Tim O'Malley (Limerick East, Progressive Democrats)

I welcome the opportunity to speak in the Seanad on this most important topic. I will outline the measures which are being taken by the Government and the Department of Health and Children, in conjunction with the Health Service Executive and many community and voluntary organisations, to address the issue of suicide, which is a serious problem in Irish society. Official mortality data from the Central Statistics Office indicate that there was an annual average of 494 deaths by suicide in Ireland between 2000 and 2002. The figure peaked at 519 in 2001. Such a number of deaths represents a rate of approximately 12.9 suicides per 100,000 people. Ireland ranks 17th among the 25 EU member states in terms of its overall suicide rate. The rate of youth suicide in Ireland, which is the fifth highest in the EU for those between the ages of 15 and 24, is of particular concern. The suicide rate in this country is even higher among those in their 20s and early 30s. Men under the age of 35 account for approximately 40% of all Irish suicides.

Deliberate self-harm is a further significant public health problem. According to the National Parasuicide Registry, over 11,000 cases of deliberate self-harm, some of which result from serious suicide attempts, are presented to Irish hospitals each year for assessment and treatment. The highest deliberate self-harm rates are found among younger age groups. The rate for girls peaks between the ages of 15 and 19 and the rate for young men peaks between the ages of 20 and 24.

The historical reluctance in Irish society to discuss the issue of suicide has thankfully changed. While it is to be welcomed that the level of discussion and openness about mental health issues, including deliberate self-harm and suicide, has increased significantly in recent years, we need to ensure that public discussion and media coverage of suicide and deliberate self-harm remains measured, well-informed and sensitive to the needs and well-being of psychologically vulnerable and distressed individuals in society. In particular, we need to continue to work as a society to create a culture and an environment in which people in psychological distress feel able to seek help from family, friends and health professionals.

Suicide touches the lives of many people. It is a tragedy in every case, because a life has ended and family, friends and community have been left behind. Many of us know someone who has attempted or completed suicide. Preventing suicide and reducing the rate of suicide in Ireland is an urgent public health issue that is at the heart of our efforts and policies, aimed at creating a healthy, prosperous and socially inclusive Ireland. In addressing the rate of suicide, we must continue to try to eliminate poverty, to achieve greater social justice and inclusion for vulnerable people in society, to address inequalities where they exist and to improve and expand educational opportunities.

I recognise that many challenges lie ahead and I am aware that no easy or single interventions guarantee success in this area. International evidence shows that reducing the suicide rate and preventing suicides requires a collective and concerted effort from all groups in society. Work needs to be done by those involved in the health and social services, other professions, communities, voluntary and statutory agencies and organisations, as well as parents, friends, neighbours and individuals. A strategic framework is required to help us to identify the actions we can undertake in a co-ordinated way, by means of partnership between statutory, voluntary and community groups and individuals, supported by the Government.

Reach Out — A National Strategy for Action on Suicide Prevention was launched by the Tánaiste and Minister for Health and Children on 8 September last. It builds on the work done in 1998 by the national task force on suicide and takes account of the efforts and initiatives developed by the former health boards in recent years. It was prepared by the project management unit of the Health Service Executive, in partnership with the national suicide review group, and supported by the Department of Health and Children. Since the work on the development of a national suicide prevention strategy was initiated almost two years ago, wide-ranging consultation has taken place throughout the country to draw on the experience, perspectives and ideas of the key stakeholders and interested parties. I thank those who participated in the process of consultation which, combined with continuous monitoring of evidence and best practice, allowed the project team to take an evidence-based and pragmatic approach to prioritising the actions to be undertaken by the various agencies and groups if they are to effect real change over the next five to ten years.

A straightforward approach is advocated in the strategy, which identifies four principal levels of action — a general population approach, a targeted approach, an approach to responding to suicide and an approach to information and research. Some 26 action areas have been identified across the four levels and specific points of action, which are to be implemented in three phases over the coming years, have been specified. The combined public health and high-risk approach to suicide prevention that is identified in the strategy is the same as that advocated by the International Association for Suicide Prevention. It is in keeping with the European action plan for mental health, which was signed and endorsed on behalf of the health ministers of the 52 member states of the European region of the World Health Organisation at the ministerial conference on mental health in Helsinki in January 2005.

