Wednesday, 26 October 2005
Suicide Prevention Strategy: Statements.
I welcome the opportunity to speak in the Seanad on this most important topic. I will outline the measures which are being taken by the Government and the Department of Health and Children, in conjunction with the Health Service Executive and many community and voluntary organisations, to address the issue of suicide, which is a serious problem in Irish society. Official mortality data from the Central Statistics Office indicate that there was an annual average of 494 deaths by suicide in Ireland between 2000 and 2002. The figure peaked at 519 in 2001. Such a number of deaths represents a rate of approximately 12.9 suicides per 100,000 people. Ireland ranks 17th among the 25 EU member states in terms of its overall suicide rate. The rate of youth suicide in Ireland, which is the fifth highest in the EU for those between the ages of 15 and 24, is of particular concern. The suicide rate in this country is even higher among those in their 20s and early 30s. Men under the age of 35 account for approximately 40% of all Irish suicides.
Deliberate self-harm is a further significant public health problem. According to the National Parasuicide Registry, over 11,000 cases of deliberate self-harm, some of which result from serious suicide attempts, are presented to Irish hospitals each year for assessment and treatment. The highest deliberate self-harm rates are found among younger age groups. The rate for girls peaks between the ages of 15 and 19 and the rate for young men peaks between the ages of 20 and 24.
The historical reluctance in Irish society to discuss the issue of suicide has thankfully changed. While it is to be welcomed that the level of discussion and openness about mental health issues, including deliberate self-harm and suicide, has increased significantly in recent years, we need to ensure that public discussion and media coverage of suicide and deliberate self-harm remains measured, well-informed and sensitive to the needs and well-being of psychologically vulnerable and distressed individuals in society. In particular, we need to continue to work as a society to create a culture and an environment in which people in psychological distress feel able to seek help from family, friends and health professionals.
Suicide touches the lives of many people. It is a tragedy in every case, because a life has ended and family, friends and community have been left behind. Many of us know someone who has attempted or completed suicide. Preventing suicide and reducing the rate of suicide in Ireland is an urgent public health issue that is at the heart of our efforts and policies, aimed at creating a healthy, prosperous and socially inclusive Ireland. In addressing the rate of suicide, we must continue to try to eliminate poverty, to achieve greater social justice and inclusion for vulnerable people in society, to address inequalities where they exist and to improve and expand educational opportunities.
I recognise that many challenges lie ahead and I am aware that no easy or single interventions guarantee success in this area. International evidence shows that reducing the suicide rate and preventing suicides requires a collective and concerted effort from all groups in society. Work needs to be done by those involved in the health and social services, other professions, communities, voluntary and statutory agencies and organisations, as well as parents, friends, neighbours and individuals. A strategic framework is required to help us to identify the actions we can undertake in a co-ordinated way, by means of partnership between statutory, voluntary and community groups and individuals, supported by the Government.
Reach Out — A National Strategy for Action on Suicide Prevention was launched by the Tánaiste and Minister for Health and Children on 8 September last. It builds on the work done in 1998 by the national task force on suicide and takes account of the efforts and initiatives developed by the former health boards in recent years. It was prepared by the project management unit of the Health Service Executive, in partnership with the national suicide review group, and supported by the Department of Health and Children. Since the work on the development of a national suicide prevention strategy was initiated almost two years ago, wide-ranging consultation has taken place throughout the country to draw on the experience, perspectives and ideas of the key stakeholders and interested parties. I thank those who participated in the process of consultation which, combined with continuous monitoring of evidence and best practice, allowed the project team to take an evidence-based and pragmatic approach to prioritising the actions to be undertaken by the various agencies and groups if they are to effect real change over the next five to ten years.
A straightforward approach is advocated in the strategy, which identifies four principal levels of action — a general population approach, a targeted approach, an approach to responding to suicide and an approach to information and research. Some 26 action areas have been identified across the four levels and specific points of action, which are to be implemented in three phases over the coming years, have been specified. The combined public health and high-risk approach to suicide prevention that is identified in the strategy is the same as that advocated by the International Association for Suicide Prevention. It is in keeping with the European action plan for mental health, which was signed and endorsed on behalf of the health ministers of the 52 member states of the European region of the World Health Organisation at the ministerial conference on mental health in Helsinki in January 2005.
A fundamental aim of the new strategy is 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 multi-disciplinary 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 identifies expected outcomes and sets targets which can be measured, monitored and revised. Continual quality control and ongoing modification and improvement of the strategy will be central to its implementation. At present, 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. The new strategy includes specific recommendations for action in this area.
The Health Service Executive is taking a lead role in overseeing the implementation of the strategy, in partnership with those statutory and voluntary organisations that have a key role in making the actions happen. Driving the implementation of the strategy is the recently established National Office for Suicide Prevention, which is based within the national population health directorate of the HSE. This office is headed by Mr. Geoff Day, formerly assistant chief executive officer of the North Eastern Health Board and chairman of the National Suicide Review Group.
The first task of the national office will be to work on the following five key priorities: stigma reduction and mental health promotion; the development of a national training programme; the development of an effective service response for those who have engaged in deliberate self-harm or who are acutely suicidal; the development of bereavement support services; and improving data collection, management and use in regard to suicidal behaviour and suicide prevention. In addition to these five priorities, all of which will be worked on simultaneously, the National Office for Suicide Prevention is committed to developing the potential use of information and communications technology — for example, using the Internet or SMS text messaging through mobile telephones — to reach out and provide support to young people and those feeling isolated and alone.
An annual report will be produced by the National Office for Suicide Prevention detailing progress in regard to the implementation of strategy actions in the previous calendar year, beginning with a report in 2006. This will provide an important tool for monitoring progress in meeting the priority objectives of the strategy and reporting on rates of suicidal behaviour, which it is hoped will be significantly reduced over the coming year. The annual report will meet the requirement of the Health (Miscellaneous Provisions) Act 2001, which requires a report on activities in the area of suicide prevention to be presented to the Houses of the Oireachtas each year. The production of this report had previously been a function of the National Suicide Review Group.
An advisory group comprising key individuals who can offer their expertise to guide the work of the national office and the HSE will also be appointed. This advisory group will replace the current National Suicide Review Group, the contribution of which to suicide prevention has been considerable. In turn, a representative national forum will be briefed by the national office on the achievements overall in suicide prevention and, in particular, in regard to strategy implementation. This forum will also provide an opportunity for the exchange of views on developments in suicide research and prevention.
Much consideration was given to the setting of an overall target for the reduction of our national suicide rate as an outcome measure of this strategy. At this stage, it has been decided that a specific target will not be set because the priority is to establish the accuracy of suicide mortality in Ireland whereas, due to the range and interplay of factors that influence the suicide rate, it is virtually impossible to establish a direct cause and effect relationship between prevention programmes and a change in the overall population rates. Nevertheless, there are undoubted advantages to setting targets for an overall reduction, not least the fact that it focuses the attention of those working at all levels of suicide prevention. An overall target for the reduction of suicide rates will be set by the Government, on the advice of the Minister for Health and Children, when the Minister is satisfied that suicide rates have been accurately determined.
I am pleased to inform the House that funding of €500,000 has already been allocated to commence the implementation of the strategy for the remainder of 2005. This includes funding towards the development of a major national campaign for the promotion of positive mental health; the delivery of a second national intervention skills training of trainers programme; the creation of new, dedicated services for treating deliberate self-harm in accident and emergency departments; the further development of existing services; and the further development of bereavement support services. Additional funding will also be made available over the coming years to support the strategy and complement local and national efforts. This has been confirmed by the Taoiseach and the Tánaiste.
In August 2003 I appointed the expert group on mental health policy to prepare a new national policy framework for the mental health services. In the course of its work, the expert group will consider the area of suicide prevention and reduction and will make recommendations on the matter, taking account of the national strategy, Reach Out. It will also set the issue of suicide prevention and reduction within the broader context of a mental health policy framework.
