Paddy Burke (Fine Gael)
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I welcome the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, to the House.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank the Leas-Chathaoirleach for the opportunity to make a statement in this House concerning the incidence of suicide in Irish society. At the outset, I stress that the Government shares the concern expressed here and by the general public about the country's level of suicide. Suicide has become a serious problem, which touches the lives of many people. In each individual case it is a tragedy, both for the life that has ended and the family, friends and community left behind. Many of us know someone who has attempted or completed suicide.

Suicide is a serious social problem. We cannot ignore or be complacent about the increasing incidence of suicide and self-harm in this country. Preventing suicide and reducing its rates is, therefore, an urgent public health issue, one that goes right to the heart of our efforts and policies to create a healthy, prosperous and socially inclusive Ireland. I recognise the many challenges that lie ahead and am aware there are no easy or single interventions that will bring us guaranteed success. International evidence shows that reducing the suicide rate and preventing suicide requires a collective and concerted effort from all groups in society, such as those is the health and social services areas, professionals, communities, voluntary and statutory agencies and organisations, parents, friends, neighbours and individuals. In addressing the rate of suicide, we must continue our efforts to eliminate poverty, achieve greater social justice and inclusion for those who are vulnerable in our society, address inequalities where they exist and improve and expand educational opportunities for all our children.

As we are aware, there was a reluctance to discuss suicide in the past. Thankfully, this situation has now changed and I welcome the Seanad's decision to make statements on the matter. The more discussion on this issue and the greater the focus on it, the greater the contribution to bringing before the public this social problem. In Ireland, the level of discussion and openness on mental health issues, including deliberate self-harm and suicide, has increased significantly in recent years. This is a welcome development but we must ensure that public discussion and the media's coverage of suicide and deliberate self-harm remain measured, well informed and sensitive to the needs and well being of psychologically vulnerable and distressed individuals in our society.

We must remain measured in our discussions on this matter at all times in the Seanad and in the Dáil. We had a three hour debate in the Dáil on suicide recently and I compliment everyone who took part because the discussion was useful, well informed and sensitive to the needs of this psychologically vulnerable group. We must continue to work as a society to create a culture and environment wherein people in psychological distress feel able to seek help from family, friends and health professionals.

Since the publication of the report of the national task force on suicide in 1998 there has been a positive and committed response among both the statutory and voluntary sectors to finding ways to tackle this tragic problem. Significant progress has been made in a number of different areas. Suicide resource officers have been appointed in each Health Service Executive area and I compliment them on the valuable work they carry out continually. They supply positive messages about how to access the relevant services and deal with the educational aspect of suicide. The National Suicide Review Group, the National Suicide Research Foundation and the National Parasuicide Registry have been established. Liaison psychiatric nurses have been appointed to accident and emergency departments in many general hospitals, which is a welcome development. Unfortunately, not all departments have procured the services of liaison psychiatric nurses but I will put as much pressure as possible on those that have not to do so soon. We have information now from the accident and emergency units with liaison psychiatric nurses indicating it is a significant development and of considerable help to those vulnerable people who have harmed themselves.

Ongoing training has been provided for relevant health care personnel in regard to suicidal behaviour in all Health Service Executive regions. There is a need for a co-ordinated effort in assessment, watching for the telltale signs of depression and getting people help before they do anything untoward. Much has been done in this regard by everyone in the executive's areas and especially by those with responsibility for young people, such as the Garda, GAA clubs, soccer clubs, rugby clubs and teachers. A great deal has been done in securing a co-orinated effort to note tell-tale signs of people who are depressed and to get them help before they do anything untoward.

Other measures include the following: the enactment of legislation to restrict the availability of medication which can be used to overdose; the development of a social and personal health education programme, which is now compulsory for all junior cycle students in secondary schools; the publication of a directory of services in each Health Service Executive area for those who may be at risk of suicidal behaviour; and the development of a new form 104, which is the form on which the Central Statistics Office figures are based. A Garda inspector within each division has been nominated to oversee the use and completion of the form. These are just some examples of the progress made to date. Much greater detail about various initiatives under way throughout the country can be found in the annual reports of the national suicide review group, which are laid before the Houses of the Oireachtas each year. As Members will be aware, many of the recommendations of the task force require continuous development, particularly in the area of training and in the enhancement of our mental health services.

In 1998, the year in which the report of the task force on suicide was published, the number of deaths by suicide registered by the Central Statistics Office reached an all time high of 504, reinforcing the need for sustained and co-ordinated action in response to the ongoing problem of suicidal behaviour. Five years later in 2003, 444 deaths from suicide were registered. While the decrease in the figures over the past five years, since the high of 1998, is encouraging, it is too soon to draw any firm conclusions from the reduction. The figures indicate that no effort can be spared in reducing what is still a major cause of death in our country, particularly among young people and young males.

Young males have shown a significant increase in the rate of suicide in the past decade, with 305 such deaths in 1994, increasing to 358 in 2003. However, it is important to point out that youth suicide in Ireland is not the highest in the EU. The most recent analysis suggests it is the fifth highest of the 25 member states and in terms of the overall suicide rate, Ireland ranks 17th of the 25 member states. It is important in a measured and constructive debate about suicide to remember that 16 other countries in the EU have higher suicide rates than Ireland.

Words that should not be used are sometimes used in media reports. The word "epidemic" is used, which is not helpful to the debate, particularly when we know that Ireland ranks 17th of the 25 EU member states. I do not say this by way of boasting or complacency. I agree there is a significant problem but all of us in the Dáil, Seanad, the Department and the HSE are doing all we can to try to get to grips with this tragic social problem in society. I reiterate that we do not have the highest suicide figures in Europe.

Recent figures suggest that the rate has stopped increasing. However, it is correct to say that we experienced probably the greatest increase in suicide rates in Europe during the 1980s and 1990s, albeit from a low base rate. These are worrying trends which require further research so that better strategies are developed to help people who are particularly at risk.

A cumulative total of more than €17.5 million has been provided by Government since the publication of the report of the national task force on suicide in 1998, towards suicide prevention programmes and for research. Some €17.5 million has been spent in the past seven years on this topic alone. This includes funding to support the work of the Health Service Executive areas, the National Suicide Review Group, the Irish Association of Suicidology and the National Suicide Research Foundation for its work in the development of a national parasuicide register.

My Department also supports the ongoing work of many organisations such as Mental Health Ireland, GROW, Aware and Schizophrenia Ireland in raising public awareness of mental health issues. Many of these voluntary groups, including many I have not mentioned, do great work in promoting positive mental health and helping their counterparts in the areas in which they work. Much of this voluntary work goes on unseen and unheralded. We only read in the media about the tragic cases of suicide. We do not often read about the great voluntary work done by committed people in their communities in helping young people and who seek neither financial recompense nor public recognition. It is important that I, as Minister of State with responsibility for mental health, should congratulate all these people.

I stress that the figure of €17.5 million does not encompass funding provided by other Departments, such as the Departments of Education and Science, the Environment, Heritage and Local Government and Justice, Equality and Law Reform in addressing areas within their responsibility, as identified in the report of the national task force on suicide. Significant additional funding has also been made available by my Department in recent years to further develop mental health specialties such as liaison psychiatry, child and adolescent psychiatry, adult psychiatry and old age psychiatry services. These services can assist in the early identification of suicidal behaviour and provide the necessary support and treatment to individuals at risk. In this regard, figures recently published by Comhairle na nOspidéal indicate that a total of 87 additional consultant psychiatric posts in a wide range of specialties have been approved since 1997. This is a significant increase in the number of consultants appointed to psychiatry. I look forward to the benefit of their work in improving the services to the mentally ill.

One of the key recommendations of the task force was that steps should be taken to make the mental health services more accessible to the public, particularly to young people and young males. Preventing suicide means influencing, in a corrective and constructive way, a person's development and their own resources at different phases of life. Adolescence is traditionally viewed as a time of profound change when young people make the transition to adult status. This transition is not easy and for many young people is accompanied by levels of self-doubt, fear and stress. An important aspect of suicide prevention for young people will be to promote self-esteem and self-confidence and to ensure they develop personal and social skills. Children and young people often need support and encouragement in gaining control over their lives and coping with their problems.

However, it is important to realise that of all the children in schools, including young children and adolescents, well over 90% of them have no mental health issues. In the past ten, 15 or 20 years, as people become better educated and there is much more education available to students in secondary schools and third level institutions, there has been a remarkable growth in confidence of young Irish people throughout the world. That and the way in which they are wonderful ambassadors for our country, has been remarked on by many people in other countries. When speaking about young people we should remember that the vast majority of them are excellent and well adjusted people and that it is only a small number who have mental health issues. That is why it is important that those of us dealing with these issues do all we can to ensure these people receive the help they need, especially at the appropriate time with early intervention.

The Department of Health and Children recently identified as a priority the development of a comprehensive child and adolescent psychiatric service. The Department established a working group in June 2000 to review child and adolescent psychiatry provision and to finalise a plan for the further development of this service. The group published its first report in March 2001. This report recommended the enhancement and expansion of the overall child and adolescent psychiatric service throughout the country as the most effective means of providing the required services. It also recommended that priority be given, in the first instance, to the recruitment of expertise for the completion of existing consultant-led multidisciplinary teams.

My Department has provided additional revenue funding of more than €20 million since 1997 for the further development of our child and adolescent psychiatric services. Steady progress has been made in developing a specialised service for this client group. In 1997, there were few child and adolescent psychiatry services available outside the major cities. Funding is now available for 56 consultant posts in child and adolescent psychiatry.

In its first report, the working group also examined the issue of inpatient psychiatric services. It recommended that a total of seven child and adolescent inpatient psychiatric units for children ranging from six to 16 years be developed throughout the country. Project teams have been established to develop these inpatient psychiatric units in Cork, Limerick, Galway and one in the HSE, eastern area, at St. Vincent's Hospital, Fairview.

The process of appointing design teams for the units in Cork, Limerick and Galway has commenced. The work of the project team established to advance the development of the new unit at St. Vincent's Hospital, Fairview, is continuing. Children and young people are our vital and precious resource for the future, and investing in services for these age groups now will ease the burden on adult mental health services in the future.

