Dáil debates

Tuesday, 10 March 2009

Adjournment Debate

Suicide Prevention.

8:00 pm

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I thank the Ceann Comhairle for giving me an opportunity to raise the important issue of the level of suicide during recessionary periods.

A report appeared last week in the press about a reduction of 12.5% in the allocation by the National Office for Suicide Prevention to the voluntary organisations involved in suicide prevention and suicide bereavement. We understand there was also a cut in funding to the National Office for Suicide Prevention that will affect its work on the implementation of the recommendations of Reach Out, the recommendations of the expert group on suicide prevention and suicide issues and other reports, including A Vision for Change and the report of the Oireachtas Joint Committee on Suicide Prevention.

Research into suicide since the 1890s shows there is an increase in suicide rates and mental illness during times of economic recession. The Minister for Health and Children should recognise and accept this and ensure that adequate resources are available to respond to the needs that exist. We suggest that an additional €10 million should be allocated to the National Office for Suicide Prevention. It received €4.5 million in 2008 and given the cuts that are being made, it will receive less than that this year.

There is a precedent for this approach. In November 2008, the Minister for Social and Family Affairs allocated approximately €11 million in additional funding to provide for a range of marriage, child and bereavement counselling services and supports to help families to cope through the difficult times they face as a result of the recession. I have a list of the 29 organisations that received substantial support from that allocation. We urge the Minister for Health and Children to respond in a similar fashion to the challenges arising for mental health and suicide prevention services.

Economic strain and personal financial crises have been well documented as precipitating events in individual deaths by suicide. Stressful life events, financial and otherwise, have a significant impact on those vulnerable to suicide where typical coping mechanisms are compromised by the effects of mental disorder, substance abuse, acute psychiatric symptoms and the other risk factors associated with suicide. We have already seen several suicides that can be attributed to the difficulties and pressures arising from economic changes. Increasing unemployment leads to an increase in the suicide rate. Unemployment has a profound effect on a person, especially the young and those in middle age.

Irish society awards status and prestige according to a person's position and contribution to work. Correspondingly, unemployment is associated with loss of face and prestige, a lack of self-esteem and confusion and concern about the future for individuals and their families. The unemployed are six times more likely to suffer from a psychiatric disorder than those in employment. Studies show that those who die of suicide are significantly more likely to have experienced unemployment, job instability or occupational problems. The Kelleher-Daly study in Cork, conducted during the economic recession of the 1980s, showed that of the male deaths by suicide analysed in that study, two-thirds involved men who were out of work at the time of their deaths.

The high rate and threat of home foreclosure is of particular concern. For most Irish people, our homes are our primary investment and the focus of our identity. When combined with loss of employment, home loss or the threat of it, has been found to be one of the most common economic strains associated with suicides. I urge the Minister to respond immediately to the psychological, emotional and psychiatric difficulties affecting people as a result of the changed economic times.

Perhaps the Minister of State will clarify the situation. I raised this matter earlier with the Minister for Health and Children and she denied there were any cuts to the national suicide prevention office. She stated there was in excess of €2 million extra funding for suicide issues in 2009. We need clarification in that regard because there is confusion about what is available to the office. The message we have got is that there is a cut of 12.5%, but the message from the Minister is there is an increase of €2 million.

Photo of Máire HoctorMáire Hoctor (Tipperary North, Fianna Fail)
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I am taking this Adjournment on behalf of my colleague, the Minister of State with responsibility for equality, disability and mental health, Deputy John Moloney. I thank Deputy Neville for raising this matter.

The Government acknowledges that suicide is a serious issue for this country and we must, as an entire community, continue to strive to prevent the further tragic loss of lives. No doubt the economic crisis is putting greater stress on many people and families. However, these financial difficulties do not in any way dilute the Government's commitment in the area of mental health. We know that tackling suicide is not just about increased levels of funding. Reducing suicide rates requires a collective, concerted effort from all groups in society. It also involves creating a culture and society where people in distress are not afraid to seek help. Thankfully, we are making progress in this area.

