Dáil debates

Thursday, 26 October 2006

High Level of Suicide in Irish Society: Statements


11:00 am

Tim O'Malley (Minister of State, Department of Health and Children; Limerick East, Progressive Democrats)
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I welcome this opportunity to discuss the report of the Joint Committee on Health and Children, The High Level of Suicide in Irish Society, and to outline the measures which are being taken by my Department, in conjunction with the Health Service Executive and the many community and voluntary organisations involved, to address the issue of suicide in Irish society.

The joint committee sets out detailed recommendations that have been based on written submissions to it, as well as presentations by a range of statutory and voluntary groups, academics and researchers. These recommendations, 33 in all, include practical interventions and research priorities. Suicide is a serious problem in this country. Data from the Central Statistics Office indicates that between 2000 and 2003 there were, on average, 495 deaths by suicide in Ireland annually, peaking at 519 in 2001. In 2004 there were 457 registered deaths by suicide and in 2005 there were 431. This represents a rate of 11 per 100,000 population. Of particular concern is the rate of youth suicide in Ireland, which was the fifth highest in the European Union for 15-24 year olds in 2004. Sadly, the rate is even higher in Ireland among young men in their 20s and early 30s.

Deliberate self-harm is also a significant public health problem. According to the National Suicide Research Foundation, more than 11,000 cases of deliberate self-harm present to Irish accident and emergency departments each year. Deliberate self-harm rates are highest among women and the younger age groups, peaking for girls aged between 15 and 19 years and for young men aged between 20 and 24. The joint committee recognised the need for the provision of nurse-led liaison psychiatric services in A&E departments. I am pleased to inform Deputies that the National Office for Suicide Prevention made additional resources available in 2005 to put in place experienced psychiatric nursing staff in A&E departments to respond to deliberate self-harm presentations. Further investment is being made in 2006 to ensure all A&E departments have a service to respond to such presentations.

The joint committee report suggests that suicide is a societal problem and that those that are, or who perceive themselves to be, disenfranchised or marginalised are at greater risk. The report identifies the close relationship between suicide and mental illness, especially those with psychotic illnesses who have a 10%-15% risk of dying by suicide. The role of alcohol in suicide and suicidal behaviour is highlighted. These findings are echoed in Reach Out — A National Strategy for Action on Suicide Prevention, which was launched in September 2005.

The joint committee recommends that young people be consulted about mental health services and service development. This area was also identified in Reach Out. The National Office for Suicide Prevention is exploring ways of reaching young people through e-mail, texting and instant messaging, in order to develop a sustainable programme of action which can be funded in late 2006-07 onwards. The national office will consult young people, voluntary organisations and those using technology to reach out and provide services. This work is currently being scoped and will be reported on later this year.

As regards the putting in place of a sustainable anti-stigma and positive mental health promotion campaign, which is also recommended in the joint committee report, I am pleased to inform the Dáil that the National Office for Suicide Prevention is planning a national mental health promotion campaign to take place early in 2007. The aim of this campaign is to address the stigma relating to suicide and mental health which are serious barriers to seeking help. The campaign will be whole population based initially, but as it develops over time more targeted and local campaigns will be initiated. The National Office for Suicide Prevention has looked at the Scottish "See Me" campaign which is beginning to have an impact on public views of mental health.

The joint committee recommended a target of reducing Ireland's overall suicide rate by 20% by 2016. As part of the Reach Out strategy, consideration was given to the setting of an overall target for the reduction of our national suicide rate as an outcome measure of this strategy. At this stage, it has been decided that a specific target will not be set because the priority is to establish the accuracy of suicide mortality in Ireland. The range and inter-play of factors that influence the suicide rate mean that a direct cause and effect relationship between prevention programmes and a change in the overall population rates is virtually impossible to establish.

Nevertheless, there are undoubted advantages to setting targets for an overall reduction, not least that it focuses the attention of those working at all levels of suicide prevention. An overall target for the reduction of suicide rates will be set by the Government, on the advice of the Minister for Health and Children, when suicide rates have been accurately determined.

As we are all aware, there was in the past a reluctance to even discuss the issue of suicide. Thankfully, this situation has now changed. In Ireland, the level of discussion and openness on mental health issues, including deliberate self-harm and suicide, has increased significantly in recent years. This is a very welcome development. However, we must ensure that public discussion and media coverage of suicide and deliberate self-harm remains measured, well-informed and sensitive to the needs and well-being of psychologically vulnerable and distressed individuals in our society. In particular, we need to continue to work as a society to create a culture and environment where people in psychological distress feel able to seek help from family, friends and health professionals. A strategic framework is required to assist all of us in identifying actions we can undertake in a co-ordinated way, through partnership between statutory, voluntary and community groups and individuals, supported by Government.

Reach Out builds on the work of the National Task Force on Suicide and takes account of the efforts and initiatives developed by the former health boards in recent years. It recommends a combined public health and high risk approach. This approach to suicide prevention is also advocated by the International Association for Suicide Prevention and is in keeping with the European action plan for mental health which was signed and endorsed on behalf of ministers of health of the 52 member states of the European region of the World Health Organisation at the ministerial conference on mental health in Helsinki, Finland in January 2005. The Health Service Executive is taking a lead role in overseeing the implementation of the strategy, in partnership with those statutory and voluntary organisations that have a key role to play in making the actions happen.

Following the publication of the strategy, the HSE established the National Office for Suicide Prevention. The role of the national office is to coordinate suicide prevention activities across the State, consult widely in relation to the planning of future initiatives, and ensure best practice in suicide prevention.

The report of the expert group on mental health policy, A Vision for Change, which was launched in January 2006, highlights the importance of mental health promotion in the prevention of mental health problems through the development of coping and problem-solving skills, help-seeking and resilience. It also recommends that mental health promotion should be available for all age groups to enhance the protective factors and decrease risk factors for developing mental health problems. The recommendations in the report have been accepted by Government as the basis for the future development of the mental health services. In the region of €800 million will be spent on mental health services in 2006, up from €433 million in 2000.

This year an additional €26.2 million funding was provided to further develop our mental health services. This included €1.2 million specifically for suicide prevention initiatives. In addition, earlier this week the Government approved the allocation of almost €1 million from the dormant accounts to fund 20 projects providing suicide prevention supports. The key objective of this funding measure is to provide interventions and supports to strengthen community based initiatives, particularly, although not exclusively, those targeting young men under 35 years of age. The intention of the funding is to support locally-based initiatives supporting suicide prevention. The projects approved are varied and include the provision of early intervention measures for those at risk and also the provision of services for those bereaved through suicide.

This Government shares the public concern about the levels of suicide. I thank the members of the Joint Committee on Health and Children for their work in preparing the report on the high level of suicide in Irish society. We all have our part to play in helping those who may experience and face adverse events in life, and emotions and feelings so strong that they consider taking their own lives. We must aim to provide accessible, sensitive, appropriate and, where required, intensive support.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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Suicide is an emotional subject and every Member fully understands the trauma families suffer as a result of a death by suicide. It would be difficult to predict our own response if any of us received the call many families receive. To be informed of the sudden death of a father, mother, brother, sister, son or daughter is a terrible event and death by suicide is accompanied by raw emotion that can often be difficult to understand or discuss. All too often, a close family member discovers the victim of the suicide, something that will never leave him or her. Last week before the Joint Committee on Health and Children, we were told of a five year old child discovering his father hanging in the garage. That will never leave that young boy.

Those left behind often spend the rest of their lives asking questions of themselves, if something they said led to this catastrophic event for the family. Regrettably, sometimes angry words have been exchanged between parents and a child before this terrible occurrence.

As the Minister of State pointed out, the Oireachtas committee published a report on the high level of suicide in society and every Member of the Houses should read it. It gives important background information on suicide. It states:

Despite the disparity of backgrounds and experience of those who came before the Committee, a number of common opinions emerged from the evidence presented. These included the fact that:

1. Suicide, the act of voluntarily or intentionally taking one's own life, is a growing global problem. In itself, suicide is not an illness but rather it is a term used to describe the act of the taking of one's own life.

2. The causes of suicide are multi-faceted and entail an interaction of biological, psychological, social and environmental risk factors occurring in an individual who may have various socio-demographic vulnerabilities interfacing with life-long susceptibilities that are then usually subject to a precipitating event, with catastrophic consequences.

That might sound academic but it points out that there are social factors and vulnerabilities in an individual's life that can lead him or her to taking that life. The easy part to understand is that such an act has catastrophic consequences for the individual.

Suicide and suicidal behaviour are societal problems and society must alter social policy to deal with risk factors. Effective action to prevent suicide behaviour requires the co-operation of the whole community, with inputs from the Departments of Education and Science, Justice, Equality and Law Reform, Health and Children and Social and Family Affairs, as well as employers and voluntary agencies and organisations committed to positive health promotion.

It was recognised in 1897 that many suicides occur when the attachments between an individual and society are strained or fragmented. This association was made more than 100 years ago and Irish society, like the rest of the world, has changed dramatically in the period since, particularly in the past decade. Given that people have become much more detached from interactions in their communities, it should not come as a surprise to learn that the risk of suicide has increased significantly. New policies are needed to address the risk of suicide, especially among young people.

The report focuses on two further key issues, namely, suicide clusters and the role of alcohol. Suicide clusters are a well-known phenomenon. I had a shocking experience of it in my constituency of County Wexford where, over a brief period, the bodies of five victims of suicide were taken from the River Slaney. The media must take extreme care in reporting suicides. If vulnerable persons perceive that the reporting of a suicide appears to elevate the victim, a rash of copycat suicides may occur in the same area. Clusters of suicides will continue unless we can persuade the media to adopt a sensible policy on reporting suicides.

The second key issue is alcohol. Many people forget that alcohol is a depressant. As the report states, it produces a "significant fall in mood". It also notes that an "individual may not have a history of suffering from depression for this to come about", adding that alcohol is "disinhibiting". I have been made aware of cases in which individuals who had attempted to take their own lives were discovered and their lives saved. They may have been found hanging in a garage or shed. Usually, they had consumed a large quantity of alcohol and had no recollection of making preparations to take their lives. For reasons connected either to the disinhibiting or mood altering effects of alcohol or events in their lives, they took the decision to end their lives without being conscious of doing so. In other words, they did not start out with the intention of taking their lives.

Alcohol consumption has increased by 40% in the past decade. It may be coincidental but the increase in suicide over the same period was also roughly 40%. Given the significant contribution alcohol makes to the suicide rate, it must be a focus of attention because it is an area in which we can make a difference.

The Minister of State indicated that more information would be sought and baselines established before the Department would set reduction targets. Other countries have successfully reduced suicide rates through targeted programmes, particularly those focused on young people. Apart from young people, the other group most vulnerable to suicide is elderly people, particularly those living alone. Of the 500 suicides per annum, at least half involve young people. When one adds a further 250 young people who lose their lives on the roads each year, one finds that every year 500 young people are killed in two areas where prevention measures are required.

Between 50,000 and 60,000 young people sit their junior certificate every year. Statistically, by the time a class of 15 year olds reaches the age of 25 years, one tenth of its number will have died either in road traffic accidents or as a result of suicide. It is shocking that we are not tackling these two key causes of death among young people. Rather than waiting to set baselines, we should take immediate action.

To return to the issue of alcohol, young people's alcohol consumption has changed dramatically in the past 15 or 20 years. They consume much larger amounts of spirits and aim to get intoxicated quicker. This could have a significant knock-on effect on the two growing trends of suicidal and parasuicidal behaviour. Many of those who engage in parasuicidal behaviour do not realise that while they did not set out to kill themselves, their actions may have serious consequences. I have worked in accident and emergency departments in Dublin and Cork. Frequently, young people would tell me on admission that they had taken 20 or 30 paracetamol tablets. They would be dismissive at first but would become anxious when they learned that paracetamol could potentially kill them as it would cause their liver to shut down. They thought paracetamol was relatively safe and would not result in death. While technically parasuicidal, their behaviour could have serious consequences. In many cases, young people who did not intend to kill themselves have been discovered dead.

We need to be alert to parasuicidal behaviour, which frequently occurs when young people consume large amounts of alcohol and row with their friends. Many 15 and 16 year olds are not psychologically prepared for the emotional relationships they enter and may, when they drink too much, make a cry for help by taking paracetamol with devastating results. The Minister can no longer sit on this issue because far too many young people are losing their lives.

The all-party report of the national task force on suicide was published in January 1998 when Deputy Cowen was Minister for Health and Children. The seventh report on the high levels of suicide notes that one of the reasons the task force report failed to have an impact on suicide rates was that resources were not allocated to target them. Two years after the publication of the task force report, suicide rates peaked and continued at high levels for a further three years. If the necessary resources had been forthcoming in 1998, how many of the lives lost in subsequent years could have been saved?

We can no longer sit on the fence. It is unacceptable for the Minister of State to indicate action will be taken when suicide rates have been accurately determined. Suicide rates are too high to take a bookkeeper's attitude on the need to have precise figures. Cross-departmental action is required to dramatically reduce the suicide rate. The Department of Education and Science must establish suicide prevention programmes in schools. I do not know what age children should be involved in these programmes. Ten years ago, we probably would have favoured starting with transition year students but these students have become much more aware of what is happening in the wider world. For this reason, it may be necessary to move the goalposts and focus suicide prevention efforts on 12 and 13 year olds.

The recommendations of the task force on alcohol have been ignored by the Government. This is something for which it must take responsibility. If the huge increase in the consumption of alcohol by young people is a contributing factor to the incidence of suicide, the Minister should take that on board and implement the strategies required immediately. The Opposition wants the Government to do its job in this regard. It is not good enough just to list what is being done when it is clear that despite all the programmes, not enough is being done to protect people.