The health strategy, Quality and Fairness — A Health System for You, included a commitment to intensify the existing suicide prevention programmes and I am pleased to report that work is now well under way on the preparation of a national strategy for action on suicide prevention. This strategy is being prepared by the project management unit of the Health Service Executive in partnership with the National Suicide Review Group and is supported by the Department of Health and Children.

Work began on the development of a national strategy for action on suicide prevention almost two years ago. Since then, approximately 700 people have attended regional and national consultation meetings, and submissions were sought in the national press. A national and international expert group of 16 people reviewed the strategy during the past two weeks in April and their analysis is being incorporated into the strategy. The extent of consultation, the input of the external reviewers and a dedicated writing team will result in a high-quality, action-focused, evidence-based strategy. This will highlight immediate priority actions, targets for implementation over the next five years and long-term objectives for suicide prevention and mental health promotion in Ireland. I have met on several occasions with Dr. Rosaleen Corcoran who is leading this process.

A fundamental aim of the new strategy will be to prevent suicidal behaviour, including deliberate self-harm, and to increase awareness of the importance of good mental health among the general population. Ongoing, quality, multidisciplinary research will be an essential strand of the strategy and findings will be of greatest value where they can inform and stimulate action and service development. The strategy will identify expected outcomes, and set targets which can be measured, monitored and revised. Continuous quality control and ongoing modification and improvement of the strategy will be central to its implementation.

Best international practice suggests that suicide prevention programmes should be developed on the basis of improving the mental health of the general population in combination with developing strategies for known high-risk groups. This new strategy will include specific recommendations for action on those in the high-risk groups.

We must do all we can to make it as easy as possible for those bereaved by suicide to confront, face and deal with the situation. People often do not want to ask for help as they may feel this will be perceived as a sign of weakness. Looking for, and expecting, practical help is not a sign of weakness, rather it is a confrontation with one's problems. Everyone can learn to cope with such a tragic loss, but for some people this can be a long and difficult process.

The encouragement and support provided by the various statutory and voluntary organisations which work with those who suffer the intense trauma of bereavement through the suicide of a loved one is immensely important. This Government has recognised this fact through the provision of financial support for groups active in this area.

In August 2003, I appointed the expert group on mental health policy to prepare a new national policy framework for the mental health services. The expert group will consider the area of suicide prevention and reduction and will make recommendations in the matter, taking account of the national strategy for action on suicide prevention. It will also set the issue of suicide prevention and reduction within the broader context of a mental health policy framework. The expert group is due to report later this year.

The National Suicide Research Foundation was founded in January 1995 by the late Dr. Michael J. Kelleher, whom I knew well and with whom I worked on the former Mid-Western Health Board. It consists of a multidisciplinary research team with contributions from a broad range of disciplines, including psychology, psychiatry and sociology. The foundation's primary aims are: to define the true extent of the problem of suicidal behaviour in Ireland; to identify and measure the factors which protect against suicidal behaviour; and to develop strategies aimed at preventing suicidal behaviour. Much of the foundation's work to date has involved the monitoring of parasuicide which is extremely important.

International studies have found parasuicide to be one of the most significant risk factors associated with suicide — those who engage in parasuicide are 20 times more likely eventually to kill themselves. Studies have shown that at least one third of all suicides have a history of parasuicide.

The National Parasuicide Registry is a national system of population monitoring for the occurrence of parasuicide. This important project is being undertaken by the National Suicide Research Foundation, with funding from the Department of Health and Children. The National Suicide Research Foundation's reputation for high-quality research is such that it has been invited to participate in several important international studies, among them the WHO — Euro Multicentre study of parasuicide.

Last December I launched the third annual report of the National Parasuicide Registry. The findings in this report indicate that approximately 8,800 individuals presented to hospital due to self-harm in 2003. That is an accurate figure, recorded because we receive information from all the accident and emergency units around the country which the national suicide registers are collating.

Some of these people presented more than once accounting for the total figure of 11,200 presentations of parasuicide in 2003. The report highlights the challenge that self-harm and suicide prevention poses for our health system and our society as a whole. It will help identify groups which are particularly vulnerable and will assist the health service areas to evaluate the impact of the preventive and clinical services being provided.

The Government shares the public concern about the levels of suicide in Ireland. We all have our part to play in helping those who may experience and face adverse events in life and emotions and feelings so strong they consider taking their own lives. We must aim to provide accessible, sensitive, appropriate and, where required, intensive support. The national strategy for action on suicide prevention to be published in September 2005 will provide us with a targeted, measurable action plan for tackling this serious social problem in a coherent and integrated fashion involving all relevant stakeholders.

Fergal Browne (Fine Gael)
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I welcome the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, and his officials to the House.

The life of a politician involves attending many funerals. There is nothing worse than attending a funeral of a person who has committed suicide. Unfortunately, we have had our fair share of these in Carlow recently, not only of young men but of young women. I attended a funeral recently of a man in his sixties, the father of ten children, who took his own life. There is a horrible sense of helplessness when going up to sympathise with the family at the funeral because one does not know what one can say.

It is different if one is attending the funeral of an elderly person who has lived a long and healthy life. That can be a joyous occasion from the point of view of acknowledging the major contribution the person made in life. When a person's life is cut short by his or her own hand it is tragic, and everybody experiences a sense of helplessness.

It is ironic that at the funerals of those who commit suicide invariably the church is overflowing with people. I often think it is a pity the person who had committed suicide had not realised how many people could have helped him or her. It is certainly a tragedy, particularly for the family. I do not know if the family ever gets over it. I know many families in Carlow who suffered suicide bereavement and I can safely say they have never got over it and never will.

The Minister of State pointed out that Ireland ranks 17th out of 25 EU member states in terms of the overall suicide rate. That may well be the case. Almost the same number of people commit suicide in Ireland as are killed in car crashes. There is a difference in emphasis compared with the campaigns run by the National Safety Council and the role of the Garda in that respect. The amount of resources provided by the Government for the prevention of suicide is in sharp contrast with that provided to the National Safety Council.

I compliment a former Member of this House, Deputy Neville, who has played a significant role in this area and is president of the Irish Suicidology Association. He has raised this issue at every opportunity in his role as a parliamentarian.

Before becoming spokesman on health and children I was spokesman on transport. A study published in Canada indicated there was a suspicion that suicide was involved in many single-vehicle crashes. I am not sure how that was proved. I raised this issue previously at a meeting of the Joint Committee on Transport and perhaps the Department would look at it while liaising with the National Roads Authority. Unfortunately, we wake up every morning to news of single-vehicle crashes. In some cases there is no excuse for them as they may have occurred on a good stretch of road. There is a possibility that some may involve suicide which would add to the overall figure for the incidence of suicide.

I compliment Young Fine Gael on its initiative in launching its recent document on suicide. The document contains some disturbing facts, some of which I will put on the record. In 2003, 444 people died by suicide in Ireland. That figure may be higher as some deaths which involved suicide may not have been identified as such. In 2003, 213 people under the age of 35 died by suicide. Suicide is the greatest killer among the 15 to 34 age group, accounting for one quarter of all deaths.

A quarter of all people who died as a result of suicide had a history of self-harm and for the five-year period 1999-2003, 1,012 young people under the age of 35 died by suicide in the Republic. More than two thirds of people who died by suicide tell someone of their intention in the last week of their lives. In a recent case in Carlow, a young lady who committed suicide bought a rope and was seen with it by her friends. Unfortunately, none of them asked her what she was doing with it. It was something on which everyone commented later. This was a terrible tragedy. She had been outgoing and happy and everybody assumed she wanted the rope for a different reason. Unfortunately, she used it to commit suicide.

Almost one in three people who died by suicide in 2003 were treated as inpatients in psychiatric care units in the three months before they took their own lives. The majority were classed as low to medium risk upon discharge. I do not envy the task of psychiatric nurses when assessing patients. It must be upsetting for them to hear of the death of a former patient who may have appeared to be on the road to recovery but, unfortunately, slipped through the net.

In 2003, 11,204 cases of parasuicide were reported involving 8,800 individuals. Of these, 42.6% involved men and 57.6% involved women, and 46.9% involved people under 30 years of age. In 2003, the incidence of deliberate self-harm by women in the 15 to 19 year old age group increased by 5% on the previous year. The highest rate for men was among the 20 to 24 year old age group which was up 8% on 2002.

Relationship problems were the precipitating factor in 26% of all suicides, with financial difficulties being present in 17%. The most startling statistic from the Young Fine Gael report was that every 45 minutes at least one person attempts suicide. These are just the known cases. Many reasons lie behind attempted suicide, including relationship difficulties, mental illness, depression, family relations, financial difficulties, bullying, isolation or loneliness, alcohol or drug abuse, homelessness, copycat suicide — which is a serious problem — and sexual orientation.

Young Fine Gael acknowledges the important contribution made by voluntary groups which should be complimented today. However, these groups must be given every assistance and I hope the Government will honour its commitment in that regard. The Government reckons this issue needs to be scrutinised because since 1997 the mental health budget has been reduced from 11% of the overall health budget to 6.9% in the current year. The figure in the United Kingdom is 13%. In 1960, 20% of the health budget was spent on mental health.

The national task force on suicide made 86 recommendations on suicide prevention in 1998 which have largely been ignored. On 12 April 2005, the Minister of State informed the Dáil, "Work is well under way on the preparation of a national strategy for action on suicide prevention which will be published later this year." At best, all we will get is another report but we need action. There is "reportitis" at this stage in the Department of Health and Children.

Young Fine Gael makes the point that no State helpline is in operation to assist those feeling depressed or suicidal. I read a recent article by, I think, Deputy Gregory in which he outlined the problems he encountered when trying to contact a suicide helpline. He brought this matter to the attention of the health board and this was acknowledged by the Minister in the Dáil.

There is no mandatory second-level education programme which addresses the issues of positive mental health, problem-solving skills and the development of self-esteem. In 2005, the Government will invest €15 million in the development of psychiatric services which is exactly one quarter of what was expended on the e-voting debacle.