The simple fact is that mental health affects us all. The World Health Organisation estimates that about one in four people will experience some mental health problems in his or her lifetime. Many factors can affect our mental health and there is a wide variation in how people deal with stress. In his role as Minister of State, Deputy Moloney, meets many individuals and representatives of various groups every day and acknowledges that some have expressed concerns and fears about the impact the recession is having on their lives.

The Government has a clear role in addressing those fears. Deputies will be aware of the greatly increased funding base for mental health services that has been built up over recent years. Overall spending on mental health services in 2007 and 2008 amounted to an estimated €1 billion annually. It is also important to bear in mind that some 90% of mental health problems are dealt with in primary care, but expenditure on these primary care services is not captured in the figure mentioned.

We are certainly operating in straitened times, but nonetheless in 2009 the Government allocated additional funding of €2.8 million for the recruitment of 35 therapy posts for the child and adolescent mental health service, including clinical psychologists, occupational therapists, speech and language therapists and social workers for new and existing multi-disciplinary teams. An additional €l million was also allocated on a once-off basis for suicide prevention initiatives. This brings the total funding for suicide prevention to €8 million this year. Some of this money will be invested in youth-based suicide prevention and awareness campaigns.

The budget for the National Office for Suicide Prevention, NOSP, is set by the Health Service Executive, specifically, within the population health area. The HSE advised the office that its core funding, or annual budget, is to be reduced by 12.5%, even as it receives additional once-off funding of €1 million. Accordingly, the office's budget for 2009 amounts to €3.3 million, as core funding, plus the once-off amount of €1 million, a total of €4.3 million this year. Last year's national office budget was €4.5 million.

It is the responsibility of the national office to allocate its funding effectively within the office itself and to organisations it funds. I emphasise that the national office has met with all of the organisations involved to ensure that existing levels of service will be maintained. This is critical. All organisations have agreed to introduce the required reductions and have agreed that cuts in expenditure will be restricted to non-pay and non-service related costs, for example, training and travel etc. It is worth recalling that, in 2008, the national office made no reduction in funding to any of the voluntary bodies it supports, even though other parts of the HSE reduced funding to voluntary bodies. A further €0.75 million was provided to the HSE for mental health projects supporting service users and carers.

Many of our young people have grown up in an era of unprecedented prosperity and the wide availability of work and opportunities. As our economy adjusts to the impact of the global economic crisis, it is important to acknowledge the strains many younger people and young adults may be experiencing for the first time in coping with a very difficult economic environment.

In 2008, the HSE prioritised the development of child and adolescent mental health services. By the end of March 2009, the total inpatient bed complement for child and adolescent mental health services will have increased from 12 beds in 2006 to 30 beds, an increase of 18 beds. There are currently 50 child and adolescent teams and a further eight will be in place by the end of the first quarter of this year. Construction of two 20-bed units for children and adolescents in Cork and Galway has commenced.

Financial investment in mental health is important, but it is also vital that we utilise the existing resources within mental health. The development of mental health services as outlined in "A Vision for Change", the report of the expert group on mental health policy, requires substantial change in the organisation and delivery of mental health services. To implement this, current resources require to be reallocated and remodelled to fund the new structure.

However, it is more important, in the context of today's debate, to establish what we can all do to ensure that the potential impact of the economic downturn is minimised. Mental health promotion is a key ally in a quest to minimise the consequences of a recession. Promoting well-being and addressing the needs of those at risk of mental health difficulties requires a multifaceted approach. The Minister of State sees it as a key task of the health services not just to treat mental illness but more important, using the principles of health promotion to try to improve the mental health of the population at large. What is needed is a concerted effort, managed in a pragmatic and rational manner.

Mental health promotion works on three levels, strengthening individuals, strengthening communities and reducing structural barriers to mental health through initiatives to reduce discrimination and inequalities. One of the Government's main priorities is to eliminate social exclusion and discrimination of the mentally ill and create a culture and environment where people in distress feel they can seek help from family, friends and when appropriate, health professionals.

To conclude, I assure the Deputy of the Government's commitment to the development of a high quality mental health service. The Deputy will acknowledge my time ran out before I could conclude the Minister of State's response.