In conclusion, I reiterate that the Government shares the public concern about the levels of suicide in our country. 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, that they consider taking their own lives. We must aim to provide accessible, sensitive, appropriate and, where required, intensive support. The new suicide prevention strategy is practical and achievable, and based on evidence and international best practice. It is further evidence of the Government's determination to take whatever steps it can to reduce the level of suicide in our society. It will be subject to ongoing, regular evaluation to ensure the expected outcomes are achieved.
I welcome the Minister of State and his official to the House. I am privileged to sit with Senator Glynn and others on the sub-committee investigating the high level of suicide in Irish society. The stories and facts the sub-committee has heard from different groups have opened my eyes to this issue, although we are only half way through our deliberations at this stage. While we have all been touched by suicide and every county has experienced a certain number of suicides per year, the stories told by those directly involved are harrowing. The establishment of the sub-committee is welcome and I look forward to its report, which will be published before Christmas and, I hope, acted upon.
A presentation was made to the sub-committee yesterday. It was fascinating to hear the different reports. We were told that Dr. Schneidman in 1969 stated that for every death through suicide, six people suffer intense grief reactions. A report by Dr. Byrne in 2001 stated that a minimum — I stress the word "minimum"— of 50 people suffer from loss, grief, blame or shame as a result of a single suicide. When we think about suicide, we should not think only of the known cases but of the bigger picture, namely, those affected by the suicide, including those on the outer margins.
Irish society has come a long way. Those who committed suicide in the past were treated shockingly by the State and church. It is terrible that burial in their home graveyards was not allowed but, thankfully, this practice has stopped. We have opened up more in recent times with regard to the issue of suicide but, unfortunately, we have a long way to go. A speaker at yesterday's sub-committee meeting drew a good analogy. If a person had a problem with an eye, he or she would have no difficulty contacting an optician or doctor to get immediate help. However, if that person had a problem one inch above the eye, he or she would tend to close down and hide. That is a difficulty.
I am impressed by the large number of voluntary groups working in the area, such as Console, Living Links, Aware and the Samaritans. However, looking from the outside in, I am aware there is a clear need to co-ordinate their services. All groups that came before the sub-committee spoke about the need for additional funding and stated they are not happy that they cannot give a full national service due to limited resources. I understand this comes under the remit of the National Office for Suicide Prevention which will examine co-ordinating services. It should be one of the key targets of the office.
I was struck by one group explaining how it got telephone calls from individuals expressing concern about another with suicidal thoughts. Often it was the concerned individual who had suicidal thoughts. These individuals tended to speak in the third person instead of admitting openly they themselves had a problem. Thankfully, the groups were able to deal with this and prevent some suicides.
In Europe, it is generally older people who commit suicide. Ireland is unique in that it has a large rate of suicide among young people, particularly among men. The suicide rate among men is four times that of women. However, more women attempt suicide and self-harm. In the past five years, the average rate of suicide stands at 490. It went over 500 in one year. These are the known cases of suicide which means the actual rate could be higher. Several studies have been carried out in other countries on single vehicle crashes which estimate that 10% of them could be suicides. As there is no data on this in Ireland, the Minister of State must set up an investigation into it.
The 25 to 44 year age group, the youngest people in our society, has the highest suicide rate. Last year, there were 5,000 known attempted suicides. However, there are cases where attempted suicides go unreported. For example, an individual who had taken a drug overdose could have woken up the next morning, thankfully surviving it. He or she would have told no one about the attempted suicide. More research needs to be done in this area. While 409 people took their lives last year and 5,000 were involved in self-harm, we still do not have the full picture.
The Minister of State said that €500,000 was given to the National Office for Suicide Prevention, which seems to be a large amount. However, the national road safety campaign costs €22 million and the agency involved in advertising road safety received a budget of €6 million last year. By comparison, it is obvious the National Office for Suicide Prevention is way behind in funding. The message the sub-committee has received from every group is that proper resources need to be put in place. There are delays for treating those with psychological problems. Yesterday, the sub-committee heard of 23-month waiting times for some individuals. There is no infant psychological service and our adolescent services are far from perfect. One can see in the context of the mental health budget that no proper emphasis is being placed on it.
Aware estimates that only 50% of people with depression seek help. This is a worrying figure. Aware also estimates that depression and intoxicant problems present in 90% of suicides. One issue that emerged at the sub-committee hearings was that alcohol consumption and suicide rates have increased in parallel by 40% from 1993 to 2003. While this is a reflection of our growing affluence, as alcohol consumption levels increased, so too, unfortunately, have suicide levels. An alcohol addiction counsellor explained to the sub-committee the connection between binge drinking and suicide. In some cases, suicide is not attempted at the time of binge drinking but two to three days later. Alcohol is a mood-altering drug which not only physically affects one the following day with a hangover but also psychologically for two to three days afterwards.
The Government must put pressure on the advertising industry to stop glamorising drink. People must be educated on the downsides of alcohol consumption as it is causing havoc in people's lives. I am not demanding a puritanical society where alcohol is not available but people must be given the full facts on the effects of alcohol consumption. An onus must be put on the drinks industry to balance its promotional advertising on the positive effects of alcohol and explain its downsides and the risks involved.
I welcome the establishment of the National Office for Suicide Prevention. It has much work ahead of it. It was recommended in the Reach Out strategy for suicide prevention. The office informed the sub-committee that one of its main aims was to increase the number of counselling facilities offered at accident and emergency departments. Approximately 50% of accident and emergency departments have facilities for people who present in cases of self-harm. The office hopes to get this figure to 90%, which must be done without delay. The sub-committee also heard about the need for early intervention. We need better psychological services at infant and adolescent level. Children as young as seven years of age have attempted suicide.
National helplines for suicide prevention are often not available 24 hours a day. As with car crashes, there are certain peak times for suicides. It is fine having helplines available nine to five, but people do not necessarily commit suicide during these hours. Many groups find themselves unable to afford 24 hour helplines. The Government must assist in providing helplines, 24 hours a day, seven days a week.
Stigmatising suicide is a large aspect of the issue. The term "committing" resonates with the idea of committing a crime. It is a phrase that should be taken out of the lexicon. People who commit suicide have an illness. People suffering from depression need to be encouraged to come forward. However, they should not necessarily be treated at psychiatric units but at some alternative.
The statistics are bleak and there is much work to be done in this area. When the Minister of State receives the sub-committee's report in late December, I hope he will increase funding substantially to enable the National Office for Suicide Prevention to co-ordinate services, properly funding the voluntary agencies involved.
Another issue is that of those families left behind who must deal with bereavement through suicide. It is bad enough to lose a loved one through natural causes. Suddenly losing someone through suicide is, however, one event a family can never get over. All Members who have been to funerals sympathising with people in such circumstances will agree it is a horrible experience. Proper resources must be given to those agencies to provide counselling to bereaved families. I hope the Government will take stock of this. It must match the funding for suicide prevention with that for road safety, particularly as more people commit suicide every year than are killed in road accidents.
Suicide is a subject that until recently people did not like to confront. Society in general was in a state of denial, believing that if we ignored the subject it would go away. It has not gone away and is as large as life. Unfortunately in these circumstances "life" is the operative word, as it is snuffed out by a wilful action. At long last, however, society recognises we have a serious problem. Certain groups and services, especially the psychiatric services, say we have known for some time that suicide is a major problem. Regrettably, as Senator Browne pointed out, there is a stigma attached. It is not as bad as it was but we still have some distance to get rid of that stigma. It is important that people who might be listening today or reading a report pertaining to this session in Seanad Éireann realise that psychiatry, which is the area of medicine and nursing that deals with suicide, attempted suicide, depression and all the conditions that contribute to suicide, is not taken seriously enough. Decisions were taken some years ago by a number of Governments that resulted in a serious drop in the number of psychiatric nurses being trained, and in people training in medical psychiatry. They are contributing factors.