I hope the Minister of State has read the document produced by Young Fine Gael which is available on-line and is very well thought out. Young Fine Gael calls for an advertising campaign using the media of television and cinema aimed at the detection of depression and suicidal tendencies among young people and a proactive nationwide campaign to address the stigma and taboo attached to the issue of life problems, mental illness, depression and suicide. The campaign will encourage young people to seek help and advice. However, it should be noted that suicide affects all ages and both genders. The document recommends the immediate implementation of a national support service to include sufficient funding for all voluntary groups, allowing them to adequately provide the services required and the provision of a tracking and long-term support service for those who present at accident and emergency units or to GPs, having partaken in parasuicide and deliberate self-harm. It recommends that a national strategy to co-ordinate suicide prevention needs be activated immediately to include the various strategies published since 1998 and the recommendation of the 1998 task force on suicide, the national youth work development plan and the Youth Work Act 2001. It recommends the provision of training for teachers in the detection of suicidal tendencies in second-level pupils. Higher rates of suicide exist among early school leavers and therefore special resources should be directed towards these young people. The Young Fine Gael document calls for an immediate increased investment in the mental health sector to increase the overall budget to the 1997 level of 11% with special attention paid to suicide prevention initiatives such as counselling.

Those points should be borne in mind by the Minister of State. The Young Fine Gael document is born out of frustration because while we are told the issue of suicide is receiving a lot of Government attention, we are not seeing the action that is needed. The key word in the Young Fine Gael recommendations——

Ann Ormonde (Fianna Fail)
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The Senator should have a look at the VECs.

Timmy Dooley (Fianna Fail)
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Fine Gael frustration.

Fergal Browne (Fine Gael)
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I thank Senator Ormonde for reminding me of that point. An exemplary system is in place in Cavan-Monaghan but unfortunately this is not replicated throughout the country but is something for which we must aim. I know of a hospital in the south east where the staff watched a patient around the clock for a week without proper facilities. We do not have the same facilities as Cavan-Monaghan in the south east.

This is a huge issue and a price cannot be put on the value of a human life. There is no doubt that people never get over a suicide. We should do everything in our power to help prevent suicide and save family life from being wrecked.

Camillus Glynn (Fianna Fail)
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I will not say I am pleased to have the opportunity to speak on this subject because I wish there was no need to talk about it. However it is a reality and we must deal with it as it is.

Suicide is a very serious social problem in this country and everywhere else. It is a tragedy for any family. Unlike when somebody dies suddenly from an unsuspected illness or in a traffic accident, it has a different effect. I have experienced suicide in my own family and there is no question that it has a ripple effect which permeates right though the suffering family and includes the whole community. One of the great social implications of suicide is that close family members and friends will experience a sense of guilt and self-blame. They will wonder whether there was anything they could have done or said and whether they should have known in advance.

Senator Browne stated that 444 people died as a result of suicide in 2003. He referred to a statistic showing that somebody dies by suicide every 45 minutes.

Fergal Browne (Fine Gael)
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I said somebody attempts suicide every 45 minutes.

Camillus Glynn (Fianna Fail)
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The total would be 6,570. I cannot vouch for the accuracy of those statistics. The third annual report of the National Parasuicide Registry launched by the Minister of State, Deputy Tim O'Malley, in December 2004 indicates approximately 11,200 presentations to hospital due to deliberate self-harm were recorded for 2003.

I have worked in the psychiatric services and I know there are many reasons people will inflict self-harm. It is true that persons indulging in parasuicide are likely at some stage to take their own lives. Self-harm can also be used as a means of attracting attention. I regard the figure of 444 deaths by suicide as being 444 deaths too many; one death is one too many.

All sections of society are affected by suicide. It is true that young males are particularly vulnerable but this is also the case for schoolchildren. In my own town of Mullingar, three friends committed suicide one after the other. I do not know if this was a case of a suicide pact between them.

A number of factors seem to create suicidal tendencies, such as social exclusion. Many people who commit suicide are found to have alcohol in their system. I do not know how scientifically correct are the suggestions of a strong correlation between the taking of alcohol and suicide. People who have abused drugs and are in debt, forcing them to borrow money from moneylenders to feed their habit, are often not the nicest people in society. When the pressure is too much they take the ultimate step and take their own life.

Another factor to be considered is bullying in school. The mother of a little girl who took her own life has been making inquiries as to what is being done to address the events which led to her daughter taking her own life. Bullying in the workplace and in the home must also be considered as contributory factors in the incidence of suicide. The greatest stress of all for schoolchildren is at examination time. I worked on one occasion in the female admissions unit. One of the patients was a leaving certificate student. Her mother was putting unbelievable pressure on her to do well. She warned her that she had to get a certain number of points in the leaving certificate and that nothing else was acceptable. I find this behaviour absolutely repulsive. These are all situations which contribute to the incidence of suicide.

The person who makes the decision to take his or her own life is normally very secretive about it. People are resourceful in planning the act. In many cases they have never been "psychiatrised". They are people one meets every day of the week. They will go about their daily business, have their lunch, get up from the table and commit the act. It can therefore be very difficult to pinpoint the suicidal intention.

The high incidence of suicide in the population is not exclusive to Ireland, as has been referred to by the Minister of State in his contribution. Senator Browne is correct in his reference to the inordinate level of suicide in Carlow but it is the same in Westmeath. When I was a member of the association of health boards, I remember a councillor from Donegal wondering what was wrong with Donegal because of the high incidence of suicides. In my own parish of Killucan and in Mullingar hardly a week goes by without a suicide. What can we do about it? It is important to realise that everybody in society is part of the therapeutic community. We cannot say it is only a matter for Government or for those excellent voluntary bodies, such as the national task force on suicide and Aware. It is in everybody's best interest to take an interest and give support by keeping an eye on people, especially those living in isolated locations.

The Minister of State made a very important point in referring to the appointment of psychiatric nurses to accident and emergency units, which was one of the most practical steps ever taken. As everybody would know, and nobody would know better than Senator Henry, the statistic was that one in three patients attending a doctor had a psychiatric aspect to their illness. I am not sure what is the present figure; perhaps it is even higher.

The Minister of State said that in its first report, the working group examined the issue of inpatient psychiatric services. I came up through the service and was involved in a health board when the report, The Psychiatric Services — Planning for the Future, was published in the 1980s. I strongly support the concept of acute psychiatric units in general hospitals. Psychiatry is a medical discipline, which should be part of an overall campus. I have said this in the House before and I will say it again. While people did not like it when I said it before, the truth is the truth and sometimes it hurts. The Inspector of Mental Hospitals should be the inspectorate of hospitals with somebody responsible for the psychiatric division.

We should ensure that for those who need psychiatric services the hospital facilities are of the best possible standards. We seem to have let hospital standards slip because the units are built as part of general hospitals. However, for logical and practical reasons many people cannot spend the amount of time they need to spend in psychiatric units. As anybody who knows about the discipline will know, while some patients will do very well in a week, a fortnight or a month, others need much more time. It is not appropriate to have those needing longer-term care in acute units as this will lead to overcrowding. A unit below the acute unit is needed, which makes common sense. Again, I have said this before and perhaps some people did not like it. However, the truth is the truth and I will say it as I see it. Those in hospitals and especially in long-term care institutions should be visited and it should be mandatory for their relatives to visit them. Regrettably, far too often this is not the case.

The Minister of State stated that steady progress has been made in developing a specialised child and adolescent psychiatric service. In the midland region we have been lucky in having such a service and also psychiatry for later life. Addressing these specialised areas in the way the Minister of State has done is very important. The Minister of State referred to 56 consultant posts in child and adolescent psychiatry. How far have we come in recruiting those people? The Minister of State also referred to the number of additional consultant psychiatrists to be appointed, which is also very important.

A most stupid decision in the recruitment of nurses, of all disciplines, was taken in the 1980s. As we had a number of nurses not in the workforce, it was decided that until they were inducted into the workforce we had no need to train any more. A number of smaller training hospitals closed and consequently a number of disciplines, not least the psychiatric nursing profession, the mental handicapped nursing profession and, to some extent, the general nursing profession were unable to fulfil their requirements. We need to take into consideration the length of time it takes to train a nurse. Any intake of students will have some dropouts, some who wish to continue to do postgraduate courses and some who will emigrate, which impact adversely on retaining a core figure from the intake. This again comes back to the number of people we have in those specialised units to cater for people who present with depressive illness.

Reference has been made to the voluntary organisations. We cannot praise them enough as they play a huge role. Mental Health Ireland, GROW, Aware and the Schizophrenia Association of Ireland are all very worthy associations and deserve our commendation. They will bring about in the community the changes for which we all hope. I also mention the National Association of Suicidology. This issue has been abiding interest of Deputy Neville, as it has been of mine and others.

This is a very serious issue and begs the question of what we should do. While we can throw all the money we like at it, every member of society is part of the therapeutic community and has a role to play. It is pointless to point fingers at others; we all have a role. The sporting organisations have a particular role in the matter. We need greater sporting facilities, especially for young people in towns and cities and this matter should be addressed as soon as possible.

Suicide is a very difficult and complex issue. I do not believe anybody has the answer. However, at least we are looking for the answer, which is of help.

Mary Henry (Independent)
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I wish to share my time with Senator Ryan.

Paddy Burke (Fine Gael)
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Is that agreed? Agreed.

Mary Henry (Independent)
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I welcome the Minister of State to the House. I also welcome his speech, which really addresses the issue of suicide. We are fortunate to have here people like Senator Glynn who have experience of working in the psychiatric services. I have little to add to what the Minister of State, Senator Browne and Senator Glynn have said. While doctors and nurses in the psychiatric service get considerable training to become aware of people who may attempt suicide and in how to deal with those who are suicidal, we should place greater emphasis on the possibility of suicide in the general training of medical students, particularly those who become general practitioners.

Senator Glynn is right to highlight accident and emergency departments. I have seen people who had taken overdoses treated on a much too casual basis owing to not having people with an expertise in psychiatry to whom they could be referred. All accident and emergency departments should have a psychiatric nurse available at all times to whom a patient who arrives after making a suicide attempt can be referred and a proper follow-up can be instituted.

