Frances Fitzgerald (Fine Gael)
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I welcome the Minister of State, Deputy Devins, thank him for attending the House and wish him success in his important portfolio.

Some of the points raised by the Minister of State were disturbing. For example, he quoted from the recent mental health awareness and attitudes survey which showed that the public underestimates the prevalence of mental health problems in the population. This is a continuation of the denial on mental health issues we have seen due to ignorance, fear and lack of education on mental health issues. It shows the significant challenge that remains to normalise attitudes to mental health difficulties.

I recently spoke at a breast cancer seminar run by the Marie Keating Foundation. As I went in to talk I met a nurse who has been working with breast cancer patients in St. Vincent's Hospital for a long time. She remarked that it was wonderful to see the level of support now for breast cancer patients which was not available ten years ago. There was complete silence on breast cancer and it was almost stigmatised. Thankfully that is changing, although not for all physical illnesses. Cervical cancer still attracts quietness, denial and even stigma, and people are nervous about discussing it. However, we have made great advances.

In mental health a significant challenge on dealing with stigma and denial must be met. On the Order of Business I said Senator Harris noted that by discussing it in the House, we help change the tenor of the debate and ensure mental health issues, including those relating to suicide, are spoken about and normalised. It is clear from the research the Minister of State quoted that every family is affected by mental health issues, just as every family is affected by physical health issues. We must create a society in which people can easily get the help they need so that they can resume their normal lives quickly. Dealing with stigma in mental health is still a major issue and a real challenge. I welcome some of the innovative approaches being taken which the Minister of State mentioned. They are very important.

However if a child has a mental health difficulty which his or her parents want to have assessed, most local clinics will tell them there is a waiting list and that unless the child is suicidal or it is an emergency, he or she cannot be seen. Will the Minister of State take an interest in this to see what can be done to change it? It is all there in A Vision for Change, but most parents seeking help for children with mental health difficulties cannot access help quickly. Some clinics have closed their waiting lists, which are up to two years. Most clinics have waiting lists of several months. It is critical that there is prevention and that action is taken at an early stage when a child experiences problems, yet this is difficult. The same applies to adult mental health care. It is difficult to access help quickly, and in mental health, as in physical health, this is critical. Access to help and counselling remains an issue, especially for more vulnerable and disadvantaged groups. It is not easy to get the counselling help needed.

As the Minister of State said in his paper, thousands of people attend accident and emergency departments owing to self-harm. The National Office for Suicide Prevention says the figures we have are probably an underestimate. While I note the Minister's point on more nurses being available at accident and emergency departments, many who attend hospitals with self-harm do not get the help they need after the episode. That is another area in which we must invest more resources. Spending on mental health as a percentage of our gross domestic product is low by international standards. I welcome the work being done by the National Office for Suicide Prevention and the Irish Association of Suicidology, whose recent conference in Killarney was excellent. It was addressed by President McAleese. I will mention later some of the points that arose at the conference.

Everybody knows somebody who has dealt with a mental illness or a mental health issue and somebody who has recovered from such an illness and gone on to resume normal life, which is an important message to convey. Ireland's record of dealing with mental health and assisting those with mental illness is shameful and inexcusable but, thankfully, we are moving away from that. However, we must work in partnership to change cultural attitudes to mental health issues.

The National Office for Suicide Prevention has initiated some innovative measures. Its campaign, Your Mental Health, is worthy of mention. The Minister said the worldwide web can be an ally or a foe. It is most important that we use it as an ally in the area of mental health. The potential to reach the young people who are most at risk of suicide by using the Internet should be developed. The number of hits the Your Mental Health campaign has received on the Internet is a positive sign. That young people have been making positive comments on the Bebo site is tremendous because these are the people we must reach. Young people, particularly young men, are very vulnerable and if we can reach them through more modern methods, we should develop that.

Of course, more funding is needed in this area. I urge the Government to invest that money; it is money well spent. The priority areas that require funding include supporting mental health awareness campaigns to reach vulnerable young people. We have learned a great deal from research reports and should implement some of their findings. We should also support community and voluntary organisations. Pieta House in Lucan in my constituency provides people with tremendous counselling support. In addition, we must focus on accident and emergency departments. It is a cry for help when people come to those departments after harming themselves. This is where we should reach out to them and ensure they are given counselling and ongoing help. That is not happening.