We should get real. Community services have a pivotal role to play in suicide prevention. In the mid-1980s the report, The Psychiatric Services — Planning for the Future, was launched. That report needs to be reviewed urgently. Much was made of community services, which are a better service but far more expensive. We should not fool ourselves. Mr. P.J. Fitzpatrick, who was programme manager of community care with the former Midland Health Board at the same time I was a member, made the point exhaustively that we should develop our community services and our hospital services in tandem. We should not neglect hospital services like they did in Britain. Regrettably that has happened to some extent in this country. Thankfully, the intake of students into psychiatric nursing has improved immensely. The Midland Regional School of Nursing, established by the former Minister for Health and Children, Deputy Cowen, is doing great work. Once again psychiatric nurses are being trained in the midlands, which was not the case for over 20 years. How can this House be serious about mental health and suicide statistics when a situation like that obtained for over 20 years?
The ten year strategy developed by the programme management unit of the HSE and the National Suicide Review Group, supported by the Department of Health and Children, set out a range of actions to be taken by various State and non-governmental agencies on four different levels. This has been referred to by the Minister but I repeat, if only to underline it, that regarding suicide the population as a whole is a therapeutic community. It cannot be dealt with by the psychiatric services or the support services on their own — everybody has a role to play. Specific target groups such as young men and prisoners are vulnerable groups. Young men under 35 years of age account for approximately 40% of all suicide deaths, according to the Central Statistics Office. Over 11,000 cases of deliberate self-harm are seen in Irish hospitals every year, according to the National Parasuicide Registry. Some 21% of cases of deliberate self-harm are repeat acts. The highest rates of deliberate self-harm are among females aged 15 to 19 year olds. In a community sample of young men it was reported that 78% knew somebody, 42% knew more than one person and 17% knew a close friend who died by suicide. They are damning statistics.
There are not many families who have not been touched by the icy fingers of suicide, including my own. When it happens it is comparable to throwing a pebble into a pond and seeing a ripple effect. It goes from one side of the pond to the other. The emotions that surface among family and friends when a suicide occurs range from anger, when they ask how somebody could be so selfish to do that without thinking of others, to remorse and self-blame when they ask if they could have done something or recognised something was wrong. People will reflect that they suspected something was wrong but did nothing about it. Then depression ensues for those people, accelerated by self-blame. Thus the ripple effect extends from family to friends to neighbourhoods.
Then there is the "DID" group, the dealers in death or the drug pushers. In my experience they have a pivotal role, as has alcohol. It has been proven by statistics that in a high percentage of suicides alcohol has been taken. I have regrettably come to realise in the past year or so that other substances as well as alcohol are involved in the many unprovoked attacks taking place in our society at the moment, in the depredation, the fights and the brawls we hear of. Yet people advocate the legalisation of a certain drug. We know what happened in Britain. It went down that route but has now retracted. History is a useful subject because if one learns from its mistakes one will not repeat them. Some people in this country want us to repeat the mistake of legalising cannabis. As a legislator that will never get my support.
I agree with Senator Browne that the drinks industry has a case to answer. In many respects the industry glorifes alcohol products, such as alcopops, targeted specifically at young people.
Certain commentators have unfairly vilified publicans. I do not agree with that approach as I know many publicans who are very responsible. Publicans are in the business of selling drink products, but if the drink product is not made it cannot be sold. There is a culture among young people where they wish to become intoxicated as quickly as possible, especially at the weekend. There is also a well-established practice of spiking drinks. I have stated before and I again contend that there should be a mandatory prison sentence for those who spike a drink. Alcohol is a social drug and people do not really worry about its cost. The main worry would be that it might become scarce.
I am pleased to be a member of the sub-committee of the Joint Committee on Health and Children dealing with the high levels of suicide in Ireland, although its operation clashes at times with events in the Seanad. It would be wonderful if we had bi-locational talents and could do several things at once. I am cursed with being human and can only be in one place at a time. As I play a minor role in this House I must attend the Order of Business and, regretfully, I cannot attend all the sessions of the sub-committee I would like.
The sub-committee had an excellent presentation by Professor Eadbhard O'Callaghan of DETECT, and one of his stronger points concerned early intervention. Such intervention saves lives and money while giving young people a chance. This country is playing catch-up to the rest of the world on this issue. There is also strong evidence suggesting that early intervention should be a core part of any effective suicide prevention strategy.
Psychosis and the role psychosis plays in suicide was also referred to. It is a strong role. Professor O'Callaghan also explained the different types of psychosis, such as drug-induced psychosis. It may not be appreciated by many people who take drugs that the end result of such a practice is psychoses like organic psychosis; schizophrenia; bipolar syndrome, which is also known as manic depressive psychosis; or psychotic depression. There are 75,000 people with varying forms of psychosis in Ireland, which is a significant number. Schizophrenics account for 34,000 people in the country. The suicide rate for individuals with psychosis is 20 times the rate in the general population, a large discrepancy. This relates to my point on the importance of having a strong psychiatric service based in both the community and hospitals.
A reduction in mental illness leads to a decrease in the danger of suicide. This can be related to the therapeutic community and the manner in which it can be developed. General practitioners, who currently carry out an excellent service, must be educated. They have a pivotal role in identifying in the first instance psychiatric disorder. They can contact a local psychiatric hospital or a community psychiatric nurse to enable at-risk patients to get help at an early stage. The development of child and adolescent psychiatry is imperative. A good service exists in the midlands, although it is not so good that it cannot be improved.
There is a large problem in the country with regard to suicide. The most important step in a journey of a million miles is the first step. An important step has been taken with the establishment of the National Office for Suicide Prevention, and I wish the office and those working in it well. I will do anything I can for it as a Member of this House and a concerned member of the community.
I welcome the Minister of State to the House and recognise his commitment to the mental health services in the country. I was pleased to hear Senator Glynn speak before me, as his comments as someone who has experience working in the psychiatric services are very useful. I welcome the establishment of the National Office for Suicide Prevention, but how much more do we need to find out before action is taken on the issue? What worries me about the report and the discussion on it today is that there has been little concentration on the resources that are required to implement the recommendations within the report.
We have seen report after report. Senator Browne mentioned the problem with alcohol and he is correct. There was an excellent report on deaths in Cavan, Monaghan and Louth in 2001 and 2002. There were other reports, such as the 2004 report from the National Suicide Research Foundation; the 1998 report from the national task force on suicide; the 2002 report from the strategic task force on alcohol, as Senator Browne pointed out; the 1991 report of the advisory group on prison deaths; and a 2001 report entitled Suicide in Ireland — A National Study. I could go on quoting even the home-grown reports. However, minimal action has been taken in areas outlined by Senator Glynn, for example.
Despite the publication of these reports, nothing has been done. Although we see the direction that should be taken no progress is made. I am pleased Senator Glynn highlighted the important issue of pre-existing mental illness in people who commit suicide or those who attempt suicide. We are on shaky ground by stating that much has been done over the past ten or 15 years to improve mental health treatment in the country.
The policy document Planning for the Future was published over 20 years ago. The report made the transition from large mental hospitals, which would hold about 30,000 people in custodial institutions, to care in the community. Senator Glynn is correct to say that care in the community is more expensive. This is the issue on which we are failing. Having brought people out into the community, we have not put in place teams which are now recognised as necessary to treat the people. Although the acute phase of an illness might be treated, a person might be left too much to his or her own devices with inadequate support and care.
The report being discussed today makes for very interesting reading but it is profoundly depressing. With regard to the section on unemployed people committing suicide, we know that a third of those who commit suicide are unemployed at the time. We also know that a problem of homelessness exists in this city and the country as a whole. Even if a person gets into a hostel, it can be difficult for people to happily integrate into them because a considerable number of homeless people have mental illness that could be out of control.
How are we dealing with the problem? A psychiatrist to treat homeless people in the north Dublin area was appointed approximately six months ago.
She said she required a backup team. Members have heard Senator Glynn discuss the importance of teamwork in psychiatry nowadays whereby one needs psychiatric social workers, psychiatric nurses and communities in which patients are accepted. Unfortunately, some communities completely reject people who have had any psychiatric illness. While the psychiatrist asked for backup staff, she did not get them and the post was subsumed. What message does that send out about our commitment to people who are among the most vulnerable to committing suicide in this city? It sends an appalling message.