I have frequently raised the issue of bullying and I was glad to hear Senator Glynn raise it again. As well as having problems with alcohol and depressive illness, we find that a considerable number of those who commit suicide may have been subjected to bullying. We should tell people that bullying is not only bad for the individual but for the organisation in which he or she is involved. The issue of support for the bereaved has been raised, something extremely important. However, it is also very important to remember the professionals who may be dealing with such people. They have a great sense of failure if a person commits suicide. Support for nursing and medical staff and for prison officers is essential.

The last issue I would like to mention is the problem of the very difficult ethical struggle regarding assisted suicide. It was great that Pope John Paul II made his illness so public and that his wishes were acceded to when he said that he did not wish to return to hospital. Perhaps we need far more discussion regarding those with terminal and chronic illnesses. Nothing appears to happen except when a case hits the headlines. Should a percutaneous endoscopy or gastrostomy tube be replaced? It is terribly hard for those who are dealing with such cases to be involved in the decisions regarding what should happen to the patient. There should be far more support from clinical ethicists for those of us in medical or nursing practice dealing with the terminally and chronically ill. Situations may seem very simple from a distance, but they are sometimes extremely complex. The stress on the family is always looked at very carefully, but the stress on staff is extraordinarily difficult too, and I would like us to make more of an effort to get the advice of clinical ethicists into those hospitals where such help may be needed. The issue will arise more and more. People have left Ireland for assisted suicide in other countries. I would like to think that those people who decided to go had also had the benefit of advice from such people as clinical ethicists.

I greatly applaud the work of the hospice movement, which should be mentioned in this context. Hospices have made life totally different for those who are dying, particularly that majority of us who would wish to die at home. We must recognise there is a group of chronically or terminally ill people, sometimes with conditions which cause absolutely dreadful deaths, such as motor neurone disease. We must address that. We managed to address suicide, which for years had such a stigma, and now we are seeing in what practical ways we might deal with this. We can also deal with the situation regarding the terminally and chronically ill.

Brendan Ryan (Labour)
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I thank Senator Henry for sharing time with me.

There are issues on which politicians can and do show considerable sensitivity. For the most part, they avoid turning such things into political confrontations. Of course, as an Opposition spokesperson I would say that we should have more resources. However, it would be dishonest to pretend that if we flipped around, with me over there on the Government side and all those others over here, we would suddenly do something dramatic. The truth is that the forces that drive people into self-destructive behaviour, the most extreme of which is suicide, must be examined in a series of ways.

I should probably desist from saying that my wife is a psychiatrist, but I remember her saying to me that if one were to hospitalise everyone who turned up at a psychiatric unit claiming suicidal tendencies, not only would the psychiatric hospitals be full, so would the general hospitals and nursing homes. There is a genuinely difficult clinical judgment to be made by doctors, nurses or whomever makes the decision, and I sympathise with them. The Minister might say that I have to say that, since otherwise I might as well not go home. However, my sympathy is genuine. It is not easy, and my beloved has been involved in unpleasant inquests involving questions about why and how one did or did not act. All one can say is that it was one's best professional judgment. The conscientiousness of the person of whom I speak would never be in dispute.

However, this does not detract from the massive problem. Several points must be made. Michael Kelleher — God rest his soul — whom I knew, pointed out several years ago that the prevalence was quite contrary to our assumed stereotypes. For instance, it is easy to assume, particularly if one has an interest in modern music or literature, to believe that suicide is a consequence of the alienation of urban living. Michael Kelleher wrote an article in The Furrow less than ten years ago stating that in Ireland suicide among young people was more of a rural than an urban problem and had more to do with loneliness in a rural environment than with the perceptions of urban alienation. That was news to me, since I had assumed that it was one of those dreadfully unfortunate consequences of the fracturing of life in urban areas. The evidence did not confirm that, although that is not to say that suicide is not an important issue in urban areas too.

We must reflect a great deal on the self-destructive tendencies that seem to be part of the lifestyle of considerable numbers of younger people. Suicide is not the only one. I have said before in the House that I would be a liar if I pretended I had not been drunk on more than one occasion in my life.

John Minihan (Progressive Democrats)
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Twice.

Brendan Ryan (Labour)
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Senator Minihan is very charitable.

I never in my entire life set out to get blind drunk; I had no interest in it. I claim no virtue, but circumstances caused things to happen. However, it seems to me that there is now a peculiar value system among some young people in society — I say that not judgmentally but with concern — that necessitates such self-destructive behaviour. The tragic consequence is that, if one drinks to that extent, the following day one will feel depression on a level that one could never have imagined, since that is one of the consequences. If one has self-destructive impulses, one has that consequence too. In Ireland we can never separate alcohol from part of our problem with suicide. It is not the only one, and it is too dramatic a statement on the part of some of the crusaders on alcohol to say that if we could restrict it, this would have a dramatic impact on suicide. It probably would impact on some young suicides.

However, some of it is a consequence of the extraordinary social changes that have happened. Some aspects not often addressed in this debate concern me profoundly. I know that Senator Cox has mentioned on a few occasions before Christmas the degree to which commercial forces target young people when they are at their most vulnerable, between 12 and 17 or 18 years, and use subliminal — or, increasingly, less than subliminal — messages of sex and personal and emotional security. At a time when people are most vulnerable, sophisticated marketing schemes exploit those insecurities. It is bad enough that they are used for commercial purposes, but it is worse when they are calculated to make people more aware of their own inadequacies.

One of the many problems of politics is that we can never admit to our own inadequacies. Publicly, the Minister of State must say that he is the best Minister of State at the Department of Health and Children the country has ever seen. Publicly, I must say that he is not.

Tim O'Malley (Limerick East, Progressive Democrats)
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I never said it.

Ann Ormonde (Fianna Fail)
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I will say it.

Brendan Ryan (Labour)
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Senator Henry considers him to be among the best. I am reluctant to use the word "consumerism", as criticism of consumerism seems to blame the working class for getting their hands on the goods that the ruling class always had anyway. The papacy and the other ruling orders of 100 years ago lived in a life of ostentatious luxury. The fact that ordinary people can now do that should not be a problem. However, the sophistication of modern marketing makes people more aware of the negative side of their lives.

Some of the manifestations of our successful economic model are quite destructive. For example, we often say that we must reward effort. The Government parties and even the Opposition claim that part of the job of taxation is to reward effort. However, we do not reward effort but success. Someone can work extremely hard but be unsuccessful and be branded a failure. The horrible word "loser" is part of modern parlance.

I am pleased to read from the Minister of State's script that the numbers are beginning to stabilise. We need to state that we have an obligation to protect our young people from many of the worst forces — be it alcohol advertising or the more insidious suggestions of their own inadequacy. All adolescents, from the most confident to the most self-effacing, feel inadequate and it is only a question of how they present that to the outside world. We must ensure that the political and economic systems do nothing to manipulate that inadequacy. We must put the protective arms of our society around young people at their most vulnerable.

John Minihan (Progressive Democrats)
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I welcome the Minister of State and his officials to the House. It is with a certain amount of trepidation that I enter this debate in the House this afternoon. It is not that I do not welcome the contributions of the Members. Rather, I am concerned about two aspects.

First, I am mindful of an article published over the weekend in the national press that was entitled "Keep Suicide out of Murky Politics". While I do not accept the implications of the word "murky", elements of the piece did strike a chord. The article states that parties are out of order when they try to make suicide a political issue. It is described as an astute populist tactic. Specific reference was made to a recent Fine Gael campaign. However, we must ensure that, despite our best intentions, those affected by suicide do not equate our actions as merely astute populist tactics.

Fergal Browne (Fine Gael)
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The journalist was entitled to her view.

John Minihan (Progressive Democrats)
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The article states:

Suicide is an emotive subject on which it is all too easy to stir up public indignation... Whenever someone, especially a young person, takes their own life, there will always be a willing market for a politician or pundit who demands that something must be done... The State cannot stop your relationships ending, or your loved ones dying; they cannot stop people failing their exams, losing their jobs, hating their lives. Misery cannot be legislated away.

How can any of us read these words and not approach this debate without some sense of trepidation? Senator Browne may have interpreted that I am being critical of Fine Gael, but I am not. I am merely acknowledging our right as politicians to speak on this issue.

My second concern is that many of the debates on suicide are reduced to a web of words spun around numbers and statistics such as the incidence of deaths and the levels of investment. Numbers and statistics will be bandied about to an extent that the humanity of the topic is lost. I am glad that the Minister, in his speech today, gave us a combination of the necessary statistics and the actions of the Government but also apportioned a great part of his speech to the human side of all of this. I intend to complete my contribution without uttering a single number or statistic, and to concentrate on the human side of the issue.

I wish to contribute to this debate because of the issue of stigma, which has been central to suicide in Ireland for many years. For too long, if someone died by suicide, there existed a stark silence and a lack of support for the bereaved. This undoubtedly made grieving the loss of the loved one even more difficult. The silence was often excused as merely being respectful. Even the media engaged in this by reporting suicide as a death in tragic circumstances or by using some similar phrase. This euphemism only served to stigmatise and isolate those bereaved families. It also left society paralysed by the fear of suicide. There is a need across the country to de-stigmatise suicide by breaking the silence.

A leading doctor has written on the subject of stigma and states:

We can heal from our injuries and our suffering. If we have a healthy environment, healthy behaviours, healthy relationships, we will recover. We need to identify our histories of trauma, abuse, neglect, grief, and loss. We need to overcome denial on all of our behaviours.

This means dealing with the stigma associated with suicide. Speaking about suicide and its impact represents a key part of removing the stigma. Removing the stigma has been identified as central to tackling the issue. The reasons for the stigma are numerous. Even the phrase "to commit suicide" attaches a stigma. The word "commit" is associated with crime or error. Given that suicide was decriminalised in this State over ten years ago, the phrase " to commit suicide" should be avoided.

In many cases, we cannot know whether suicide was intended. I have been close to two people who committed suicide. Both tried to correct their actions after the act of self-harm and prior to death. I contend that neither of these people committed suicide. For each family, this was an important fact in the death of their loved one. However, both people were classified as having committed suicide.

