Tim O'Malley (Limerick East, Progressive Democrats)

I commend the House on holding statements on this topic. I also commend the speakers for their contributions. They have done the Seanad proud today by their constructive handling of this emotive and sensitive issue. I have listened carefully to all the contributions and will reassure everyone that there is an equal amount of compassion regarding this issue on both sides of this House. The matter is a complex one and the importance of exploring the causes and ways of dealing with suicide cannot be overemphasised.

Many of the contributions have focused on the recommendations contained in the report of the national task force on suicide. Contrary to some of the statements that suggested little or no progress has been made in the implementation of the recommendations, the opposite is the case. Since the publication of the task force report in 1998, there has been a positive and committed response from both the statutory and voluntary sectors to finding ways of tackling the tragic problem of suicide. The task force made approximately 86 recommendations, some of which are completed and many of which will be ongoing for years. It is simplistic to suggest the Government has not followed these recommendations. It is following up on all the recommendations, but many of them, including education and working with the youth, are ongoing. This work will never be completed.

The former health boards have played and, under the umbrella of the new Health Service Executive, will continue to play a major role in co-ordinating efforts to help reduce the level of suicide and parasuicide in the country. Following the publication of the task force report, resource officers were appointed in all the former health board areas with specific responsibility for implementing the task force recommendations in their area. The resource officers also engage in the promotion of positive mental health, the destigmatisation of suicide and provide information on suicide and parasuicide within their area. Perhaps there is an opportunity for politicians to invite resource officers to their areas. It has been said people are not aware of what the resource officers do. Perhaps the resource officers would welcome a forum to inform the public what they are doing, because much of the excellent work they do gets no publicity. It is good work and not sensational. Perhaps there is an opportunity for people in their own regions to invite the resources officers to public meetings and so on.

Another key response to the recommendations of the task force was the establishment in 1999 of the national suicide review group. Membership of this group includes experts in the areas of mental health, public health and research. Its main responsibilities are to review ongoing trends in suicide and parasuicide, co-ordinate research into suicide and make appropriate recommendations. The annual report of the national suicide review group meets the requirements of the Health (Miscellaneous Provisions) Act 2001, whereby the Minister for Health and Children will report annually to each House of the Oireachtas on the measures taken to prevent suicide in the previous year. The report outlines the measures taken by health service providers and other agencies in the previous year to help prevent suicide and reduce the impact of suicidal behaviour. The aim of the report is to facilitate the sharing of information across the health and other sectors regarding suicide prevention projects and to provide accurate and current information on the patterns of death by suicide in Ireland.

The report draws attention to the many initiatives being undertaken throughout the country in the area of suicide prevention. Among the developments highlighted is the appointment of liaison psychiatric nurses to the accident and emergency departments of many general hospitals to deal with people who present following attempted suicide. The provision of this type of service ensures that psychological problems in patients presenting to general hospitals are dealt with promptly and referred to the mental health services for further support and follow up, if necessary. This benefits the patient and ensures a more efficient use of medical and surgical services in accident and emergency departments. Other initiatives highlighted in the report include the provision of training to health service staff and public information campaigns.

My Department allocates funding through the National Suicide Review Group for voluntary and statutory groups engaged in prevention initiatives, many of which are aimed at improving the mental health of the younger age groups. These projects include life skill courses for high risk youths, school-based personal development modules and mental health promotion campaigns. A number of these projects have been positively evaluated and proved to enhance the coping skills of the participants. It is anticipated that such campaigns will lead to a reduction in youth suicide behaviour over time.

At national level, priority is being given to education awareness and promoting a better understanding among the public towards mental health in general. We are all aware of the pressures on young people such as bullying, emotional distress, addictions, peer pressure and examination pressure. We often tend to think that people are weak if they suffer from anxiety, depression, inability to cope or have suicidal tendencies. However, it is now widely acknowledged that one in four women and one in ten men will experience depression during their lifetime. Many of these are successful people, role models and celebrities whom we all know. There is a growing awareness and concern among the community about mental health matters. The national health promotion strategy 2000-05, in conjunction with the new health strategy, regards mental health as equally important to physical health in a person's overall well-being.