Some 14 beds in the Mater Hospital were to be allocated to deal with such patients when they became acutely ill. What happened? The beds were not put in place, apparently because the space pressures on the Mater Hospital are too great. We have a terrible problem regarding acute beds for mentally ill patients. While we try to treat them in general hospitals rather than mental hospitals these days, we have had much trouble in setting up such wards in the general hospitals.
We also have a shortage of psychiatrists. I believe that approximately ten extra posts were created last year and the Minister has stated that a further 13 will be put in place next year, in the hope that my colleagues, the consultant psychiatrists, will become involved in the Mental Health Commission. It will be essential to start the mental health tribunals in operation. However, if those consultant psychiatrists who have been already put in place do not receive back-up support, we will have much trouble in persuading them that future promises will be any better than past events. I have received constant complaints from people installed in posts around the country that they have not received such support. For example, a psychiatrist was installed in Navan, where she eventually received an office. It was then discovered that the office did not have planning permission enabling her to consult with patients there, thus obliging her to see people in their homes. What productivity levels does that suggest? We must have some adequate planning and team structures. This is the most important way to go forward.
On page 34 of the report, it is pointed out that in a recent review paper, it was reported that 97.3% of those who died by suicide had diagnosable mental illness. This refers to Arsenault and Lapierre's study of 2004. The authors note that caution should be exercised in interpreting such results, as many of the studies included in the review did not use a control sample. They examined more than 3,000 cases and reported on them. However in the report, Suicide in Ireland: A National Study, 47% of those who committed suicide could have been identified by a GP as having mental health problems. Senator Glynn has pointed out the importance of major depression in these circumstances. Senator Browne noted the effects of substance abuse. Personality disorders and psychotic disorders such as schizophrenia are also significant. These are all recognisable conditions with which we should make an attempt to deal.
We also have a serious problem regarding the lack of child and adolescent psychiatrists and facilities in which to treat such people. I believe there are six beds in Dublin and 14 in the west. While others have been promised, I do not know when they will come into effect. Frequently with mental illness, it is important to begin treatment as soon as possible. The situation regarding prisons is also appalling and it is reckoned that 30% of inmates have a psychiatric problem. While there has been an improvement in the number of psychiatrists working within the prison system, it is in no way adequate. We have an enormous responsibility to care for those whom we involuntarily detain within our prisons in the best possible manner. If such people commit suicide, Members, as legislators, will be held partially responsible for the inadequacy of care.
The situation regarding accident and emergency departments is also extremely important. Such departments are where one encounters parasuicides and such people should be referred immediately to psychiatric help. Can the Minister state that this happens? I do not believe so. Many such patients are referred from accident and emergency departments without adequate referral to psychiatric help. Sometimes, I have received complaints from general practitioners that they did not even know that their patients had in fact attended an accident and emergency department in such serious circumstances.
To a great extent, we are obliged to rely on drug treatment for psychiatric illness. This is an international problem, rather than simply being an Irish problem. I visited the United States last week and listened to Dr. Tim Murphy, who is a Republican Party member of Congress and a psychologist, speak about the fact that 75% of anti-depressants in the United States are prescribed by non-psychiatrists. While I do not claim that one must be a psychiatrist to prescribe such drugs, they are extremely potent. It is important to remember — it is far more common in the United States than here — that the psychotropic drugs prescribed for children are never tested on them and a considerable number of such drugs are not recommended by their manufacturers for children.
How are general practitioners supposed to deal with such children if they cannot get help for them from specialists in child and adolescent psychiatry or if they cannot procure verbal therapy, such as the services of psychologists or psychotherapists for them either? These two professions are also in short supply. This has led to concerns on the part of members of the public whose closest relatives have been prescribed drugs, particularly selective serotonin reuptake inhibitors, that these were the cause of the patient committing suicide.
When Dr. Murphy spoke in Congress, he made a good point, namely, that when people were put on such treatment, their initial improvement might have led us to believe they were doing better than was the case. Subsequently, those who were not experts in the area let their guards down, so that sufficient supports of other kinds were not given to such patients. Hence, they committed suicide due to lack of support rather than due to the effects of the drug itself. There have been many claims made in the United States and the United Kingdom about these drugs but no proof has been forthcoming that they were the cause of suicide. We must be cautious about damning drugs which have been useful in some cases. Nevertheless, I have practised medicine for long enough to have seen many drugs prescribed, particularly in psychiatry, which were considered to be entirely unsuitable ten years later. This is an area on which I hope the Irish Medicines Board is keeping a close eye.
As I have stated, the lack of specific resources is what really troubles me about this issue. Sometimes, my breath is taken away by the manner in which legislation is introduced in these Houses with a lack of concern for the resources. When the Mental Health Act passed through this House, I raised the issue of resources and they were considered to be important by the Minister at the time. However, considering the current dispute with the consultant psychiatrists, in some cases they have a choice of leaving their patients to attend the tribunals in situations where no locum is available to deal with the patients in their absence. If they do not attend the tribunal and adhere to the law, they may be very heavily fined or imprisoned. They will be in a difficult situation unless more resources are invested in the area to ensure that neither the patients they have nor the patients who should be before the tribunals are neglected.
It is wrong that such a high proportion of patients are held involuntarily in this country, a higher proportion than most countries in Europe, and that we have not managed to establish the tribunals. I do not know whether it was helpful for the Tánaiste and Minister for Health and Children to start telling the consultants they will not get their 1.6% benchmarking increase unless they co-operate; half of that 1.6% will vanish in tax. It was not a tactful comment by the Tánaiste.
I thank the Minister of State for correcting me. I will speak about another Minister, one who is closer to home for the Minister of State. When the Criminal Law (Insanity) Bill 2002 was before this House, the explanatory memorandum indicated that it had no financial implications. Have we ever heard of any legislation that did not have financial implications? Of course it will have financial implications as the same type of tribunals were to be established.
That legislation left this House in a worse state than when it came in. I will address one of its worst aspects. When it came before the House, it was agreed that a patient, who was a prisoner and had no choice but to be a patient in those circumstances, would get care and treatment. I tabled an amendment to the effect that the entire Bill would hold that a prisoner who became a patient would get care and treatment because it read "care or treatment" in places. What happened? All of the changes were made in the opposite direction so that the prisoner who was a patient would get care or treatment. This is outrageous. All of these reports are splendid but, when we examine mental health in this manner, they are only paying lip-service to a very depressing situation.
I welcome the Minister of State. The last time I spoke about suicide in the House was May of this year and one of my primary concerns at that time was that statements would be reduced to a web of words and spun around numbers, namely, statistics, numbers of deaths and levels of investment. I tried to concentrate on the heart of the issue and completed my contribution without referring to a single statistic. It is with great relief, for want of a better word, that we are concentrating on an actual strategy this time. The bleak picture painted by statements dominated by numbers of deaths provided no optimism for bereaved families, society or policy makers.
No one could be criticised for saying no optimism is possible on the topic of suicide but I cannot accept that. I thank the Health Boards Executive, its director, Mr. Denis Doherty, the lead chief executive officer, Mr. Paul Robinson, the National Suicide Review Group under the chairmanship of Mr. Geoff Day, the steering and reference groups, the Department of Health and Children and the many others who contributed to this strategy. In doing so, they have shone a light on a truly bleak and dark issue. I specifically thank and congratulate the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, not just for his contribution today but for his ongoing dedication to tackling some of society's most difficult problems in his challenging portfolio and doing so with a quiet and effective determination that deserves great credit.
I was struck by the vision statement of the Reach Out strategy: "A society where life is valued across all age groups, where the young learn from and are strengthened by the experiences of others and where the needs of those who are going through a hard time are met in a caring way." When we see these words before us, it is quite stark as many assume this is the way society is. We take it for granted. However, the Reach Out strategy does us a great service by reminding us this is not the case. It reminds us to think about people, especially younger people who are experiencing a hard time.