The view has been expressed that people should not think ill of a person who died by suicide. People should, in fact, not have that opportunity, just as they no longer have it in regard to children born out of marriage. It is no longer acceptable to speak of illegitimate children. The removal of moralistic stigma was overdue for children and it is overdue for those who die as a result of suicide and their families.

I offer gratitude to the Irish Association of Suicidology for its work in this area. As we heard in earlier contributions, the association was founded in 1996 by Dr. John Connolly, the late Dr. Michael Kelleher, who was known personally to the Minister of State and Senator Ryan, and Deputy Neville. It is to be commended on its aim to disseminate information about suicide and suicide prevention so that public opinion can respond to the issue in an informed manner. The information it offers about the stigma associated with suicide and its work to debunk media myths are worth particular mention.

The myth is perpetuated that talking about suicide encourages it. The association observes that some people worry that talking about suicide could lead to a general perception that suicide is acceptable and a reasonable action to take. However, the IAS argues that allowing people to talk through their worst fears and feelings may provide them with a lifeline that makes all the difference between choosing life and choosing to die. I support the view that responsible discussion will also educate society about suicide without giving encouragement to susceptible people to attempt it. For this reason, I support the statements in the House today.

Echoing the concerns I set out earlier, the IAS states that positive explanation of suicide in a sensitive way can help to educate and destigmatise the issues of suicide and attempted suicide. I agree with the association's view that suicide is a legitimate topic for serious discussion in the media, like other mental health issues. However, its presentation should be undertaken with great care. As politicians, we must be careful not to leave ourselves open, fairly or unfairly, to accusations of "astute populist tactics", as stated in last week's Sunday Independent.

To ensure this is not the case, and to ensure that our contributions are truly helpful, I refer Members to the advice of the IAS. The focus should be on educating and informing the public rather than trying to shock, present graphic details or, worse, titillate. I do not wish to initiate an argument with elements of the media. However, I point to the publication in recent days of a sequence of photographs of a man who jumped into a river. This was offensive and intrusive. Should we accept lectures on our contributions when the media is guilty of this type of intrusion on a man's fears, concerns and worries by publishing his photograph so legibly?

Fergal Browne (Fine Gael)
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Hear, hear.

John Minihan (Progressive Democrats)
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Perhaps the most important guiding principle is to consider the readers, listeners or viewers, who may be in crisis when they read, hear or see a report. The consideration must be whether this piece makes it more likely such people will attempt suicide or more likely they will seek help. The media have a major responsibility in this regard.

Organisations such as the IAS, the Samaritans, the telephone number for which is 1850 60 90 90, and the Let's Get Together foundation, based in Midleton, County Cork, can all facilitate access to the help and support people need. If people experience a sense of despair, a terrible weight of stress or pressure, it is important they do not keep it a secret. If nobody knows, nobody can help. People in such circumstances should talk to someone they trust, such as a friend or relative. They can also contact their GP, a member of the clergy or one of the agencies to which I referred. People should be aware they are not alone with these feelings. Most people, at some time in their lives, face difficulties and may feel they can no longer cope. They must be aware there is help available and there is hope.

For our part, we must take every opportunity to get the message across that people should never feel there is nowhere to turn. Help is available and suicide is never the answer to whatever problems people encounter in modern Ireland.

Maurice Cummins (Fine Gael)
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I welcome the Minister of State, Deputy Tim O'Malley. I am pleased to have an opportunity to contribute to this debate on a delicate and sensitive subject. The most recent statistic, as cited by the Minister of State, indicates that 444 people took their lives in 2003. This is most likely a conservative figure when one considers the incidence of deaths of undetermined cause in that year and that some suicides cannot be recognised as such because of the circumstances of death. A more realistic, but still possibly conservative, estimate is 500 to 600 people. This is a serious situation and deserves urgent attention.

The funding for suicide prevention measures is inadequate. I ask the Minister of State to endeavour to ensure more money is channelled into the area of prevention and research. Many families and communities are deeply traumatised by suicide each year. Some communities witness a cluster of suicides over a period, which they view as a major crisis. That the incidence of suicide is a crisis is undeniable. However, we must remember that of the total number of deaths, 30,000 per year, suicide represents only 2%. We must deal with suicide in the context of the total number of deaths. Nevertheless, suicide is by far the most significant category of cause of death for young people. It is certainly a crisis among young males. The ratio of deaths by suicide among young men is 8:1 in comparison with females.

The issue of parasuicide is also of great concern. The latest figures which show 11,200 people presented at accident and emergency units with evidence of self-harm do not take into consideration those who presented to their GPs and those who do not present for any assistance. Urgent research into attempted suicide is absolutely necessary because approximately one third of people who took their lives had previously attempted suicide. Psychiatric patients are ten times more likely to take their lives than the community average. In the first weeks after discharge from psychiatric hospital, people are between 100 and 200 times more at risk of suicide.

In young people, it is often undiagnosed depression that is the problem. We must educate people who are in trouble or despair to recognise that support is available for them to cope with and talk about their problems. Whatever the problem, the message must go out that there is another way and that there is a light at the end of the tunnel of depression. In this regard I commend organisations such as the Samaritans, the National Suicide Research Foundation, the Irish Association of Suicidology and the many other non-governmental organisations which have done so much to raise the profile of this issue in Irish society.

The decrease in the level of investment in our psychiatric services is unforgivable. In 1960, 20% of the total health budget was spent on psychiatric services but that has since greatly declined. Of course it was correct to reduce the numbers in psychiatric hospitals and integrate patients into the community where possible, but this requires similar investment as heretofore so as to provide the necessary multidisciplinary psychiatric services. This is not being done at present.

We must examine and debate the way in which the cultural and economic changes in Ireland over the past decade have detached people from traditional values and supports as well as the linkage between these changes and mental health or suicidal behaviour. The way in which individuals are influenced as they react to changes in their social life is central to the prevention of suicide.

Young people tend to be very hard on themselves. Success is an increasingly important goal in society, placing great pressure on young people. A common perception is that achievements are made through hard work and that failure is the responsibility of the individual. Society no longer appears capable of helping those who fail or perceive themselves to be failures. The uncertainties of life are increasing. Life seems to be dictated by what may be owned or bought and by the brands one wears. Young people are faced with choices that would have been unthinkable in previous generations. At the same time the cultural icons of the past, such as the church and the political establishment, have become debased in the eyes of the young. One may ask whether adolescents are more vulnerable to perceived failure or less likely to ask for help. The pressure to succeed academically at all costs is another issue which needs to be examined.

Suicide prevention is not only a health issue but also an educational one. Research, understanding and analysis of the pressures on young people are vital if we are to address the epidemic of suicide. We must regard suicide prevention as a multidimensional area that requires promotion and investment.

International research has proven that a link exists between the per capita alcohol consumption of a country and suicidal behaviour. Alcohol consumption leads to depression, which is a major factor in suicide and suicidal behaviour. Similarly, depressed people frequently turn to alcohol in the mistaken belief that it will improve their mood. Alcohol impairs judgment, reduces inhibition, increases risk taking behaviour and, most frequently among young people, may result in impulsive suicidal behaviour.

Gambling is another factor in terms of suicide. Recently, I introduced a Bill to this house to prevent children from gambling which, despite recommendations from an interdepartmental review group, was shamefully voted down by the Government. I understand that the Minister for Justice, Equality and Law Reform will re-examine this issue. The Leader of the House remarked that I was passionate about the subject. This was because I know people who committed or attempted to commit suicide due to problems arising from compulsive gambling. In many cases, these problems began when, as young people, they placed a few bob on the tote.

The national suicide review group was set up in 1998. To date, few of its 86 recommendations have been implemented. We have seen reports on mental health and strategy groups but I urge the Minister for State to implement the recommendations of the task force at the earliest possible opportunity.

Timmy Dooley (Fianna Fail)
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I welcome the Minister of State to this House. He has shown a phenomenal capacity on the issues associated with suicide and has been to the fore on many of the previous initiatives taken by the Government. I look forward to the national strategy for action on suicide prevention, which is due in September and in which I have no doubt the Minister of State will have a strong input. It will be necessary that funding be provided to ensure that services are delivered in line with needs.

I am pleased that we are holding this debate because I was among those calling for it last week. It is important that we are holding discussions on this issue. It is also welcome that the non-partisan approach being taken belies last weekend's media comments which sought to indicate that a political dimension existed. This matter is one of people elected to public office taking their responsibilities seriously by highlighting an issue and ensuring their discussions will contribute to Government policy. This is why we are elected. We are criticised by the media for spending time on local council work rather than acting as national legislators. We have been criticised over this issue, despite its importance in terms of national debate and policy formulation. I give little credence to these criticisms and am happy to address the issue. I have my own view of some aspects of media comment, which Senator Minihan has ably addressed.

The statistics are staggering but, as they have already been discussed, I will not further elaborate on them. It is clear that suicide has a devastating effect on families and drains the lifeblood of the villages and towns. I doubt that this issue will be resolved within the present generation of these communities, which are being destroyed. Ongoing attention and regular reviews of policy are required to ensure best practice is brought to bear. While I do not think a solution will ever be found, best efforts must be made to alleviate the problem and develop means of coping.

The Minister of State has identified target groups which include young males in particular. We are all familiar with this problem. However, it is critical that the strategy sets a clear path to a resolution of the existing high rate of suicide. I do not like to use the word "epidemic" in the context of this issue.

Senator Browne made comparisons with the road safety strategy. We frequently discuss road safety but comparatively higher numbers are affected by suicide. It is important the type of strategies set out in regard to road safety are mirrored in the strategy document the Minister of State will bring forward. We must set targets for a reduction in the number of suicides, identify ways to reach these targets and ensure action on the ways identified.

More funding is obviously needed and early intervention has been spoken about, particularly with target groups. A co-ordinated approach is important. Myriad organisations have various responsibilities. Those organisations should be co-ordinated and, hopefully, that can be done when the strategy is brought forward.