The statistic I mentioned earlier might not be 100% accurate but it is the case that in every classroom of 30 or 40 students who are about to sit their junior certificate examination, at least two or three of those students will not see their 25th birthday because of death either by suicide or in a road traffic accident. These are the two main crises for young people at present. The Government has all the reports it needs on these issues. It is now time for it to do its job by tackling these problems and really making a difference to people's lives.

The issues surrounding death by suicide among elderly people are far different. It is usually caused by loneliness, where people are living alone and have become detached from society. They no longer feel wanted by society. It is a separate issue. Society has changed dramatically; there is not the same respect for elderly people and they are not valued as much. In some respects we have sidelined the elderly from involvement in their communities and in family life over the past decade due to the fast pace of modern life. This is the next issue on which the Minister must focus his attention. Again, however, it must be dealt with across all Departments, not just the Department of Health and Children.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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I welcome this debate. It is probably the first time there has been a full debate in the House on suicide, despite the fact that all Members, in the course of their work, have encountered families whose lives have been blighted by the suicide of a loved one. Few of us have been trained in how to deal with that type of crisis so we can only imagine what is involved and empathise with and support those families as best we can. Indeed, many of us have family members who have committed suicide and have had to cope with that terrible crisis. Many parents never fully recover from the loss of a child who has died in this way.

This is an important debate. It is important that we know the extent of the problem. It is striking that in the past we thought Ireland had a low level of suicide. Certainly, the evidence is that the level was lower than it is now. In the 1960s there were approximately 164 suicides per annum; now the figure is approximately 450 per annum. That is a big increase. We can debate the reason for that but I suspect that in the past the figures were suppressed because of the stigma attached to suicide. I recall that there was general smugness in Ireland with regard to a country such as godless Sweden, which had a considerably higher level of suicide. The reality, of course, is that we often covered up cases of suicide, often for the benign reason of protecting people and minimising the damage.

It is better that we know the truth. It is healthier for the community to know the extent of the problem. I welcome the fact that there is better data collection now. Nevertheless, it is clear that we do not know the full extent of the incidence of suicide, and the Minister has used this as an excuse. There are hidden suicides, something we need to explore and study. There is circumstantial evidence that some car crashes are deliberate. We have seen instances of risky behaviour in cars, particularly by young men, and have learned to our cost in recent times where that can lead. There is a general view that some car crashes resulting in the death of young male drivers might in some cases be deliberate rather than accidental. Accurate research and accurate data collection is most important for getting to grips with this issue.

This is referred to in the report:

We have a body of statistics about suicide in Ireland that are likely to underestimate the true state of affairs. While accurate data collection is the ideal, avoiding unnecessary duplication of collecting information is also important. The best possible use of the existing data held by statutory and professional agencies relating to suicide deaths in Ireland supplemented when possible by information from the bereaved family and the deceased's social network would also help to build up a picture of the deceased. However, our relentless problem of suicide requires us to engage in preventative programmes and set targets for a reduction in self destructive behaviour in parallel as a matter of urgency.

The committee's report makes a key point, namely that while we collect this more accurate data we should not delay in setting targets. However, the Minister has just told the House that because we do not have accurate data and do not know the cause and effect of measures, targets will not be set. The report says that is the wrong way to proceed in tackling this issue. Perhaps the Minister will reconsider and have a little courage.

There is no lack of reports and information. There are two significant reports available, the Oireachtas joint committee report and the strategy report. These contain good information and proposals. The Oireachtas committee employed Dr. Siobhán Barry, an expert in psychiatric illness and suicide, and consulted with people and families who had been bereaved. The partnership between the expert and the people who are directly affected is fundamental to ensuring that we reach out to those at risk and to those who have lost loved ones.

The strategy outlined by the Minister lasts to 2014 but does not set clear targets. That is a key weakness in the Government's approach. Deputy Neville will probably discuss the example of Scotland. When the authorities in Scotland were tackling the high level of suicide they set out targets and were effective in reducing that level. On this morning's "Morning Ireland" a person in charge of dealing with the accident and emergency crisis stated that setting targets was crucial to tackling the problems in that area. If targets are not set, what are we working towards other than a series of aspirations that become more woolly as they become more ineffective? This is a crucial point.

This report and others point to the reasons for the increase in the incidence of suicide, apart from the fact that we have better knowledge about the problem. There is a loss of values and a loss of a sense of security among young people. We must take on board that Irish society has changed rapidly and become more unequal and divided. There is a greater sense of marginalisation as a result of our prosperity. Those who, for whatever reason, are left behind feel even more isolated. There is a raft of research to support the case that poverty and social exclusion have a detrimental effect on people's health, that social determinants of health are hugely significant and that poor people have shorter lives and, on average, are more liable to become ill than those who are better off and employed. The position is similar in respect of mental illness, which is a significant factor in suicide.

The Minister of State is a member of a party which believes that inequality is a good thing. His party's new leader has espoused the cause of inequality but when it comes to health, that is a load of baloney. Inequality is anything but good. In circumstances where good measures are in place in societies where the divide is not so wide, health outcomes are generally much better. In the US, of which the Minister for Health and Children is so fond and with which she is besotted, the health service spends enormous amounts of money but does not deliver better health outcomes. This is largely because US society is so unequal. Those at the bottom of the ladder in America cannot access health care and suffer much greater ill health.

Consideration must be given to societal issues. A fair society is a healthier society. Until we grasp that concept and begin to promote the principle of a fair society, we will continue to be obliged to climb the hill with a burden on our backs.

Another issue to which I wish to refer is that of the victims of abuse. It is part of a painful legacy that is also coming to the surface that there is a higher level of suicide among victims of abuse. We must ensure that full counselling and psychotherapy services are put in place to try to ameliorate the damage and destruction done to people's psyches by abuse. This gives rise to a general point regarding counselling and psychotherapy, namely, that it is difficult for people facing emotional crises in their lives, particularly if they do not possess adequate financial resources, to seek help of the kind to which I refer. Such help is not incorporated into our health service in the way it should be and it is not accessible via the medical card system. There are many voluntary organisations which are trying to meet the huge need for counselling. For many people, counselling can open a door to happiness and relieve them of enormous emotional burdens that they often carry in isolation. Whether we can rely on counsellors' judgment and evaluate whether they are good at what they do is another matter. In my opinion, this area should be professionalised. However, that is a matter for another debate.

I welcome any beneficial moves in respect of mental health that the Minister of State intends to make. I will not begrudge anything being done by the Mental Health Commission, the establishment of which was an extremely positive development. It is vital that mental health should be given higher priority within the health service.

I wish now to deal with the issue of alcohol abuse, to which the requisite attention has not been paid. The Government has at its disposal all the information it needs in the form of the second report of the strategic task force on alcohol. We are aware that there is a strong link between alcohol and some suicides. Members raise issues in the Dáil and table questions about, for example, the alcohol products (control of advertising, sponsorship and marketing practices/sales promotions) Bill. I inquired about the latter in 2003 and I was informed that publication was expected in early 2004. The legislation has disappeared from the horizon. The reason for this is that the Minister for Health and Children capitulated to the alcohol industry.

The second report of the strategic task force on alcohol indicates that Ireland has a major problem in respect of alcohol abuse. Chapter 2.21 of the report states:

A recent study showed that adults in Ireland had the highest reported consumption per drinker and the highest level of binge drinking in comparison to adults in other European countries... The study showed that binge drinking is the norm among Irish men; out of every 100 drinking occasions, 58 end up in binge drinking. Among women, 30 occasions out of 100 end up in binge drinking. Binge drinking was conservatively defined in this study as drinking at least one bottle of wine, or 7 measures of spirits, or 4 pints of beer or more, during one drinking occasion... While young Irish men reported the highest consumption of alcohol and had more binge drinkers than any other group in the population, binge drinking was common in all age groups up to 64 years.

There are two points to be made. First, we have a real problem as regards the abuse of alcohol and, second, it is clear from the research that this problem does not merely exist among young people. We espouse a culture which ensures that practically every part of our social lives revolves around the pub and that the young are educated into the culture of alcohol abuse by older people. We are creating a range of problems, including those which relate to liver damage and mental conditions.

We are aware that there are many problems associated with the abuse of alcohol but the Government is not dealing with this matter. That is disturbing, particularly because the link between alcohol and suicide is well known. However, it is also disturbing because young people are being exposed to the opportunity to suffer great ill health, such as that caused by liver damage, in the future by a culture that we do not seem to be able to control or redirect in any way.

The summary of recommendations in the report of the task force is extremely clear and states that we should increase taxes, restrict greater availability, deal with advertising, reduce exposure of children to alcohol, etc. Regrettably, however, the recommendations remain in the report and have not been taken on board elsewhere. That is one of the examples of the Government's acute failure to deal with this issue.

Everyone understands that difficult decisions must be made. When the Government introduced the smoking ban, I found myself in the extraordinary position, at public meetings in my constituency, of defending it against a Minister who also represents the constituency and who was highly critical of the ban. However, that was my choice and I would make it again.

Séamus Pattison (Carlow-Kilkenny, Labour)
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The Deputy's time is exhausted.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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And I had only just got started.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I propose to share time with Deputies Connolly and Gormley.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Is that agreed? Agreed.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I welcome the report of the Oireachtas committee and the continuing focus of Members on the high level of suicide in society. This is a serious issue and it ranks with the appalling toll of deaths on our roads as the leading cause of deaths of young people and as a source of terrible grief for individuals, families and entire communities.

There is widespread concern and a greater awareness of the scale and depth of this problem. However, it is sad that this has not been reflected in concerted and effective action by the Government. That much is clear from the committee's report, which is to be commended for outlining the situation in factual and blunt terms. In his opening address, the Minister of State avoided these criticisms.

The report is especially critical of the state of our mental health services. It points out that people with mental illness are known to be at greater risk of death by suicide but "the type of mental health service one can access is a matter of luck". That is a terrible indictment. It states that funding for mental health services is "allocated in a random manner with scant regard for need". Perhaps most damning of all in the context of suicide, the report asserts that "the provision of mental health services for adolescents is high on aspiration but low on action". All of these findings by the joint committee must be taken on board by the Government. What is required is not aspiration, but action. The findings represent a severe indictment of the State's management of our health services, as is the conclusion that despite 11,000 admissions per annum to accident and emergency departments following suicidal behaviour, we have not yet put swift and appropriate standardised interventions in place to treat this high risk group and thus reduce repeat acts.

I welcome the target set by the report to reduce the overall suicide rate by 20% by the year 2016. I also welcome the detailed and costed recommendations for action. This is the most important element of the report and I urge the Government to act swiftly and comprehensively to implement these constructive proposals.

There is a particular focus on our education system in the recommendations and a range of measures is proposed. We need to see this problem in the overall context of an education system at second level which places enormous pressure on students. Children are going from a progressive, child-centred, primary education system into secondary schools where an exam-driven pressure cooker environment is the order of the day. Along with the natural personal and family pressures faced by adolescents, they face the social challenge of their peers and the educational challenge of a highly competitive leaving certificate which is driven by the scramble for places in third level education. This occurs in a consumer society in which young people are increasingly being judged by how they look, what they wear and what they possess. Anti-social behaviour and bullying in our schools are very serious and growing problems. To be in any way troubled as a young person in this context is to be open to the risk of mental illness, self-harm and ultimately suicide. We must address all of this with the full participation of young people themselves.

Sinn Féin has identified suicide as a distinct priority requiring concerted co-operation between the Government, the health services, the voluntary sector and communities. Our youth section, Ógra Sinn Féin, has campaigned on this issue. We have also included suicide prevention as a key element in our policy document entitled, Healthcare in an Ireland of Equals.

Séamus Pattison (Carlow-Kilkenny, Labour)
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The Deputy has spoken for six minutes.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I do not want to encroach on the time of other speakers. I ask the Minister of State to note the points I have made.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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It is very important that we discuss this topic at length in the House. We have spoken about it in committees, but this is the first time we have done so in the Chamber. At a time of unprecedented economic growth and prosperity, why is there an increase in suicide? There are several answers to the question. If one reads the report, one can get an indication of that. Going back 100 years, Durkheim stated that many suicides occur when the attachments between an individual and society are strained and fragmented. We have an economic system and parties, such as that of the Minister of State, which advocate a certain economic orthodoxy that places the emphasis on the individual as opposed to society. Margaret Thatcher once famously said that there is no such thing as society, only the individual. That is very dangerous and we can see the consequences of that kind of thinking.

So much of life has now become a commodity. The rearing of children, child care and looking after older people are now commodities. People are paid to do things and the idea of volunteerism is now gone. The extended family is gone and the type of society that we now have is based on capitalism and the market. We can call it an industrialised society or a consumer society, but it amounts to the same thing; the individual seems to be under enormous pressure. That has led to an increase in suicide, despair, depression and alienation from society as the individual sees it.

One of the ways we allow the market a free reign in this country is in regard to alcohol. It is now possible to buy alcohol in a local supermarket as it is freely available. I was listening to an interview being conducted with women who were in Killarney for a hen weekend. They consumed shots which allow the same amount of alcohol into the system in two seconds as that of a pint over a longer period of time. People are under real pressure to go out and binge drink as they are so busy with their lives.

The Government had the opportunity to introduce the alcohol products Bill and we know that alcohol is related to suicide, but the Government funked it. It shelved the Bill and it caved in to the alcohol industry. If the problem of suicide is to be tackled, a little bit of joined-up thinking is needed and the alcohol products Bill should be put back under promised legislation. Let us get at the root causes of this problem.

Paudge Connolly (Cavan-Monaghan, Independent)
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I welcome the opportunity to speak on this report. I was a member of the sub-committee that produced the report and I would like to see action on it. Suicide is a very difficult subject and is difficult to address. There are approximately 450 suicides per annum and 11,000 attempted suicides. It is a major challenge for society. Some studies suggest that suicide is under-reported by about 16%. There is an economic and human cost to suicide at a direct and indirect level. Suicide costs about 0.5% of the country's GNP, 72% of which is in human terms and 28% of which is due to loss of production. Each suicide costs around €1.5 million, which is a crude way to measure it.

