Thursday, 12 July 2012
Topical Issue Debate
I will begin my contribution with the following quote from an editorial in the Irish Independent of today:
Suicide remains the great unmentionable in Irish life... The biggest obstacle to reducing the number of deaths from suicide is the taboo most of us still have about discussing our mental health.
We should be extremely concerned about the figures published yesterday by the CSO which reveal an increase of 7% in the rate of suicide. The figures show that 525 people died by suicide in 2011, of whom 439 were men and 86 were women. Some 193 of those who died were under 35 years of age. There were also 65 undetermined deaths in 2011. Combining this figure with the fact that many suicides go unidentified because, for example, they involve single occupancy road crashes suggests that more than 600 people died by suicide last year.
This should be a matter of concern for anybody who values life and understands the trauma experienced by those who feel there is no way out of their crisis other than taking their own lives. They did not wish to die but they did not know how else to deal with their difficulties. The question of what people are thinking when they take their lives deserves much longer debate than is possible in this context. Extensive research is required to understand why suicide rates are so high but we can easily identify two contributory social factors, namely, the neglect of mental health services over many decades and the lack of suicide prevention programmes. Bearing in mind that up to 80% of those who died by suicide suffered from mental health difficulties, the neglect of mental health services is nothing short of scandalous.
The link between suicide and economic recession has also been well-established. Unemployment and the threat of unemployment are the leading predictors of suicide, especially among men. Those who are unemployed are between two and three times more likely to take their lives than those who are in employment. Being out of work has an especially profound effect on the young and the middle-aged.
In the budget, €35 million was allocated to develop mental health services. It is vital that the money is spent as intended because, as the Minister will be aware, in 2006 and 2007 moneys intended for mental health services were spent elsewhere by the HSE. The first step in developing mental health services is establishing community-based multidisciplinary psychiatric services. Recruitment is ongoing for 150 posts in child and adolescent psychiatry. Perhaps the Minister can inform the House when it is planned to have the 150 posts in place. A further 254 new posts are due to be created for adult psychiatry. What is the position on recruitment for these posts, when will they be in place and what is the breakdown between psychiatrists, psychotherapists, psychologists, occupational therapists, family therapists and psychiatric nurses? Perhaps the Department of Health can supply that information. How much progress has been made on the 90 community-based multidisciplinary psychiatric teams promised across the four regions and which areas are being covered? I understand that considerable planning was carried out earlier in the year in regard to how the €35 million will be spent. I am sure these plans are available for discussion.
I thank Deputy Neville for raising this important issue. The Deputy is known to be a great champion of the cause of suicide prevention.
The suicide rate in Ireland gradually declined between 2003 and 2007 from 497 to 458. However, this trend has reversed and evidence supports a link between the economic downturn and the increase in the rate of suicide. A recent CSO report indicates an increase of 7% in the number of suicides. Some 525 suicides were registered in 2011, compared with 490 in 2010. The figures also revealed a rise in male suicides, which accounted for 84% of all suicide deaths in 2011. These latest figures for the numbers of people who died by suicide last year are truly disturbing. Suicide is a tragedy that we are constantly working to prevent. We are also working to give more support to the families affected.
Reach Out, our national strategy for action on suicide prevention, sets out a series of specific actions and calls for a multi-sectoral approach to the prevention of suicidal behaviour in order to foster co-operation between health, education, community, voluntary and private sector agencies. Up to 20 voluntary organisations are part funded by the HSE to provide excellent support services, including telephone and web based helplines. The National Office for Suicide Prevention, NOSP, has implemented most of the Reach Out recommendations in a four way strategy of delivering a general population approach to mental health promotion and suicide prevention, using targeted programmes for people at high risk of suicide, delivering services to individuals who have engaged in deliberate self-harm and providing support to families and communities bereaved by suicide. A wide range of awareness and training programmes is also available, including safeTALK and ASIST, which trains participants to become more alert to the possibility of suicide in their communities. The NOSP has also piloted a system of suicide crisis assessment nurses working with emergency departments and GPs which will be rolled out nationally this year.
