John Gilroy (Labour)

I welcome the Minister of State, the group from Clondalkin and Deputy Derek Keating, who is doing tremendous work in this area. As Senators, every day we hear about people dying by suicide - it is sometimes one person but it is sometimes several people. It is very easy to feel helpless in the face of that but it is important that, as policymakers, we do not allow ourselves to be overwhelmed.

I have worked in the mental health service for 27 years. I was a psychiatric nurse and I spent approximately six years working in the voluntary and community sector. I claim no particular expertise in this area apart from the fact that I have seen at first hand the consequences of suicide and suicidal behaviour on families, individuals and communities. Suicide is the greatest challenge facing Irish society.

I have a great deal to say about suicide but I will confine myself to making one or two points. I have been appointed rapporteur on suicide prevention to the Oireachtas Joint Committee on Health and Children and I will bring a report to the committee in due course. As part of this, I have spent the past six months meeting stakeholders from the voluntary, community and statutory sectors as well as individuals who believe they have something to say.

I am rather critical about the way we are approaching this problem but before I give a critique, I must acknowledge the great work going on in many areas. It is necessary for us to be clear in our prescriptions and in our analysis. Our methodology of collecting information on suicide is rather unsatisfactory. So much so that the real levels of suicide are not clearly known or understood. Garda form 104 is the document used to collect data. As far back as 2007, questions were raised about whether it was the most appropriate way to gather information.

I will not give a lot of statistics except to note that in the five years before the publication of our national policy, Reach Out, on average, 493 deaths by suicide were recorded each year. In the five years since the publication of the policy, on average, 461 deaths by suicide were recorded each year. When we consider the population growth since then, there seems to be some evidence to suggest our policy is working. However, there are many ways to read statistics and if we are to include deaths recorded as being of undetermined intent, the statistical difference in the numbers before and after the publication of the document is very small. Therefore, we must ask whether our policy is working.

The figure for 2009 of 527 people dying by suicide is the highest on record and we must ask what is going on here. Can we say the rise in the number of deaths is due to some dynamic associated with the economic recession? We might be able to answer "Yes" but then again, we might well answer "No" because we just do not know. There is no research in this area.

When we have a suspicion something might not be doing what we hoped it would do, it is prudent and, indeed, necessary to review it. The one omission from the policy is the lack of a review date. It is a ten-year policy and it seems strange there is no provision at all for any type of review. I understand the policy has been under-resourced and perhaps it is unfair to say it is not working when we have not provided the resources to make it work. This might be another good reason a review is due, that is, to ensure the same circumstances pertain now as in 2005.

Reach Out contains 96 recommendations for action on a broad range of prescriptions. However, of the 96 recommendations, 41 require some sort of a review - a survey, a determination, a revision, a evaluation or an audit. They are fairly standard desk top research operations which could be done fairly quickly at minimal expense yet they have not been done almost six years after the publication of the policy.

One reason for this failure is a lack of clearly identified roles and functions and the failure to assign responsibility for these functions inevitably means that the work will not be done. As has been said by many commentators, when there is a conflict between political convenience and evidence-based initiatives, political convenience always wins. I hope that will not be the case with this policy.

Another difficulty with the policy is the manner in which some of the objectives relate to the proposed outcomes. I will choose one objective to illustrate the point but I could choose any number. I refer to objective 18 in the policy which is to support the development of services and programmes for unemployed people and to help increase resilience and reduce the risk of engaging in suicidal behaviour. There is evidence that there is an increased risk of suicide associated with unemployment but the vagueness of objective 18 and its lack of specificity makes it very difficult to see how we can realise its aims. The untargeted approach of the policy renders the policy objective and many other objectives unworkable.

While I do not wish to appear excessively critical or to voice criticism for the sake of it - none of the criticism I make is directed at the Minister of State whose commitment on this issue is not in doubt - I must make some critical observations. In 2007, it was recommended that the National Suicide Research Foundation develop a model to obtain detailed information on suicide and possible suicide deaths. In consultation with the Coroners Society of Ireland the suicide support and information system, SSIS, was developed and piloted in Cork. The service identified deaths an early stage and offered to support families and friends of people who it was suspected had died by suicide. The scheme, which was internationally recognised as a proven life saver, identified an emerging cluster of 18 young men in one part of Cork who had died by suicide in a period of two years and introduced the necessary supports for families and communities affected by the cluster. Without the SSIS, the cluster would have remained unidentified. Despite this, funding for the service ceased in January 2010 and the service is no longer in operation. This is a case of decisions being made in one policy area which have a direct and contradictory effect on decisions in other areas.

I also query whether the document contains a publication bias by over-emphasising the biomedical model at the expense of the psycho-social model. This question needs to be asked and while I do not have an answer, I suspect there is such a bias. A major study by 80 suicidologists across the world found more research and a better understanding of the pathways that lead to suicide and suicidal behaviour were required. It is clear from the literature that there is a lack of an evidence base on which policy in Ireland and across the developed world is built. A great deal appears to be based on observed experience and intuition, which is not to say the various initiatives are not working. While some clearly are working, the manner in which they work needs to be better understood. One strategy that has been shown to work because it is an intervention that can be directly related to a positive outcome is the training of general practitioners. Studies have shown that GP recognition of the earliest symptoms of depressive illness, which may include sleep disturbances and an early diagnosis and treatment plan, has reduced the number of suicides in some countries, most notably, Sweden.

Other research has found that depressive illness, diagnosed and undiagnosed, may account for up to 90% of deaths. If one takes the broadest definition of depression, one can see how this could be the case. Under this definition, depression is viewed as more than just being low in mood. Instead, feeling low in mood is considered a symptom of depression. The essence of depression may well be feelings of low self-esteem and low self-worth. If this is the case, we can see another dimension of depression which may not be considered an illness but is something that arises from life experience. If this theory is correct, we must combine the biomedical model with the psycho-social model to achieve a comprehensive policy response grounded in strategies which help people cope with life's adverse advents. Such a strategy must be introduced in primary school or even earlier. Coping skills, building resilience and dealing with loss and failure must be viewed in the context of normal living.

As this is a vastly complex area which is not fully understood, I hope the Minster of State will continue to make funds available for research as well as actions. I ask her to instigate a review of the position we have taken on the policy response. I am aware of her personal commitment to addressing the issue of suicide and wish her well in her work.