Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I understand that. There is a range or menu of actions that can be taken in regard to road safety. One can ensure limiters are installed in cars, implement road improvements, introduce penalty points and so on. One cannot go down that route with suicide prevention because it is a different and far more complex area.

People die by suicide for a range of reasons. Some of those people are in receipt of mental health services, but many are not. There are undetermined deaths, as mentioned by Senator Paul Coghlan. As long as those deaths are undetermined, who are we to make a judgment on them? The families of those people would not thank us if we made a judgment call on those deaths; those deaths are undetermined and are defined as undetermined. We have mechanisms by which we evaluate whether people have died by suicide, such as those operated by the Garda, the CSO, the coroner and a range of others. We just need to be cautious in what we are doing.

I love coming to the Seanad to hear debates and I always make myself available for these debates, although perhaps I should not be so available. It strikes me, however, that everybody has an agenda. While everyone's agenda might have the same central aim, it is the agenda of that individual. It is obvious, for example, that our newly elected Senator has an interest in education. We all have an agenda. My agenda is to ensure A Vision for Change is implemented in so far as it can be, but I must point out the facts also. A Vision for Change was published in 2006, but it had a stop-start beginning. There is a difficulty, therefore, in that it is not being implemented as quickly as possible. Until 2012, it stopped and started. One year it seemed about to happen, but it did not and only bits of it were implemented.

Since 2012 we have had a clear view on the strategy, and we are driving it forward, although we have not fully implemented it yet. Perhaps if we had had what we have now since 2006, we would be further down the road. I cannot say the reason for the delay is the fault of anybody and I do not lay the blame at anybody's door. I do not do that. I just say to myself that it is now my job and I get on with it. I realise that some people believe the job I do is not good enough and others believe I have too much to do, but we will never agree on that. The reason we have not progressed further at this stage is the stop-start nature of the programme until 2012.

I agree with Senator Bacik that all the research suggests that early childhood trauma is a significant issue. This may not emerge in the formative years - at 14, 15 or 16 - but even when issues emerge later, they can all be traced back to early childhood trauma. We must, therefore, cherish our children far more than we do.

Senator van Turnhout spoke about child and adolescent mental health services, CAMHS. This service will remain within the mental health service rather than moving over to Tusla, the Child and Family Agency. I admit that I question my judgment on that. I put up a substantial fight and dug my heels in to ensure the service stayed within the mental health services and that it would be a seamless service, but I question that judgment more and more. While I am not convinced that I made the wrong decision, I question my judgment, because we are not getting the results we want for the resources we are putting into the service. I will keep this under review and will continue to question my judgment on the issue.

There is a difficulty in regard to child and adolescent psychiatrists. We are looking for one currently, and not only have we trawled for one in Ireland, we have gone to an agency in England through which we had some success previously. We have not succeeded so far. At the same time, a private provider has been offering a salary far in excess of what we can offer, but it has not been successful either. There is clearly a difficulty in getting people for this area and we have a problem in that regard at this time.

The strategy to ensure we have a follow-on strategy on suicide and suicide prevention is completed and will be published. This will ensure there will be no gap between strategies, and it is a sign of success for the Department. I still have a copy of the Planning for the Future strategy introduced by Barry Desmond in 1983 on a bookshelf at home. The strategy previous to that was published in 1964. There have been enormous gaps between plans. I should mention that apart from including tables on the staff required, there is little difference between A Vision for Change and Planning for the Future, although the latter was not as intricate or as detailed. I intend to ensure we no longer have significant gaps between strategies. A Vision for Change will run out in 2016 and we intend to put a group in place to plan for the time beyond that.

We are also preparing to deal with other areas. The gap in the services available for children and adolescents between the ages of 16 and 18 is unacceptable, but the bigger issue relates to what happens when a person reaches 18. Should these young people fall off the cliff and go automatically into an adult service that they may not be ready for or that may not be ready for them? We are looking at what has been done in regard to mental health services in Birmingham by Professor Swaran Singh. A transition programme has been put in place there for young adults between the ages of 16 and 25, and the two services interact so as to ensure not only that the person is familiar with the service but that the service is familiar with the person. We are considering this seriously because it is what needs to happen.

It is difficult to get everything one wants to say into a speech, despite its being 24 pages in length. I am constantly being told that it should be possible to spot the signs of suicidal intent if an approach is made by the person. If a person approaches his or her GP, a family member or a health professional, it should be possible to spot the signs of suicidal intent, even without the person expressing that intent. I have asked somebody to put this in writing for me and to explain these signs for me. I do not mean that I want 40 pages of a single assessment tool. I am talking about a list of questions on a page that could be ticked that would lead us further, provided the person ticked enough of the questions.

Suicide crisis assessment nurses, SCANs, will be important in our programme. Significant numbers of people who self-harm go on to die by suicide. A significant proportion of the 12,000 people who self-harm are repeat visitors to our services. Why are we not picking up on those people who are returning again and again for help? Why are we allowing this sort of behaviour to become embedded? SCANs and specialist nurses within emergency departments will pick up on this issue and will ensure that these people do not simply get patched up and let go. Follow-up appointments will be made and people will be phoned and reminded to attend again later. It is important all of this happens.

Counselling in primary care, CIPC, is important. We did not know how successful this initiative would be when we put it in place last year and had no idea of the numbers that would be involved. The initiative has been so successful that we already have waiting lists, and clearly we need more resources in the area. GPs can now refer people without going through the psychiatry model. We realise now how important this is and the need for more resources.

We have difficulties in some areas in regard to recruitment of clinical psychologists. A friend of mine has told me it is good that our graduates are going abroad because they get experience that we will benefit from in the future. Rather than standing up here every month and telling the House that I cannot get clinical psychologists, we are now going to retrain social workers and nurses in dialectical behaviour therapy, DBT, which has a significant impact.

It is about the progression, but it is also true that we have not done everything wrong. There are some people who will say that I have done nothing right since I came into the post, but that is not true either. There is a balance there somewhere; sometimes the scales go one way, sometimes they go the other way. We are making progress, contradicting all the negativity that we hear constantly, day in, day out.

There is a difficulty in filling specialist posts in the area of intellectual disability. We are addressing that this year. There is a similar difficulty in the fields of old-age psychiatry and eating disorders, with the clinical pathways and so on. We know about them and we have a plan in place in order to get the specialists. Sometimes it is quite difficult but we are going to do it. We are going to try our very best, and are now going further afield to try and bring them in. There are obstacles and there are people who will stand up and say they are completely in favour of A Vision for Change but really they are not. They will oppose and block and do all they can in order to stop it. I must admit that I cannot really blame them. If one is working in a particular area all of one's life and there is a particular set of values in the organisation it is difficult enough to move that along. It is not all bad. It is not all right - there is a lot to be done - but it is not all bad either.

I appreciate being asked to the House. We have made enormous progress in terms of our attitudes and our ability to say it out loud. Up to now we had been hiding in shadows and we should stop that. It is not health or mental health, it is part of what we are. Some days we feel good, some days we feel bad and that is the difficulty with it.