Increasingly, mental health is being recognised as a major challenge facing health services in the 21st century, not just in Ireland but across the world. My Department recognises the need for positive mental health promotion. Mental health promotion is a very broad concept as it emphasises the promotion of the psychological health and well-being of individuals, families and communities. I consider it 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 whole population.

A fundamental aim of the new national strategy for action on suicide prevention to be published in September 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 the findings will be of greatest value where they can inform and stimulate actions and service development. The strategy will identify expected outcomes and set targets which can be measured, monitored and revised. Continual quality control and ongoing modification improvement of the strategy will be central to its implementation.

I would like to respond to a few points made by some speakers. Senator Browne referred to low self-esteem among people who take their own lives. A psychotherapist friend told me recently that he has never come across a person who attempted parasuicide or had mental health problems who also had high self-esteem. These are mainly people with low self-esteem, which is a challenge for all of us, particularly in motivating people in the educational sphere.

Single vehicle accidents was referred to by many Members. I have asked the review group to examine this aspect because we are becoming aware of an increased incidence of single vehicle accidents among young males. It appears that some of them are either parasuicide or suicide cases. In the case of people who survive, there is an onus on the health services to follow up these cases and ensure that if it was a parasuicide or an attempted suicide, people get the help they need immediately.

Many Senators spoke about the Fine Gael document which was launched recently. I welcome any contribution from any political party on this subject. It is a matter that is apolitical, which affects all of society. I welcome any group or political party that contributes to the debate.

Senator Browne referred also to the national helpline and what Deputy Gregory said in the House recently about trying to access some of these lines and the responses he received. I have been aware of this problem for some time, as has the expert group and the strategy group. We are all aware that we need to focus on young people, in particular, in regard to suicide and parasuicide. However, it is not as simple as just throwing money at the problem. That particular group is into technology, texting and so on, therefore, we must examine new ways of getting our messages about positive health across to them. I have not adopted a simplistic ad hoc approach. I am well aware of the problem. People are examining the best approach to target these young people.

Senator Glynn and many others mentioned alcohol and drug addiction as being a serious problem. This does not apply only to illicit drugs. More information is emerging to the effect that people abuse and overdose on prescribed mood altering drugs, such as benzodiazepines, etc. There is a high level of addiction to prescription drugs, an issue we must consider seriously.

Senator Henry mentioned the education of doctors and nurses. I have often said that general practitioners could play a significant role in the area of prescribing medication and advising people on lifestyle issues. They are the gatekeepers, the first people to whom people go for help.

I am not happy about the education of doctors. This whole area needs to be reconsidered. The model of the points system, focusing on the highest achievers in secondary school, does not necessarily make the best doctors. We know from the use of that system for approximately ten or 15 years that there is a 10% drop-out rate among doctors after their first year in practice. That is a frightening statistic, not alone because it is unfortunate for those who realise after a year or two that they entered the wrong profession. They did not realise that medicine is as much a vocation as a profession. It is also a waste of public money to educate people who do not then use the skills they learnt in college.

Senator Henry and a couple of other speakers mentioned assisted suicide. I do not wish to comment on the case recently covered in the media. I have thought seriously about this issue in recent years in the context of my profession of pharmacy. I am totally opposed to assisted suicide and so is the Government. I welcome the debate, however, because this is an ethical issue on which people hold differing views, as is their right. This matter will be debated more fully in the public arena in the future. The ethical issues involve the medical and nursing professions, pharmacists and everyone who deals in this area. We must reflect on this topic.

I welcome Senator Ryan's contribution on the holistic approach to the complex issue of suicide. He also spoke about how young people now go out in a deliberately self-destructive way to get drunk. He is correct to say that 20 or 30 years ago people went out to drink and have a good time but they did not go out deliberately to get drunk. That is a change in society and something we must examine, to understand why it is happening. I take a drink, and there is value in people drinking but there is no value in people drinking to the point of such excess that they become completely drunk.