We do not really know why people commit suicide, but we know that some are in high risk categories and groups. It is known that certain factors are associated with suicide and all speakers have referred to alcohol and drugs. The 1990s saw a 41% increase in alcohol consumption and a 44% increase in suicide. This shows the direct link between alcohol and suicide. It is strange to see there has been no corresponding increase in mental illness so suicide is not directly linked to mental illness either.

Ireland has experienced an economic boom since the 1990s. We have become caught up in the fast lane and as a result of the Celtic tiger we have succumbed to the relatively recent vices of consumerism and materialism. We have lost touch with each other and we have lost our interpersonal skills. I appeal to people to talk and to share the problem. So many distraught relatives are left wondering why they did not pick up on the symptoms and why they missed the signs. Distraught parents are often left wondering how they missed the signs and why their child did not share their thoughts with them. Professional help is available. I appeal to anyone suffering from suicidal ideation to share their thoughts with somebody they trust who could direct them towards professional help.

I appeal to the Health Service Executive to address the shortage of counsellors. Many obstacles are put in the way of people looking for help. I appeal to senior people in the health service to facilitate staff who wish to train as counsellors. Many workers such as nurses have front line experience in the delivery of health care and such people should be encouraged to take an active part in society.

A seminar on suicide was held recently in Dromahair, County Leitrim and the hall was packed. The VEC and the local health services joined together to host a seminar in Monaghan town and again we were playing to a packed house. Suicide is one of the biggest killers of young people, particularly young men. Parents are almost afraid to look sideways at their children yet every so often they are accused of tossing material goods at children as if they are buying their affection. It is wrong to accuse parents because this is part of the society in which we live; it is like blaming electricity for our ills. Society moves forward, we are a consumer society and we must learn to adapt to this society. It can be frustrating for parents to be accused of being over-materialistic, not being caring enough or not giving time to people.

I appeal to young people, in particular young males. They find it very difficult to share their thoughts with other people. Young girls are better communicators and they communicate with each other. They will express their feelings to each other and this takes them out of a quandary. If a problem is shared then it is halved. Because of male ego, young guys will not share their thoughts and they will not talk. This is one of the reasons for the high incidence of suicide among young males.

12:00 pm

Photo of John MoloneyJohn Moloney (Laois-Offaly, Fianna Fail)
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I thank the fellow members of the sub-committee of which I was Chairman. I thank Deputy Neville in particular and wish to recognise his expertise. I thank Deputies O'Connor and Connolly, Senators Browne and Glynn and Gina Long and in particular, Dr. Siobhán Barry.

I note the report presented to the Oireachtas and the remarks of Deputy McManus where she made the point that this is the first time this subject has been debated on the floor of the House. I hope that the next time it is debated here we will have met many of the targets and achieved much of what we have set out to do.

I speak as someone with an interest in the issue of suicide who hopes to see changes. The figure of in excess of 450 people taking their own lives must be regarded as a huge wake-up call to us all. The aim of the committee was to try to bring about change and to ensure there would be a reduction in numbers in the future. The committee's report was not designed to be publicity-seeking. The committee deliberated over a number of months and came to certain conclusions.

I do not wish to differ with the Minister of State, Deputy Tim O'Malley, because I respect his position. However, I remain convinced that we must set targets. We will lose valuable time if we wait for more information to be collected. I say this not as a professional person because in the pecking order of responsibilities I presume I might come on the lowest rung.

I come to this debate as a country funeral undertaker. Over the years I have seen the hardship caused to families and communities by the act of suicide. I see despair and frustration, a lack of guidance and a wonderment of where we went wrong and where the system fails. I have been involved with six suicide funerals in my home area in the past six weeks. From speaking to the families I noted that a common thread in four of those funerals was that the person had been undergoing treatment, had been discharged from treatment but there had been no follow up to check how the patient was coping. There was no follow up with the family to find out how the patient was reacting to treatment or how he was dealing with going home for the weekend. Until the dreaded day came, there was no specific contact with the hospital authorities. In my view there should be targets in that area. The biggest gap is that there is very little follow up care. I do not wish to seem critical or to blame anybody.

The committee's report, unlike most reports, has stated that we should work towards achieving a 20% reduction in the rate of suicide by 2016. This can be achieved. I am relying on the professionals who came before our committee over a three to four month period. I would welcome the opportunity to read into the record of the House the 33 recommendations of the committee's report. I subscribe fully to a target figure and a price tag on those targets. We must recognise the significant problem and work on the recommendations. We do not have to accept all the recommendations but we should recognise the changes required.

We have a flourishing society with all the consumer goods we need but the one thing we cannot check is the reason people are taking their lives by suicide.

The committee's report concluded that suicide is largely a societal problem, not an illness in itself. As a consequence society needs to alter social policies to deal with the risk factors. We must decide how to change the societal background to ensure we achieve those reductions. Our report highlights that the close relationship of suicide and mental illness makes it imperative to make psychiatric services more accessible.

I do not wish to seem sentimental because, far from it, I am totally at ease with myself on this matter. My father suffered from alcoholism for a number of years. He was dry for 20 years before he died. During the 1950s, 1960s and 1970s, people were reluctant to seek help for alcohol-related illnesses because if one did not have the funding for a private hospital one went to the local mental hospital. People were reluctant to check into a mental hospital for fear of that stigma. We have moved from that era with the arrival of acute psychiatric units in hospitals. I welcome that development. I see the trend of people presenting at these units.

We must establish a pattern of treating people with suicidal tendencies. Levels of treatment must be raised to those in the alcohol treatment sector. This can be done and the report goes a long way towards suggesting this move.

One of the most important sections of the report highlights the disparity of funding in the mental health services. Services for adolescents have tended to be poorly developed. Adolescents with psychotic illnesses have a risk of between 10% and 15% of dying by suicide. That glaring fact is presented in the report. By homing in on that statistic and providing the necessary back-up support, we could reduce those figures greatly. The risk is greatest within the first five years after the onset of a psychotic illness. We need urgent programmes of early intervention for detection and treatment in the area of mental services. Only days ago, I heard of a person who arrived at an accident and emergency unit displaying suicidal tendencies. Our hospital systems are not geared to fast-tracking such a person through an accident and emergency unit. We must examine the problem of suicidal patients presenting at such units.

The recommendations in the report are well grounded and factually based. If we wait for further evidence we will not be dealing effectively with the issue. I too attended the conference on suicide held in County Leitrim. It was a two-day conference, going on until late in the evening and attended by more than 400 people. The common theme was that parents and families of those who take their lives by suicide feel absolutely helpless and deprived of guidance and direction. We must set down parameters for reducing suicide levels and fix targets. People must be held accountable or responsible for realising these targets.

We must go back to the old system where each county appointed a person responsible for bringing in measures to reduce the level of suicide in the county concerned. If this were done, I would have no difficulty accepting the recommendations of the task force report that the responsible person in each county should report to a suicide prevention officer at national level. Unless trends are established and patterns gauged and understood, we will not reduce suicide levels.

I would like to see a pilot programme or Government funded scheme to invite families bereaved by suicide to speak confidentially to professionals who would try to see if there is a set pattern leading to suicide. This would be a first step towards setting targets to reduce levels of suicide.

I fully subscribe to all the recommendations in the report. We must set targets and funding should be set aside in this regard. We have come to recognise the huge difficulty of deaths in road traffic accidents and we have set targets and provided budgets for this purpose. We must do the same for suicide. The public must be shown that suicide figures can be reduced. This matter has been tackled in Scotland. If the Scottish model can work, I am certain we can do the same in this country.

As chairman of the sub-committee which compiled the report, I made a commitment that it would not sit on a shelf and gather dust. This report is much too important. We want to reduce the levels of suicide and we hope to see that reduction very soon.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I welcome the opportunity to contribute to this debate. I welcome the report of the Joint Committee on Health and Children on high levels of suicide. The report made a thorough examination of the issue. I thank those who presented to the joint committee and I commend the expertise and work of the committee itself.

Suicide is a difficult issue for communities and families but especially for families who suffer a bereavement by suicide. No words can ever console or begin to explain to a family who suffer such a bereavement. The question most often asked is "Why?", and it is the hardest question to answer because the reason is different for every case of suicide. Different aspects of life, experience, pressure, difficulty or the state of a mental illness come to impact on a victim of suicide. It is always difficult to persuade families bereaved by suicide to accept that no one is to blame when a suicide occurs. No blame attaches to anyone in a case of suicide. People who take their own lives are not intent on ending their lives so much as ending the pain they are suffering. They see no other way out of their suffering than to take their own lives.

Much of what has been said today touches on the need to intervene in the lives of people in crisis and to promote the view that to recognise one's difficulties and despair and obtain help is to take a positive approach. A young person labelled with a psychiatric difficulty, depression or a need for counselling often loses status among his peers. If a young person goes from the midlands to speak to a counsellor in Dublin, for example, others will not know about his problem but the young person will label himself. He will self-label and know he is in trouble. The key to dealing with mental ill health and suicide is to destigmatise these areas. Programmes are needed to destigmatise suicide and mental ill health.

International experts say more than 80% — one study says as many as 87% — of people who take their lives suffer from a psychiatric illness. Young people who commit suicide are often suffering from undiagnosed depression. They feel depressed and suffer from a sense of failure and low self-esteem. They do not put a label on their condition or understand what is happening, but they need assistance. Much of the assistance needed by young people is psychotherapeutic rather than psychiatric, although psychiatric treatment is often necessary. I do not subscribe to the view that drugs can be eliminated. They are important in the treatment of mental illness. I accept that they are over-prescribed because we do not have the multi-disciplinary teams of psychotherapists and other therapists who are required to deal with suicidal tendencies. We must destigmatise suicide so that people do not feel ashamed if someone in their family has attempted suicide or has a psychiatric illness.

The report mentions deliberate self-harm. The treatment of deliberate self-harm in our hospitals is patchy. In the former Eastern Health Board area, 47% of those who deliberately self-harm are admitted to hospital but only 9% are admitted in the former South Eastern Health Board region. There is no uniformity in our understanding of deliberate self-harm. Some 10% of those who deliberately self-harm go on to take their lives. Treating deliberate self-harm and attempted suicide is a key issue in reducing suicide.

There is a need for research in all areas of suicide but there is urgent need to research the level of deliberate self-harm. Each year, over 11,000 such people present at accident and emergency units. We do not know how many people who deliberately harm themselves visit their GPs and are treated at that level. Neither do we know how many do not seek treatment at all but simply hide the failed attempt to take their own lives. Some may not even tell their families what has occurred. It comes back to the stigma surrounding suicide. Because families do not want it known that a relative is in crisis, they often do not seek assistance, including a psychiatric assessment for those who commit self harm. If suicide is de-stigmatised more people will seek the necessary help.

During the course of our discussions on this document, the relationship between alcohol abuse and suicide became evident. The report shows that in the 1990s there was an increase of 41% in alcohol consumption and 44% in suicide. There is a correlation between alcohol consumption levels and suicide. It would not be correct, however, to say that alcohol is the cause of suicide because many factors are involved, including changes in society.

Much concern has been expressed about binge drinking by young people. A person suffering from mild depression or any mild psychiatric illness who consumes alcohol, which is a depressant, can become chronically depressed as a result. Another big issue surrounding alcohol is that it can reduce inhibitions in those who may have suicidal tendencies. We need to understand the role of alcohol in causing mood changes in people who are already experiencing difficulties. Such people may reach a moment of deep crisis brought on by a combination of alcohol abuse and the personal difficulties they are facing.

Eating disorders cause higher mortality levels than any other illness in Ireland. There is some debate over whether such disorders constitute psychiatric illness but a certain psychiatric element is involved. We have no proper services to deal with eating disorders, although good models exist for treating and curing such disorders. Yesterday, I had a long discussion with the Marino therapy centre which undertakes excellent work in this area. The Minister of State should examine the successful model employed by that centre with a view to evaluating how it can be used elsewhere. It should be introduced in each HSE region because eating disorders such as bulemia, anorexia nervosa and binge eating are on the increase.

A key to reducing suicide and mental illness is the provision of modern, world-standard psychiatric services for children and adolescents. I could spend the next 30 minutes telling the Minister of State what is wrong but we know what is required. If we had such services we could reduce the levels of suicide through early intervention. We could also reduce psychiatric illness from occurring later in life because such intervention provides a better chance of curing it. According to Professor Patricia Casey, 90% of depressed young people can recover as a result of early intervention. Delayed intervention, however, allows depression to become chronic, thus causing severe problems for those involved. I cannot overstate the vital need for early intervention to cure psychiatric illness in children and young people generally.

Two weeks ago, a child and adolescent psychiatric service gave us a presentation. The officials told us that in parts of the country young people are waiting three years for a consultation. I did not think the delays were that long. Last April, the Minister of State informed me that while there were no waiting lists in some areas, in others the delays ranged from six to 12 months, and two years in Kerry. I accept the Minister of State's word but I think immediate intervention is now required to cope with these delays.

The Government has facilitated several Dáil debates on suicide. In addition, Fine Gael and the Technical Group have introduced such debates in Private Members' time. Some people are of the view that in previous years the statistics on suicide were incorrect but I do not accept that for several reasons. First, our system of collecting such statistics, on form 104, is more accurate than in most other countries. Second, very low levels of suicide were recorded among Irish emigrants abroad. Third, there was a low level of suicide in Ireland also and the figures from the 1960s are quite accurate.

