Tim O'Malley (Limerick East, Progressive Democrats)

I thank Senators for giving me the opportunity to discuss Reach Out — A National Strategy for Action on Suicide Prevention 2005-14. The Irish translation — tabhair dom do lámh — might better express the aim of the strategy. I appreciate the contributions of Members of this House to the debate on what is an extremely complex issue facing Ireland and other countries.

The importance of exploring the causes of and ways of dealing with suicide and suicidal behaviour cannot be over-emphasised. The overriding theme of our efforts to tackle the problem of suicide in Ireland is collaboration. If we tackle suicide as a one issue policy, we will fail. Our collective attempts to prevent suicide and reduce the suicide rate are at the heart of all our policies, whether they relate to economics, regeneration, social justice, inequality, education, health, local government, communities, children, better public services or improved mental health care. All of these issues have been alluded to by various Senators.

Suicide affects all age groups and communities. Few people are untouched by the devastating effects of suicidal behaviour in their lifetime. The emotional, social and practical repercussions of suicide are felt by family members, friends, neighbours, colleagues and those working in a wide range of services and agencies.

Many factors put a person at risk of suicide. They include changing societal trends, including an increase in marital breakdown and divorce; insecurity of employment; high prevalence of alcohol problems and substance abuse; social values; attitudes to mental illness and mental health; suicidal behaviour; domestic abuse; stigma; poverty and inequality; inadequate social support such as low levels of practical, emotional and other forms of assistance from family, friends and neighbours and experience of sexual and physical abuse or bullying.

I must comment on the Ferns inquiry report, which is devastating. We are all diminished by what happened in the diocese. Many priests around the country feel very inadequate because of what has happened there. A considerable amount of bullying must have been a component of the abuse that occurred and which led to suicides. We know from the report that some suicides occurred as a result of this sad episode. I commend Bishop Eamonn Walsh on his forthright behaviour and facing up to the problems in the diocese. The Government faces the considerable challenge of dealing with the issues involved.

Low self-esteem and lack of confidence are other factors often associated with suicide. The list of factors I have mentioned is not exhaustive. The relationship between these factors and suicidal behaviour is complex and none should be addressed in isolation. For example, long-term factors such as the impact of being unemployed for over a year should be differentiated from short-term triggers such as recent redundancy. We need, therefore, to consider ways in which policies and actions to prevent suicide can be made sensitive to the specific circumstances and needs of particular groups on the basis of age, gender, etc., and in particular settings such as schools, workplaces and urban and rural areas. In this regard, the work of the suicide resource officers who were appointed in each of the former health boards is crucial.

It might be useful if Senators contacted the suicide resource officers in their area who do excellent work and are involved in the community in respect of all the issues pertaining to mental health and suicide prevention. They work in schools and communicate with people. I have met several officers who are excellent individuals. I exhort Senators to utilise this resource. The Senators who stated nothing was being done to prevent suicide are diminishing the work of these officers who are doing excellent work and need their support. They also engage in the promotion of positive mental health and the destigmatisation of suicide and provide information on the issue of suicide and parasuicide.

Senators are aware that many suicide prevention initiatives are being undertaken, one of which is the appointment of liaison psychiatric nurses to accident and emergency departments of many general hospitals to deal with persons who present following an attempted suicide. The provision of this service ensures patients with psychological problems presenting at general hospitals are dealt with promptly and that they are referred to the mental health service for further support, if necessary. This benefits the patient but also ensures the more efficient use of medical and surgical services in accident and emergency departments. Other initiatives include the provision of training for health service staff and public information campaigns.

The Health Service Executive plays a major role in co-ordinating efforts to help reduce the level of suicide and parasuicide. The new National Office for Suicide Prevention, established after the launch of the strategy, is responsible for overseeing implementation of the strategy, a fundamental aim of which is to prevent suicidal behaviour, including deliberate self-harm, and increase awareness of the importance of good mental health among the general population. Ongoing, high 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 action and service development. The strategy identifies expected outcomes and sets 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. It is important to stress that it is action-based and builds on existing policy, as outlined in the national task force on suicide's report in 1998. The strategy is practical, achievable and based on evidence and international best practice.

I appeal once again to psychiatrists who recently declined to participate in mental health tribunals following year long negotiations with the Government to reconsider their decision. They were offered 13 additional consultant psychiatrist posts which would have cost the Health Service Executive approximately €10 million but they declined the offer. We are dealing with the most vulnerable in society — those involuntarily detained in mental institutions. As Minister of State with responsibility for mental health services, I am aware that the provision of resources is an issue but so are the human rights of the most vulnerable in our society. I appeal to psychiatrists to engage in these tribunals. If they decide not to do so, the Government will be forced to take alternative measures to get the tribunals up and running. It must deal with a situation outside its control.

Senator Henry mentioned the use of psychiatric drugs and argued that consultant psychiatrists and GPs were forced to use psychotropic drugs because of a lack of counsellors and psychotherapists. As a former pharmacist, I am aware of the very serious debate taking place about many of these drugs. Senator Henry has mentioned some of the new drugs which are available such as barbiturates, amphetamines, benzodiazepines and selective serotonin reuptake inhibitors. There is increasing evidence of the problems associated with such drugs. We were told when they appeared on the market that they were non-addictive and that they were the best thing since the sliced pan. After ten years of the use of the drugs in question, we know certain problems are associated with them.

I ask Senators to be objective when they listen to experts speaking about mental health matters. I have a major problem with the influence the pharmaceutical industry exerts on the medical profession, especially the psychiatric sector, and on the postgraduate education of doctors. I recently heard a psychiatrist from the United States speak during the Lilly bipolar lecture tour of this country's three principal cities. Given that the lecture tour was sponsored by a pharmaceutical company, how could the psychiatrist in question be objective? The psychiatrist said on national radio that if one was diagnosed with a mental illness, one would be on drug therapy for the rest of one's life. That is wrong. I ask Senators to challenge the so-called experts who make such comments. Some are experts, but others are not. Some are influenced by the pharmaceutical industry.

The Government which has already done a great deal in this regard will continue to do everything it can to ensure more counsellors and psychotherapists are employed. There is increasing evidence that we need oral forms of therapy in order that those who wish to speak to others can do so. Many Senators mentioned the changes in our society. One of the most significant social changes has been that people are spending more time watching television. They are less likely to interact with and speak to each other.

I thank Senators for inviting me to come to the House to listen to their views on this hugely important matter that affects every part of Ireland. The last time we discussed the issue of suicide Senator Maurice Hayes made the important point that North-South co-operation was needed in this regard. I will take steps to facilitate such co-operation. The expert group on mental health will refer to suicide when it reports to me in the near future. I look forward to the enactment of the strategy's recommendations. Senator Ryan said it was in gestation for a long time, but that was necessary because a large amount of work had to be done to ensure the right strategy was prepared. I am happy that we have published the right strategy. It is up to us to ensure it works.