Another obvious area, in which everybody has a responsibility to take action, is the disposal of unwanted medicines in family homes. Such medicines are a crucial risk factor for young people, as has been well documented. We must convey the important message that, where people suffer from conditions which sometimes carry frightening names such as bipolar disorder, schizophrenia or depression, these conditions are manageable, people can get on with their lives and there are effective and helpful treatments available. We must ensure the stigma that undoubtedly continues to be associated with mental health issues is removed.

The suicide statistics are shocking. It is now the greatest cause of death among men and women under the age of 35 years on the island of Ireland. While in recent years an average of 11,000 people have presented at hospitals following deliberate self-harm, the Irish Association of Suicidology believes this figure represents only the tip of the iceberg. It believes the real figure for deliberate self-harm could be up to 60,000. This is a huge number of people. It is suggested that more than 25% of adolescents have had suicidal thoughts at some point in their lives. There is obviously a difference between having suicidal thoughts and deliberate self-harm or being at risk of suicide, but it is a serious epidemic. For that reason it is important we are discussing it in the House today.

President McAleese gave a wonderful address about suicide in Killarney. She said each statistic represents an untold story of loss, depression, social dislocation, breakdown in relationships, substance abuse, distress or some combination of those experiences. Great credit is also due to the President for mentioning an issue that has not received a great deal of coverage in the context of its relationship with mental health issues or suicide, that is, the link between suicide, attempted suicide and sexual identity. This is most important. The Oireachtas committee which dealt with suicide prevention during the term of the last Dáil noted that young homosexual people were far more at risk of suicide than their heterosexual peers. This is an area to which we must be increasingly sensitive. There is still a great deal of homophobic bullying in schools and we must challenge that behaviour and declare it unacceptable.

David Norris (Independent)
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Hear, hear.

Frances Fitzgerald (Fine Gael)
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Teachers, parents and everybody who has a role in education must address this issue. It has not received the attention in the context of the suicide statistics that it deserves.

Alcohol and drug abuse are also important. The Minister should pay particular attention to the emerging research on cannabis and drug use in general and mental health issues. There is disturbing new information from new, well documented research on the sequelae of drug use where mental health is concerned. For vulnerable young people where there might be a predisposition to depression or mental health difficulties, drug use can precipitate serious mental health problems. We should ensure that more people are exposed to the research and understand what it means. The Minister should examine this and ensure the information is disseminated to a wider audience.

Fine Gael has made a number of proposals on this issue but I do not have sufficient time to discuss them. Suffice to point out that support services for young people are critical, while the waiting lists for child and adolescent psychiatry must be addressed. Last week I informed the House that 159 young people are still being admitted to adult mental health facilities and adult psychiatric wards. This is unacceptable; it is not the way our mental health services should respond to young people in need.

Clearly, cross-party support is required to ensure the best prevention methods are put in place. In that spirit, I ask the Minister to give due and careful consideration to the proposals Fine Gael has made in this area. I welcome this debate. There is a great deal of work to be done, culturally and socially, to create a climate in Ireland for discussing mental health issues and to give confidence to people who have had mental health difficulties to speak about them. There is a long way to go, although there have been major improvements in recent times.

Maria Corrigan (Fianna Fail)
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I thank the Minister for coming to the Seanad to facilitate the discussion on this crucial topic. As he said, suicide knows no boundaries or barriers and will affect, in some way, many in our community. Official figures indicate that between 400 and 500 people will die by suicide each year. This is on a parallel with the number of citizens dying as a result of road traffic accidents. Unofficially, many believe the actual incidence of death by suicide is higher.

Of particular concern in the Irish context is the fact that men under 35 years account for approximately 40% of all Irish suicides. Currently, the highest rate of suicide is found among young men in the age group 20-29 years. This contrasts with most other countries where suicide is more frequently observed in older men. Deliberate self-harm is also a significant problem, with more than 11,000 cases presenting to accident and emergency departments each year. As the Minister said, "Preventing suicide and reducing the rate of suicide is an issue that goes right to the heart of our efforts and policies to create a healthy, prosperous and socially inclusive Ireland."

International evidence shows that reducing the suicide rate requires a collective, concerted effort from all groups in society — health and other professionals, social services, communities, community leaders and voluntary and statutory agencies. Reach Out, the national strategy for action on suicide prevention, can provide the strategic framework required for that collective effort. The strategy builds on the work of the national task force on suicide and takes account of the important strategic and operational initiatives developed by the former health boards. A fundamental aim of the strategy is to prevent suicide and deliberate self-harm and reduce levels of suicidal ideation in the general population by addressing the contributory factors. It also aims to ensure those affected by a suicide or deliberate self-harm can receive the most caring and helpful response possible. It recognises the importance of valuing the mental health and well-being of the whole population, ensuring that mental illness is more widely understood and offering effective support to those who are experiencing difficulties. It aims to be evidence based, drawing, where possible, on published scientific research and the experience of those working in suicide prevention.

