Thursday, 10 April 2014
Topical Issue Debate
I thank the Ceann Comhairle for giving me the opportunity to refer to the recent report by the European Child Safety Alliance on national action to address the issue of child intentional injury. The report shows that Ireland has the highest rate of suicide among young females under 20 years of age, 2.5 times the European average, and the second highest rate of youth suicide among males, 5.12 per 100,000, compared to the European average of 2.39. Lithuania is the only country ahead of us when it comes to male youth suicide. These are unacceptable levels and urgently need to be addressed. These findings also confirm the findings of research conducted by the World Health Organization on the issue of youth suicide in Ireland.
Research shows that the reasons children and young people die by suicide are complex, often involving an interconnection of different factors and events. Difficulties in relationships either with a partner or a family member are a commonly cited reason for youth suicide. Parental conflict and rigid family systems can be factors influencing suicide behaviour.
Events that have an impact on a young person’s identity, autonomy and independence can also play a part, with depression, hopelessness and a history of sexual abuse. These factors are present more in young people who make more serious suicide attempts. Substance misuse, aggression, risky sexual behaviour and health problems have been found to be related to suicidality. A negative perception of body image and a lack of attention to their own physical needs are seen as risks for suicidal behaviour in some young people.
Research also found that knowing someone who had attempted suicide, having symptoms of depression, alcohol misuse, violence and lesbian, gay, bisexual and transgender relationships were associated with an increased risk of suicide. A number of studies have looked at factors that make people more vulnerable to repeating a suicide attempt. These include low self-esteem, early puberty, relationship difficulties, being physically impaired owing to illness or injury or substance or alcohol misuse, hopelessness, a previous suicide attempt or a recent suicide attempt by a friend.
Studies of suicides of homeless young people found that they had reported feeling trapped by their experiences. Factors that had made them vulnerable to suicide were drug use, experiencing familial abuse as a child, low self-esteem and feeling lonely.
Family functioning is more important than family structure. The way a family functions in particular relationships with parents can both be a protective and a vulnerability factor.
The effect of the media is often open to question, with some studies reporting that young people and adults were less likely to have copycat effects, but it is thought that reports of suicide among teenagers may be an influence in imitative behaviour.
I thank the Deputy for raising this issue for discussion. I am taking it on behalf of my colleague, the Minister for Health, Deputy James Reilly.
I welcome the national action to address child intentional injury 2014 report of the European Child Safety Alliance, published in late March. The report which examines the policy measures in place to address intentional injury to children in over 25 member states is being considered in the Department of Health. In Ireland the Government’s policy on deliberate self-harm and suicide prevention is guided by the national strategy, Reach Out, which makes several recommendations to fast-track referrals to community-based mental health services, an effective response to deliberate self-harm, training, reducing stigma, promoting positive mental health and research. Reach Out recognises the youth sector as a high risk group and sets out several specific actions. Dealing with the current high levels of suicide and deliberate self-harm is a priority for the Government.
The Health Service Executive's National Office for Suicide Prevention has primary responsibility for the implementation of Reach Out. Consequently, the office has developed a range of initiatives aimed specifically at supporting young people who are suicidal, as well as supporting their peers in recognising and responding appropriately to signs of emotional distress and suicidal thoughts.
A wide range of awareness and training programmes are available in the area of mental health promotion and suicide prevention. Several media awareness campaigns focused specifically on young people have been run in recent years and guidelines for mental health promotion and suicide prevention in post-primary schools have also been developed. Since 2012 the Government provided €90 million and 1,100 additional posts primarily to develop community mental health teams and suicide prevention resources. Some 230 of these posts were allocated to child and adolescent mental health services, CAMHS, teams and all posts are targeted to be in place by end of June 2014. Young people, children and their families have access to a range of mental health services within CAMHS teams. In addition, 37 new clinical nurse specialist posts have been created to provide additional clinical support for persons presenting with self-harm in emergency departments.
In 2014 the Department of Health and the Health Service Executive have committed to developing a new strategic framework for suicide prevention, building on the comprehensive work delivered under the current Reach Out strategy. The framework will present the key priorities to be addressed from 2015 to 2018. The aim of the new strategy will be to support population health approaches and interventions that will assist in reducing the loss of life through suicide. The new framework, expected to be published in late 2014, will build on and learn from the experience of implementing Reach Out which continues to be relevant.
The recommendations made in the national action to address child intentional injury 2014 report will also be considered in the context of the development of the new framework. The findings of the report give cause ofr concern and will be considered by a research advisory group recently established as part of the development of the new framework for suicide prevention.
The new framework being developed by the National Office for Suicide Prevention should provide for a specific examination of youth suicide among both males and females. It is important to note that funding for the office has doubled from €4 million to €8 million.
I understand the Government is allocating an extra €1 million this year. However, the service is still under-resourced and needs further investment to allow it to have a greater impact on the whole area of suicide, including on research, prevention and postvention.
I accept that increases in resources must be made on a phased basis to allow development to take place in an orderly fashion. However, it should be borne in mind that comparisons are often made between resources provided to the National Roads Authority, at over €30 million, and those provided to the National Office for Suicide Prevention, approximately €9 million now. Some 600 people die by suicide each year, while fewer than 200 - although it is too many - die as a result of road accidents. I support ongoing and further support to the Road Safety Authority to continue its excellent work. Its great success should be a template for suicide reduction, although we know that suicide prevention is totally different. There is little similarity between preventing accidents and preventing suicide, which is a highly complex area in the context of what brings people to take their lives and the consequences of the tragedy for the bereaved. The factors surrounding suicide are very different. The expertise exists nationally and internationally and is available to us to impart through any programmes the National Office for Suicide Prevention develops in all areas. I urge the Government to continue to develop the office by ensuring that the resources required are made available.
I am conscious of the important work Deputy Neville and others have been doing over the years in regard to this important issue. I assure him that the recently published report from the European Child Safety Alliance, National Action to Address Child Intentional Injury, is another opportunity for us to focus on the measures the Government is taking and how it can do more to ensure all of these issues in regard to young people are better understood. Also, the research office looking at the reports by the Department of Health will provide an additional opportunity to continue the good work necessary to understand the complex reasons people, particularly young people, engage in unfortunate practices such as self-harm. This work will continue to be funded and supported by the Government.