Fergus O'Dowd (Louth, Fine Gael) | Oireachtas source

I thank Senators MacSharry, Leyden and Mary Ann O'Brien for bringing forward this Bill. I welcome the opportunity to participate in this debate. The Minister of State with responsibility for disability, equality and mental health is unable to be here and sends her apologies to the House. Like physical health, mental health and well-being are relevant to everyone. I know that Members are well acquainted with the complex and sensitive issues that arise when this subject is under discussion. Senators and the Government share the same objective, which is to reduce the number of deaths by suicide. We are fully committed to this aim but, of course, there are different ways of achieving and funding it.

The Bill proposes the introduction of a levy on all alcoholic beverages sold from but not intended for consumption on licensed premises to be paid into a specific fund for supporting suicide prevention. While I appreciate the motivation behind this Bill, it is important to point out that issues around the misuse of alcohol are much broader than just suicide and that, therefore, any measures taken by Government must have regard to the many social and health harms caused by alcohol. It is important to state that the Minister for Finance has responsibility for levying and collecting taxes and excise duties and that the Government has no plans to alter this arrangement. The collection of an excise duty on alcohol which would be placed in a tightly defined fund would restrict the Government's ability to prioritise expenditure. This would not be in keeping with the Government's approach to revenue collection and the process by which decisions are made as to the most appropriate use of the revenues raised.

This Bill seeks to limit the levy to alcohol products sold for consumption off premises. As has already been mentioned, Directive 93/92/EEC, which governs the structure of alcohol taxation, requires taxes on alcohol products be applied by reference to the nature and strength of the product. It does not allow for differentiation of rates according to where the product is sold or the type of packaging involved. Accordingly, the introduction of a levy on take-away products only would not be possible, and we must recognise that fact here.

This debate is very welcome in that it brings a focus on the damaging impact alcohol abuse has on mental health and the role alcohol plays in suicide and self-harm. In 2012 the National Substance Misuse Strategy Steering Group reported that alcohol was responsible for at least 88 deaths every month in 2008; is associated with 2,000 beds being occupied every night in Irish acute hospitals; is a contributory factor in half of all suicides and in deliberate self-harm; and was a trigger in one third of domestic abuse cases and cost the health care system €1.2 billion in 2007. The devastating consequences that alcohol specifically has on mental health are startling. Alcohol was a factor in 40% of all cases of self-harm in 2010. Alcohol-related disorders accounted for one in ten first admissions to Irish psychiatric hospitals in 2011. The WHO has estimated that the risk of suicide is eight times greater when a person is abusing alcohol and half of all those who took their own lives in Ireland had abused alcohol in the previous 12 months.

The Government is committed to tackling alcohol misuse and the widespread harm and pain it obviously causes. Last year following a full consultation involving Ministers and Departments, a comprehensive and detailed package of measures was approved to address this problem. It is the first time the misuse of alcohol has been addressed as a public health issue. We understand that we need decisive and innovative actions. The overall objective is to reduce the consumption of alcohol from 12 l of pure alcohol per person per year to 9.2 l, which is the OECD average, by 2020. That is what these measures have been framed to address.

The key measure is the drafting of a health orientated legislation on alcohol, the public health (alcohol) Bill. This Bill will be drafted taken into account the recommendations of the national substance misuse group's report. The Bill will provide for minimum unit pricing for retailing of alcohol products, regulation of marketing and advertising of alcohol, regulation of sports sponsorship specifically to place on a statutory footing an existing voluntary code that governs sports sponsorship, separation of alcohol from other products in retail settings, enforcement powers for environmental health officers in relation to alcohol and health labelling of alcohol products. The nature of the challenge we are addressing requires a significant public health response. This public health (alcohol) Bill and the measures for which it will provide are proportionate to the scale of the problems we face as a society.

I would like to inform the House of the work to date in regard to suicide prevention and mental health and outline the Government's approach to the development of an updated framework for suicide prevention over the coming years. Our mental health and well-being is something we all have to nourish and cherish and in these very difficult economic times it is even more important than ever to do so. Since Deputy Kathleen Lynch was appointed as Minister of State with responsibility for this area her priority has been to ensure that our mental health services are developed in such a way that we provide the best quality of care in whatever setting is needed whether that is in an inpatient setting in the community or in a person's own home. We are fortunate in the mental health area that we have our strategy document, A Vision for Change, guiding us in the way we deliver our services. This strategy is well recognised as being in line with best practice internationally. It is evidence-based and realistic and it proposes a new model of service delivery which will be patient-centred, flexible and community-based.