An excellent initiative to mark the launch of this strategy was the establishment of the National Office for Suicide Prevention. Interim targets for the office include a 10% reduction in suicide and a 5% reduction in repeated self-harm by 2010, with a further 5% reduction in self-harm by 2016. I ask the Minister of State to consider these targets with a view to achieving a larger reduction.

The questions, suggestions and comments I put to the Minister of State concern the four levels of action that were identified by the strategy as the means of achieving its overall aims. Those levels of action have been categorised by the national strategy as a general population approach; a targeted approach; responding to suicide; and information and research. In considering the general population and the targeted approaches, it goes without saying that improving access to quality mental health services is an essential part of any suicide prevention strategy. Considerable improvements have been made in these areas but more remains to be done. It is essential that implementation of A Vision of Change, the national mental health framework, is completed as quickly as possible.

The HSE's recent advertising campaign is to be commended for seeking to promote greater awareness of mental health and more openness in discussing difficulties and seeking help. However, as we cultivate an environment in which people can speak openly of mental health difficulties and decrease the stigma attached to experiencing those difficulties, it is essential that we ensure a

Our schools also have a crucial role to play in promoting from an early age the importance of maintaining good mental health. Modules such as social, personal and health education make a crucial contribution in this regard. Other fora which can contribute significantly to the normalisation of mental health discussions include colleges, businesses, employers and Government sponsored programmes such as Youthreach. An allocation of €1.85 million has been made this year to develop and implement national training programmes and complete the availability of self-harm services through accident and emergency departments. I would appreciate an update from the Minister of State regarding the progress of this training and the people accessing it.

The strategy recognises the necessity for addressing other contributory factors and specifically identifies drugs and alcohol. As previously noted, it is essential that strategies for the prevention and treatment of drug use and alcohol abuse complement each other. We can clearly see in our communities the links between the use of drugs and the abuse of alcohol, particularly among the younger population. Senator Fitzgerald referred to recent research which identified the additional dangers associated with the use of drugs. Similar research has been available for a number of years but perhaps it did not receive the recognition it deserved. It is of concern that several drugs which are considered soft or less dangerous in fact constitute significant risks and, in some situations, can act as environmental triggers for the onset of mental illness. It is important that awareness is raised on this issue in the context of possible campaigns for decriminalising softer drugs.

In seeking to ensure adequate and fast responses to suicide ideation and the development of fast track priority referral systems from primary care to community based mental health services, a number of pilot projects have been funded through the national strategy. One such pilot project is being implemented by Cluan Mhuire services in my own area. This project currently serves a specific catchment area but I ask the Minister of State to consider its expansion and similar projects from a catchment area to a regional basis. Restrictions to catchment areas may result in insufficient demand and, particularly within urban areas, can prevent the promotion of such services if knowledge of their existence is limited to local general practitioners. The Cluan Mhuire pilot project operates until 7 p.m. during working days and is not available during weekends or bank holidays.

Expanding such services regionally may provide the capacity to ensure their availability on a 24-hours a day, seven days a week basis, thereby reflecting a more realistic whole life experience of suicidal ideation. Furthermore, expansion to a regional basis would allow for the open promotion, advertisement and, most importantly, knowledge of such response services to extend beyond GP practices. This is particularly important in the context of research which indicates that a significant number of people who take their own life do not come into regular contact with the health service. A recent study found that the last visit of a patient to a GP prior to committing suicide was either in excess of one year or unknown. This illustrates the importance of ensuring that knowledge of services for people with suicidal ideation is available through a variety of channels.

I welcome the allocation of additional funding specifically for suicide prevention initiatives and the establishment of a suicide review group. I ask the Minister of State to commission research into the reasons for the variance between Irish and international figures regarding men who take their own lives. Internationally, the prevalence is higher among older men but within Ireland the reverse applies. I suggest that monitoring continue of what appears to be an emerging trend of young Irish women taking their own lives. Research should also be conducted into deaths by suicide in the past 24 months in order to establish the extent of contact with the pilot projects in place.

While I welcome the recent innovations on utilising new technology such as text services, I am concerned about the accessibility of sites which provide people with information on taking their lives. I welcome the proposed establishment of an office for Internet safety. I ask the Minister of State to consult his colleagues with a view to determining what international collaboration can be undertaken in regard to Internet safety. It appears that many of these websites operate from other countries and are not Irish.

