Phil Prendergast (Labour)

I welcome the Minister of State and wish him well with his brief.

Suicide is the single most distressing subject of our time. To take their own lives people must overcome that tremendous urge everyone has to live. People must be so overcome with despair that they see no other option. It overcomes all their instincts — personal, familial and parental — and the option of suicide takes on the appearance of a viable alternative. That is desperately difficult for us to understand, yet approximately 500 people every year succeed in doing it.

Some commentators claim that those who take their own lives are selfish, that suicide is a selfish act. Those who suggest that fail, at a fundamental level, to understand the nature of suicide. They are simply wrong. Suicide is a difficult and complex issue and our society's challenge is to find a solution that will bring about a meaningful intervention for those at risk.

As a public health problem, suicide is recognised as one of the most intractable issues we face. Fifteen out of every 100,000 people die by suicide each year. The highest rates are reported in the 15 to 24 and 24 to 44 age groups, while youth suicide in Ireland is ranked fifth highest in the 25 countries of the European Union. Male suicides exceed those of females in this age group by a factor of 7:1. Behind those stark figures lie the personal stories of 500 Irish people, their families, friends and communities.

We appear to be a society in crisis, yet we appear to be in denial as well. I acknowledge the work of the National Office for Suicide Prevention. I note the range of pilot activities throughout the country, which are welcome, but I despair at the pitiful budget we allocate to suicide prevention.

In 2005, there were 399 deaths on our roads and €29.45 million was spent by the Department of Transport on road safety initiatives. That was very welcome but when we compare that figure with the €500,000 spent on suicide prevention in the same year in which 431 people died by suicide, it shames us and confirms to me that we are in denial. Money will not solve everything — it never did — but without resources we will achieve nothing.

In 2006, €1.8 million was allocated for the purpose of suicide prevention. In Scotland, with an annual rate of suicide of 600, £18 million sterling was allocated over three years to support a similar strategy. We must increase our spending to achieve real results and demonstrate that we, as a society, are serious when we speak of suicide prevention.

Suicide is a complex issue, a point made by many speakers this afternoon, and if there were easy answers, we would find them. The causes are multifaceted and involve an interaction of biological, psychological, social and environmental risk factors. More than 100 years ago, a French sociologist, Emile Durkheim, identified the sense of detachment from society, which he called anomie, as a major risk factor. Today, as our society undergoes immense change, statistics show that between 1980 and 2002 the rate of suicide in Ireland doubled, something mentioned by other speakers.

There is a link between mental illness and suicide but it cannot be definitely stated that mental illness is the cause of all suicides. Figures suggest that the majority of those who completed suicides had no prior contact with the mental health services. One recent study has shown that of those who completed suicide in Ireland, 33% had been known to be referred to the mental health services at some point, of whom less than half had been diagnosed as suffering from a depressive illness. That is not to deny the reality that depressive illness is a major risk factor in suicide. We must remember that two thirds of people who are depressed do not consult their general practitioner while just 8% contact mental health service providers. Those figures clearly point to a difficulty in accessing mental health services.

We recognise the historical under-investment in the mental health services, especially in suicide prevention, and we see that people are reluctant to access or have difficulty in accessing the existing services. We must also see that changes at societal level have seen a doubling of suicide rates in 20 years. We have put in place the National Office for Suicide Prevention and suicide prevention strategies. That is a good start but I am not convinced we are doing enough to tackle the problem. When depressive illness and suicidal ideation are such individual and personal experiences, we can ask the despairing question of what to do and where to start in seeking an answer.

There is a wide recognition that the problem has its source in society, yet our response seems to be primarily medical in nature. While it is undeniable that there is a major role for the health services to play in the prevention and response to suicide, perhaps we are overly reliant on the medical model. When 55% of those who die by suicide do so at their first attempt, medical attention is obviously too late. We must seek the answer in the problems faced by individuals in society and put in place a structure where the response is not just medical but embraces a wide range of other disciplines where high risk groups and individuals are identified and interventions can be made before it is too late.

We are familiar with the heart-wrenching story of the young man — it is disproportionately young men — who successfully completed suicide. He had been behaving as he normally behaved but was found dead by his distraught parents. What had happened to that young man who had taken his own life? We may never know but we cannot just console his parents, wring our hands and say that it was one of those things.

Every town and village has been visited by the spectre of suicide. Every person here knows someone who ended his or her own life. That terrible figure of 500 people every year represents 500 sons and daughters, mothers and fathers, our friends and, God help us, our family members. It is time for us as a society to take responsibility for this problem and as politicians we have a role to play. It is up to us to give priority to the issue of suicide and we need to place it at the top of the political agenda.

We can see in the story of the young man who took his life that there were no indicators that he was about to do so. Nobody had noticed that he was harbouring those darkest of thoughts and the first realisation came when he was found dead. It is clear that society failed this young man. There was no medical response to his needs whether the services were available, and if we had the most sophisticated health service in the world it would have made no difference. It is time for us to make a difference now.

I want to make a suggestion, which might form part of the solution. Currently, some 11 resource officers are employed by the HSE with responsibility for implementing the suicide prevention strategy. In an ideal world we would have a resource officer in every population centre. Let us expand the role and create the position of community support officer with particular responsibility for suicide prevention. Let us place this community support officer in each town, thus creating structures that mirror those of the public health nurse network. Let us pilot this scheme in a particular area. To illustrate the idea, I could cite the case of Tipperary as I know the area so well but I will not be parochial. The community support officer could be based in community office space and the role would involve liaising with schools, youth groups, voluntary bodies, sports clubs and all other formal and informal networks within the community. The officer's role might also involve liaising with GPs, public health nurses, community mental health nurses and community leaders. The community support officer would not replace health professionals but would complement their role.

A colleague recently told me that in his town there were four incidents of self-harm among young people in a three-month period earlier this year. Fortunately, none was successful but it really was a case of mere good fortune. This town is the location of a large mental health facility which employs 150 fully trained, highly experienced and dedicated mental health nurses. Not alone did the local mental health service have no response to these crises, it was also unaware of them until after the event. The GP was not aware of them either and they had not been picked up on in school. There seems to be no prism through which these events could have been seen sooner, so something is terribly wrong. A community support officer immersed in the community and working within local social networks might have provided an early warning system in these cases and perhaps also in the case of the young man about whom I spoke.

Let us take a cold and unpleasant look at the economic cost of suicide. It is estimated by the National Office for Suicide Prevention that the human and indirect costs of suicide in Ireland amounted to €871.5 million in 2001. Actuarial studies indicate a much greater economic cost given the young age of so many of the victims. While it is distasteful to refer to an economic cost in this context, it is necessary in order to illustrate the need fully to resource suicide prevention strategies. The provision of a community support officer on a pilot basis in, for example, four or five towns would cost only a fraction of the aforementioned figure. It is not an expensive idea when one considers that one cannot put a cost on a life. I do not know if the proposal is practicable, but I ask the Minister of State to examine it. I am available to discuss the matter further at his convenience. It remains to be seen whether the plan would be effective, but it is worth trying given that anecdotal and empirical evidence suggests mental health services are failing to reduce the incidence of suicide. I propose the introduction of a pilot scheme along the lines I have outlined and I thank the Minister of State for his attention.