There is under-reporting of suicide but that is unavoidable because we do not know about every case. Car crashes were mentioned in this regard and internationally it is accepted that between 6% and 12% of all single-occupancy car crashes are suicides. We are talking of perhaps 10% to 20% in Ireland but while we recognise the problem it should not be overstated. It is accepted that the level of under-reporting of suicide ranges from 10% to 15%, which would mean we are averaging approximately 500 suicides a year. The National Suicide Prevention Office has an annual budget of €1.2 million and the National Safety Council, which promotes road safety, receives €29.4 million, yet there are more suicides than road deaths. That tells a tale concerning the level of investment in suicide prevention.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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I welcome the opportunity of making a brief contribution on the report of the Joint Committee on Health and Children into the high level of suicide in Irish society. I am sensitive to the fact I am following the contribution of my colleague, Deputy Neville, whose work in this area is impressive. He has done tremendous work in this regard and I was proud to have been a member of the Sub-Committee on the High Level of Suicide in Irish Society, under the chairmanship of Deputy Moloney, which included Deputy Neville and Senator Browne.

Every day, politicians deal with all sorts of issues from broken footpaths to broken drains. We also deal with delicate issues such as suicide. In the four years during which I have been a Member of the Oireachtas, I have never been so affected by our business as when I was sitting on that sub-committee listening to the presentations. We have tried to understand the issues involved, although I am not sure if one could ever fully understand them. We all have personal stories to tell concerning friends and families who have been deeply affected by suicide. The House should take its time in debating such important matters. Suicide is prevalent in society but it does not seem to receive headline attention. There is a responsibility on all of us to send a positive message.

I welcome the interest shown by the Minister of State on this issue. In two weeks he and I will attend a function in the city centre at which the Tallaght Travellers Youth Service, under the banner of CYC, will launch an important report on suicide among the Traveller community. I look forward to joining my friends and colleagues from Tallaght on that occasion.

Tallaght is the third largest population centre in the country and, naturally, faces similar challenges to those experienced elsewhere. I have been keen to praise the various initiatives which have taken place in my constituency. With my colleague, Deputy Crowe, I had the amazing experience of attending a conference organised in west Tallaght by the men's group of An Cosán which gave an opportunity to people who had been deeply affected by the issue to participate in discussions about suicide in a quiet atmosphere and among neighbours and friends. Kathleen O'Connor, a chaplain in Tallaght hospital, has taken a number of initiatives in that regard.

Other contributors to today's debate, including Deputy Moloney, raised the issue of people who were challenged by suicide being treated as normal patients in accident and emergency departments.

Since becoming involved with the Sub-Committee on High Levels of Suicide in Irish Society, I have received correspondence from a number of interested parties explaining how they cope with the issue. It is strange that suicide is not treated as a headline story but I will continue to do what I can to help those who are affected by the issue. Through church services and other initiatives, I am constantly reminded of the effects of suicide. Recently, I raised with the Minister of State a number of issues which had been brought to my attention. Arising from the report of the sub-committee, I asked him how his Department intended to monitor its target to reduce suicide rates by 20% over the next ten years, the actions being taken on the report's recommendations on the immediate implementation of certain steps and the arrangements being made to ensure the Departments of Health and Children, Education and Science and Justice, Equality and Law Reform and the OPW co-operate in reducing the current high levels of suicide. I also pointed out the need for a health promotion programme among young people in particular. Experts on suicide, such as Deputy Neville, have highlighted this aspect of the problem and I have often encountered stories of young people who decided to end their lives.

According to the available evidence, once a person makes a decision to commit suicide, he or she makes arrangements, such as locking doors or composing a note, which clearly indicate careful planning.

Suicide among young people generates much attention but elderly people also commit suicide. Last year, the wife of one of my friends went through considerable trouble to achieve what she set out to do by using a number of different methods. That is an issue I find difficult to comprehend.

I am glad the Minister of State has indicated that the Government is fully committed to the initiatives on suicide prevention and the development of mental health services to prevent further tragic losses of life. I hope that principle will guide us on the matter and that the recommendations of the sub-committee will be implemented.

Photo of Tom HayesTom Hayes (Tipperary South, Fine Gael)
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The issue of suicide has frightened many families and individuals across the country but it is an issue which has to be addressed. Like others in this House, I have had to attend the funerals of suicide victims and have witnessed first-hand the pain and numbness of family and friends who were bewildered about the reasons for the tragedy.

The increase in the rate of suicide over the past few years has shocked us all and has led to calls from every corner of the country for action to be taken. In the first half of the 1960s, an average of 64 people per year died through suicide. By 2004, that figure had increased sevenfold to an average of 455. That figure alone underlines the horrific problem we have. Suicide accounts for three out of every ten deaths in the 15 to 24-year-old age group and is the most common cause of deaths among young males. I compliment Deputy Neville on his tireless work in pursuing the policy agenda of suicide prevention. When the subject was not as popular some years ago, as a young Senator, Deputy Neville took up this cause. I am proud that he is a member of my party. He has brought the subject to the fore as president of the Irish Association of Suicidology. His work is acknowledged by everybody in the House. I compliment and salute him on his great work in this regard.

In recent years, the suicide rate among young males up to the age of 35 has starkly increased. Such a sharp increase forces us to ask what has gone wrong in our society. Are we failing to provide the vital support services that may have prevented needless loss of life? There has been talk of social fragmentation being partially responsible for the rise in suicide rates — the breakdown of family and community. Many factors including the prevalence of drugs and alcohol are involved. Another factor is the decline in religious beliefs which clearly forbid suicide. Depression is strongly linked to suicide and we must ask whether we have first class mental health services available for those who may be at risk from suicide or are suffering from depression. Despite our new-found wealth, we have failed to provide the necessary mental health services that would help to stem the tide of suicide.

Like others in this House, I have met many constituents who have come to me in tears over the conditions a son or daughter must endure in a mental health facility. It breaks their hearts to leave their child in an unwelcome intimidating and isolating environment, which is how they perceive mental health hospitals here. Facilities for people suffering from depression should be first class. Facing into a bleak hospital cannot help anyone to recover from depression and adds great strain to parents and loved ones who are likely to be at their wits' end with worry. I compliment the many people who work in those services. They have been frustrated for years over the lack of funding for those hospitals. The reality for those suffering from depression is that we live in a tough and fast-growing world. People are on the move and they find themselves under severe pressure. This makes their world very tough and in many cases brings on depression, which is a growing problem for many.

We have often heard about the dire problems in accident and emergency units and the dreadful circumstances in which many accident and emergency staff must carry out their work. However, it is not often mentioned that accident and emergency units admit 11,000 patients each year following suicidal behaviour. A significant number of those patients will eventually die by suicide. What referral services are available in accident and emergency units for patients who are admitted following attempted suicide? What support services exist for their families? These issues need to be addressed urgently in an overall attempt to iron out the many difficulties that make accident and emergency units so grim.

Measures must also be taken to address drug and alcohol abuse, particularly given the link between them and suicide. To date, the Government has failed to implement its own alcohol policy, the report of the strategic task force on alcohol. This is a miserable record to stand over. The 40% increase in alcohol consumption has taken place in tandem with a huge increase in suicide rates here. This development cannot be dismissed as a coincidence and needs to be explored in detail.

This week, the Garda seized a vast quantity of heroin in Dublin. The seizure was wonderful news. However, the question remains as to how such a vast quantity of illegal drugs made its way into the country. In every village, town and city drugs are freely available. Have we, as a Parliament, tackled the issue? Why are the drugs coming in and from where are such vast quantities coming? The dogs in the street can advise where drugs can be got. Have we tackled this huge problem that exists?

People are driving cars after taking drugs. This week, the Taoiseach told me that no test existed although he would gladly implement one if it were possible. Tests are available and while I appreciate the Taoiseach's concern on the matter, I hope a test will be introduced shortly for people driving cars after taking drugs. There is a link between this issue and the accidents involving young people. If nothing else comes about following all the bad road accidents that have occurred, it should be the introduction of a test for drugs.

A very good policy document was proposed by the Labour Party and Fine Gael some months ago and I ask the Government to study it. Those proposals represent a way to help the people affected by suicide.

Photo of Cecilia KeaveneyCecilia Keaveney (Donegal North East, Fianna Fail)
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I am delighted to contribute to this most important subject. I am sure many other Members will take the opportunity to add their voices to an issue that should be of great concern to us all. Based on the statistics, I am sure all Members have been touched by this issue in their communities. I endorse the compliments that have been paid to Deputy Neville for his work in this field. We both attended a conference on suicide in Bled, Slovenia, some years ago. Whatever knowledge I had before going there, after two or three days when every aspect of the subject was outlined, I came back much more aware and also horrified.

Since then the committee of which I am chairman has issued a number of reports, including ones on cannabis use, cocaine use and music therapy. We issued a report outlining why alcohol should be included in the substance misuse strategy. Throughout this work, suicide is repeatedly mentioned. Suicide is associated with alcohol and drugs. Potential help is available through non-verbal artistic therapy interventions, although I will not suggest it as a be-all and end-all.

I accept the Minister of State has a great interest in the mental health sector but he should note it is the Cinderella of the health services. The pressures of life, including the speed of life, depersonalisation and relocation without the backup of one's family, are such that we have become a "mé féin nation". The "mé féin nation" is one in which people no longer have the support mechanism of normal conversation, which would normally work out many of the problems stored in people's heads. When problems are stored in people's heads, they feel over time they cannot live with them. Ultimately, through one mechanism or another, they commit suicide.

The successful economy has not helped, which is a terrible thing to say. In a successful economy, we should prioritise the difficulties that arise. In a successful economy people have more money, the pace of life increases and the amount of recreational time available to one decreases. There should be an associated move in the health system to deal with prevention and interventions that are specific to the mental health sector.

We have considered the issue of alcohol. In spite of having created a report, listened to evidence and read the papers, we need to address certain anomalies. The headline of a recent article in the Irish Examiner reads, "Alcohol abuse is Europe's 'third biggest killer'". The article states: "The commissioner will not propose any legislation at EU level but says the member states should enforce their existing legislation better and learn from one another's successes." This is a case of the Commission abdicating responsibility. We are told in Ireland that we cannot deal with alcopops, for instance, because they comprise an EU issue, yet the Commission is saying member states need to deal with the problem themselves. This matter requires redress.

A recent headline in the Irish Independent reads, "Booze-saturated Ireland at top of alcohol abuse poll", and the subheading states, "Politicians failing to tackle binge-drinking epidemic, warns expert". The Joint Committee on Arts, Sport, Tourism, Community, Rural and Gaeltacht Affairs produced its own report which recommended that alcohol be included in the substance misuse strategy. This is not to say every suicide is linked directly to alcohol, but it should be noted that some of those who were half-considering suicide were egged on to do so because alcohol broke down their inhibitions.

The joint committee produced a report on cannabis. Representatives of the committee were in New Zealand where cannabis use is epidemic. In Ireland certain individuals scoff at our being worried about a drug as "soft" as cannabis. Anybody who believes it is "soft" should read our report. Not everyone who takes cannabis will end up psychotic, committing suicide or in desperate circumstances. The problem is that the cannabis on the streets is stronger that it was in the 1960s during which time the people contending it does not present a problem may have been using it.

It is a fact that people are starting to use cannabis at a younger age than was the case in the past. They are starting to use it between the ages of 12 and 20. Anybody who knows anything about the drug will know that one's brain is only forming in these years and that the drug distorts its capacity to develop. When young people taking cannabis reach their mid-20s, they present with psychotic illnesses. We all know schizophrenia and such illnesses can only be controlled and never reversed. We are letting this happen and allowing people to become more vulnerable to the threat of suicide.

There are very many car accidents on our roads at present. One question that remains to be answered concerns the percentage of accidents involving just one driver that result from suicide. Is it more acceptable for one to have died in a car accident than to have committed suicide? This question raises a scary issue. We all know a car can be as lethal a means of taking one's life as any. Suicides contribute to some of the road deaths we hear about on the news on a daily basis.

Music therapy and arts therapy have become a bit of an obsession with me. Deputies were asking what can be done in terms of therapy. In many cases, a person with suicidal tendencies may be very lonely or may have been abused and his or her ability to communicate with others may have broken down. In the main, if people were able to communicate with each other, they would not be forced to take their own lives. We need non-verbal forms of interaction and intervention and one such means is the creative arts. Recommendation No. 4 of the joint committee's report on this matter, which was released in September, is that the Department of Health and Children should recognise the inclusion of creative therapies in mental health policy, develop a strategy as a matter of urgency to define creative art therapies and recommend how service providers in the Health Service Executive can employ professionals in this field. I have had a huge reaction to this report from people on the ground who are dealing with individuals with mental illness.

Practitioners are saying creative therapy does work. It is therefore time we defined it, put it on the professional payscale and rolled it out around the country. If it were defined and recognised professionally, there would not be a haemorrhaging of graduates from the University of Limerick to the North and other destinations across the world. They would be able to remain in our system. Why are they not considered in the same way as occupational therapists, speech and language therapists and physiotherapists? They are as important.

Our problem in Ireland is that, owing to the pressures success has exerted on our lives, we have great difficulty in making time for recreation and for maintaining our mental health. People are like swans in that they are paddling like hell underneath the water while maintaining a calm image above the surface. They are trying to present a normal image while trying to cope with the many pressures in their lives. We must focus in these years on reacting to the reality of life and this means putting mental health services centre-stage rather than regarding them as the Cinderella of the health service.

Photo of Ruairi QuinnRuairi Quinn (Dublin South East, Labour)
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I want to contribute to this debate because of the lack of information and awareness regarding the level of suicide and its impact on those who are sadly bereaved as a result. I, too, pay tribute to Deputy Neville, who, within the Oireachtas, has been to the forefront in trying to raise awareness of the problem. We have all been affected by suicide in some way or another. We know of victims and their bereaved families in our constituencies and we ask ourselves whether we could have done anything before they took their lives. As Deputy Keaveney stated, there are deaths in suspicious circumstances, such as inexplicable car crashes, on foot of which people ask whether the victim was unhappy or committed suicide. We ask ourselves what can be done about the problem.