Deaths by suicide result in considerable distress, grief and loss and the number of such deaths may exceed that pertaining to road traffic accidents. In tackling the carnage on our roads we have harnessed a national determination to reduce such deaths. I ask the Minister of State to note the determination of this Chamber to play its role in reducing the number of deaths through suicide. I urge him to continue with the implementation of the national strategy, take on board the constructive comments in this Chamber and seek to harness a national determination to reduce such tragic instances.

David Norris (Independent)
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I seek to share time with Senator Pearse Doherty.

I welcome the Minister of State and the initiative of taking these statements but I hope the matter goes further because this is a serious problem. I also welcome the fact that we have progressed from a time when we thought there was no suicide in Ireland. The subject was covered up and we used to cock a snook, so to speak, at Sweden and criticise liberal, Protestant northern European countries where people supposedly commit suicide like lemmings. Now we know some of what is happening with regard to suicide in Ireland and this is a hopeful development because facing reality is the first step.

The situation regarding suicide is nightmarish for individuals who feel they must end their lives. This is especially clear on wonderful days such as this when everything looks so beautiful in places like Merrion Square. The idea that a person can be driven to such despair that he or she would seek to end his or her experience of this world is terrible. The impact on families is crushing and they often blame themselves. Further services should be provided in this respect. Copycat suicides are frightful and seem contagious. I know of a family of which three members committed suicide.

The elephant in the room regarding a debate on suicide in Ireland was mentioned by Senator Fitzgerald. I am glad she did so, but I wish there were more references. One of the most significant elements in suicide is the issue of sexual orientation and sexual identity. I honour President McAleese for her recent passionate speech in County Kerry in which she referred to this matter. She stated:

[Homosexuality for young gay men] is a discovery, not a decision and for many it is a discovery which is made against a backdrop where ... they have long encountered anti-gay attitudes which will do little to help them deal openly and healthily with their own sexuality.

As the multiplier effect relating to suicide is significant for young gay people and is an established fact, I will outline supporting research, of which I hope the Minister of State is aware.

The Minister of State said 'Reach Out — National Strategy for Action on Suicide Prevention 2005-2014 states: "Information on suicidal behaviour is vital in order to guide the planning of effective services and supports".' That is correct, but does the Minister of State possess such information? Does he have such information with regard to young gay people, who are more vulnerable to suicide by a multiplier of six? If so, what is he doing about the situation? Why was it that it was left to Belong To, the gay youth group, to contact the Minister of State's organisation to be included in the survey? That is what I mean when I refer to the elephant in the room.

This issue is not about some old weirdo from North Great George's Street with a background in Trinity College. I was contacted by the wonderful Doherty family in Donegal who asked me to raise this matter. They had a marvellous young son, Alan Doherty, who was 32 years old and had been bullied in school because he was gay. He wanted to become a priest but was told that he could not do so by the church and was later shunned by some members of it. He moved to England, had a relationship that dissolved, found balance and returned to Ireland. Within a short time of coming back and successfully running an art gallery, he was taunted by schoolchildren and others on the streets of his home town. He killed himself shortly thereafter. His family wrote to me and asked me to raise the issue and I was the only Member of either House who replied to them, which is shameful.

We must acknowledge this problem, examine it and look at the relevant research and statistics because it is very worrying. Belong To is a remarkable group that produced some information for me on young people who access its services. Such young people are concerned at being bullied and victimised in their schools and communities. They perceive a lack of peer support and fear communicating the problem to family members so that, unlike other minority youths, they may not receive support from such a source. Regarding education, they see a lack of inclusion of lesbian, gay, bisexual and transgender sexuality in existing school programmes. They feel poor self-image can be a consequence of negative societal attitudes to their sexual identities and may internalise homophobia owing to their experiences of it. They will see homophobia in school and the church.

I wrote in the Irish newspapers about the homophobic diatribes of the then Cardinal Ratzinger that created an intimidating storm. I was approached in this regard, in a work context, by a decent young man who I did not even know was gay. He told me not to let anyone stop me speaking out because when he was 19 years old such stuff was read from the pulpit of his church and caused him to try to kill himself. He said he would be dead but that his mother found him in time. He asked me not to stop speaking out because nobody else would.

There is a great deal of homophobic bullying in schools and teachers are aware of it but do not respond. In this regard, is it appropriate that the State funds schools controlled by a church that has shown itself unworthy of working in the area owing to its handling of serious child abuse while simultaneously engaging in homophobic attacks from the pulpit? The church was given an exemption from equality legislation by a mealy-mouthed Government. In light of the Ferns Report, it is important that we examine whether that exemption should continue.