The House will appreciate that the current economic environment presents a significant challenge for the health system generally in delivering and furthering services, however, it is being treated as a priority by this Government. In line with our programme for Government commitments, €90 million and some 1,100 additional posts have been provided since 2012 to develop community mental health teams and suicide prevention resources. The budget for the National Office for Suicide Prevention, NOSP, has also more than doubled from €4 million in 2011 to €8.8 million in 2014. Dealing with the current high levels of suicide and deliberate self-harm is obviously our key priority as well. Policy is guided by the national strategy for the period 2005 to 2014, Reach Out, which has made a number of recommendations in relation to fast-track referrals to community-based mental health services, an effective response to deliberate self-harm, training, reducing stigma, promoting positive mental health and research. The NOSP has primary responsibility for the implementation, monitoring and evaluation of Reach Out and has been tasked with co-ordinating suicide prevention efforts around the country as well as supporting agencies and individuals interested and active in suicide prevention. It funds more than 30 non-governmental organisations to carry out an array of work in communities that promote positive mental health and work to reduce the incidence of suicide and self-harm. This work is supported at a regional level by HSE resource officers for suicide prevention. In 2014 the number of officers will increase from ten to 16. The office has also developed a range of initiatives not just to support people who are suicidal but also their families, friends and peers in recognising and responding appropriately to signs of emotional distress and suicidal thoughts.

Work is also continuing to build the capacity of front-line service providers and communities to respond to suicide through the delivery of a wide-range of awareness and training programmes which are available in the area of mental health promotion and suicide prevention. These include safeTALK which trains participants to become more alert to the possibility of suicide in their community and other training programmes such as Reaching Out, ASIST, Taking Control, Mind Out and STOP. A number of media awareness campaigns have also been run in recent years, including the Let Someone Know campaign, which focused specifically on young people and delivered a message that it is important to reach out and seek the support of others. Other awareness programmes including the Please Talk initiative running in third level colleges since 2007 encourage young people experiencing problems to talk to others and identifies the supports available to those in need.

Mindful that schools are one of the key settings for the promotion of mental health and well-being of young people and that they are all also in the position to identify young people experiencing emotional difficulties, the NOSP has worked closely with the Department of Education and Skills to develop guidelines for mental health promotion and suicide prevention in post-primary schools.

Reach Out comes to the end of its ten-year term this year and, consequently, the Minister of State, Deputy Lynch, has begun development of a new national strategic framework for suicide prevention, building on the comprehensive work delivered under the existing strategy. The objective is to have the framework completed by the end of 2014. This new framework will support other relevant Government policies, including A Vision for Change, Healthy Ireland and the National Substance Misuse Strategy. The aim of the framework will be to support population health approaches and interventions that will assist in reducing the loss of life through suicide while aiming for improved co-ordination, integration of services and responses in this area. The process of developing the framework includes consideration of national and international evidence and existing good practice, addressing areas such as policy, practice improvement, engagement, research, communications and media. The process also includes a review of Reach Out, a public consultation process and a review of the evidence base for suicide prevention initiatives. This strategy will be focused on a whole of government approach and will include engagement with other Departments, including the Departments of Children and Youth Affairs, Education and Skills and the Environment, Community and Local Government. A number of new suicide prevention measures have also commenced or will commence shortly. These include increased training for GPs and practice staff, the development of the suicide crisis assessment nurse model which allows for crisis intervention at primary care level. Eight new services will commence before the year end. This service provides active liaison between primary care and mental health services; the role out of dialectical behaviour therapy, specialist therapeutic services for people who have a history of deliberate self-harm and who have certain personality profiles; a community resilience fund has been established to support local HSE suicide prevention initiatives; and the launch earlier this year of the Samaritans national free to call 24-7 number for people in emotional distress. Another worthwhile initiative is the new counselling in primary care initiative. Funding of €7.5 million has been provided from the ring-fenced moneys for mental health for the development of psychological and counselling support services in primary care.

This service is specifically for persons with mild to moderate psychological difficulties who are eligible under the GMS scheme. This initiative, together with the continued development of adult, child and adolescent community mental health teams, will help to provide services in the community where they are most needed.

I welcome the opportunity afforded by the House to debate these critical matters, in which we are all engaged, in order to address the complex societal issues associated with suicide. I reiterate the Government's commitment to the mental health service and the continued development of modern and responsive person-centered services in line with the plans set out in A Vision for Change. I acknowledge the contributions made by all Senators involved in the debate which will certainly inform Government policy. I also acknowledge the commitment, thought and effort that has gone into presenting the issue in the House. The contributions from all sides have increased our knowledge of how best to deal with it.