It would come as a great shock to the vast majority to learn that more people are killed by suicide than in road accidents. Most people take the view that road accidents account for many more deaths than other tragedies. It puts the issue in context to learn that, over the past year, there were 11,000 admissions of individuals engaging in suicidal behaviour to our accident and emergency wards. These figures must be publicised because we all know the Minister of State will not receive the budgetary allocation set out in the recommendations unless there is greater political awareness among citizens and politicians, irrespective of the party to which they belong.

It does not come as a surprise to some people that our recent economic success is one of the reasons for the increase in social alienation. However, it strikes those who thought money would solve all our woes as something of a contradiction. They do not understand why we are encountering new problems which are associated with a sense of alienation, for reasons which the report outlines in some detail, at a time when we are so wealthy, having been so poor.

I strongly suggest that the recommendations in the report, particularly those which involve a relatively small cost, should be implemented as soon as possible. I am most concerned about the extent to which counselling is made available to the survivors of a suicide. I refer to people who have to carry a sense of guilt, loss and hurt for the rest of their lives. An inexplicable burden is placed on such people in a manner that absolutely defies their attempts to understand it. They might have a sense of anger towards the person who took his or her own life. At the same time, they might have some sympathy or empathy with the fact that he or she felt the need to do so. They might also have a sense of guilt for not having been able to see it in advance. Such conflicting and difficult sets of emotions can affect the manner in which people interact with other members of the family, the people with whom they work and other members of society.

The Department of Health and Children should be concerned with health rather than with sickness. If we want to promote health, we should promote all aspects of health, including mental health. As Deputy Keaveney has just said, mental health problems will rise to the fore in our society as we increasingly solve physical illnesses with drugs, better treatment and better diagnosis. We should meet the cost of this problem in respect of the totality of human relationships. I refer not only to its cost in terms of economic productivity or personal happiness, but also to the social cost of people having to carry the burden of guilt, as they see it, and the dysfunctionality that flows from that. Many of the projects proposed in the recommendations in the joint committee's report would cost a relatively modest amount of money.

I am concerned about the phenomenon of suicide clusters, or copycat suicides. I do not know whether we have done much research in this area. I am not a specialist in the area at all. It seems to me, from reading the newspapers, that some inexplicable high-profile teenage deaths, particularly of young females, have been followed some time later by copycat events. We need more research about the factors which lead to such events so that people working in the education sector, youth counsellors, youth workers and parents can start to read the alarm signs and understand the warning signs which begin to manifest themselves in the behaviour of students.

I am delighted that this report has been prepared. I compliment all those associated with it, including the chairman of the joint committee, on its production. I hope that as a result of this useful debate, which is highlighting the problem, the Minister of State will be able to indicate to the House at some future stage the steps which will be taken, based on the report's recommendations, to help us to deal with some of these problems. We will not solve this problem — we will not be able to eliminate suicide — but we can certainly reduce the incidence of suicide. I accept that Ireland's suicide rate is the 18th highest of the 25 EU member states, but there has been a fairly dramatic increase. We have to start to address the alarming profile of suicide among young people in general, and young males in particular. In my experience, such events have a knock-on effect — they can have a terrifying impact on people in communities.

1:00 pm

Michael Smith (Tipperary North, Fianna Fail)
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I dtosach báire, tá mé buíoch as ucht am a fháil chun cuidiú leis na moltaí atá os comhair na Dála i dtaobh an ábhair thábhachtaigh agus uafásaigh seo — iad siúd atá sásta deireadh a chur lena gcuid saolta. I thank the Acting Chairman for giving me an opportunity to contribute briefly to this debate on the many proposals which have been made to deal with suicide, which is a significant problem in this country. Many families have suffered the loss of one of their own in this tragic and terrible way. I have often said — I could be very wrong — that there is really only one illness. I refer to an illness that cannot be seen or x-rayed and for which there is no explanation. The parents, brothers, sisters, sons and daughters who are left behind following a suicide receive lifelong prison sentences of guilt, anger and great anxiety. That suicide is the biggest killer of young people in Ireland — it takes more lives than accidents and cancer — is obviously something that needs to be addressed in a fundamental manner.

The Central Statistics Office has recorded that of the 457 suicides in Ireland in 2004, 189 were of people under the age of 35. That represents a decrease of 11% on the figure for 2003. However, 268 people over the age of 35 committed suicide, which represents an increase of 16% on the 2003 figure. A staggering 78% of those who died by suicide in that year were male and 22% of them were female. New research has shown that over 300,000 people in Ireland suffer from depression. One in four men and one in two women will suffer from depression at some stage of their lives. Other speakers have highlighted the number of people who are treated for deliberate self-harm at accident and emergency units.

I disagree with Deputy Gormley and others who have tried in some way to associate the development of the economy with the problems under discussion. The only way we can solve some of these problems is to dedicate resources to the personnel who are required to fill positions in counselling and psychiatric and general care. In a growing economy, such resources can be made available to meet the agreed priorities which need to be addressed in a dedicated and deliberate way. It is too easy to argue that these problems are created by the fact that people have jobs and are wealthier than at any time in our history. We are all familiar with the challenges which are associated with a developing economy. We have to cope, as best we can, with realities like the speed at which we have to travel and the competition in the world as a whole.

I represent the constituency of Tipperary North which, unfortunately, had the highest rate of suicide in Ireland in 2004. When I was sitting at a table in my local area with six people a few months ago, I learned that four of them had some family experience in this regard. That number has since increased to five, which is a staggering statistic that gives us a real sense of what this problem means to many families in a small area. Such clusters of suicides seem to occur in some areas following what might be called the first tragic event.

I am glad the joint committee's report emphasises the need for consultation with young people. It suggests that we should ask them about mental health services and service development. Deputy Keaveney rightly pointed out that in some way or other, we are not communicating with each other as we should, and as we used to do in the past. We are certainly more greedy, selfish and individualistic and do not consider what we can do on this issue through helping, discussing, listening and getting involved. If one was given a second chance to do something that could have stopped a suicide one would, of course, take it. Unfortunately we think of these things only afterwards.

The anti-stigma and positive mental health promotion campaign in the media and elsewhere is another important matter that must be dealt with. The secrecy has been removed, the walls have come down and many major institutions are no longer the places they used to be. Community development and support services have come closer to people's homes. The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, will understand that we in north Tipperary could use more help in this regard. We have nothing against our colleagues in south Tipperary but we must travel south for many services and more local support is something we wish to see as early as possible.

Much has been said about alcohol and mental illness but I wish to talk about helping people to cope. Alienation from society can happen early in the lives of some people and adult education and support from the Department of Health and Children can help broaden the circle of thinking how education and health integrate in such matters. Some people with hidden talents feel alone and miss out on the dignity associated with doing a suitable job to the best of one's ability. I have had the opportunity to present certificates relating to different courses to individuals who never thought they could achieve what they did. They have taken a step on the ladder and need to move on to the next, which requires encouragement. In this context, the community services the Minister of State and others are trying to develop to integrate these matters are significant.

It is hard to believe someone would commit this act if they felt they were wanted, had a purposeful life, and were able to achieve, join a drama society, join Macra na Feirme, Foróige and the various available activities. It is hard to believe that kind of involvement could lead to such an action. There are other cases involving alcohol and mental illness where different forces are at work, but this particular category needs inclusion. I ask the Minister of State to consider this in the context of deliberations with his colleagues and ensure the full circle is looked at. If we complete the circle we can begin to reach some of the targets all of us want to achieve.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I welcome the opportunity to speak on this debate and if we are in any way critical it is not to score points but to bring about a positive change.

Sinn Féin has identified suicide as a distinct priority requiring concerted co-operation between Government, the health service, the voluntary sector and communities. Our youth section, Ógra Shinn Féin, has campaigned on this issue along with other youth organisations. We have included suicide prevention as a key element in our health policy, Health Care in an Ireland of Equals, and many of our proposals are echoed in the report under discussion.

We propose to make suicide prevention an area of co-operation under an all-Ireland ministerial council to give the issue the strategic co-ordination it requires. Suicide does not recognise borders and people in both jurisdictions should address the issue. We also aim to frame and implement a fully resourced, comprehensive, all-Ireland suicide prevention strategy including actions to promote mental health among the general population delivered through schools, youth services, work places and the media. We propose mental health promotion actions targeting specific sections of the population incorporating diverse needs into tailored suicide prevention sub-strategies. We also propose mental health promotion and suicide prevention actions targeting groups identified as at higher risk along with actions to assist individuals identified as at risk of suicide. We propose actions to assist those bereaved through suicide and investment in further clinical and community based research on suicide prevention. We aim to develop national mental health awareness and anti-stigma campaigns and would include parasuicide, people at risk of suicide and their families and bereaved families in policy making issues.

I am a patron of a group in my area called Teenline and, like many Members, I became involved through knowing individuals and families who have suffered through suicide. In Teenline we identified that while there is sex education and drug awareness in schools, education on this issue would also be beneficial. The Minister of State mentioned an outreach campaign and I have spoken to outreach workers on this matter and it was felt that it could be helpful. I spoke to a woman whose son committed suicide, an event which led to the creation of Teenline, who went to schools and talked to young people in their classrooms. She said afterwards two children thanked her, said they had seriously considered suicide and that she had made them think. She explained the effect the suicide had on her family, friends of the family and the community as a whole.

There is an argument that bringing the issue into schools only encourages young people to consider suicide. The same might be argued about sex education and that, similarly, would be nonsense. This also goes for drug awareness. Drugs are available in most villages and towns and making people aware of the harmful effects that go with the pleasurable ones is necessary. Discussions on this issue should be taken into schools. A previous speaker referred to accident and emergency departments. I raised this yesterday at the HSE meeting for the Leinster and Dublin areas. Part of the message we are trying to deliver is that help and services are available for young people if they want them. I spoke about an outreach worker who had talked to a young person online and through Teenline and then brought this person to Tallaght Hospital. However, when this young person was brought to the hospital he had to wait along with everyone else in A&E; there was no separate room that this young suicidal person could be brought to. The health system needs to recognise that advocates trying to help suicidal young people are part of the overall service, especially if they have developed a rapport with the young person. At the meeting yesterday, the HSE recognised this was needed. When will this be put in place? I urge the Minister of State to act on this urgently.

The Minister of State referred to funding for suicide prevention programmes arising from the dormant accounts fund. This funding is welcome and it will help the groups that receive it. However, many of the groups working in this area rely primarily on voluntary contributions. We must move away from this and provide mainstream funding. There must also be appropriate training for the volunteers who will work in these services.

We must also encourage rapport between the different groups active in the area. There are groups in Belfast, Cork, and Dublin, and around the island. Best practice should be encouraged and greater rapport between the various groups would assist in this. The Minister of State referred to the number of young people who are affected. He said 11,000 young people cause themselves deliberate self-harm annually, and that Ireland has the fifth highest rate of suicide in the EU for 15-24 year-olds. The rate is even higher for men in their 20s and 30s, with men under 35 accounting for approximately 40% of all suicides.

Some weeks ago I spoke with the family of a young man who had found a suicide note which referred to bullying in school. One can imagine the impact this had on the family. They had been in touch with the school where the young man was being bullied, but no action seemed to be taken and the bullying continued. They later found the letter and the school was horrified. Schools must give an adequate response if young people are being bullied.

I look forward to the Reach Out campaign the Minister of State referred to and the actions that will flow from this debate.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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I welcome the opportunity to contribute to this debate. I compliment everyone involved in producing this report. I am not expert in this area. Like many Members, I look up to people like Deputy Neville and others who are experts and try to learn from them. We also try to learn from our friends and families — every family has been touched by suicide or mental illness.

Speaker after speaker has said how knowledgeable Deputy Neville is on this subject. Yet, if Deputy Neville were to introduce a Bill dealing with this, it would probably be voted down by those on the other side of the House. We should forget about politics and do what is right when it comes to an issue such as suicide prevention. If we can learn from each other then let us do so. I believe the Minister of State and many Members of the House have a genuine interest in this subject. If we believe Deputy Neville and others are so knowledgeable on this subject, then let us listen to them and do what they say. While I accept that politics will intrude in other areas, it should not intrude in an area such as this.

Previous speakers have compared the incidence of suicide with the level of death on the roads. They have contrasted the support and funding suicide prevention gets with that of road safety. There is also the issue of public perception. People are often angry over road deaths. The number of people dying on the roads is rising and its gets much publicity. The number of people dying by suicide is much the same but it does not get nearly as much coverage or provoke anger. People believe that most road accidents can be avoided, that accidents can be prevented and people do not have to die. This is a source of the anger, and we tackle it with more funding, public awareness campaigns etc.

People do not perceive suicide in the same way — they do not think it is preventable. Most people assume suicide will happen no matter what we do or how much money we spend on preventing it. That is not true. People need to realise that suicide can be prevented in many, but not all, cases. The public should have the same anger over suicide as it has over road deaths. If this anger existed, people would demand better services, more funding, and demand that the Government tackle it. We have an onus to lead the public and seek their help in tackling the problem. The message that suicide is preventable needs to be articulated.

Earlier this week I spoke about young people and their attitude to driving. They do not believe that an accident can happen to them. They believe they have the skills to drive at 100mph and not crash or kill someone. We are failing to get the message across to young people and others who drive recklessly that it can happen to them. The same applies for suicide. We need to let young people know that this can happen to them, their friends or their family. Young people who abuse drugs or alcohol do not believe they will become addicted. They do not believe that dabbling with drugs will lead to problems in five or ten years' time. Just as we are failing to get the message across in the areas of road deaths and suicide, so we are failing to get this message across too. Perhaps it is on this we need to hone in. How do we get through to young people? How can we talk to them on their level? I am a young person and suicide affects a high percentage of my age group. We will need a strong effort to put the message about suicide across.