This is something else we take for granted, namely, young people are universally exuberant, resilient, lively and up for a laugh or when they go through a down patch, it is just a mood, a phase, some trivial issue magnified by the naiveté of youth, that it will pass and there is no need for concern. The Reach Out strategy again does us a great service by reminding us this is not the case. For example, included in the strategy's list of some of the signs that someone may be in trouble is a sudden change in mood. When those involved are younger people, we should not glibly pass it over and put it down to typical teenage behaviour and mood swings.
The second important feature of the strategy is its quick movement from the valuable vision statement to the principle that the strategy is action focused, which brings me back to the dominating feeling of pessimism that shrouds this issue. The pessimism is based on the frequently arising question, "suicide is so awful, so incomprehensible, what can we do, what could we have done?". The need for action to help provide answers applies on two levels. At the higher strategic level, the fact that the strategy is practical, achievable, based on evidence and international best practice and will be the subject of ongoing regular evaluation to determine whether the expected outcomes have been achieved is crucial.
The next level involves the action for families and communities. The strategy correctly places this action in the context of the changing nature of the family unit, the move away from traditional extended family structures towards tighter nuclear and single parent families, increased pressure on parents and the consequent strains on relationships. This change in family structures is related to and compounded by changing work practices and living arrangements and locations. The Reach Out strategy wisely situates plans for actions in the context of these challenges to family cohesion. We yet again see a policy area become more and more complex as our society changes in terms of our interactions, communities, work and life balances. While these factors usually inform the House on discussions, such as on transport infrastructure, we are speaking about implications of life and death in this case. It is a serious matter but the strategy is so well put together that it comprehends these complex challenges and, to its immense credit, seeks to address them practically rather than leaving them floating and sustaining the aforementioned sense of helplessness and pessimism.
In recognition of our changing communities, the strategy suggests some practical measures, such as the delivery of community education on suicide prevention and mental health promotion, including public lecture series and awareness talks. These should include invited participation from specific occupations that are often well placed as gatekeepers within the community, such as taxi drivers, post office workers, shopkeepers and pharmacists. This considered and excellent strategy document contains many other examples of practical actions correctly placed in the context of all of the challenges to family cohesion and is to be commended on doing so.
It would be impossible in these few minutes to expand upon all the exceptional work contained in the strategy's 84 pages. When I last spoke on this subject, I concluded with the following words, "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". In essence, I was calling for people to reach out. The title of this strategy is apt and right. This is a two-way street. We must reach out to people at risk, younger people especially and younger men in particular. They must feel that when they reach out, a hand is there for them.
The importance of this two-way process is emphasised in the report, where it states:
It is important to stress that the general population approach to suicide prevention and targeting those who are known to be at increased risk should be complementary approaches. By effectively developing an anti-stigma campaign and by promoting awareness of positive mental health, the likelihood of vulnerable individuals with signs of mental health problems seeking help through the health services will increase.
We must do all we can, and I do not mean as policy makers but as members of society, members of our particular communities, consumers of media who can shape content, friends, relatives and even as strangers.
I cannot overstate the value of this strategy. I congratulate and thank all who worked on it. I sincerely hope it will lead us on the path to tackling this dreadful stigma in as much as it is possible to do so. This is both an imperative and a duty for all true members of society. I congratulate the Minister and the group who put the strategy together. Those of us who study the strategy and accept its recommendations must contribute in every way we can to its implementation within our communities and in society as a whole. On this day people can proudly state they made a valuable contribution to the strategy, as we continue in our fight to rid the country of this horrific stigma.
I stated previously when discussing suicide and other similar tragedies that I am reluctant to get involved in Government bashing. That reluctance is not my normal style but apart from a couple of comments I will not do so. The strategy was slow to arrive and, as with many issues, the Government did not appear to wake up to the scale of the problem until quite late into its second term.
Psychiatric services have always been the poor relations in the health services and I happily accept that is true not only during the term of office of the present Government. I do not know if that will change under the new regime. There is no doubt that every time a shortage of funds or a serious constraint occurred, one of the areas where health service managers in both the HSE and its predecessors sought cutbacks quickly was in psychiatric services. I have reason to be aware of that from family connections. Delay upon delay occurred in services for people with psychiatric illnesses. I know this from listening to long late-night conversations between a consultant psychiatrist and various junior doctors about where a bed might be found for a seriously ill patient. I know only too well about the scarcity of beds.
The Minister of State is always welcome and I stated previously in his presence that if everybody who threatened self-harm or stated they were suicidal were to be hospitalised, not only would every acute bed in psychiatric services be occupied, but also every acute bed in every hospital. Professional judgments must be made and we must ensure that we have the professional skills available, everywhere and all of the time, to make good professional judgments in these cases. I take it from the strategy that we are endeavouring to do so. We must ensure that people who are seriously at risk are not turned away. At the same time we cannot have a policy of admitting everybody.
The late and much lamented Dr. Michael Kelleher stated on many occasions that we would be foolish to view suicide as a predominantly urban phenomenon. Dr. Kelleher's figures, which are a few years old, show that suicide was an acute rural problem, particularly suicide outside younger age groups. It was a product of isolation, old age and loneliness.
I cannot take issue with the national strategy, although perhaps €500,000 is little more than a token gesture for a strategy to deal with one of the most heartbreaking problems the country has. The Government might not be correct to leave out targets although it may be correct to delay setting targets because current figures are unreliable. However, it should only be delayed until reliable figures are established. The Government's strategy should then be to match the best that has been achieved internationally. I would have some sympathy with that, but not much.
I will assume the strategy is delivered for the purposes of this debate. I would find it distasteful to recite my usual scepticism about the Government in this area because I wish it well on this. I wish to believe it is a serious attempt that will be followed through and is not merely an exercise to grab headlines and prove the Government is taking action. I am increasingly sceptical about the school of politics that believes action must be taken. Action that makes a difference must be taken. Politicians must not merely be seen to take action.
I will accept the strategy will be followed through, properly funded and universally available. I hope that subsumed into it will be the beginnings of an awareness, not merely in our psychiatric and medical services but also in our society, of the actions we are taking with regard to young men in particular and young people generally. Only four or five years have passed since a member of the same class as my then 14 year old son committed suicide. As a parent I cannot imagine much worse that could happen to a family than for any member to commit suicide, particularly a child. Even though I talk about it, I never really want to think about it. Nobody would. It had a profound effect on every member of that class, which will work its way through each one. I knew most of them. They were sensible, good natured, fairly well focused and stable boys and girls from a variety of backgrounds, and it will reverberate through their lives. One only hopes some good will come of it.
In that context let us remember the pressures on young men. I do not excuse wrong behaviour, but any self-aware young man faces a range of expectations. He is probably expected to do extremely well academically, because everybody now expects to do well. Large numbers of parents cannot accept that not all their children are academically brilliant — they blame an illness or the school — and children are at the centre of enormous ambition and pressure. In my other work I have seen youngsters reluctant to tell their parents that they got only second class degrees. While they had achieved the level anticipated by their lecturers, their parents had never adjusted to this expectation.
Young people are fed an illusion that people have limitless income. They are launched into a world where to buy is to be. Every real person is aware that this is illusory, but young people are subject to a range of pressures. As many people working in sport will attest, there is an increasing expectation to be macho. It is disappointing that people working with young people in sport say it is more difficult than ever to persuade youngsters not to retaliate if they are fouled. One is tough only if one retaliates while not to retaliate is regarded, more than previously, as a sign of weakness. It is more difficult to explain the rationale for not retaliating. I invite anyone who shares this view to read Roy Keane's biography, in which he flagellates himself for his lack of maturity when he retaliated.
I hope Members do not snigger at my next point. Therapists tell me there is an increasing expectation on young men to perform as studs in a way that did not exist ten years ago. I am told that significant numbers of young men have stopped socialising because they cannot handle expectations about their capacity to perform sexually. Those factors, along with an increasingly sexualised culture, in which children are sexualised from the age of ten years, put at risk people who are already vulnerable as they go through changes that happen at different rates in each person.