Senator Cummins made similar points to those I wish to make. People have been left behind by the Celtic tiger and the growth in the economy. Other Senators, including Senator Ryan, spoke about people feeling useless and worthless in terms of achievement. As a society, we must try to be more careful about what we place value on, how we define worth and how we deal with people who, for one reason or another, are not as motivated or as interested in the points race for college places and in achieving personal wealth or possessions. The most difficult thing will be to try to change how we value people and their contribution to society, which should not be based on their bank accounts, the size or make of their car, their educational qualifications or otherwise. Those are some of the reasons people initially stray from their career path and feel their contribution to society is somewhat less valuable than that of others who appear to achieve more in terms of personal gain or wealth, which can often lead to mental health difficulties and, in many cases, suicide. That is an issue which must be addressed.

By and large, the media have been extremely responsible in the way they have reported suicides, particularly in cases where there is a concern about the copycat effect which has occurred in a number of towns and villages in rural Ireland. The media have been careful in how such cases are reported and in ensuring they do not add, in any way, to the suffering of the families or in informing other people about what happened thereby affecting them further. This policy has been breached in a recent case, although I do not wish to add to the suffering of a family in the south whose son took part in an assisted suicide in Switzerland. The case has been very well documented in the print media and on radio and television. I think a line was crossed. I do not wish to blame the media as I am sure the people who made those editorial decisions did so with the best of intentions. However, I think it was a step too far and has created great difficulty not only for the family but for many others.

The case highlighted the enormous difficulties faced by people who suffer from particular illnesses which, in this instance, was multiple sclerosis. I have tremendous respect for Marion Finucane who has performed a hugely important role over the years as a public broadcaster and has informed debate in so many areas. While I am not apportioning blame to her in this case, I think her programme created more problems than it solved, particularly for people suffering from and recently diagnosed with multiple sclerosis. It put forward the life story of an individual who suffered from an extreme form of multiple sclerosis and who decided for his own reasons that the only way he could die with dignity was to take his own life through an assisted suicide. This has created enormous difficulty not only for the Multiple Sclerosis Society of Ireland but for many people who suffer from the disease. I put on record that the Multiple Sclerosis Society of Ireland is my nominating body for the Seanad election. I am familiar with the tremendous work it does and with many of the difficulties its field operatives have faced as a result of this case.

An organisation such as the Multiple Sclerosis Society of Ireland should receive greater funding and I am not only saying that because I am familiar with it. In some cases, multiple sclerosis is a terminal illness but many people continue to live fulfilling lives despite the fact they suffer from this illness and its associated difficulties. The society does tremendous work in helping people to cope with their illness and in understanding what they can achieve and how they can perform a worthwhile role in society in spite of the disease. The work of an organisation such as this should be funded as part of the strategy. Its work should be included in the strategy to ensure people do not reach a decision that the only way out for them is an assisted suicide. There are other organisations, with which I am not as familiar and on whose territory I do not want to encroach, which deal with particular categories of people and which could play a beneficial role in regard to the issue under discussion.

James Bannon (Fine Gael)
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I welcome the Minister of State to the House to discuss the important subject of suicide. Cyril Connolly rightly said there is no suicide for which society is not responsible. Ireland today is no more or no less responsible than any nation for the increasing level of suicide, especially among young people. We are all responsible but the ultimate responsibility rests with the Government. The Minister of State went into great detail in his contribution and Senator Dooley spoke about funding for the various organisations helping people who have depression and other ailments. The bottom line is that we should try a little harder to fund those organisations.

Senator Dooley mentioned the Multiple Sclerosis Society of Ireland. Rehab is organising a huge fund-raising event next week in Citywest at which the guest speaker will be President Clinton. The aim is to raise funds to help people with depression and related problems which bring about suicide. The Samaritans provide a 24 hour, 365 day per year service and do a great job helping people. Those involved give a great deal of their time and energy in a voluntary capacity and should be complimented on their efforts. We all underestimate the huge voluntary involvement of so many people in so many charitable organisations. The least a Government can do is to give them support by way of funding. That is the bottom line. When we attend organisations' meetings, launches or functions, complaints relate to the shortage of funding.

Over the past five years, 1,015 people under 35 years of age have taken their lives in this country. These are mainly young men under the age of 25. In Ireland, suicide is the principal cause of death among young people. Studies have shown that an increase in the suicide rate in young people is usually associated with a significant social change in a country and in this, Ireland is no exception. In our pursuit of personal happiness and the success we have now taken for granted, the most vulnerable among us are often overlooked by the Government and others in terms of lack of funding. Other supports should be available to help people, including leaflets and other aids in public places and, indeed, in schools. A problem exists in rural Ireland regarding accessibility to information and this matter should be examined more seriously.

I congratulate Young Fine Gael, and in particular Paul Ross, the chairman as well as the executive of the County Longford branch which initiated the proposal, for its excellent work, which has resulted in the "Talk" campaign policy document. It addresses and highlights the issue of youth suicide. Young people in the various political organisations and particularly in my own party have taken this problem on board, on which they should be commended.

A Young Fine Gael executive member, Conor Cresham, has pointed out that in the time it takes to watch the first half of a football match, there is another documented case of attempted suicide in Ireland. There were 11,204 cases of attempted suicide in 2003 alone. Young Fine Gael has called for a tracking and long-term support service for those who have attempted suicide. It is important that if a person makes such an attempt, whatever assistance is required should be made available.

One suicide takes place every 84 minutes in Ireland and the UK with approximately 6,300 people taking their lives each year. Men are likely to kill themselves between the ages of 25 and 34, while women most commonly commit suicide between 45 and 54. Some 90% of suicides are attributed to pre-existing mental disorders while more than 80% of people with depression can be successfully treated if they seek help, assuming that such help is available. I spoke about this earlier.

Throughout the world — I am sure Ireland is no exception — psychiatrists have been puzzled by the rise in suicide rates in the spring and summer months. The increase can be dramatic, with up to 50% more suicides in some areas. The seasonal effect is seen all over the world, with the northern hemisphere seeing a high rise in suicides in May and June while the southern hemisphere witnesses a similar rise in November and early December. While no one has a complete explanation for this phenomenon, the leading theory is that the increase is caused by the effects of sunlight on people's hormones. This is something that is being investigated further. The positive seasonal changes which brighten up most people's moods after a long winter may work against those who come out of a severe depression. It is ironic that the partial remission experienced by most sufferers of depression at the end of winter often provides the energy boost required to carry out a suicide. This is evident from the research undertaken in this area.

Paradoxically, the sunlight effect on the "feel-good" chemical serotonin may make people more aggressive. This aggression in depressed people may be turned against themselves. Research in Canada links seasonal changes in bright sunlight to the most violent suicides. Senator Browne referred to the number of car accidents with single occupants. A study is also being carried out on that issue and I understand the Senator dealt with it in greater detail. A well-known British psychiatrist has stated: "Spring is a time for new beginnings and new life, yet the contrast between a literally blooming world and the barren inner life of the clinically depressed is often too much for them to bear".

The entire area of mental health can be a minefield. Families find it impossible to find services for loved ones with a mental health problem. Often, the burden falls almost solely on the family. For many, suicide is the ultimate revenge, leaving the bereaved without a right to reply. This is a dreadful problem for families of suicide victims and parents in particular, who must live with it for the rest of their lives. This can have long-term effects on the victim's family and the community in which he or she lived.

While many schools throughout the country do an excellent job of educating their pupils about suicide and mental health, the Department of Education and Science must become actively involved in the education of all young people concerning these issues. We have young people who drop out of school early and we cannot depend on the schools to help them. We must examine other ways and means of helping and getting the information to such individuals.

All Members have seen the effects of suicide in their own constituencies. As politicians, we attend many funerals. Personally, I attend approximately five to six funerals in a week. I can remember the funerals of suicide victims because of the quietness and stillness around the place. No one knows what to say or how to say it when visiting a home, morgue or church. The effects stay with us for longer than for most tragedies.

We have seen the devastation, anger and despair of those left behind. We all suffer for the bereavement, but that suffering must be translated into action. I have spoken of ways and means of overcoming the problem. The Minister of State has referred to some of them in his speech. A national support service must be put in place and funds made available to the voluntary organisations. Although suicide and mental health are no longer taboo subjects in Ireland, there appears to be a puzzling reluctance to spend money on preventative measures. Essentially, increased spending and facilities must be provided by the Departments of Health and Children, Education and Science and other Departments which must become involved. We associate the problem with the Department of Health and Children, but additional community services should also be provided.

In some parts of rural Ireland there has been a major lack of spending as far as facilities for young people is concerned. For example, in Longford, we have waited for a new swimming pool facility for seven or eight years, as well as for other services in the town. It would help if such facilities and outlets existed for young people to help, support and entertain themselves, rather than suffering from depression.

Ann Ormonde (Fianna Fail)
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I welcome the Minister of State to the House. I have confidence in him and have acknowledged his competence in his role as Minister of State at the Department of Health and Children and his sensitivity in dealing with this area, drawing from both his ministerial position and his professional background as a pharmacist.

I would never use this House to score political points on an issue like this. A suggestion that a journalist from a Sunday newspaper should lecture me about sensitivity in this area would cause me to take umbrage. As far as that profession is concerned, many lessons have yet to be learned. Many journalists have breached their own code of professionalism when handling some recent cases. I took umbrage at the newspaper article last Sunday which told me how I should behave in my role.

Fergal Browne (Fine Gael)
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Hear, hear.

Ann Ormonde (Fianna Fail)
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I will remove my political hat when dealing with this issue as there are no quick fixes to it. We must go about this business slowly and meticulously. The facts are available and we must examine them. We now know that there are more suicide deaths annually than there are road accident deaths. That is the bottom line. In 2003, a total of 11,200 people who had attempted suicide presented themselves at hospital accident and emergency units. This is a very worrying figure. Suicide is the main cause of death in people between the ages of 15 and 34, accounting for one-quarter of all deaths in this age group. Another disturbing trend is the high rate of suicide among males, which accounts for over 80% of all suicides.

