John Crown (Independent) | Oireachtas source

I welcome the Minister of State. I know she takes this problem very seriously and I am grateful to her for giving it such a priority. Earlier, I was going through a mental checklist of people I know who lost their lives, sadly, through self-harm, and I came up with 14 names. These included a few nurses, medical students, doctors and world-famous cancer experts. There were also a couple of patients or family members of patients, as well as a relative of mine. Every one of these is a tragedy and these people came from all strata of society and age groups, although the average age was very young.

I am doing mental arithmetic on the median average age of death for this personalised cohort, which was the early 30s. We are talking about decades of lost life of the folks who sadly died and decades of bereavement for parents, siblings and others. They are all tragedies but we must suspend sentiment and look at the problem as policymakers and people who scrutinise policy in a scientific way to work out how to go forward.

It is a health care and health professional problem as well as being a personal problem and a public policy problem. We need to get a whole lot of metrics, and know how many people die in Ireland through self-harm, how many people attempt self-harm, and how many have recovered from the illness that led them to the awful brink. We must also know the metrics of the service we provide, including the ratios of consultant psychiatrists per head of population compared to other countries, of practising clinical psychologists per head of population, of trained psychiatry nurses per head of population, and of social workers per head of population.

We must also know, comparatively speaking, the level of access we provide, the days of the week and hours of the day provided to people suddenly facing a crisis. In those cases, an intervention may be lifesaving. We also need to know the waiting lists for people accessing routine psychiatry care where they do not express self-harm ideation but where such ideation may be lurking in the pathology affecting them. This may not be something they admit the first time they see a doctor or a nurse. We must ask ourselves critically the effect the blunt instrument of health service staff level embargoes have had on the problem. This is perhaps the time for introspection and self-scrutiny and a collective consideration of our contribution to the problem. We all understand the economic context in which the health system exists but we must seriously think about priorities within the service. Money is still being spent poorly, inefficiently and unwisely on aspects of health policy that are considered luxurious compared to the absolute necessity of doing things that save people's lives.

I urgently asked the Minister of State to really make it her business to have a root and branch discussion, not with the experts in the expert groups but with the practitioners on the ground, with whom it is critical important to speak. The Minister of State should ask what these people would like and what they believe would have saved the life of people who took their lives. She should ask what practical steps should be taken and whether that involves more clinics, more centralisation or more diversification of services, more staff on the ground, or greater availability of out-of-hours services. These strategies and practical advice should be taken on board. Perhaps the Minister should have a series of informal visits, where the supervisors and bosses are not present. The Minister of State should talk to the mental health nurses in a unit or the junior doctors in psychiatry and the consultants. Perhaps she can talk to the social workers and may find practical suggestions come to her in this regard. It may be that some of them are not expensive and practical suggestions can be offered.

The colleagues with whom I work most closely are not specialist medical health workers and interact with the psychiatry and mental health support services in the area called liaison psychiatry. It is a critical area and some patients primarily present with a psychiatric complaint to a doctor and seek psychiatric help. Others will develop it in the context of another type of illness. Many mental illnesses are physical illnesses but we have not yet worked out the physical basis for them. We will get there. Patients with more traditionally defined physical illnesses often need psychiatry support.

In my experience, this is an area which is desperately under-provided for at multiple levels within the service. In the case of psychiatry support for patients who primarily present with very distressing medical problems and may have a psychiatric problem develop or unmasked because of the physical, psychological, social and familial stress of an illness such as chronic neurological disease, stroke or cancer, the needs are often not well met.

I do not know much about this issue, but I ask the Minister to examine the care provided by private insurers for patients with psychiatric and mental health diagnoses to ensure they are pulling their weight also. They take a great deal of money from people who may become patients. I am aware that they reinvest in some cases; some of them are for-profit, while some are not for-profit organisations. However, there is, potentially, a pressure escape valve for some parts of the service and we should ensure these services are being provided with the moneys being paid.

Ultimately, on a day when we have seen rather distressing figures for what appear to be economic disparities in cancer mortality rates, let us ensure something similar does not emerge in the case of death resulting from self-harm.