Tim O'Malley (Limerick East, Progressive Democrats)

I thank the Leas-Chathaoirleach for the opportunity to make a statement in this House concerning the incidence of suicide in Irish society. At the outset, I stress that the Government shares the concern expressed here and by the general public about the country's level of suicide. Suicide has become a serious problem, which touches the lives of many people. In each individual case it is a tragedy, both for the life that has ended and the family, friends and community left behind. Many of us know someone who has attempted or completed suicide.

Suicide is a serious social problem. We cannot ignore or be complacent about the increasing incidence of suicide and self-harm in this country. Preventing suicide and reducing its rates is, therefore, an urgent public health issue, one that goes right to the heart of our efforts and policies to create a healthy, prosperous and socially inclusive Ireland. I recognise the many challenges that lie ahead and am aware there are no easy or single interventions that will bring us guaranteed success. International evidence shows that reducing the suicide rate and preventing suicide requires a collective and concerted effort from all groups in society, such as those is the health and social services areas, professionals, communities, voluntary and statutory agencies and organisations, parents, friends, neighbours and individuals. In addressing the rate of suicide, we must continue our efforts to eliminate poverty, achieve greater social justice and inclusion for those who are vulnerable in our society, address inequalities where they exist and improve and expand educational opportunities for all our children.

As we are aware, there was a reluctance to discuss suicide in the past. Thankfully, this situation has now changed and I welcome the Seanad's decision to make statements on the matter. The more discussion on this issue and the greater the focus on it, the greater the contribution to bringing before the public this social problem. 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 welcome development but we must ensure that public discussion and the media's coverage of suicide and deliberate self-harm remain measured, well informed and sensitive to the needs and well being of psychologically vulnerable and distressed individuals in our society.

We must remain measured in our discussions on this matter at all times in the Seanad and in the Dáil. We had a three hour debate in the Dáil on suicide recently and I compliment everyone who took part because the discussion was useful, well informed and sensitive to the needs of this psychologically vulnerable group. We must continue to work as a society to create a culture and environment wherein people in psychological distress feel able to seek help from family, friends and health professionals.

Since the publication of the report of the national task force on suicide in 1998 there has been a positive and committed response among both the statutory and voluntary sectors to finding ways to tackle this tragic problem. Significant progress has been made in a number of different areas. Suicide resource officers have been appointed in each Health Service Executive area and I compliment them on the valuable work they carry out continually. They supply positive messages about how to access the relevant services and deal with the educational aspect of suicide. The National Suicide Review Group, the National Suicide Research Foundation and the National Parasuicide Registry have been established. Liaison psychiatric nurses have been appointed to accident and emergency departments in many general hospitals, which is a welcome development. Unfortunately, not all departments have procured the services of liaison psychiatric nurses but I will put as much pressure as possible on those that have not to do so soon. We have information now from the accident and emergency units with liaison psychiatric nurses indicating it is a significant development and of considerable help to those vulnerable people who have harmed themselves.

Ongoing training has been provided for relevant health care personnel in regard to suicidal behaviour in all Health Service Executive regions. There is a need for a co-ordinated effort in assessment, watching for the telltale signs of depression and getting people help before they do anything untoward. Much has been done in this regard by everyone in the executive's areas and especially by those with responsibility for young people, such as the Garda, GAA clubs, soccer clubs, rugby clubs and teachers. A great deal has been done in securing a co-orinated effort to note tell-tale signs of people who are depressed and to get them help before they do anything untoward.

Other measures include the following: the enactment of legislation to restrict the availability of medication which can be used to overdose; the development of a social and personal health education programme, which is now compulsory for all junior cycle students in secondary schools; the publication of a directory of services in each Health Service Executive area for those who may be at risk of suicidal behaviour; and the development of a new form 104, which is the form on which the Central Statistics Office figures are based. A Garda inspector within each division has been nominated to oversee the use and completion of the form. These are just some examples of the progress made to date. Much greater detail about various initiatives under way throughout the country can be found in the annual reports of the national suicide review group, which are laid before the Houses of the Oireachtas each year. As Members will be aware, many of the recommendations of the task force require continuous development, particularly in the area of training and in the enhancement of our mental health services.

In 1998, the year in which the report of the task force on suicide was published, the number of deaths by suicide registered by the Central Statistics Office reached an all time high of 504, reinforcing the need for sustained and co-ordinated action in response to the ongoing problem of suicidal behaviour. Five years later in 2003, 444 deaths from suicide were registered. While the decrease in the figures over the past five years, since the high of 1998, is encouraging, it is too soon to draw any firm conclusions from the reduction. The figures indicate that no effort can be spared in reducing what is still a major cause of death in our country, particularly among young people and young males.

