Holly Cairns (Cork South West, Social Democrats)
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I will raise a range of mental health topics, including suicide. I thank the Leas-Cheann Comhairle for including this matter in today's Topical Issue debate. International Men's Day is on Friday, giving us a chance to reflect on issues relating to men and boys. Mental health is one of these issues. While it is a significant matter that affects everyone, a focus on men's mental health is important this week. The majority of people who end their lives in Ireland are male, being as high as 80% in some years. As of September, 437 people were recorded by the CSO as dying by suicide in 2018. Of these, 327 were men or 75%, and 110 were women. These figures and comparable ones for previous years demonstrate the need for a strong strategy to address male suicide. The situation is more nuanced, as we know that the rate among middle-aged men aged between 40 and 59 has been the highest of all age cohorts.

Research has shown that economic recession and increased rates of unemployment are associated with a decline in mental health and increased rates of suicide and self-harm, not only in Ireland, but across the world. Compounding this are larger gender issues, such as reticence to seek help, higher rates of alcohol and substance misuse, and belonging to an at-risk group, such as men who are gay, transgender, Travellers, victims of domestic abuse, migrants, former prisoners and rurally isolated. The State's response must acknowledge these complexities and work to address not only mental health, but also the larger societal conditions that exacerbate them and increase suffering.

I appreciate that the Minister of State, Deputy Butler, is committed to improving our mental services, but she can only work with what the Department is given.

Mental Health Reform points out that our national mental health budget represents only 5.1% of the total health budget, when the World Health Organization recommends 12% and Sláintecare recommends 10%. This deficiency is being felt with insufficient staff to meet current needs. When it comes to taking mental health seriously, campaigns and champions are important, but specialist healthcare will always have to do the heavy lifting. We need more therapists in the community and we need more psychologists, psychiatrists, nurses, social workers, occupational therapists and peer support workers in all HSE regions. The waiting lists for child and adolescent mental health services, CAMHS, also need to be addressed. The importance of early interventions cannot be overstated, and yet we have over 2,000 children and young people on CAMHS waiting lists. I have been working with families across Cork South-West to get help for their children, and I know most, if not all, other Deputies, are doing the same.

Another matter I have repeatedly raised is the lack of eating disorder treatment services. Tomorrow evening, RTÉ will broadcast a programme about men who live with an eating disorder, which is under-reported and is not spoken about enough. No funding was allocated under the national eating disorder treatment plan for 2020, and not one cent of the €1.6 million allocated in 2019 was spent. The Minister of State, Deputy Butler, has committed to making change in this area but we have to acknowledge that people are still not getting the treatment they need, as demonstrated recently by a young Cork woman who had to fundraise to get the inpatient bed she needs. There are only three inpatient beds in the entire country. All of those beds are in Dublin, yet eating disorders are the mental health conditions most associated with mortality.

The Government’s Sharing the Vision mental health strategy, launched earlier this year, will remain another hollow HSE document unless it is supported with the necessary funding. Medical and healthcare professionals and advocacy groups have repeatedly pointed out what is required to provide the proper mental healthcare for boys, men, and all who need it.

Helen McEntee (Meath East, Fine Gael)
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I thank the Deputy for raising the important issue of men's mental health, particularly in the context of suicide and the fact that this Friday is International Men's Health Day. Any loss of life to suicide is a tragedy, and my deepest condolences go out to any family or individual who has lost someone to suicide or who has been affected by suicide. As the Deputy rightly pointed out, it is a complex problem and situation that individuals and families find themselves in and it means they need support in many different ways. As the Deputy has outlined, this is not just about the Department of Health; it is about so many other Departments coming together to try to tackle this issue.

International Men's Health Day is this Friday, and it is an opportunity to consider men's mental health and to look at what is being done and what more can be done to try to support men. In doing so, we need to acknowledge that most deaths by suicide are among men. This is an international phenomenon and in this respect, Ireland is unfortunately no different. This was highlighted in a joint report by the Men's Health Forum in Ireland and the HSE National Office for Suicide Prevention in 2018. The report notes that men are more likely to die by suicide than women are and that the highest suicide rate is among those aged 45 to 54. As the Deputy pointed out, it is extremely high among those aged 40 to 59 as well. The report explored the specific mental health and well-being needs of at-risk and vulnerable middle-aged men. It noted the stigma attached to mental health. It is unfortunate that this stigma still exists but we have made huge strides in talking about it, exploring this issue and providing support and help. It still exists, however, and it was highlighted as a significant issue and barrier to seeking help. Middle-aged men are identified as a priority group in Connecting for Life, the national strategy to reduce suicide, and this continues to work with and support the Men's Health Forum in Ireland to implement a number of its strategic recommendations.