I take issue from an intellectual, not a political, position with many of the values of the Government. I do not say that the Government created these values but it articulates them well. We have an individualistic culture based on the illusion of instant gratification, where any suggestion of delayed gratification — that sometimes one must do without or make sacrifices — has no merit. I know what competition does in terms of economic performance, but inside every increasingly competitive market are human beings who have limited ability to cope with the increasing pressures of work and performance. People who work in financial services say it is standard practice to increase targets each year. If one fails to achieve a target one is in trouble. If one does achieve it, the target is ratcheted up the following year. That sort of expectation has an unimaginable impact on young people. The response is the work hard, play hard culture, and playing hard usually means alcohol. The Minister of State knows better than I, not because of his drinking habits but because of his profession, that alcohol is a depressant. If people are suffering from the pressures of life and feeling overwhelmed by them, the worst thing they can do is try to drown their sorrows. In the long term it will exacerbate their depression. Our society promotes a way of life that makes bad situations worse.
I have frequently spoken in this House of the illusion that Governments, not just the present one, try to reward effort. In fact, we do not reward effort but success, and we brand people who are not successful as "losers". This is one of the most offensive terms but it is common parlance now. In conclusion, somebody on the political left must deal with these issues because most of society runs away from them. One of our problems is that society has changed profoundly and every signpost of good ethical behaviour is gone. All the institutions that offered ethical guidance are either impoverished or undermined by their own misbehaviour, and the Minister knows what I am talking about. Our young people are floundering without a moral compass. They have the illusion of escape given by such people as Kurt Cobain. We must re-establish an ethical consensus. Scandinavian countries, where there is no strong religious tradition, have a social ethic. If we are about to move away from a religious ethic as the compass by which we live our lives, we need to replace that with a social ethic based on a set of values, one of which is that human life is precious and that suicide is never an acceptable response to a human crisis.
I welcome the Minister of State. I congratulate the HSE, the health boards before them and the Department of Health and its staff on the national strategy document. It is a comprehensive and targeted document that includes 26 areas of action. It shows us the way forward. From 2005 to 2014 may seem like a long time but that indicates the complexity of this issue, and it is probably one of the most complex and perplexing issues to face the country. The statistics on suicide in Ireland are frightening. When one considers that this the most common cause of death among our young people today, we all have a role and an obligation to try to reduce the incidence of suicide and to find alternatives for people who are vulnerable, specifically young people. In a recent report, the OECD pointed out that out of a group of 30 countries Ireland has the second highest rate of suicide among people under 25 years of age.
The stigma attached to suicide, depression and mental illness in general is still a huge issue for people in this country. The stigma it brings to a family is probably the most difficult type to deal with and its consequences are deep and long lasting. It has been pointed out that due to the changing nature of our family structures, it is becoming more difficult for people to cope with daily life. In the national study conducted in 2001, which was mentioned by other speakers, it was found that two thirds of those who died by suicide lived at home with other family members. The family unit is a crucial target when building awareness, as is pointed out by the strategy. It is also crucial in building supports for people who might be vulnerable.
I have teenage children and I see how difficult life is for them compared to my teenage years. There are many more pressures, be it peer pressure, media pressure and so forth. Time has brought social changes. Marriage break up and divorce put huge pressure on people. Everybody copes with situations such as bereavement, family separation and so forth in different ways but young people need support and reassurance. How they grow up, get through school and deal with their family, friends and the wider community will play a part in how the person deals with any stress and particularly with severe stress.
The strategy points out that statutory agencies have a crucial role to play. There is particular emphasis on schools. The strategy recognises the role of schools in building up a positive attitude to mental well being and in building up resilience among young people. From primary school to third level, major advances have been made through the inclusion of mental health issues in the curriculum and in the provision of staff and resources. SPHE is a welcome initiative which has proven very successful. It is now compulsory in secondary schools. It plays a vital role in making young people aware and in strengthening the links between education and health.
In my constituency I work with various groups and schools and I see how these programmes work. Under the home school liaison programme staff visit young people in their homes. They see their living conditions, the parental arrangements and the community in which they live. These initiatives can play a huge role in dealing with suicide prevention. One of the Senators mentioned early intervention programmes. The younger the age at which these take place, the better. When one talks to children about these matters it is difficult for them to understand at first but as they grow older and take part in programmes such as SPHE, they quickly get a good grasp of the subject.
Other groups have a vital role in dealing with this issue, particularly youth groups, clubs and organisations. The strategy refers to this. The National Youth Council, the National Youth Federation, Foróige, Gaisce, the Catholic Youth Council, Macra na Feirme, the Union of Students in Ireland, Comhairle le Leasóige and many more groups were consulted and asked for their inputs when the strategy was being compiled. These groups have vast experience dealing with young people and the population in general.
The strategy also points to the importance of sports and organised activities in suicide prevention. Sport provides positive role models. The Department, in fact, has been concentrating on selecting good role models for young people. All studies show that suicide victims are more likely not to be members of organised clubs or organisations. This is an area where we can act. I have seen the benefits of investing through the young persons' services and facilities fund in different areas, particularly areas of disadvantage. Suicide as an issue does not recognise class barriers but in some areas of disadvantage life is more difficult for children. The more we invest in these areas, the better. Greater investment in sports facilities, play areas, buildings and rooms for organisations and sports clubs will bring us greater benefit in the future.
The strategy examined the detailed causes of suicide. Alcohol and drug abuse are major factors. We have made progress in highlighting this link but we must do more to underline for young people the connection between these factors and suicide. One study showed that in 90% of suicides either a mental illness, such as depression or schizophrenia, or an intoxicant problem was present. That is a startling statistic. We must use imaginative ways of attracting young people's attention to explain this to them.
We must change the way suicide is reported. It is accepted that the incidence of suicide is under-reported. Coroners' hands are tied in cases involving car crashes or poisoning where, due to a lack of evidence, they cannot be reported as suicides. That is another matter that must be examined.
Everybody has a role to play in dealing with this issue. The strategy shows the way forward. It provides for ongoing monitoring and research and I believe it will prove to be of benefit in the future. The strategy relates to the period 2005 to 2014, which might appear to be a long time but this is a very complex issue.
The last time the Seanad discussed suicide was in May this year but it is fitting that we again debate it in the context of Reach Out — A National Strategy for Action on Suicide Prevention 2005-2014. That we are debating the issue is important. For too long, people, including politicians, were wary and shied away from discussing suicide. It is refreshing that there is now more openness and that people are prepared to talk about the subject rather than brush it under the carpet, which was previously the case.
We must examine and debate how the cultural and economic changes that have taken place in Ireland over the past decade have detached people from traditional values and support. That might also have a formal link with mental health and suicidal behaviour. Influencing the way individuals react to changes in their social life will be central to the prevention of suicide. Young people tend to be hard on themselves. Success is increasingly an important goal in society. Individual success appears to be even more important. This places great pressures on young people. Their perception is that anything can be achieved if one works hard and is smart but if one fails, it must be down to oneself. Society seems to no longer help those who fail or those who perceive themselves as failures.
The uncertainties of life are increasing, as we are all aware. Life seems dictated by what we can own, what we can buy and what brand 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 our own political establishments, have been debased in the eyes of the young.
One may ask are adolescents more vulnerable to perceived failure today or is it that they are less likely to ask for help. The pressure to succeed academically at all costs is another area which needs to be examined. Suicide prevention is not just another health issue; it is also an educational issue. That has been pointed out in the report which emphasises that there is a greater need for more education in letting people know how they can solve their problems, how they can talk about issues and that help is available. Research, understanding and analysis of the pressures on young people are vital if we are to address this epidemic of suicide. We must regard suicide prevention as a multidimensional area that requires promotion and investment. This also comes out strongly in the report.
International research has proven that there is a link between alcohol consumption and suicidal behaviour. Alcohol consumption leads to depression which is a major factor in suicide and suicidal behaviour. Likewise, depressed people frequently turn to alcohol in the mistaken belief that it will improve their mood. We all know that alcohol impairs judgment, reduces inhibition, increases risk taking behaviour and may result in impulsive suicide and suicidal behaviour, most frequently in the young.