When one asks young people about the problems of suicide and what the solutions are, they will talk about simple things. They seek counsellors in their communities and schools. Many schools have counsellors, or have access to them if they require, but young people do not believe they have someone they can talk to and seek advice from. While one can often talk about the roles of parents and teachers, we must accept that life is not the way it once was. Parents do not always have the time or understanding to give to their children. There must be someone in the community that young people feel they can talk to.

The community has a major role to play in preventing suicide. I was struck by a comment the parish priest made when the five young girls were killed in the Navan bus crash. He said it takes a community to raise a child. That is what we forget these days. The community is dwindling and the community spirit we once had no longer exists to the same degree. Not everyone is involved. Years ago there was time to look out for young people growing up, to keep an eye out for them. The same support structures no longer exist. Sadly, that is how life is in many areas and we must try to rekindle that spirit. We must also provide more services to lend a listening ear to people who need help.

I welcome the report and its recommendations. Many of them involve listening to young people about their concerns related to mental health. We must not, however, spend too long listening; we know what the issues are. Young people have spoken to us all, the message has got through and the experts are aware of the problems. We must act as well. People talk about pilot programmes but I have a problem with them. We have all the research from various countries and we know what is right. We should just act. Pilot programmes are a delaying tactic. We should put the money in place across the board. If a pilot programme is needed in County Meath, it is needed everywhere else. We can learn from Canada, Australia and other countries that have been successful in tackling this.

Suicide is a major health concern for Irish youth and we must tackle it. I have been to enough funerals of young people who have taken their own lives, I have seen the horror and trauma it causes for their families and their communities. We have all experienced this but we still do not do enough to prevent it. We must wake up and do our best to stop this.

Suicide is not a disease in itself, it is the most traumatic, tragic and unfortunate symptom of a major illness in Irish society, the lack of care and regard for our fellow man and woman, and the lack of a joined-up society populated by fully rounded and mentally healthy people. This is caused by pressures of life and modern society, an education system that puts pressure on young people, bullying and intolerance.

It is important that mental health is not confused with mental illness. Mental health involves the whole person, how he feels about himself and interacts with others. It is important to have friends, good relationships at work and mechanisms for coping with the stresses of life. We must realise that we are not all perfect. Young people are under pressure, they do not feel they are perfect but think they should be as a result of the messages from the media. Parents are often not in a position to offer the necessary gifts or powers to their children to help them to deal with these issues. We must help. In many cases, parents say they would like to attend parenting courses. A person who wants to adopt a child must undergo an 18 month course but can have a child without any advice, lessons or counselling. It is time to examine this area. Are all parents equipped with the tools to pass on to their children what they need?

I am not here to blame the Government or the HSE, we must all do our part. The community must be empowered to act and given the necessary resources. We must put community spirit at the centre of planning and development so that we develop areas where people can grow up with the necessary help and where they do not feel they must all be the same. Pressure to conform and do well can cause serious problems.

Assist in Newfoundland and Mental Health First Aid in Australia are successful courses. Those dealing with potential suicide victims or others with mental health problems find these courses useful for identifying and preventing problems. Frontline staff across the board in health and youth services should be able to attend such courses to better equip them to spot potential problems.

We can continue to talk about this but we must act to prevent any further increase in the numbers of those who have decided to take their own lives for various reasons. Many of those reasons can be addressed, just like with road deaths.

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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I welcome the opportunity to contribute to this debate on the high level of suicide in Irish society. We all have friends, neighbours and family who have been directly affected by this sad situation. It is a nightmare for everyone, the person and his or her family. It seems to be getting worse in spite of all the wealth and extra resources in modern Ireland.

Suicide prevention starts with us, we are all part of the problem but can also be part of the solution. We must look at ourselves and ask if we are listening to each other enough. Are we paying attention to friends, family, neighbours and the community? We live in a fast moving age where everyone is busy and stressed. Is there a need to be so stressed and busy? We must pay more attention to people at home, in our jobs and in our local areas as part of the preventative strategy for suicide in this country. I commend those families and carers who have done a lot of good work in this area, particularly those who support young people.

More than 11,000 cases of deliberate self-harm were seen in accident and emergency wards around the country in 2004, with many more cases coming to the attention of other sections of the health service. This is the reality in Ireland in 2006. Each case is complex and involves many issues but a clear strategy is needed and when it is not working we should be brave enough to admit it and to look for new solutions. This is too serious an issue to turn a blind eye to and I urge the House to unite on this issue and deal with suicide in a balanced and measured way.

People who were abused as children make up many of these figures. They are seriously damaged, with dark, hidden secrets. Often they do not declare their abuse until they are in their 30s. I have met many of them in constituency clinics. We must face up to this because the connection between abuse and suicide is clear. Bullying of young children in schools can also lead to suicide later in life. A good teacher can do a lot by watching children, dealing with bullying and addressing the harassment of children in schools who feel the world has turned its back on them.

Elderly people are suffering from depression, feeling that no one cares about them. When doing constituency work during the summer months, I often see elderly people cowering behind locked and bolted doors, afraid to answer a knock for fear of intimidation. They are trapped in their own homes and society must face this.

Other Deputies have mentioned drug abuse. I have been involved in anti-drug campaigns and have had to attend the funerals of many of my past pupils and have seen others end up in Mountjoy Prison because of drugs. We must ask, however, how they were sucked into this as children. It was usually as a result of low self esteem and problems in their personal and family lives. If we do not identify those children, and help them at four, five and six years of age, we can forget about them when they are 12 or 13 because we have already lost most of them; the damage is done. They will look for a buzz that will make them feel important and happy, hence the huge market for drugs. The children I describe are drawn from the thousands of dysfunctional and crisis families, many of which are violent. That is the drugs connection and it must be addressed on the ground.

We must also challenge well-off young people from middle class areas who work in high profile jobs and take a little cocaine at the weekend. They are part of the problem because they create a market for these types of drugs. It is unacceptable that people take cocaine at the weekend and go into their nice, yuppie jobs on Monday morning. It is unacceptable that Donna Cleary was sprayed with bullets in my constituency. There is a connection between violent crime and cocaine and drugs, low self-esteem and suicide.

It is important to note the facts and figures. Every year, approximately 450 people die as a result of suicide and the figure is increasing. I commend the Joint Committee on Health and Children for its work in producing this report and compliment Deputy Neville on his excellent work in this area. The report proposes many constructive, sensible solutions and politicians have a role to play in implementing them.

The Celtic tiger has created a society which moves so fast that a section of our population is overlooked. This brings to mind the words of the famous French sociologist, Emile Durkheim, who, addressing this topic in the 19th century, wrote: "Man is the more vulnerable to self-destruction the more he is detached from any collectivity, that is to say, the more he lives as an egoist." We must tackle the spiritual void at the heart of Irish society which is producing a form of escapism that leads to drugs, binge drinking, violence and suicide.

I commend those on the ground who have produced serious strategies and policies to address the issue of suicide in our schools. In many cases, part of the solution for a child from a dysfunctional family can be the support given by a primary school teacher or classroom assistant. Being available when needed often means deciding not to send a child home from school at 3 p.m. to face a crisis in the family home but instead keeping them in school and involving them in art, sport or music projects. This type of approach generates positivity and helps address low self-esteem.

Tragically, as several speakers noted, the suicide rate among males here is among the highest in Europe. While the economic boom has brought many fruits, it is dawning on us that growth for growth's sake may not sit well with a caring and inclusive society. Politicians, as leaders, must address this issue. Given the financial resources and income available to us, there are no acceptable excuses for leaving people behind. How should additional resources be distributed? The Government will have to face up to the fact that they must be allocated to the most needy because this is part of the solution. We cannot allow the people of whole areas to feel completely excluded. If intimidation is widespread on estates or blocks of flats in various parts of Dublin, Limerick, Cork or Galway, we can expect that some of the residents will suffer from depression and low self-esteem and believe the State does not care about them. This fact is part of the broader social debate which must be faced if we are to effectively address issues such as suicide.

While I have focused on young males and suicide, young females and elderly people are also vulnerable. I hope a sub-committee on the high level of suicide in Irish society will be established, as recommended by the Joint Committee on Health and Children's report. I commend Deputy Neville and many other Deputies for focusing on suicide. Irrespective of political differences, Members must come together to adopt sensible policies to address the problem. We must wake up and smell the coffee because it is unacceptable that 450 people are dying as a result of suicide every year.

Insufficient attention has been paid to the connection between child sexual abuse and suicide. The first question I often ask victims and survivors of this form of abuse is why they did not tell people what had happened to them earlier. The response is always mixed. They say they were afraid to do so, felt guilty or believed it was their fault. This frequently results in the victim suffering from depression and other problems. We must tell the victims of child sexual abuse that they are not at fault and the community wants to help them. Many groups and organisations are doing a great deal of work on sexual abuse. We must expose this problem, which persists in many of the large number of dysfunctional families in our community. Those who have been directly affected by childhood sexual abuse are familiar with the hardship associated with it.

This is an important debate and a wake-up call for us all. We must address the tragic crisis of suicide by adopting sensible policies in the areas of prevention, education and families. I do not use the word "crisis" lightly in the House but the situation is serious. The Minister of State, Deputy Tim O'Malley, has some sensible ideas and Members will support him, the HSE and all those on the ground who have a genuine interest in taking action to prevent suicide. The onus is on us all to do something.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I welcome the opportunity to say a few words on the seventh report on the high level of suicide in Irish society. In common with other speakers, I am not an expert on suicide but, like them, I have dealt with scores of constituents whose family circle has been touched by the problem. We have all been contacted by people who are in distress for one reason or another.

I acknowledge the tremendous work done by my colleague, Deputy Neville, in pursuing the causes of suicide in an effort to prevent suicide and highlight those who are vulnerable to it. We all owe him a debt of gratitude. It is no harm to discuss the causes of suicide. Internationally, the number of suicides appears to track the number of deaths in road traffic accidents. This trend suggests that the level of development and affluence in societies may be a contributory factor.

We would learn a great deal if we could ascertain what drives people from depression into despair. We have all known people who have become depressed. It could be due to failure in an examination. Consider the pressure on young people in second level schools studying for the junior certificate and leaving certificate. That continues later in college.

Society has become extremely demanding and aggressive. It has set high standards and we must aspire to meeting those standards. However, not everybody in society is capable of keeping up with the pack. There is a tendency for people in that situation to feel squeezed out and incapable of ever achieving a degree of fulfilment. When it reaches the stage that they get the impression, wrongly, that they cannot reach the degree of fulfilment which they believe others have, the depression becomes despair and they move on.

Young people need an anchor; they need something in society that is solid, that they can identify with and that they believe will give them encouragement and security regardless of how they measure up. This is most important. Several speakers have referred to bullying in school. It is an important issue and not enough is done about it. I have raised the issue many times in the House. There is a failure to follow up on bullying by reporting, recording and identifying it. Each school has its own way of dealing with the matter but that is not the solution. There should be a co-ordinated reporting system, whereby an investigation is undertaken into the causes. We must try to put ourselves in the shoes of a school child who has been the victim of bullying and consider the isolation, fear and absolute depression that must haunt that child.

Speakers have referred to teenage suicides. We have an extremely aggressive and impersonal society. Oddly, when there was no affluence in this country, its society was inclusive. We shared what we had with each other. That is not so easy now. A different society has emerged. It is an aggressive society with a hard edge. This is encouraged in many quarters as being necessary to succeed economically. That may well be the case but people have succeeded economically previously without excluding others.

I recall being a member of the health board some years ago. On the retirement of a matron of one of the much maligned rural hospitals we were asked to say a few words about her. At the time, the most important feature I could discern was that she brought a personal touch to an impersonal world. This was some years ago. She was an anchor for people. She always had an encouraging word for everybody. Instead of breaking down the character of a person or creating further doubt in their mind, she had the ability to say something or relate to them in such a way that they felt better. That is the best thing one could say about a health care worker.

Alarmingly, almost 75% of suicides are young males, yet more women suffer from depression. Approximately one in four women is affected by it. There is something wrong that we have not yet identified which causes the depression to progress to despair and leads to a person taking his or her life. We are familiar with the many current descriptions of society — the ready-made society, the disposable society, the customer-driven society, the consumer society, the oven ready society and so forth. If everything does not fit in properly, a problem arises.

Perhaps we should not be so keen to assure the young generation that everything will be provided and that the highest standards will always prevail. Our generation did not have a great deal but we were willing to share it. The trend now, however, is that when young people are faced with an obstacle in their life, they do not appear to have the ability to cope with it. At that stage, sadly, the depression becomes despair. This is a situation society must address.

All Members have dealt with cases in their constituency involving suicide. They are very sad cases. In most cases the psychiatric services have engaged with young people, particularly in second level institutions. However, if one offers one's assistance, advice or local knowledge, one will be quickly told it is a confidential matter and that one is not competent to discuss the issue. It is about time that this sector of the health service got a rude awakening. Local elected public representatives are, in many cases, in possession of far more information than somebody who graduated last year and has suddenly become an expert. I have been in this situation on more than one occasion. At this stage of my life, I am tired of being told that something is so confidential it cannot be discussed with me. That is a clear sign of an insular attitude, which is bad, defeatist and self-serving.

The degree to which there are vocations in society is not nearly as great as it was previously. That applies to all professions, including our own. In the past, the aim of helping others was the biggest single factor in convincing people to put themselves forward as public representatives. That is no longer the case. There is ample evidence to suggest that more and more people who come into politics see it as a job, and that at a certain time of the day that job switches off. Unfortunately, that is not the case. A time will come again when people will realise that a vocational commitment in the vital services is critical for service delivery and fulfilling the expectations of the individual. Society must become more inclusive and more supportive of individuals. It must be more willing to recognise that just because people have more money, they cannot afford to be in the fast lane all the time without negative consequences.