A fundamental aim of the new strategy is 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 multi-disciplinary 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 identifies expected outcomes and sets targets which can be measured, monitored and revised. Continual quality control and ongoing modification and improvement of the strategy will be central to its implementation. At present, 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. The new strategy includes specific recommendations for action in this area.

The Health Service Executive is taking a lead role in overseeing the implementation of the strategy, in partnership with those statutory and voluntary organisations that have a key role in making the actions happen. Driving the implementation of the strategy is the recently established National Office for Suicide Prevention, which is based within the national population health directorate of the HSE. This office is headed by Mr. Geoff Day, formerly assistant chief executive officer of the North Eastern Health Board and chairman of the National Suicide Review Group.

The first task of the national office will be to work on the following five key priorities: stigma reduction and mental health promotion; the development of a national training programme; the development of an effective service response for those who have engaged in deliberate self-harm or who are acutely suicidal; the development of bereavement support services; and improving data collection, management and use in regard to suicidal behaviour and suicide prevention. In addition to these five priorities, all of which will be worked on simultaneously, the National Office for Suicide Prevention is committed to developing the potential use of information and communications technology — for example, using the Internet or SMS text messaging through mobile telephones — to reach out and provide support to young people and those feeling isolated and alone.

An annual report will be produced by the National Office for Suicide Prevention detailing progress in regard to the implementation of strategy actions in the previous calendar year, beginning with a report in 2006. This will provide an important tool for monitoring progress in meeting the priority objectives of the strategy and reporting on rates of suicidal behaviour, which it is hoped will be significantly reduced over the coming year. The annual report will meet the requirement of the Health (Miscellaneous Provisions) Act 2001, which requires a report on activities in the area of suicide prevention to be presented to the Houses of the Oireachtas each year. The production of this report had previously been a function of the National Suicide Review Group.

An advisory group comprising key individuals who can offer their expertise to guide the work of the national office and the HSE will also be appointed. This advisory group will replace the current National Suicide Review Group, the contribution of which to suicide prevention has been considerable. In turn, a representative national forum will be briefed by the national office on the achievements overall in suicide prevention and, in particular, in regard to strategy implementation. This forum will also provide an opportunity for the exchange of views on developments in suicide research and prevention.

Much consideration was given to the setting of an overall target for the reduction of our national suicide rate as an outcome measure of this strategy. At this stage, it has been decided that a specific target will not be set because the priority is to establish the accuracy of suicide mortality in Ireland whereas, due to the range and interplay of factors that influence the suicide rate, it is virtually impossible to establish a direct cause and effect relationship between prevention programmes and a change in the overall population rates. Nevertheless, there are undoubted advantages to setting targets for an overall reduction, not least the fact that it focuses the attention of those working at all levels of suicide prevention. An overall target for the reduction of suicide rates will be set by the Government, on the advice of the Minister for Health and Children, when the Minister is satisfied that suicide rates have been accurately determined.

I am pleased to inform the House that funding of €500,000 has already been allocated to commence the implementation of the strategy for the remainder of 2005. This includes funding towards the development of a major national campaign for the promotion of positive mental health; the delivery of a second national intervention skills training of trainers programme; the creation of new, dedicated services for treating deliberate self-harm in accident and emergency departments; the further development of existing services; and the further development of bereavement support services. Additional funding will also be made available over the coming years to support the strategy and complement local and national efforts. This has been confirmed by the Taoiseach and the Tánaiste.

In August 2003 I appointed the expert group on mental health policy to prepare a new national policy framework for the mental health services. In the course of its work, the expert group will consider the area of suicide prevention and reduction and will make recommendations on the matter, taking account of the national strategy, Reach Out. It will also set the issue of suicide prevention and reduction within the broader context of a mental health policy framework.

In conclusion, I reiterate that the Government shares the public concern about the levels of suicide in our country. 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, that they consider taking their own lives. We must aim to provide accessible, sensitive, appropriate and, where required, intensive support. The new suicide prevention strategy is practical and achievable, and based on evidence and international best practice. It is further evidence of the Government's determination to take whatever steps it can to reduce the level of suicide in our society. It will be subject to ongoing, regular evaluation to ensure the expected outcomes are achieved.