Young males have shown a significant increase in the rate of suicide in the past decade, with 305 such deaths in 1994, increasing to 358 in 2003. However, it is important to point out that youth suicide in Ireland is not the highest in the EU. The most recent analysis suggests it is the fifth highest of the 25 member states and in terms of the overall suicide rate, Ireland ranks 17th of the 25 member states. It is important in a measured and constructive debate about suicide to remember that 16 other countries in the EU have higher suicide rates than Ireland.

Words that should not be used are sometimes used in media reports. The word "epidemic" is used, which is not helpful to the debate, particularly when we know that Ireland ranks 17th of the 25 EU member states. I do not say this by way of boasting or complacency. I agree there is a significant problem but all of us in the Dáil, Seanad, the Department and the HSE are doing all we can to try to get to grips with this tragic social problem in society. I reiterate that we do not have the highest suicide figures in Europe.

Recent figures suggest that the rate has stopped increasing. However, it is correct to say that we experienced probably the greatest increase in suicide rates in Europe during the 1980s and 1990s, albeit from a low base rate. These are worrying trends which require further research so that better strategies are developed to help people who are particularly at risk.

A cumulative total of more than €17.5 million has been provided by Government since the publication of the report of the national task force on suicide in 1998, towards suicide prevention programmes and for research. Some €17.5 million has been spent in the past seven years on this topic alone. This includes funding to support the work of the Health Service Executive areas, the National Suicide Review Group, the Irish Association of Suicidology and the National Suicide Research Foundation for its work in the development of a national parasuicide register.

My Department also supports the ongoing work of many organisations such as Mental Health Ireland, GROW, Aware and Schizophrenia Ireland in raising public awareness of mental health issues. Many of these voluntary groups, including many I have not mentioned, do great work in promoting positive mental health and helping their counterparts in the areas in which they work. Much of this voluntary work goes on unseen and unheralded. We only read in the media about the tragic cases of suicide. We do not often read about the great voluntary work done by committed people in their communities in helping young people and who seek neither financial recompense nor public recognition. It is important that I, as Minister of State with responsibility for mental health, should congratulate all these people.

I stress that the figure of €17.5 million does not encompass funding provided by other Departments, such as the Departments of Education and Science, the Environment, Heritage and Local Government and Justice, Equality and Law Reform in addressing areas within their responsibility, as identified in the report of the national task force on suicide. Significant additional funding has also been made available by my Department in recent years to further develop mental health specialties such as liaison psychiatry, child and adolescent psychiatry, adult psychiatry and old age psychiatry services. These services can assist in the early identification of suicidal behaviour and provide the necessary support and treatment to individuals at risk. In this regard, figures recently published by Comhairle na nOspidéal indicate that a total of 87 additional consultant psychiatric posts in a wide range of specialties have been approved since 1997. This is a significant increase in the number of consultants appointed to psychiatry. I look forward to the benefit of their work in improving the services to the mentally ill.

One of the key recommendations of the task force was that steps should be taken to make the mental health services more accessible to the public, particularly to young people and young males. Preventing suicide means influencing, in a corrective and constructive way, a person's development and their own resources at different phases of life. Adolescence is traditionally viewed as a time of profound change when young people make the transition to adult status. This transition is not easy and for many young people is accompanied by levels of self-doubt, fear and stress. An important aspect of suicide prevention for young people will be to promote self-esteem and self-confidence and to ensure they develop personal and social skills. Children and young people often need support and encouragement in gaining control over their lives and coping with their problems.

However, it is important to realise that of all the children in schools, including young children and adolescents, well over 90% of them have no mental health issues. In the past ten, 15 or 20 years, as people become better educated and there is much more education available to students in secondary schools and third level institutions, there has been a remarkable growth in confidence of young Irish people throughout the world. That and the way in which they are wonderful ambassadors for our country, has been remarked on by many people in other countries. When speaking about young people we should remember that the vast majority of them are excellent and well adjusted people and that it is only a small number who have mental health issues. That is why it is important that those of us dealing with these issues do all we can to ensure these people receive the help they need, especially at the appropriate time with early intervention.

The Department of Health and Children recently identified as a priority the development of a comprehensive child and adolescent psychiatric service. The Department established a working group in June 2000 to review child and adolescent psychiatry provision and to finalise a plan for the further development of this service. The group published its first report in March 2001. This report recommended the enhancement and expansion of the overall child and adolescent psychiatric service throughout the country as the most effective means of providing the required services. It also recommended that priority be given, in the first instance, to the recruitment of expertise for the completion of existing consultant-led multidisciplinary teams.

My Department has provided additional revenue funding of more than €20 million since 1997 for the further development of our child and adolescent psychiatric services. Steady progress has been made in developing a specialised service for this client group. In 1997, there were few child and adolescent psychiatry services available outside the major cities. Funding is now available for 56 consultant posts in child and adolescent psychiatry.

In its first report, the working group also examined the issue of inpatient psychiatric services. It recommended that a total of seven child and adolescent inpatient psychiatric units for children ranging from six to 16 years be developed throughout the country. Project teams have been established to develop these inpatient psychiatric units in Cork, Limerick, Galway and one in the HSE, eastern area, at St. Vincent's Hospital, Fairview.