Mention must be made of drugs and drink. We have all met people in the aftermath of indulging in drugs and drink who are in a serious state not just due to hangovers but also to depression. I do not know the answer to this problem. We talk about the need for less consumption and less dependence on drink. Undoubtedly, there is a growth in the consumption of the shots youngsters drink nowadays to reach a certain level of inebriation in the shortest time possible. When I was young it would take a week to consume sufficient alcohol to produce the same degree of inebriation as can be achieved these days in half an hour. There is a vast difference now in the degree to which a person is prepared to achieve a colossal level of inebriation by pumping hard drink into his or her system to achieve that level quickly. There is no question of them drinking pints of shandy because they would not get drunk very quickly if they did so.

We must consider the position vis-À-vis the club scene. People involved in the latter appear to engage to a major degree in "topping up" before entering a club or while they are there. The club scene carries on beyond the normal pub closing time. In many cases, colossal amounts of alcohol and drugs are being consumed on a nightly basis. This can have nothing other than a serious impact on the stability of those who are consuming them. If any Member consumed such an amount of alcohol or drugs in one day or during a two-hour period at night, he or she would not be able to work the following day.

I was a member of a health board when the major psychiatric hospitals underwent a massive change, namely, that of closing down and engaging in a changeover to community treatment. That was a great development. However, at the time I stated that the support required in the community in this regard would have to be of a good standard. That support is not as good as it should be and that is one of the main reasons certain people are, to a large extent, floating along from day to day. Careful consideration must be given to that matter.

2:00 pm

Photo of David StantonDavid Stanton (Cork East, Fine Gael)
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I am sad about the necessity to address this issue. I pay tribute to the joint committee and the author of the report, which is short, to the point, easily read and brings forward 33 recommendations that will cost €60.09 million. Will the Minister of State communicate with each Member and indicate what will be the Government's reaction to each of those recommendations? He stated that the Government will spend €1.2 million on suicide prevention initiatives this year. The report calls for €60.09 million to be spent. I accept that there are various overlaps, but we must be clear on the areas of the report that will be addressed by the Government. We must be informed as to how much will be spent in each area and when such spending will take place. I call on the Minister of State, when replying or at a later date, to indicate to Members what will be the Government's exact response to each of the 33 recommendations.

I am pleased that the Government, as the Minister of State indicated, has accepted the recommendations in the report. Does that mean they will be implemented? It is crucial that they should be implemented. We need to be informed as to the timeframes and the details involved in respect of each of the recommendations.

I worked for many years as a counsellor in a second level school. I dealt with younger people on a one-to-one basis in that capacity. It is important that counsellors are available to young people in our schools. On previous occasions in the House, I have referred to the position of career guidance counsellors. Emphasis is often placed on the career guidance side of their work. In the United Kingdom, however, the job has been split and there are now career officers and counsellors. Students often approach the relevant teachers under the guise of seeking career guidance advice when they really want to discuss a problem with which they are faced or a feeling they are experiencing. In such circumstances, a skilled counsellor will be able to identify that something is not right and will know what questions to ask. He or she will know how to refer the person with the problem on for further help. It is important that there should be a place to which such individuals can be referred.

I received calls from general practitioners in my area who indicated that, until recently, there were no beds available for young people who were at risk and who required psychiatric placements. I discussed this matter with the Minister of State in the House on a previous occasion. I am pleased that the HSE has some plans to provide beds for people in the 16 to 18 age group, which is crucially important.

The town from which I come, Midleton, County Cork, experienced, until approximately 18 months ago, an alarming incidence of suicide among young males. For a particular period, there was, on average, one suicide a week. In many of these cases, alcohol was a factor. We know that this is a complicated matter and the literature indicates that many reasons are put forward in respect of it. The list of such reasons includes mental disorders, mood disorders, unipolar depression, substance misuse disorders, personality and antisocial disorders, anxiety disorders and schizophrenia. It appears, however, that among adolescents depressive disorders, substance misuse disorders and conduct disorders play a crucial role.

I want to focus on the issue of substance misuse disorders, particularly as they relate to alcohol. Many of the people in the area I represent who committed suicide were, to a high degree, under the influence of alcohol either when or shortly before they took their lives.

I have stated on many occasions that we need to take a long look at our society and the economy we have created. Members are aware that there are housing estates in this country which are nothing more than concrete wildernesses and which have no social centres. Hundreds of houses are being built but places for people to meet and socialise are not being provided. I have continually called for the Government to provide leadership on this issue and to insist that social, community and youth centres and youth workers should be provided. However, the latter is not happening. We appear to be more interested in the economy than in society. We must reverse the position in that regard.

I have been informed by young people that at night they walk up one side of the street and then down the other because that is the only place they can meet their friends. They have nowhere to go and nothing to do. They are merely waiting until they reach 18 years of age in order that they can gain entry to pubs. They informed me that they ask other people to buy alcohol for them and then go out into the fields or down alleyways to consume it. This matter must be addressed. We need to employ youth workers who can reach out to young people who are at risk, but this is not happening.

Bullying is an issue in schools, in the workplace and elsewhere. Both the bully and the person who is being bullied are at risk. We must also give consideration to aging white males. None of us white males can prevent ourselves getting older. Reference was made to the work of Durkheim and his theory of anomie which refers to people's sense of hopelessness and detachment from society. We know that this is relevant to any discussion on suicide.

We must take action in respect of firearms. We need to encourage people who own firearms for recreational purposes to keep them under lock and key and to make them unusable. At times it is not good enough to keep them under lock and key because the keys can be found. I have had personal experience of this. The word must be put out that firearms need to be locked up and disabled in some way.

The report also mentioned the importance of support for those bereaved by suicide. In his response, the Minister of State said that we need to carry out more research. The report recommended a target to reduce the overall suicide rate by 20% by 2016, but the Minister of State said that this cannot be done straight away because the priority is to establish the accuracy of suicide mortality in Ireland. Nonetheless at the beginning of his speech, he outlined the problems that exist and how many deaths by suicide had occurred. He also said that due to the range and interplay of factors that had influenced the suicide rate, a direct cause and effect in the relationship between preventative programmes and a change in the overall population rates is virtually impossible to establish. I hope that this is not some form of cop-out because that would be terrible.

Recommendation No. 15 of the report states that the recommendation of the Inspector of Mental Health Services must be implemented within a five-year period of his or her report, or a resignation of the inspector or the Minister with responsibility for mental health services should be a matter of course. The report effectively states that if the recommendations of the Inspector of Mental Health Services are not implemented, we should see a resignation from the Minister of State. It is that serious. That is why targets are important and must be set. If targets are set, as is the case for accident and emergency departments, all the agencies will move to address those targets.

Is the rate of suicide underestimated in our society? We only know of a certain number, and Members have mentioned single occupancy road deaths at night. We need to have people trained in order that others can approach and talk to them. There is a very interesting project in Midleton which involves the development of peer counselling and it seems to be working. Young people are trained in listening skills, which is not easy. When they are out with their friends they listen to what they say. If they hear someone say that life is not worth living or wonder why he or she gets up in the morning, they will pick this up straight away and ask how the person is feeling. They try to identify whether there is an issue. A young person in a training network who discovers that one of his or her friends may have an issue can help that friend seek assistance. Counselling, psychological and psychiatric services must be made available at the level needed and it is crucial that they are available straightaway.

I compliment the Minister of State on being here today for this debate. I am a bit disappointed that none of his senior Cabinet colleagues has come in to lend the weight of the Cabinet to this issue. I would have been happy if the Taoiseach, the Tánaiste or the Minister for Health and Children came in to address this issue because it is so important.

Photo of Aengus Ó SnodaighAengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Ba mhaith liom buíochas a ghabháil as an deis labhairt ar an gceist rí-thábhachtach seo agus comhghairdeachas a ghabháil leis an gcoiste as an tuairisc áisiúil atá curtha ós ár gcomhair, agus na moltaí atá sa tuairisc sin. Tá na moltaí réasúnta, agus is féidir linn, mar shochaí, díriú isteach orthu agus déileáil leis an gceist thábhachtach seo, ceist a chuireamar ar leataobh thar na blianta, agus is trua é sin. Tá muintir na tíre seo go ginearálta, agus daoine óga ach go háirithe, ag fáil bháis trí fhéin-mharú. Tá a lán daoine eile istigh in oispidéil ar feadh tréimhsí gairide agus fada toisc iarracht a dhéanamh ar fhéin-mharú. Tá a gclann acu, agus tá siad fágtha ina ndiaidh.

I was impressed by the list of those who gave evidence to the committee and those who made written submissions. A wealth of knowledge was expressed in the committee's report. If we cannot listen to what the committee has to say, we should listen to those who have tried to commit suicide and those who have inflicted harm on themselves. They are crying out for help. As a society, we need to look away from the materialist culture that has developed in recent years. We are all in a rush and we forget the basic steps that we must take as parents, friends, adults and young people. We must listen to each other and take the time to find out what is wrong if there is an indication that something is wrong. Too often, people have not taken the time to listen.

I commend the report and hope the Government will provide the required resources to deliver on the action that the committee has set out. In many cases, the committee has done our work by telling us how much its recommendations would cost. In many cases, the cost is minimal, and if it saves just one life then it is money well spent. This was the hidden history in Ireland for years. We now have an opportunity to speak about it and we need to address it. We need to give much more attention to this aspect of our society.

A helpline was set up a few weeks ago for teenagers in Ballyfermot who feel depressed and that they need somebody to whom they can talk. That action must be commended and I hope it can be extended to other areas around the country, especially those areas which are suicide blackspots. The money should be made available for it. The Minister of State noted that €1 million from the dormant accounts fund was allocated to 20 projects that provide suicide prevention supports. That must be doubled, trebled or even quadrupled. It is within the community and within families that many of the suicides can be prevented. This is where the additional supports and training are required in order to recognise the telltale signs and help address this tragic problem in our society.

Only two weeks ago my own children's football training was held up because a young man had committed suicide on the grounds. This was harrowing and tragic for the victim and for his family, but those who suddenly became aware of the suicide were also victims such as the young kids who saw what had happened the night before.

The figures provided by the Minister of State may be an under-estimation but they are the statistics with which we must work. They stand at more than 400 a year for a number of years. Every year, 400 families are suffering the tragic consequences. This takes its toll on parents, siblings, friends and acquaintances of the victims, whether young or old. It is not bound by any class but is something which affects all people on this island. As we are an island nation, there is a need to address this problem on an all-Ireland basis. We need to make the links with those in the Six Counties who are tackling suicide and trying to help prevent it. We must ensure the message goes out loud and clear that we are willing to listen as a society, that we are not too busy with our own work and trying to make ends meet to take the time to listen to those who are closest to us.

Simple steps can be taken. One of the first matters I raised in this House on being elected was the issue of the Ballyfermot health centre. People with mental illness are expected to go to this centre for support and help. The building is a living disgrace. It would do nothing to encourage those who are suffering from depression or other mental disabilities to seek help. It is like an old aircraft hangar and it has not been painted in God knows how long. It is dilapidated and damp and is not suitable for its current purpose. The reply to my query four years ago was that there was a plan to replace it. A plan is not good enough because there have been no moves to replace it and there is no plan in place. It will be another three or four years before that mental health centre and the problems it is facing will be addressed. I presume the same is true throughout the country.

The Minister of State is probably correct about the amount of money being spent on this sector but we also need to address the facilities being used. I hope the HSE will look at these centres because people with problems of depression are being encouraged to go to these centres to seek help.

Prison suicides make headline news more than the suicides of young people or of those who commit suicide in their own homes or elsewhere. In this day and age, prisoners should not be committing suicide. There should be adequate supports within the prisons. Prison officers do their best but more supports are obviously needed.

People in general must be proactive in their approach to suicide. If a suicide black spot is known within a community where there have been a number of suicides within a short period, we must ensure that the proper supports and professional staff address the problem within an area before it gets worse. It is the case that sometimes suicides happen in clusters, especially among young people who may believe they have no alternative but to take their own lives. The message must go out that there are alternatives, that it does not matter what mistake was made or what the problem is, and that society is willing to help them to try to rebuild their lives.

The reasons for suicide may include simple reasons such as a personal mistake or that a person does not feel strong enough to face up to the pressures of work or examinations. We need to ensure that we, as a society, do not impose those pressures.

Other speakers referred to the role of alcohol which is a significant factor in teenage suicide and in those who are no longer teenagers. We need to continue to address the effects of alcohol, including its depressant effect. I have called on many occasions in this House for society and the Government to take a harder stance on the drug issue and on the effects of cocaine in particular. Cocaine has led to a number of suicides in my area. The number of suicides in Dublin South-Central has increased each year. The community made efforts to establish the Teenline scheme which is now up and running.

We need to provide significant supports for those 12,000 people who committed self-harm and attempted suicide. I have visited a number of such people. In some cases, it was a cry for help because they thought nobody was listening while others believed there was no future for them. Thankfully, they have come through and rebuilt their lives.

It is not solely the duty of Members of this House, youth workers or those in the medical professions to be vigilant. Employers and employees need to be vigilant. Employers are too busy ensuring that profits are made and that there is compliance with health and safety regulations or with other regulations. They sometimes forget that they must look after the well-being of their employees. They need to ensure they understand the pressures being faced by their employees and that they are not put under undue pressure.

I commend the work of the committee. I hope that when the House returns to discuss this issue in another year's time, most of the recommendations will have been delivered by the Government.

