Freddie's death. I appreciate that senior personnel from the services made themselves available to the family after the event on Saturday, and possibly again on Sunday, but I genuinely believe that a situation like this one, where there was a clear cry for help, should not and must not be ignored.

I put this case on the record not in a vindictive way but in the slight hope that somebody will listen and ensure that when people like this man cry out for help, they will be listened to. This death is one of four similar deaths in my immediate area within a few short weeks of each other. I appreciate the fact that the VEC organised two very successful open meetings in County Monaghan to discuss this issue and try to get some help for those who are left behind because they are the ones who have to deal with one of life's most difficult situations.

I beg the Government to treat this issue with sincerity and urgency, make every effort to deal with the cases it knows about and, through the educational structures, try to deal with the possible problems. We must recognise that young people, especially young males, are no longer actively involved in Church structures and find it more difficult to discuss their anxieties. The churches no longer appear to be as relevant and young people do not have the same access to clerics and others involved in churches.

There is also a major problem with family structures and poor family life when two members are working. There is a lack of the older type family support. One has to examine the situation in Belfast where so many people have taken their own lives by suicide, perhaps partly related to the troubles. There is also the problem of isolation in rural Ireland, which I believe will get worse rather than better.

Photo of David StantonDavid Stanton (Cork East, Fine Gael)
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I welcome the opportunity to contribute to the debate. I express sympathy to those who have experienced suicide in their families, many of whom I know, as do my colleagues. I remember at one time looking into a coffin where a young man of 22 with curly hair lay who had committed suicide. He should not have been in that coffin. He had his whole life ahead of him. I said to him, "You should not be in there". How many of us over the years have been in similar sad circumstances?

The official figure for suicides is 444 but the real figure is probably much higher than that, perhaps over 500 per year if one takes single car accidents, drownings and so on into account. If two jumbo jets crashed every year in Ireland, would the Government take notice? One can imagine the reaction to that. When responding I ask the Minister of State to outline to the House what he has done in his time in office and what he intends to do about this issue.

Alcohol is a major factor in suicide. We must tackle that problem because my experience is that many people who commit suicide, young men in particular, were under the influence of alcohol at the time of the suicide or shortly before it. Alcohol is a depressant drug that is greatly abused in this country and whatever else we do we must not extend the scope of its availability.

There is also a breakdown between the person and society — Durkheim called it anomie years ago. I have called on the Government to examine youth services. We need professional youth workers on the ground who can interact with young people outside school. Schools cannot solve every problem. The school environment can be artificial. I dealt with schools for 20 years and I know what I am talking about. Programmes in schools have limited value. We need youth workers on the ground in our towns and villages to interact with young people and identify those at risk.

We also need training for professionals. We must train young people to pick up cues from their peers. When a young man says "Life is not worth living", his friend might hear that cue, ask him to explain what he means and then direct him to help. We need more services in this area. Professionals must be available at the end of a phone line 24 hours a day, seven days a week or in hospitals to which people can go and get help immediately. We must also raise awareness about mental health issues. Deputy Neville has worked hard on that issue. That is something the Minister should do immediately.

We are turning into an economy, not a society. We must stop and think about that. I welcome this debate but we need a long debate with more Members involved in it because this is a vitally important issue that impacts on communities.

Families with teenage children are worried sick about the plague of suicide in our society and we must do much more about it than we have done until now. The President set up a forum recently. Communities that experience suicide set up their own groups but they are working hard and struggling to deal with this major problem but no leadership is being given. The recommendations that came forward included setting up a national body to co-ordinate these groups in the area of suicide prevention. That is something the Minister should do immediately. That was recommended by the forum the President set up, and I congratulate her on that.

There is too much fragmentation in this area. The various groups are doing their own thing and there is duplication of the work. They all believe they have the answer to the problem but no one group has the answer. I have met many of those groups and they are frustrated because they get so far and then come up against an obstacle. My own town, Midleton, in east Cork, has had a major issue with this over the years. Action is needed to deal with this problem immediately and I challenge the Minister to get working on it.

Photo of John McGuinnessJohn McGuinness (Carlow-Kilkenny, Fianna Fail)
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I will be brief. I compliment the Minister on his work in this area to date, the sincere way he is approaching the issue of suicide and his commitment to the task. I listened carefully to Deputy Neville's contribution to the debate, and I listened to his comments outside it, and he is to be complimented on leading the campaign on this issue. Far too many families are affected by suicide.

The services must be expanded rapidly and must include funding, not just for community care beyond the psychiatric hospitals but also in bringing in expertise from outside the country and making it available to those who need it. Families with relatives suffering from depression and threatening suicide must be able to find the type of care needed for that family member. Such care must be made available because those families should not have to fight with the authorities to get the services they need.

On a local issue, I ask the Minister to re-examine the Ryan case in St. Canice's Hospital. It involves a death that occurred unnecessarily in the hospital some years ago. The family has continued to try to get the case reopened and properly investigated. I ask the Minister to examine that issue and deal with it. Another family is suffering trauma and sadness and is unable to let go because death was caused by suicide and the family believes questions need to be answered.

Dr. Harding Price was struck off by the Privy Council in England but he is able to practise in this country. He was employed by the South Eastern Health Board and there are many cases in that area where questions need to be answered. Those families are affected by the decision taken, which cannot be explained as he is barred from any kind of practice in the UK. The documentation is available on the Internet and must be read to be believed, yet the authorities here have sanctioned the resumption of his practice while cases are still unresolved in the south east. These cases relate to family members touched by deep depression, with the threat of suicide. That is incredible and I have written a letter to the Minister asking her to reopen the case to see if the suspension can be continued and if the decision of the Medical Council can be overturned, or at least suspended until a further investigation takes place. Given the problems, we cannot afford this type of approach, which falls short of best practice, within our system.