The process of appointing design teams for the units in Cork, Limerick and Galway has commenced. The work of the project team established to advance the development of the new unit at St. Vincent's Hospital, Fairview, is continuing. Children and young people are our vital and precious resource for the future, and investing in services for these age groups now will ease the burden on adult mental health services in the future.

The health strategy, Quality and Fairness — A Health System for You, included a commitment to intensify the existing suicide prevention programmes and I am pleased to report that work is now well under way on the preparation of a national strategy for action on suicide prevention. This strategy is being prepared by the project management unit of the Health Service Executive in partnership with the National Suicide Review Group and is supported by the Department of Health and Children.

Work began on the development of a national strategy for action on suicide prevention almost two years ago. Since then, approximately 700 people have attended regional and national consultation meetings, and submissions were sought in the national press. A national and international expert group of 16 people reviewed the strategy during the past two weeks in April and their analysis is being incorporated into the strategy. The extent of consultation, the input of the external reviewers and a dedicated writing team will result in a high-quality, action-focused, evidence-based strategy. This will highlight immediate priority actions, targets for implementation over the next five years and long-term objectives for suicide prevention and mental health promotion in Ireland. I have met on several occasions with Dr. Rosaleen Corcoran who is leading this process.

A fundamental aim of the new strategy will be to prevent suicidal behaviour, including deliberate self-harm, and to increase awareness of the importance of good mental health among the general population. Ongoing, quality, multidisciplinary research will be an essential strand of the strategy and findings will be of greatest value where they can inform and stimulate action and service development. The strategy will identify expected outcomes, and set targets which can be measured, monitored and revised. Continuous quality control and ongoing modification and improvement of the strategy will be central to its implementation.

Best international practice suggests that suicide prevention programmes should be developed on the basis of improving the mental health of the general population in combination with developing strategies for known high-risk groups. This new strategy will include specific recommendations for action on those in the high-risk groups.

We must do all we can to make it as easy as possible for those bereaved by suicide to confront, face and deal with the situation. People often do not want to ask for help as they may feel this will be perceived as a sign of weakness. Looking for, and expecting, practical help is not a sign of weakness, rather it is a confrontation with one's problems. Everyone can learn to cope with such a tragic loss, but for some people this can be a long and difficult process.

The encouragement and support provided by the various statutory and voluntary organisations which work with those who suffer the intense trauma of bereavement through the suicide of a loved one is immensely important. This Government has recognised this fact through the provision of financial support for groups active in this area.

In August 2003, I appointed the expert group on mental health policy to prepare a new national policy framework for the mental health services. The expert group will consider the area of suicide prevention and reduction and will make recommendations in the matter, taking account of the national strategy for action on suicide prevention. It will also set the issue of suicide prevention and reduction within the broader context of a mental health policy framework. The expert group is due to report later this year.

The National Suicide Research Foundation was founded in January 1995 by the late Dr. Michael J. Kelleher, whom I knew well and with whom I worked on the former Mid-Western Health Board. It consists of a multidisciplinary research team with contributions from a broad range of disciplines, including psychology, psychiatry and sociology. The foundation's primary aims are: to define the true extent of the problem of suicidal behaviour in Ireland; to identify and measure the factors which protect against suicidal behaviour; and to develop strategies aimed at preventing suicidal behaviour. Much of the foundation's work to date has involved the monitoring of parasuicide which is extremely important.

International studies have found parasuicide to be one of the most significant risk factors associated with suicide — those who engage in parasuicide are 20 times more likely eventually to kill themselves. Studies have shown that at least one third of all suicides have a history of parasuicide.

The National Parasuicide Registry is a national system of population monitoring for the occurrence of parasuicide. This important project is being undertaken by the National Suicide Research Foundation, with funding from the Department of Health and Children. The National Suicide Research Foundation's reputation for high-quality research is such that it has been invited to participate in several important international studies, among them the WHO — Euro Multicentre study of parasuicide.

Last December I launched the third annual report of the National Parasuicide Registry. The findings in this report indicate that approximately 8,800 individuals presented to hospital due to self-harm in 2003. That is an accurate figure, recorded because we receive information from all the accident and emergency units around the country which the national suicide registers are collating.

Some of these people presented more than once accounting for the total figure of 11,200 presentations of parasuicide in 2003. The report highlights the challenge that self-harm and suicide prevention poses for our health system and our society as a whole. It will help identify groups which are particularly vulnerable and will assist the health service areas to evaluate the impact of the preventive and clinical services being provided.

The Government shares the public concern about the levels of suicide in Ireland. 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 they consider taking their own lives. We must aim to provide accessible, sensitive, appropriate and, where required, intensive support. The national strategy for action on suicide prevention to be published in September 2005 will provide us with a targeted, measurable action plan for tackling this serious social problem in a coherent and integrated fashion involving all relevant stakeholders.