The special allocation of €35 million for mental health which was announced in budget 2012 will be used primarily to further strengthen community mental health teams in adult and children's mental health services and initiate the provision of psychological and counselling services in primary care specifically for people with mental health problems. I am pleased to announce that Dr. Stephanie O'Keeffe, former head of the Crisis Pregnancy Agency, has recently been appointed as permanent director of the NOSP. Dealing with the current levels of suicide and deliberate self-harm is a priority for this Government. I am continuing to monitor NOSP initiatives and the activities of voluntary agencies, as well as funding by the HSE and, in particular, progress on our special €35 million package of measures for mental health.
The challenge of suicide prevention is one of the most urgent issues facing society but I am confident that by working collectively policy makers, service providers and service users can and will respond to this challenge. I assure the House of the Government's unwavering commitment to addressing this issue.
I welcome the appointment of Dr. Stephanie O'Keeffe as director of the National Office for Suicide Prevention. The permanent position was vacant since last October. I wish her well in the task ahead of her.
I am glad that the Minister recognises this is one of the most urgent issues facing society. He has promised to appoint a director of mental health services. What progress has been made on this vital appointment? Heretofore there has only been an assistant director of mental health services. Mr. Martin Rogan is doing a great job in that position but we need a senior person who will report to the chief executive of the HSE. The Minister has identified the people who collectively should work in this area, but this is a societal issue involving various bodies. Leadership should emanate from Government and those mentioned by the Minister, but the broader society should also take an active part as it has in other countries through various sporting and community organisations as well as clergy and gardaí. In addition, it should be recognised that general practitioners have a role to play.
We wish to promote the rolling out of the applied suicide intervention skills training or ASIST programme and the SafeTALK programme. Last year, the Irish Association of Suicidology provided a short course to over 700 members of the Society of St. Vincent de Paul. In addition, almost 500 gardaí in the Limerick area have been trained by the National Office for Suicide Prevention in a programme, similar to ASIST, under the auspices of the European Union.
A lot of leadership, understanding and discussion are required in dealing with this matter. Until we remove the taboo, people will not seek help in time. The biggest challenge in the area of mental health and suicide is to break down the stigma surrounding it. In that way, people will feel comfortable speaking about their difficulties and will be able to seek assistance without feeling that they are being labelled in any way, as they feel at present.
Amnesty International recently published an excellent survey on mental health, including patients and service users. It outlined the stigma they feel and have experienced as people suffering from a mental health condition. The survey is very revealing although we do not have time to go into it now.
I thank Deputy Neville for raising this important issue. I recognise, as he does, that the figures we have for suicide could in fact be an awful lot higher if single vehicle accidents were considered. We have seen some tragedies, including one more recently in a foreign clime involving an Irish couple who ended up losing children as a consequence of a man with suicidal intent. I would like to take this opportunity to convey our deepest sympathies to the family concerned.
I agree with Deputy Neville that the response needs to be community-wide and involve the sort of people to whom he has alluded who reach deep into the community at many different levels, including gardaí and clergy. The business community is particularly vulnerable in a recession and there is a role for chambers of commerce, parish councils and other community groups. We need to harness all these groups to try to tackle this problem which is of a very serious nature and a real priority for the Government.
I commend the National Office for Suicide Prevention on the ASIST and SafeTALK programmes. I agree with Deputy Neville that we need to destigmatise mental health issues, which are the same as any other health issues. That is why we want all primary care centres to have a mental health facility. People with mental health issues should attend their local primary care centre in the same way as if they had a sore throat or a chest pain.
We must recognise that not just for the last couple of decades, but also for centuries, psychiatry and mental health issues have been the Cinderella of our health services. They do require particular attention and will receive that from this Government.