Senator Ryan also mentioned the models of success in our society and how these do not include artistic people or those who do not wish to have the trappings of success, or money. They may be artistic or creative people, writers and so on and have their own lifestyle. In times gone by they would have been classified as daoine simplí. There is nothing wrong with those people, indeed because they may be slightly different from the norm they may have better attributes than many of us do. How society deals with them is a matter of education and values which we must consider.

Senator Minihan made some important points, namely, that for people with mental illness there is hope, and help is available. Too often in the past, under the psychiatric model, as soon as one attended a psychiatrist one was labelled and told one had a condition for life. There is, however, a recovery model. People who have recovered and come out of the system have much to tell us.

It is important to listen to them because they can point out the flaws in the system. There were major flaws in the way in which people with mental illness were dealt in the past. There is hope, help and a recovery model. Many people who receive the proper intervention and treatment survive and overcome their mental illness and recover completely.

Senator Cummins called for more resources and money. While I do not disagree with him, and I will ask for more resources from the Government, it is not just a question of resources. As Minister of State with responsibility for this area I receive many cries for help from around the country from those using services. However, many of those who are unhappy with the services are so because of the manner in which certain people have dealt with them. These are people employed in the services who do not deliver them.

Most of those working in the mental health area are good people delivering excellent services to a very vulnerable group. Unfortunately, however, there are some who do not give the best of service to people with mental illness, which can have catastrophic results for the vulnerable patient. Senator Cummins also mentioned gambling, a topic on which few people speak, so I will take it on board.

Senator Bannon mentioned that Rehab is hosting a fund-raising event next week in Dublin which former US President Bill Clinton will attend. While I welcome Rehab's initiative to raise funds for the effort to prevent suicide, our approach as a Government and a society cannot be that one or two organisations take over this area. If we are to get this process right the voluntary and statutory sectors must engage in a co-ordinated approach. This must begin at parish level, as Senator Scanlon said.

Senator Ormonde said we must move slowly and meticulously. We have walked cautiously, not slowly, over recent years. Later this year we will publish two reports, from the expert group and the strategy group, which I initiated as soon as I came into this office. They will point the way to major reformation of our mental health services. It will be a challenge for the Government to provide more funds and to many people working in the field because many aspects of the work in this area could have been done differently and need to be done differently.

Many patients and clients who use the mental health services have reported to us. They are telling us they are not happy with many of the services and are not happy with the way they have been dealt with in the past. Not only is it important to hear those messages; it is also important to put into practice strategies that will take those issues on board and employ different methods of doing things. For example, medical card holders cannot as of right in Ireland go to a counsellor. They must first go to a general practitioner and be referred to a psychiatrist. That is one issue that will have to be changed.

Senator Maurice Hayes reminded me of our common problem with Northern Ireland. I will certainly take that issue on board but probably not until the autumn when I receive the two reports. The Senator is correct in saying it would be much better if an all-Ireland approach were adopted. Senator Scanlon mentioned the effects on the ground in local communities.

I thank all Senators who contributed to what was a worthwhile debate. I thank them for their efforts today in helping me, on behalf of the Government, to get to grips with this complex problem. If it were a simple problem it would have been solved years ago. It is a problem not only for Ireland, but is an ongoing global problem. I admit we have a problem; Ireland ranks 17th in the EU in terms of the overall suicide rate. Having read some of the articles in the newspapers, one would swear Ireland had a problem that was out of all proportion to the other 24 member states. That is not the case. However, there are warning signs especially with young people and we must face up to what is happening. This is a challenge for the Government and all of us who have the responsibility to put meaningful services in place which will alleviate people's suffering. There is also a social inclusion issue. Unfortunately, mental health issues and suicide cut across society and are not confined to any strata or socio-economic group.

I thank Senators and you, a Chathaoirligh, for the opportunity to come into the House to discuss this important matter.