When I read these figures, I reflected on the reasons for them. Upon examination, the reasons, with which we are all familiar, turn out to be the pressures facing young people. Our society has become materialistic. There is a high rate of family breakdown and the norms that used to govern behaviour have disappeared. Young people are subject to pressures from their peers and parents and pressure arising out of our education system and the points system. In addition, young people face many disappointments and work outside the professions has been devalued. Binge drinking is another contributing factor to the high suicide rate among young people. Young people feel insecure because their parents are no longer there to guide them. Young people also suffer from low self-esteem. These are the fundamental reasons why our society has become so volatile. There are supports for those who are vulnerable but they are not being used.

I decided to make some inquiries and contacted the Institute of Guidance Counsellors, of which I am a member, to ascertain what it is doing to combat suicide. The institute told me about the strategies it used and cited the City of Dublin VEC as a model for suicide prevention in Dublin. A three-pronged approach that consisted of prevention, intervention and postvention was used.

How can we devise a suicide prevention strategy? I will leave aside the health aspect for the moment because educational strategies to combat suicide are important. Every school should have a suicide prevention procedure, which they do not have at present. I do not know whether my colleague on the other side of the House is aware of this. Armed with the appropriate suicide prevention procedure, the school must operate as a team. The team effort must involve the principal, teachers, the home school link and the Early Start programme if the school operates it. Those at risk of suicide can thus be identified and helped.

The Institute of Community Health Nurses, which is my nominating body, invited me some time ago to chair one of its spring conferences. During the conference, suicide and the ways in which public health nurses deal with it was debated. Delegates spoke of the necessity of using a collective approach to deal with it. This leads on to my point that the Department of Health and Children and the Department of Education and Science must work together to combat suicide.

The Minister of State referred to social and personal health education. This works up to the junior level but more is needed. Those at risk of suicide must be identified before they enter the social and personal health education programme. Parents must also be involved in this effort. In the City of Dublin VEC, if a teacher becomes aware that a pupil is at risk of suicide, he or she contacts the guidance counsellor who in turn contacts the educational psychologist who in turn contacts the clinical psychologist. The whole process is undertaken very quickly. Suicide prevention must be a collective effort.

It appears that most suicides take place in rural areas. The reason could be the isolation and lack of supports that can result from living in a rural area. This is where public health nurses can play a major role, along with local GPs and other rural organisations. In this regard I compliment the Minister of State on the number of new bodies that are being appointed to deal with suicide. I am particularly impressed by the appointment of a suicide resource officer in each Health Service Executive area. Possibly more than one officer is needed. Very often, as a guidance counsellor, one wants to contact someone but cannot find the right person within one's area.

It is possible to prevent suicide if one puts the right structure in place. The right people are in place for intervention programmes to be set up. Postvention is a key area in which work is carried out with families. The three key words are "prevention", "intervention" and "postvention". If the Minister of State gets these three elements right, we are the road to developing an effective suicide prevention strategy.

Maurice Hayes (Independent)
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I welcome the Minister of State to the House. I do not have much to add to Senator Ormonde's sensitive and insightful contribution. The only thing I would implore her to do would be to stick to decent terms like aftercare and leave terms such as "postvention" to people who think up awful terms, such as "proactivity".

I wish to contribute to the debate because suicide is also a common problem in Northern Ireland. It would be helpful if an all-island approach to suicide prevention was used or at least if there was an exchange of views and experience. As Senator Ormonde said, suicide is an extremely complex subject and a variety of agencies need to be involved in combating it.

It is important to introduce short-term measures to combat suicide in addition to establishing organisations and engaging in research. Suicide research is extremely important and I commend the Minister of State for the support he has given to that. Much of this research could take the form of action research in particular places. The Government should look at measures that work, as Senator Ormonde mentioned with regard to schools in Dublin, and see if they can be replicated.

A feature of suicide that fascinates me is the clustering of suicides around the country. Why is the incidence of suicide higher in some places than in others? Is it because some locations offer more opportunities to commit suicide, because of copycat suicides or because of a particular set of circumstances in certain locations? Research is either being carried out or will be carried out into this subject. I would encourage the Minister of State to support this research as an aid in our understanding.

As Senator Ormonde noted, there are connections between alcohol, drugs and suicide. People's lack of self-worth is another contributing factor. What is it in the system, particularly the education system, that makes people feel this way? There is also the question of whether suicides are the result of a cry for help. We need people who are trained and sensitised to pick up signals of suicide, however, these signals will not always be visible. There is a need for resources on the ground, particularly psychiatrists, psychologists and paediatric and adolescent services.

Getting in touch with young people also presents a problem. Some of the practitioners in this field have suggested to me that the best people to speak to young people at that level are those who have themselves attempted suicide but drew back from it. How can we mobilise these people or make contact with them? I am not sure what the suicide resource officers of the Health Service Executive do and I do not want to refer to particular cases, but there is little point in their being there if they only work office hours. People tend to attempt suicide "out of hours".

Accident and emergency services, particularly in larger departments that run 24 hours a day, should have the capacity to deal with this problem and have psychiatric care available around the clock. An increasing number of people who present in accident and emergency units have psychological or incipient suicide problems. The Minister of State's Department will know that interesting actions are being taken in Scotland, for instance, where the resources of a whole town, village or area are mobilised to deal with the issue. This should be encouraged but will the Minister of State try to ensure that whatever is done happens in conjunction and consultation with people in the North who have the same problems?

Eamon Scanlon (Fianna Fail)
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I welcome the Minister of State and will make a few comments on what is a very sad problem in Irish society. This matter is a tragedy of enormous proportions as not a town, village or parish is unaffected by suicide today. The figure of 444 people who took their own lives in 2003 is only the documented figure but there are experts who would suggest that many more people fall within this category. For example, car and other accidents may have been suicides but were not recorded as such. That so many deaths are due to suicide is a terrible tragedy.

Being a politician, I know many people, including a number who committed suicide, but I do not believe they had psychiatric problems. They appeared to be the sanest people in the world to me and many of their friends and acquaintances. However, they snapped and, unfortunately, took their own lives for some reason. A situation occurred within my family 14 years ago, from which I know that suicide has a terrible effect on families, including hurt and anger. The length of time it takes to get over such a tragedy is something one must go through to understand it fully. People feel guilty because they believe it should not have happened or that they could have done something to prevent it. Unfortunately, it is too late by that stage.

I will mention the work that is being carried out by the voluntary mental health associations in certain areas. I do not know whether this is true elsewhere in the country but I can speak about Ballymote, where great work has been done. The groups even had a junior mental health association. When I started work in Sligo 32 or 33 years ago, I lived with the man I was working with and was situated across the road from the mental hospital, as it was called at the time. None of my friends would visit me. Such were the attitudes to those institutions then. Thankfully, this has changed as people are more prepared to talk about the issue. This is due to the work organisations have done on the ground. They got people involved, visited mental hospitals and took people on day trips. They have done tremendous work.

Located across the road from my business in Ballymote is a centre attended by approximately 30 people from within a 15 to 20 mile radius. They are collected every day, taken to the centre where they can visit doctors, chiropodists or whoever, are given their dinners and are taken back home in the evenings. They also have the freedom to do their shopping or to go to the local pub to have a drink. Many of these people would not otherwise be seen outside their front doors from one week to the next. The only person who might see them would be the postman, depending on the form they were in on the day the post man called. Fantastic work is being done and the people who are doing it should be complimented.

The issue of suicide is difficult to resolve and it is hard to know where to start. The Health Service Executive in the north west has a number of people involved in carrying out studies on suicide, as the incidence of suicide has been high in that area. Senator Maurice Hayes mentioned clustering, which is a problem all over the country. A person may think about committing suicide and see someone else do it, triggering them in turn. This may be one cause but no one really knows what causes it. However, there is no doubt that clustering is a factor. I know of areas where one suicide is followed by another a week later and so on but dealing with clustering is very difficult.

The Aware organisation carried out a study on suicide in 1998 and made a number of good suggestions, such as addressing the issue in schools. Young people should be made aware of the problem and it should be talked about because doing so makes it better understood. Young people should know there are structures available to help them. If we start there it may be of help. Alcohol is a problem, of course, and drugs destroy lives, which we all know. I wish the Minister of State well in whatever he does. This is a serious and difficult problem that will not be solved easily. All we can do is continue to try to reduce the number of suicides.

Tim O'Malley (Limerick East, Progressive Democrats)
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I commend the House on holding statements on this topic. I also commend the speakers for their contributions. They have done the Seanad proud today by their constructive handling of this emotive and sensitive issue. I have listened carefully to all the contributions and will reassure everyone that there is an equal amount of compassion regarding this issue on both sides of this House. The matter is a complex one and the importance of exploring the causes and ways of dealing with suicide cannot be overemphasised.

Many of the contributions have focused on the recommendations contained in the report of the national task force on suicide. Contrary to some of the statements that suggested little or no progress has been made in the implementation of the recommendations, the opposite is the case. Since the publication of the task force report in 1998, there has been a positive and committed response from both the statutory and voluntary sectors to finding ways of tackling the tragic problem of suicide. The task force made approximately 86 recommendations, some of which are completed and many of which will be ongoing for years. It is simplistic to suggest the Government has not followed these recommendations. It is following up on all the recommendations, but many of them, including education and working with the youth, are ongoing. This work will never be completed.

The former health boards have played and, under the umbrella of the new Health Service Executive, will continue to play a major role in co-ordinating efforts to help reduce the level of suicide and parasuicide in the country. Following the publication of the task force report, resource officers were appointed in all the former health board areas with specific responsibility for implementing the task force recommendations in their area. The resource officers also engage in the promotion of positive mental health, the destigmatisation of suicide and provide information on suicide and parasuicide within their area. Perhaps there is an opportunity for politicians to invite resource officers to their areas. It has been said people are not aware of what the resource officers do. Perhaps the resource officers would welcome a forum to inform the public what they are doing, because much of the excellent work they do gets no publicity. It is good work and not sensational. Perhaps there is an opportunity for people in their own regions to invite the resources officers to public meetings and so on.