Men's Health Week is held in June each year. Many activities highlighting and promoting positive mental health and well-being are supported by the HSE and the Department of Health. The HSE also supports men's sheds, which are a great social network for men, as social contact is vital to positive mental health. Not every man goes to his local men's shed but for those who do it is a vital support and something the Government supports.

We are all determined to reduce the incidence of suicide in Ireland. Last November, the Government extended Connecting for Life by four years to 2024. Implementation of the strategy involves a cross-departmental and cross-sectoral approach, acknowledging the significant complexities involved and the strategy is overseen by the Department of Health. The National Office for Suicide Prevention was specifically established to co-ordinate suicide reduction efforts around the country and to implement Connecting for Life. I appreciate that there are a lot of strategies but all of these elements are connected and it is all being driven by the Department of Health in connection with the various other Departments. Since 2010, funding for Connecting for Life has been increased from €3.7 million to the current level of €13 million.

A key part of Connecting for Life is development of local Connecting for Life plans. These plans were developed in collaboration with the HSE, community groups, organisations and individuals who have been impacted by suicide who want to help and play their part. They are designed to reinforce social supports, follow-up care, tackle stigma at local level and support those bereaved by suicide. We have to always remember that it is not just the individuals involved but that many others are impacted by suicide.

I know we are not where we need to be in the levels of overall funding and we all appreciate that. We are at a point where €1.149 billion has been allocated to mental health and that has increased significantly in the past ten years. That will only continue to increase because we appreciate that more needs to be spent on this issue.

Holly Cairns (Cork South West, Social Democrats)
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I thank the Minister for her response. That is welcome and I encourage her to push for the necessary resources and services to be allocated and spent. In response to a parliamentary question, I learned that the non-spend of the €1.6 million allocated to eating disorder treatment in 2019 happened because HSE and departmental officials assigned it elsewhere. When we have these allocations, which are so welcome, we cannot allow this to happen again.

Services and groups that help address the larger societal issues are important too. The State's response to domestic violence continues to be inadequate. The Istanbul Convention’s standard is one refuge space per 10,000 people but Ireland provides one space per 10,000 women, leaving us with 50% less capacity. We ignore men in that and there is very little infrastructure for men. This structural deficit compounds the stigma for male victims and survivors of domestic violence.

I agree with the Minister that the men’s shed movement has made an incredible impact in addressing isolation among men, especially in older cohorts. Any support the Government can give local sheds will have a manifold impact in mental health. Rural transport schemes are also important factors in helping people to socialise. There should be more and later running buses to provide these connections. There is also inadequate supported living and social housing available for people with mental health disabilities in many areas and it is particularly hard for single men to get social housing.

It is essential that we have more conversations to challenge the stigma around mental health to help people get the help they need. It is especially important for boys and men to talk with their families, classmates, teammates, friends and colleagues. If people do anything for International Men’s Health Day, they should have that conversation. When discussing these issues it is important to note that the Samaritans are available 24 hours a day for those who need confidential and non-judgemental support. People can use the Freephone number 116 123 and the number for the helpline of BodyWhys, the eating disorders association of Ireland, is 01-2107906.

Helen McEntee (Meath East, Fine Gael)
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The Deputy has highlighted the two most important issues and I agree with and support her wholeheartedly on that. This is about each and every one of us looking after our mental health. I visited my father's grave last night for the first time in a while and it is almost nine years since he died by suicide. When I visit the grave, I always think about my mental health and that of the people around me. It is important that we continue to look out for ourselves and each other and that we allow a space where people feel they can talk about it, come forward and talk to each other, particularly with those in their family, close circle and community as well as with their friends.

When people decide to take that step forward, the support must be there for them when they need it and in the way in which they need it. I appreciate that we still have to make a lot of progress on some of the issues the Deputy highlighted. The Government has increased funding and developed HSE services, including specialist services and the various different programmes.

There is still a huge stigma around issues like eating disorders, not only for boys but also girls and in particular men. There is a particular problem there. I am concerned the Deputy says funding has not been spent. That is something I will raise directly with the Minister.

Domestic violence is an issue on which I am particularly focused and determined to address in my role as Minister for Justice. Again, there is a stigma when it comes to men who are victims of domestic violence, and I am trying to address that as part of Supporting a Victim's Journey but also other areas that do not come under health, such as rural transport, isolation, people being on their own and feeling they do not have anyone to turn to or that they are not connected to anyone. Again, that goes back to Connecting for Life. It is about looking at all the Departments to see where we can join up all the dots and make sure people have these supports and, when they do come forward, they are there for them.

I thank the Deputy for raising this important issue. There are a number of things she specifically raised that I will bring back to the Minister.