Photo of Pat CareyPat Carey (Dublin North West, Fianna Fail)
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I thank Members of the House who have taken an interest in the issue, in particular Deputy Neville, who has been very helpful to me with good advice on how to approach this problem in my own constituency. I thank the Minister of State, Deputy Tim O'Malley, for his unstinting support for me and the area I represent at a time when we had a cluster of suicides earlier this year which I thought, frankly, would never end. Without the concerted help of his Department, I am not sure we would have been able to bring together a strategy which it is hoped will make a difference.

Earlier this year, in a part of my constituency of Dublin North-West, over half the bereavements at one stage were as a result of suicide. These were, by and large, young male suicides, some of whom I knew and whose families I know. One of the most harrowing and frightening experiences anyone can have is to get a telephone call about a death. However, getting a telephone call to say the body of one's son has been found hanging from a tree in a field in the middle of nowhere and wondering what drove that favourite son, who seemed to be perfectly well adjusted but for some reason took his own life, is particularly harrowing. That tragedy continues.

In the case of devastating tragedy, it is an appalling indictment of our system that it takes so long for an inquest to be carried out and for a coroner's report to be presented. Some families have small insurance policies on their children in order to pay funeral expenses. I recently heard of a strategy used by at least two insurance companies whereby a policy claim is refused until the family produces, not a death certificate or a coroner's report but a letter from a general practitioner to confirm that the deceased person was never prescribed medication for depression. This is appalling behaviour on the part of insurance companies and it should stop. When I intervened with an insurance company on behalf of one such family I was told to clear off and mind my own business. I was simply advocating on behalf of the family who had waited just short of a year for a coroner's decision and were then being put through the further harrowing experience of having to crawl to have their just entitlement paid to them.

Earlier this year I had a long involvement in helping the families of two young women who had been engaged, from time to time, in acts of self-harm. In these cases I found the psychiatric services wanting. Young adolescents are falling between the cracks of childhood and adult psychiatry. This observation is made in the report and has been made elsewhere. The issue was raised at a briefing meeting with the HSE some time ago and a commitment was made by HSE officials to provide a seamless delivery of psychiatric services for troubled teenagers. This needs to be done sooner rather than later.

Tragedy by suicide is probably the most appalling of all. It leaves a lasting pain, anguish and sometimes anger which affects a family and an entire community. Some communities and some authorities are more resilient than others. I agree with Deputy Stanton when he refers to a lack of facilities. However, in my constituency we have put in place physical facilities such as youth centres, playgrounds and after-school services and other facilities such as youth workers and counsellors. Despite this, we still have a huge level of suicide. The report refers to the need for joined-up thinking in this regard.

There seems to be an ever-increasing level of suicide, although statistics show it is not as high as some of us perceive it to be because suicides occur in clusters. Whatever the figures, they would be shocking even if they were only half what they are. The fact that four times as many men as women died by suicide in 2003 is alarming. There is a statistical link between unemployment and suicide, especially in young men. However, I have found that many young men who are working or on training programmes also have fallen victim to suicide. Research shows that suicide rates are concentrated in the lowest social class where they are four times as high as in the high earning brackets. However, we may need to confront this statistic. There is now evidence that, irrespective of income bracket, one is likely to be confronted by the issue of suicide. In 2003, 30% of all deaths in the 15 to 24 age group were recorded as suicide. In the 25 to 34 age group the figure was 23%. Ireland has the second highest youth suicide rate of the 30 OECD countries. We need to make a targeted response, and many communities are doing this.

Psychiatric disorders or addiction problems are present in 90% of people who take their own lives. Earlier this morning, I had a meeting with the Finglas addiction support team, which is part of a network of people in the Finglas area who are putting together strategies to support families who must confront issues relating to alcohol and drug misuse. Availability of alcohol to young people and the ever-increasing availability of drugs of one kind or another are important factors. This morning I was told that one of the greatest worries youth workers in my area have is the easy availability of cocaine and the even easier availability of benzodiazepines mixed with alcohol, which is a lethal concoction. I ask the Minister of State to consider how further restrictions can be placed on the availability of medicines over the counter. There is anecdotal evidence that significant amounts of benzodiazepines make their way into Ireland in the luggage of people coming back from holidays in Spain and elsewhere, where they can be bought cheaply over the counter. If something can be done about this problem in our jurisdiction we should do it.

Deputy Ó Snodaigh referred to the availability of alcohol. Any of us who has experience of working with young people, whether in formal education or otherwise, knows that alcohol is available to young people at whatever age they want it. Parents have a greater responsibility than some of them care to admit to engage in alcohol education in the home. I do not advocate a young person having his or her first couple of glasses of wine around the family dinner table at the age of 13 or 14 years. That does little for alcohol awareness. I am a believer in the identity card system and the Garda watch card, which unfortunately can be too easily copied or ignored by unscrupulous operators of off-licences. I pay tribute to some larger supermarkets which operate a strict regime with regard to supplying alcohol to minors. However, in many years working in this area I have seen much evidence to suggest independent off-licence operators are less scrupulous in their insistence on identification being produced.

I referred to the need for continuing adolescent psychiatric support. I welcome the Government's initiative, as outlined by the Minister of State, Deputy Tim O'Malley, to establish liaison officers in each HSE area. There is no doubt that they are making a difference. As well as working within their own statutory remit, they can network with, for example, the Bethany bereavement groups which are providing a really good service. I have had some contact with Console, an organisation for which I have the greatest regard and which was instrumental in establishing the Finglas suicide network. I thank Dublin City Council and other local authorities which have allocated local facilities for such organisations, including a drop-in centre. Prevention is better than cure.

Listening is more important than talking to those who are at risk of suicide. The more trained people who are available to listen the better things will be. I commend the report, as well as the Minister and the HSE for the initiatives they have taken.

Photo of Séamus HealySéamus Healy (Tipperary South, Independent)
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I thank the Leas-Cheann Comhairle for the opportunity to say a few words on this important, yet difficult, subject. I welcome the report of the committee and compliment its members on their good work. Over the years, Deputy Neville has shown a particular interest in this area and has given the benefit of his valuable advice to various Members. The report contains the results of much excellent work and makes 33 recommendations. I welcome the assurance of the committee's chairman, Deputy Moloney, that the report will not gather dust. I also welcome the Minister of State's announcement that some 20 projects across the country have received approximately €1 million in funding from dormant accounts. That is a welcome start and I hope that when we discuss this matter again in six or 12 months time, all 33 recommendations will have been implemented.

While I welcome funding for such projects, I note that no funding has been provided for clubs such as the No Name Clubs which do excellent work for young people around the country. They try to ensure that young teenagers can enjoy themselves in an alcohol-free environment. The work of these clubs is very important and I hope the Minister of State will examine how he might support them.

Suicide is a big issue and, unfortunately, over the years the numbers have increased. Back in the 1960s, there were approximately 160 suicides a year, while in the 1980s the number had risen to 220. In 2004, however, some 457 suicides were recorded, which is a huge figure. The problem is multiplying. In previous years, there was a problem of under-reporting but I hope that issue has been overcome to a large extent. Ireland is not alone in this respect because internationally the situation is also difficult, with an estimated one suicide occurring every 40 seconds. In Scotland, there are two suicides every day. A recent report indicated that Ireland has the second highest suicide rate of 30 OECD countries.

This problem has touched almost every family in the country over the years, causing difficulties for bereaved families. In one case that I know of personally, a whole family has been devastated by the experience. It is not a one-off matter; it is commonplace. Deputy Carey spoke of clusters of suicides occurring in his constituency, but that has happened throughout the country in recent years.

I wish to say something about youth suicide. The environment in which teenagers grow up now is totally different from that experienced by previous generations. We live in a highly stressed and information-packed society. Competition for success in personal relationships and academic achievement is intense among young people. Teenagers are expected to participate in extra-curricular activities in addition to doing homework and household duties in a highly pressurised atmosphere. Today's world is different from the one in which we grew up. Ireland is now a highly materialistic society and young people expect to have access to significant resources. Many young people feel it necessary to undertake part-time work as well as attending school, which places further pressure on them. Such a lifestyle can expose young people to alcohol, particularly at night-time and, consequently, alcohol might begin to play a major role in their daily lives.

The loss of a friend through suicide can be traumatic for young people, whereas adults may be better able to cope in such situations. Nowadays, teenagers need to solve problems quickly and they seek instant solutions which are not practicable. Young people are living in a different society, which is highly pressurised and materialistic. That is the background to the problem of suicide.

Road deaths are highlighted every day but while suicide is a bigger problem, it does not seem to have attracted public attention to the same extent. Since the 1960s, there has been a 300% increase in alcohol consumption and there is no doubt about the correlation between that and suicide among young people. That is one reason I would like to see the advertising of alcohol banned completely. Legislation to effect such a ban should be introduced in due course.

I commend the Samaritans on the work it has done on this issue. This week, the organisation launched the developing emotional awareness and learning, DEAL, initiative in secondary schools. That type of approach is vital because statistics indicate that emotional difficulties are encountered among 20% of students. There is no doubt that the early targeting of young people by providing them the information and wherewithal to deal with problems is a positive step in terms of fighting suicide.

The text service which the Samaritans have provided since April highlights the fact that young people can find it difficult to raise their problems with parents, peers and professionals. I hope young people will be able to refer themselves to psychiatric services. Previous speakers have pointed out the difficulties that exist in terms of the gap between youth and adult psychiatric services and I too would like that issue to be addressed.

Tim O'Malley (Minister of State, Department of Health and Children; Limerick East, Progressive Democrats)
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I thank Deputies for their contributions on an issue which clearly hits a nerve within society. The fact that 20 Deputies spoke indicates the importance with which the matter is regarded. I will attempt to address some of the main points raised in the debate.

I congratulate the Sub-Committee on High Levels of Suicide in Irish Society on the report it has put before us. I assure the House that my Department and the HSE will pay close attention to the report's recommendations, many of which have already been taken on board by the Reach Out programme launched in September 2005. We will give further consideration to any recommendations which have not yet been implemented with a view to acting on them.

The issue of alcohol consumption in Ireland was raised by almost every speaker. I will undertake to speak to my Cabinet colleagues on that issue because we now have scientific evidence on the relationship between alcohol and suicide. We will have to investigate the increase in consumption in society.

Several Deputies suggested that targets should be set for the Reach Out programme. The chairman of the sub-committee, Deputy Moloney, feels strongly that such targets should be put in place, although I am open minded about the matter. I will consult the head of the National Office for Suicide Prevention, Mr. Geoff Day, in that regard because, irrespective of whether a target is reached, its very existence means that progress can at least be measured.

References were made to the lack of psychotherapists and counsellors. We have established a number of training programmes in this regard, graduates of which will shortly supply the numbers of professionals needed.

I concur with Deputy Healy with regard to his support for self-referral. GPs should be able to refer patients directly to psychotherapists rather than sending them first to consultant psychiatrists because putting a depressed person through a series of hoops will only cause further problems.

We are aware of the problems caused by the points system for the leaving certificate but nobody has been able to devise a better system.

Questions were asked by several Deputies regarding how members of society can look out for each other. Long ago, when we did not have television, people conversed with each other more often and the community spirit was better. Unfortunately, that spirit has suffered in modern society. The Taoiseach is a strong advocate of volunteerism and the Cabinet is giving its attention to the issue. In the past, people in the country always helped each other but, nowadays, people can live in a huge estate or a concrete jungle without knowing their neighbours and, if the parents do not know anybody, we can be sure their children will feel the same sense of alienation.

One speaker suggested that each county should set a target or delegate responsibility to one person for suicide prevention. Around the country, liaison officers are already employed who do a great deal of valuable, if largely unseen, work by liaising with troubled families, schools and accident and emergency units. Most of the officers are either counsellors or psychiatric nurses and have special training in this area.

Some 11,000 people deliberately self-harm every year. Mention is often made about the lack of resources in this area but, until recently, when people presented to accident and emergency units after self-harming, medical professionals tended to treat them and then allowed them leave the hospital without any follow-up care. That may be an issue of best practice rather than simply a resource problem. Given that people who presented to accident and emergency units after being severely injured in accidents received follow-up care, is it not ironic that, until recently, there was no follow-up care for patients who self-harmed? Almost every accident and emergency unit now employs psychiatric nurses to liaise with patients.

Reference was made to the importance of early intervention by child and adolescent services. Several speakers noted that the recovery rate is 90% among those for whom early diagnoses are made. Medical evidence suggests that 95% of people with depression can be treated in the community. Those figures seem to indicate a lack of diagnosis of depression by GPs. We need more targeted education of general practitioners to ensure they identify people with depression, otherwise they will cause self-harm and end up in hospitals.

I do not claim the child and adolescent psychiatric services are all that they should be: they are not. However, resources have increased significantly. In 2005 we had 56 consultant psychiatrists and this increased to 70 in 2006. Obviously each consultant psychiatrist needs an associated team. It takes some time to gather those teams, including social workers, nurses, psychotherapists and counsellors, and we are working at forming those teams.

Deputy Hayes said we should have tests for those driving while under the influence of drugs. While the Government has investigated the matter, a solution is not easy to find. We would need to determine the level of cocaine, cannabis or ecstasy involved. Considerably more work remains to be done in that regard.

Deputy Keaveney spoke about music therapy and greater use of the creative arts for people. I intend investigating the matter further. There would be considerable merit in considering it for people who may feel depressed. The Deputy also mentioned that some people refer to cannabis as a soft drug. It is not a soft drug. The latest information suggests cannabis causes major psychological problems and leads on to psychiatric problems.

I have been here since 11 o'clock listening to each of the 20 Members who spoke. I will be discussing the matter with my colleagues in the Cabinet to ascertain what we can do to alleviate the suffering and pain being experienced by all the families affected. This is not just a problem for Government and there is no point scoring involved. The Government and the Dáil must face up to the problem and ensure that it gets our best attention.