Another key response to the recommendations of the task force was the establishment in 1999 of the national suicide review group. Membership of this group includes experts in the areas of mental health, public health and research. Its main responsibilities are to review ongoing trends in suicide and parasuicide, co-ordinate research into suicide and make appropriate recommendations. The annual report of the national suicide review group meets the requirements of the Health (Miscellaneous Provisions) Act 2001, whereby the Minister for Health and Children will report annually to each House of the Oireachtas on the measures taken to prevent suicide in the previous year. The report outlines the measures taken by health service providers and other agencies in the previous year to help prevent suicide and reduce the impact of suicidal behaviour. The aim of the report is to facilitate the sharing of information across the health and other sectors regarding suicide prevention projects and to provide accurate and current information on the patterns of death by suicide in Ireland.

The report draws attention to the many initiatives being undertaken throughout the country in the area of suicide prevention. Among the developments highlighted is the appointment of liaison psychiatric nurses to the accident and emergency departments of many general hospitals to deal with people who present following attempted suicide. The provision of this type of service ensures that psychological problems in patients presenting to general hospitals are dealt with promptly and referred to the mental health services for further support and follow up, if necessary. This benefits the patient and ensures a more efficient use of medical and surgical services in accident and emergency departments. Other initiatives highlighted in the report include the provision of training to health service staff and public information campaigns.

My Department allocates funding through the National Suicide Review Group for voluntary and statutory groups engaged in prevention initiatives, many of which are aimed at improving the mental health of the younger age groups. These projects include life skill courses for high risk youths, school-based personal development modules and mental health promotion campaigns. A number of these projects have been positively evaluated and proved to enhance the coping skills of the participants. It is anticipated that such campaigns will lead to a reduction in youth suicide behaviour over time.

At national level, priority is being given to education awareness and promoting a better understanding among the public towards mental health in general. We are all aware of the pressures on young people such as bullying, emotional distress, addictions, peer pressure and examination pressure. We often tend to think that people are weak if they suffer from anxiety, depression, inability to cope or have suicidal tendencies. However, it is now widely acknowledged that one in four women and one in ten men will experience depression during their lifetime. Many of these are successful people, role models and celebrities whom we all know. There is a growing awareness and concern among the community about mental health matters. The national health promotion strategy 2000-05, in conjunction with the new health strategy, regards mental health as equally important to physical health in a person's overall well-being.

Increasingly, mental health is being recognised as a major challenge facing health services in the 21st century, not just in Ireland but across the world. My Department recognises the need for positive mental health promotion. Mental health promotion is a very broad concept as it emphasises the promotion of the psychological health and well-being of individuals, families and communities. I consider it a key task of the health services, not just to treat mental illness but, more important, using the principles of health promotion, to try to improve the mental health of the whole population.

A fundamental aim of the new national strategy for action on suicide prevention to be published in September will be to prevent suicidal behaviour, including deliberate self-harm, and to increase awareness of the importance of good mental health among the general population. Ongoing quality multidisciplinary research will be an essential strand of the strategy and the findings will be of greatest value where they can inform and stimulate actions and service development. The strategy will identify expected outcomes and set targets which can be measured, monitored and revised. Continual quality control and ongoing modification improvement of the strategy will be central to its implementation.

I would like to respond to a few points made by some speakers. Senator Browne referred to low self-esteem among people who take their own lives. A psychotherapist friend told me recently that he has never come across a person who attempted parasuicide or had mental health problems who also had high self-esteem. These are mainly people with low self-esteem, which is a challenge for all of us, particularly in motivating people in the educational sphere.

Single vehicle accidents was referred to by many Members. I have asked the review group to examine this aspect because we are becoming aware of an increased incidence of single vehicle accidents among young males. It appears that some of them are either parasuicide or suicide cases. In the case of people who survive, there is an onus on the health services to follow up these cases and ensure that if it was a parasuicide or an attempted suicide, people get the help they need immediately.

Many Senators spoke about the Fine Gael document which was launched recently. I welcome any contribution from any political party on this subject. It is a matter that is apolitical, which affects all of society. I welcome any group or political party that contributes to the debate.

Senator Browne referred also to the national helpline and what Deputy Gregory said in the House recently about trying to access some of these lines and the responses he received. I have been aware of this problem for some time, as has the expert group and the strategy group. We are all aware that we need to focus on young people, in particular, in regard to suicide and parasuicide. However, it is not as simple as just throwing money at the problem. That particular group is into technology, texting and so on, therefore, we must examine new ways of getting our messages about positive health across to them. I have not adopted a simplistic ad hoc approach. I am well aware of the problem. People are examining the best approach to target these young people.

Senator Glynn and many others mentioned alcohol and drug addiction as being a serious problem. This does not apply only to illicit drugs. More information is emerging to the effect that people abuse and overdose on prescribed mood altering drugs, such as benzodiazepines, etc. There is a high level of addiction to prescription drugs, an issue we must consider seriously.

Senator Henry mentioned the education of doctors and nurses. I have often said that general practitioners could play a significant role in the area of prescribing medication and advising people on lifestyle issues. They are the gatekeepers, the first people to whom people go for help.

I am not happy about the education of doctors. This whole area needs to be reconsidered. The model of the points system, focusing on the highest achievers in secondary school, does not necessarily make the best doctors. We know from the use of that system for approximately ten or 15 years that there is a 10% drop-out rate among doctors after their first year in practice. That is a frightening statistic, not alone because it is unfortunate for those who realise after a year or two that they entered the wrong profession. They did not realise that medicine is as much a vocation as a profession. It is also a waste of public money to educate people who do not then use the skills they learnt in college.

Senator Henry and a couple of other speakers mentioned assisted suicide. I do not wish to comment on the case recently covered in the media. I have thought seriously about this issue in recent years in the context of my profession of pharmacy. I am totally opposed to assisted suicide and so is the Government. I welcome the debate, however, because this is an ethical issue on which people hold differing views, as is their right. This matter will be debated more fully in the public arena in the future. The ethical issues involve the medical and nursing professions, pharmacists and everyone who deals in this area. We must reflect on this topic.

I welcome Senator Ryan's contribution on the holistic approach to the complex issue of suicide. He also spoke about how young people now go out in a deliberately self-destructive way to get drunk. He is correct to say that 20 or 30 years ago people went out to drink and have a good time but they did not go out deliberately to get drunk. That is a change in society and something we must examine, to understand why it is happening. I take a drink, and there is value in people drinking but there is no value in people drinking to the point of such excess that they become completely drunk.

Senator Ryan also mentioned the models of success in our society and how these do not include artistic people or those who do not wish to have the trappings of success, or money. They may be artistic or creative people, writers and so on and have their own lifestyle. In times gone by they would have been classified as daoine simplí. There is nothing wrong with those people, indeed because they may be slightly different from the norm they may have better attributes than many of us do. How society deals with them is a matter of education and values which we must consider.

Senator Minihan made some important points, namely, that for people with mental illness there is hope, and help is available. Too often in the past, under the psychiatric model, as soon as one attended a psychiatrist one was labelled and told one had a condition for life. There is, however, a recovery model. People who have recovered and come out of the system have much to tell us.

It is important to listen to them because they can point out the flaws in the system. There were major flaws in the way in which people with mental illness were dealt in the past. There is hope, help and a recovery model. Many people who receive the proper intervention and treatment survive and overcome their mental illness and recover completely.

Senator Cummins called for more resources and money. While I do not disagree with him, and I will ask for more resources from the Government, it is not just a question of resources. As Minister of State with responsibility for this area I receive many cries for help from around the country from those using services. However, many of those who are unhappy with the services are so because of the manner in which certain people have dealt with them. These are people employed in the services who do not deliver them.

Most of those working in the mental health area are good people delivering excellent services to a very vulnerable group. Unfortunately, however, there are some who do not give the best of service to people with mental illness, which can have catastrophic results for the vulnerable patient. Senator Cummins also mentioned gambling, a topic on which few people speak, so I will take it on board.

Senator Bannon mentioned that Rehab is hosting a fund-raising event next week in Dublin which former US President Bill Clinton will attend. While I welcome Rehab's initiative to raise funds for the effort to prevent suicide, our approach as a Government and a society cannot be that one or two organisations take over this area. If we are to get this process right the voluntary and statutory sectors must engage in a co-ordinated approach. This must begin at parish level, as Senator Scanlon said.

Senator Ormonde said we must move slowly and meticulously. We have walked cautiously, not slowly, over recent years. Later this year we will publish two reports, from the expert group and the strategy group, which I initiated as soon as I came into this office. They will point the way to major reformation of our mental health services. It will be a challenge for the Government to provide more funds and to many people working in the field because many aspects of the work in this area could have been done differently and need to be done differently.

Many patients and clients who use the mental health services have reported to us. They are telling us they are not happy with many of the services and are not happy with the way they have been dealt with in the past. Not only is it important to hear those messages; it is also important to put into practice strategies that will take those issues on board and employ different methods of doing things. For example, medical card holders cannot as of right in Ireland go to a counsellor. They must first go to a general practitioner and be referred to a psychiatrist. That is one issue that will have to be changed.

Senator Maurice Hayes reminded me of our common problem with Northern Ireland. I will certainly take that issue on board but probably not until the autumn when I receive the two reports. The Senator is correct in saying it would be much better if an all-Ireland approach were adopted. Senator Scanlon mentioned the effects on the ground in local communities.

I thank all Senators who contributed to what was a worthwhile debate. I thank them for their efforts today in helping me, on behalf of the Government, to get to grips with this complex problem. If it were a simple problem it would have been solved years ago. It is a problem not only for Ireland, but is an ongoing global problem. I admit we have a problem; Ireland ranks 17th in the EU in terms of the overall suicide rate. Having read some of the articles in the newspapers, one would swear Ireland had a problem that was out of all proportion to the other 24 member states. That is not the case. However, there are warning signs especially with young people and we must face up to what is happening. This is a challenge for the Government and all of us who have the responsibility to put meaningful services in place which will alleviate people's suffering. There is also a social inclusion issue. Unfortunately, mental health issues and suicide cut across society and are not confined to any strata or socio-economic group.

I thank Senators and you, a Chathaoirligh, for the opportunity to come into the House to discuss this important matter.

Mary O'Rourke (Fianna Fail)
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We appreciate the presence of the Minister of State.