There has been report after report. What we need now is action and the provision of resources to implement the various recommendations, not only in this latest report but in other reports, especially the report of the National Suicide Review Group which was set up in 1998. Fewer than ten of the 86 recommendations of the national task force on suicide have been implemented. Reports are welcome but are useless unless we are prepared to provide the resources to implement their recommendations. I urge the Minister of State to secure the necessary funding.
I acknowledge the Minister of State's commitment to mental health but the reduction in the level of investment in the psychiatric services is unforgivable. In 1997 such spending formed 13% of the total health budget whereas it now forms 7%. There is a need to act on that. I strongly urge the Minister of State to secure the necessary funding and ensure that the recommendations of this fine report are implemented.
I am grateful to my colleague, Senator Cummins, for making some time available for me to make a couple of clear and specific points and recommendations. I hope the Minister of State, Deputy Tim O'Malley, will bear them in mind and take them to his colleagues.
This is a serious issue. Senators will be aware that committees of both Houses have looked at it in some detail and obtained expert evidence. According to the figures available to me, in 1993 some 360 people committed suicide. The suicide figure peaked in 1998 at 504 and it is now increasing again towards the 500 mark, which is very regrettable.
There are vulnerable groups, a number of which have been mentioned here. There is also the issue which arose on the Order of Business today. Among those vulnerable groups are the victims of sexual abuse, both by the clergy and the laity. Among the recommendations from everywhere, both in this country and abroad, is education, and particularly education on matters of sexual identity, etc. Unfortunately, conservative church groups opposed the Stay Safe programme, for example. The Government needs to take its courage in its hands, go into areas and not be put off by opposition from these kinds of groups. Those bodies, which are in difficulties now because of an abrogation of their responsibility to the vulnerable young people, were exempted by what I described this morning as a craven Parliament from the operation of the equality laws. I hope we have learned our lessons.
I want to look at a couple of because we know that there are marginalised groups that are more likely to encounter this difficulty, the first of which is asylum seekers and refugees. We must monitor that group much more carefully. There was a report in Metro Éireann, the newspaper of the asylum seekers and refugees in Ireland, of a Nigerian man who came here. He was here for three or four years with his partner by whom he had a son. He was an inoffensive man. He wanted to get refugee status and it was denied. Then he looked for it on compassionate grounds. The authorities were proposing to deport him to Nigeria, a country which we know from the newspapers is not safe for anybody. There was a report in The Irish Times last week of a Nigerian police officer who ran amuck and shot six people in the back of a car, and then planted evidence on them suggesting that they were robbers. Life is cheap in such countries. The man to whom I referred was served with a deportation order, went missing, committed suicide and was found on 11 September on the beach at Skerries. We know that is a vulnerable group.
The other group to which I wish to refer is that of young gay people. There is clear indication that young males are about four times more likely to commit suicide than young females. Within that group, young gay people are at least three times more likely to commit suicide. Internationally, sometimes this rate is much higher.
The national strategy for action on suicide prevention mentions this and refers to the various marginalised groups, particularly gay people, the bullying in school, etc. However, the report's recommendations are very weak. It is ridiculous. They include a recommendation to determine the risk of engaging in suicidal behaviour associated with belonging to this group. We know this already and if we do not, why do we not? The survey done in the North on the vulnerability of this group could not be more clear about what needs to be done, that is, education about sexual identity in the schools, but nobody is prepared to do it. Nobody is prepared to require that it be done in case it might conflict with the ethos of a group that has presided over the serial molestation of children. That is a real dereliction of responsibility on the part of Government. One cannot fault the church altogether for sticking up for what it sees as its territory — it is a natural institutional response — but the Government should now have the courage to take on this matter. The report makes vague recommendations about developing educational resources, etc. I agree, but let us be clear and specific. Let us have an education programme.
I would recommend the Belong To group and its report to the Minister of State. That group points out that being bullied and victimised, particularly in school and in their local communities, is the primary issue for young gay people. There is a lack of support and lack of inclusion of issues affecting lesbians, gay men, bisexuals and transgender people in school. We know, from the North, that young gay people are five times more likely to be medicated for depression, two and a half times more likely to commit self-harm and at least three times more likely to commit suicide. We also know that there is a complete absence of real educational support for these young people in school. The report also makes clear that approximately 90% of young people in school know their sexual identity by the age of 14, but they get no support.
I wish to relate to the House some of the sad human messages that come from the background of the Northern Ireland report. One young person said that when in his last year at school he contemplated telling people he was gay, but some of them made derogatory remarks about queers and so he kept quiet. Another stated that a neighbour told his parents and they threw him out saying he was disgusting. He then stayed with some friends but could not get his own place because he was in school. A third said that when the church groups he helped for his Duke of Edinburgh award discovered his sexuality, they asked him to leave as they did not feel it appropriate. A fourth said he approached a youth leader for support. However, he was told to go home and not talk about being gay.
I remind the Minister of State that we know these groups. I speak with particular passion because I have known young people who have committed suicide at an early age. We know that the most vulnerable are young, gay people. The suicide ratio is 4:1 male to female and 3:1 inside that group are young, gay people. Often, this does not come out because the family is ashamed and does not want it to be known that the son was gay. I understand that. There is a problem. We know what it is and how to address it. It is up to the Government to have the courage to do that.
Cuirim fáilte roimh an Aire Stáit. I welcome the Minister of State to the House. I compliment him on the work done in the area of mental health. In many ways the Minister of State is the human face of corporate government. It is relevant to touch on that aspect of his portfolio today.
Over the years the issue of suicide has been raised several times on the Order of Business in this House. This generally reflected some experience some Member had in his or her community in the preceding days. Most of us have experienced suicide in our communities. We often ask whether people close to the person who died by suicide observed anything in the person's behaviour relevant to the suicide. In most cases we are told there was nothing, that the person, usually young males but sometimes females, was quite normal. We often ask ourselves whether something could have been done to help the young person. There is severe trauma for a family in that position whose members continually ask the same question over and over again.
Many speakers have dealt with fundamental issues such as the changes that have taken place in society and family structures, the difficulties facing young people, drugs and alcohol, etc. We welcome the national strategy, but as I am sure most people agree, it remains to be tested. While it is important we have a strategy, we must build a bridge between it and the changes taking place in society. We cannot deal with the issue in isolation or without looking at how community and society have changed.
Recently, Professor Puttnam, an adviser to former President Clinton, came here from Boston's Harvard University. He spoke about how communities had disintegrated in America and pointed out that the same thing was happening in Ireland and in most developed countries. We did not really need him to tell us this because there is nobody in this Chamber who has not thought the same at some stage, but we have felt particularly helpless about doing anything about it.
Two or three decades ago, at the start of what might be regarded as the "new liberated generation", people were particularly cautious about making any comment that might cast them as being out of touch or not politically correct. Having come through that so-called liberated period, many of that generation now comment on what they were deprived of in their lives. Most often they were deprived of an anchor at a time they needed it most. The title of this strategy, Reach Out, is significant in this regard. Often we acquiesce and do not examine what is happening in society, particularly with regard to the media, entertainment, education pressures and the various challenges facing people today. We should try to revisit what Tony Blair calls basics but what I would term fundamentals.
We can speak out now. I do not believe we will be castigated for asking ourselves to review the good progress we have made and, at the same time, what we have lost in the process. Senator Brady was right to say that we must provide particular amenities, sporting, artistic and cultural. In fairness, in our new found affluence most Governments have focused on doing something in this regard.
There is something else we must bear in mind and that is the terrible trauma that attaches to suicide. It was wrong to stigmatise suicide, because that added to a family's trauma. However, we must be careful that we do not glorify suicide. I know of situations where well-meaning people brought classmates together on the death of a young person through suicide and where almost a celebration took place. We must be particularly careful that we do not bring the wrong influence on young people in this regard. Young person dying by suicide are crying out for help, but they also seem to expect to be at their own funeral. They expect to experience the response to that cry. It is important, therefore, that we do not glorify suicide. We need to discuss this aspect of suicide openly through fundamental education so that young people are not drawn into the belief that by taking their life they will be celebrated later by their peer group. I was surprised when I heard of some of these gatherings, although I believe those who organised them were well-meaning.