As the Deputy mentioned there is a need for a wider debate encompassing the use of drugs and alcohol. The greatest curse I see in my clinic every week is the effects of drug and alcohol abuse on the people abusing, their families and their extended families, and the difficulties in convincing the current structures within our psychiatric services to deal with them, to reach out and be proactive in support for these families in the home, or to take them in and deal with them in a hospital setting.

In Kilkenny a multi-million euro, state-of-the-art hospital was recently opened. We need to build the appropriate staffing levels, skills and qualification around that to ensure we can deal with this issue. The Minister should not be shy in asking the Government to put money into projects that deal with this issue. For far too many years the mental health services have not received a proportionate amount of the billions of euro we have invested in the health services.

Photo of John PerryJohn Perry (Sligo-Leitrim, Fine Gael)
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I thank Deputy McGuinness for allowing me to contribute. Considering the figures for suicide, self-harm and non-fatal suicidal behaviour over the last ten years, it is clear this is an increasing problem among young people. In 2003, 440 cases of suicide and 11,000 cases of deliberate self-harm were referred to accident and emergency departments through the national parasuicide register. We also know that those at high risk of suicide are young men between the ages of 20 and 34, for whom suicide is now the first cause of mortality. Among those who harm themselves the majority are young men, although this behaviour is increasing among young women. There is still too much speculation about the causes and risk factors as to why suicide and deliberate self-harm has increased in Ireland in recent years. Most people who are depressed do not die of suicide and do not harm themselves so one of the priorities should be to find out more about the specific cause and risk factors that are associated with suicide and deliberate self-harm. We do not even know if young people who harm themselves are the same people who die by suicide years later. We can only speculate about this because evidence is lacking.

As Deputies will be aware from recent media coverage many initiatives are being developed to address the problem of suicidal behaviour. This is a reflection of the increased commitment of people all over Ireland to work towards prevention. Most of the initiatives are ad hoc and there is a clear lack of co-ordination at national level. This is not helpful in the long term. Long-term planning and investment in research and prevention of suicidal behaviour is needed. We need to support ongoing long-term efforts in research and prevention such as work by the National Suicide Research Foundation and the national strategy for action on suicide prevention, which will be launched this year.

I wish to give credit to a new organisation, Suicide, Teach, Observe and Prevent, STOP. It was set up by two families from Dromahaire, County Leitrim. Both of these had sons who committed suicide last year. In an attempt to understand more about what happened to their sons they conducted research and discovered frightening statistics in the north west. A figure of 450 people, mostly young males, committed suicide and over 10,000 attempted to do so. STOP aims to educate mental health professionals and to turn a spotlight on the epidemic of suicide that exists in the north west.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputies who contributed to the debate. I would welcome a debate at any time and obviously we have not had enough time this afternoon. Several other speakers wished to contribute.

In my initial remarks I welcomed the President's intervention in calling a forum and the points made by Dr. Bates on the "Marian Finucane" programme recently. I hope the other speakers were not insinuating the President acted because of a lack of leadership on my part. I discussed this matter with the President and I welcome any contribution from anybody to solve the problem. Deputy Gay Mitchell correctly pointed out that the problem of suicide goes right across society. It is not a matter for one particular political party, and it concerns all societies, not just in Ireland.

I concur with all other speakers on the involvement of Deputy Neville in this issue. I thank him for his contribution again today. He is right in saying that unemployment is one of the biggest factors in suicide and recent reports agree with that. I disagree with Senator Neville that only eight of the 86 recommendations——

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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It should be Deputy Neville, not Senator.

Tim O'Malley (Limerick East, Progressive Democrats)
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The Deputy should bear with me, I did not interrupt anyone over the last two hours. Many of the recommendations are ongoing. There are several recommendations on training doctors. That will take years to do. I have strong views on the education of doctors and their participation in the mental health area. I have said that training of doctors in the psychiatric area has been taken over by the pharmaceutical industry. I have asked many people to look into that.

I agree with Deputy Neville's comments on alcohol, which is a wider issue and a major problem in our society. The mental health tribunals have not yet gone ahead and this is not due to a lack of resources, but because of an industrial dispute between psychiatrists and the HSE. I attended a meeting yesterday and another meeting took place today. I appeal to the psychiatrists to engage with the tribunals as soon as possible. I believe progress is taking place and I hope the psychiatrists will come on board. We need them on the tribunals as we are dealing with the most vulnerable people who have been involuntarily detained in psychiatric institutions.

I agree with the speakers' points on inequality and unfairness in our society. As several speakers have said, our media focus on success and as Deputy Higgins said in the previous debate we have an unfair society and do not pay enough attention to the vulnerable and the disadvantaged groups.

Deputy Carey is correct in his comment that we should not tackle suicide in isolation. It is a much bigger problem, and I await the expert group that will report later this year. They will specifically speak about suicide, but they will speak about the whole area of mental health, which is a challenge for all of us. I applaud Deputy Gay Mitchell's contribution about the value of the respective contributions of the various churches to our society. That is something upon which we can all ponder.

I agree with Deputy Stanton's comments about training. I have been listening.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Not enough.

Tim O'Malley (Limerick East, Progressive Democrats)
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I agree that over the years, there has been little leadership in the area of mental health. I am giving that leadership. While there are no instant fixes, I want to do it in collaboration with many people, especially voluntary groups. We must work with them in driving forward the positive mental health message.

As the economy has progressed, those who have not succeeded, in society's view, have been left behind and not enough attention was paid to their contribution. Many who opt out and fail in the points system are some of the most creative people in society. Unfortunately, society, including the media, regards them as failures. Much work remains to be done in the area of mental health.

I thank all contributors to this debate which was very worthwhile. I will return to the House at any time in the future to discuss this matter again.