The point I make now is not intended as a response to Senator Norris. In some way I am responding to a debate we had here this morning on the Order of Business. I will not go into the particular issues involved. We should not overlook that fact that over past decades the church — all churches — provided a positive service to young people. The more faith is diminished or diluted, the more we remove confidence and hope from young people at the time they need it most. I do not want to sound as if I am giving a sermon, but I believe this is relevant. Senators Ryan and Cummins touched on this same issue. If we do not give young people a basis for hope in this world and the next, we will take away a tool which can help them and which helped previous generations. I hope we do not castigate the agencies and groups which helped us in the past.
The strategy must interact with all the elements mentioned today and take cognisance of the broader issues. It highlights the fact that suicide is such a complex issue that one cannot focus exclusively on any one section or item. It is a starting point based on a positive rather than a pessimistic approach. It is for this reason that we must all welcome it but we must also understand it and try to play an active role.
I thank Senators for giving me the opportunity to discuss Reach Out — A National Strategy for Action on Suicide Prevention 2005-14. The Irish translation — tabhair dom do lámh — might better express the aim of the strategy. I appreciate the contributions of Members of this House to the debate on what is an extremely complex issue facing Ireland and other countries.
The importance of exploring the causes of and ways of dealing with suicide and suicidal behaviour cannot be over-emphasised. The overriding theme of our efforts to tackle the problem of suicide in Ireland is collaboration. If we tackle suicide as a one issue policy, we will fail. Our collective attempts to prevent suicide and reduce the suicide rate are at the heart of all our policies, whether they relate to economics, regeneration, social justice, inequality, education, health, local government, communities, children, better public services or improved mental health care. All of these issues have been alluded to by various Senators.
Suicide affects all age groups and communities. Few people are untouched by the devastating effects of suicidal behaviour in their lifetime. The emotional, social and practical repercussions of suicide are felt by family members, friends, neighbours, colleagues and those working in a wide range of services and agencies.
Many factors put a person at risk of suicide. They include changing societal trends, including an increase in marital breakdown and divorce; insecurity of employment; high prevalence of alcohol problems and substance abuse; social values; attitudes to mental illness and mental health; suicidal behaviour; domestic abuse; stigma; poverty and inequality; inadequate social support such as low levels of practical, emotional and other forms of assistance from family, friends and neighbours and experience of sexual and physical abuse or bullying.
I must comment on the Ferns inquiry report, which is devastating. We are all diminished by what happened in the diocese. Many priests around the country feel very inadequate because of what has happened there. A considerable amount of bullying must have been a component of the abuse that occurred and which led to suicides. We know from the report that some suicides occurred as a result of this sad episode. I commend Bishop Eamonn Walsh on his forthright behaviour and facing up to the problems in the diocese. The Government faces the considerable challenge of dealing with the issues involved.
Low self-esteem and lack of confidence are other factors often associated with suicide. The list of factors I have mentioned is not exhaustive. The relationship between these factors and suicidal behaviour is complex and none should be addressed in isolation. For example, long-term factors such as the impact of being unemployed for over a year should be differentiated from short-term triggers such as recent redundancy. We need, therefore, to consider ways in which policies and actions to prevent suicide can be made sensitive to the specific circumstances and needs of particular groups on the basis of age, gender, etc., and in particular settings such as schools, workplaces and urban and rural areas. In this regard, the work of the suicide resource officers who were appointed in each of the former health boards is crucial.
It might be useful if Senators contacted the suicide resource officers in their area who do excellent work and are involved in the community in respect of all the issues pertaining to mental health and suicide prevention. They work in schools and communicate with people. I have met several officers who are excellent individuals. I exhort Senators to utilise this resource. The Senators who stated nothing was being done to prevent suicide are diminishing the work of these officers who are doing excellent work and need their support. They also engage in the promotion of positive mental health and the destigmatisation of suicide and provide information on the issue of suicide and parasuicide.
Senators are aware that many suicide prevention initiatives are being undertaken, one of which is the appointment of liaison psychiatric nurses to accident and emergency departments of many general hospitals to deal with persons who present following an attempted suicide. The provision of this service ensures patients with psychological problems presenting at general hospitals are dealt with promptly and that they are referred to the mental health service for further support, if necessary. This benefits the patient but also ensures the more efficient use of medical and surgical services in accident and emergency departments. Other initiatives include the provision of training for health service staff and public information campaigns.
The Health Service Executive plays a major role in co-ordinating efforts to help reduce the level of suicide and parasuicide. The new National Office for Suicide Prevention, established after the launch of the strategy, is responsible for overseeing implementation of the strategy, a fundamental aim of which is to prevent suicidal behaviour, including deliberate self-harm, and increase awareness of the importance of good mental health among the general population. Ongoing, high 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 action and service development. The strategy identifies expected outcomes and sets 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. It is important to stress that it is action-based and builds on existing policy, as outlined in the national task force on suicide's report in 1998. The strategy is practical, achievable and based on evidence and international best practice.
I appeal once again to psychiatrists who recently declined to participate in mental health tribunals following year long negotiations with the Government to reconsider their decision. They were offered 13 additional consultant psychiatrist posts which would have cost the Health Service Executive approximately €10 million but they declined the offer. We are dealing with the most vulnerable in society — those involuntarily detained in mental institutions. As Minister of State with responsibility for mental health services, I am aware that the provision of resources is an issue but so are the human rights of the most vulnerable in our society. I appeal to psychiatrists to engage in these tribunals. If they decide not to do so, the Government will be forced to take alternative measures to get the tribunals up and running. It must deal with a situation outside its control.
Senator Henry mentioned the use of psychiatric drugs and argued that consultant psychiatrists and GPs were forced to use psychotropic drugs because of a lack of counsellors and psychotherapists. As a former pharmacist, I am aware of the very serious debate taking place about many of these drugs. Senator Henry has mentioned some of the new drugs which are available such as barbiturates, amphetamines, benzodiazepines and selective serotonin reuptake inhibitors. There is increasing evidence of the problems associated with such drugs. We were told when they appeared on the market that they were non-addictive and that they were the best thing since the sliced pan. After ten years of the use of the drugs in question, we know certain problems are associated with them.
I ask Senators to be objective when they listen to experts speaking about mental health matters. I have a major problem with the influence the pharmaceutical industry exerts on the medical profession, especially the psychiatric sector, and on the postgraduate education of doctors. I recently heard a psychiatrist from the United States speak during the Lilly bipolar lecture tour of this country's three principal cities. Given that the lecture tour was sponsored by a pharmaceutical company, how could the psychiatrist in question be objective? The psychiatrist said on national radio that if one was diagnosed with a mental illness, one would be on drug therapy for the rest of one's life. That is wrong. I ask Senators to challenge the so-called experts who make such comments. Some are experts, but others are not. Some are influenced by the pharmaceutical industry.
The Government which has already done a great deal in this regard will continue to do everything it can to ensure more counsellors and psychotherapists are employed. There is increasing evidence that we need oral forms of therapy in order that those who wish to speak to others can do so. Many Senators mentioned the changes in our society. One of the most significant social changes has been that people are spending more time watching television. They are less likely to interact with and speak to each other.
I thank Senators for inviting me to come to the House to listen to their views on this hugely important matter that affects every part of Ireland. The last time we discussed the issue of suicide Senator Maurice Hayes made the important point that North-South co-operation was needed in this regard. I will take steps to facilitate such co-operation. The expert group on mental health will refer to suicide when it reports to me in the near future. I look forward to the enactment of the strategy's recommendations. Senator Ryan said it was in gestation for a long time, but that was necessary because a large amount of work had to be done to ensure the right strategy was prepared. I am happy that we have published the right strategy. It is up to us to ensure it works.