The school of education studies at Dublin City University, DCU, conducted a study that found that 94% of social, personal and health education, SPHE, teachers in single sex schools and 82% in co-educational schools were aware of verbal homophobic bullying in their schools. The study also found that 25% of these teachers in single sex schools and 17% in co-educational schools were aware of instances of physical homophobic bullying. In the study, 90% of teachers indicated that there was no mention of gay and lesbian related bullying in their schools' bullying policies. This is a catastrophic failure because we know there is such bullying, we know the terms of abuse, we know it can be both verbal and physical and we know that the teachers know this and do nothing about it. It is the responsibility of the Minister of State's Department to address this situation as a matter of urgency if we are serious about suicide, especially when one considers the multiplier effect.

My old university, Trinity College Dublin, conducted a study that found that 50% of lesbian, gay, bisexual and transgender youth had been bullied at school in the past three months, which compares with 16% of the general youth population. Of this group, 76% had experienced verbal abuse, 39% had experienced physical abuse and one in ten had left education earlier than they would have wished. This is an appalling situation and we know that, regarding suicide, there is at least a sixfold multiplier effect for young gay people.

These figures are reflected outside the State. An American study and a Northern Ireland study also lie behind what I have quoted. The Government must research this area because we have done no research so far. Helen McNamee's study of 2006 from Northern Ireland found that more than one quarter of young gay respondents had attempted suicide, of whom 70.8% had attempted suicide more than once. Almost three quarters of respondents had thought about taking their own lives, 80.5% of whom said it was related to same sex attraction. Almost one third had self-harmed, 64.4% of whom said it was related to same sex attraction and over one third had been diagnosed with a mental health problem, the most frequent diagnosis being depression.

I appeal to the House, in light of this catastrophic situation, not to just sit or make speeches. We know there are young, vulnerable people being bullied in our schools and people being driven to the point of suicide. We can do something about the situation, but we must stop being mealy-mouthed. We must stand up to the bullies, not only those in the schoolyard, but also those in the churches.

Pearse Doherty (Sinn Fein)
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I thank Senator Norris for sharing his time. He outlined the state of emergency with regard to suicide. He referred to a young lad from Donegal, Alan Doherty. Unfortunately, there are too many Alan Dohertys throughout the 32 counties who are not with us today because, for one reason or another, they have taken their own lives. One of my concerns is that the Government is not doing enough to put in place supports to fund suicide prevention initiatives throughout the State. Alan Doherty is an example. After his death a fund was set up to help communities address some of the issues relating to suicide prevention. Does the Minister really believe we are taking the issue seriously, when we only have an investment of €8 million per year for suicide prevention? We need to go much further.

I welcome the Government suicide prevention strategy in as far as it goes. However, very little has changed since the mental health commission annual report for 2004 showed the Government was falling far short of international obligations. That report highlighted the lack of services, the under-resourcing of existing services, poor management, a wide variation in clinical practice across the State and inconsistency in service availability between regions. It is a system in need of fundamental change.

The high level of suicide in Irish society was again confirmed by the report of the Joint Oireachtas Committee on Health and Children, published a year ago. That report was particularly critical of the state of our mental health services. It points out that people with mental health illnesses are known to be at greater risk of death by suicide, but notes that the type of mental health service one can access is a matter of luck. It goes on to say that funding for mental health services is allocated in a random manner, with scant regard for need. In the context of suicide, the most damning comment of all is the assertion that the provision of mental health services for adolescents is high on aspiration, but low on action. This is a severe indictment of the State's management of our health services.

The same is true with regard to the conclusion that despite 11,000 admissions to accident and emergency units each year, following suicidal behaviour, we have not yet put in place swift and appropriate standardised interventions to treat this high risk group, thereby reducing repeat acts. The Government and the Executive in the North must take on board all the findings of the joint committee. The report makes 33 detailed and costed recommendations for covering increased public awareness and improving mental health services, especially at primary care level and in targeting those most at risk.

It is important that Government assistance is given to support networks for families affected by suicide. This point was made at a seminar on suicide prevention organised at Stormont by the Sinn Féin president, Gerry Adams, last month. Bereaved families participated in that seminar, as did members of other political parties from this House. Sinn Féin has identified suicide as a priority area, requiring concerted co-operation between the Governments North and South, the health services, the voluntary sector and communities. We have made a number of policy recommendations which the Government needs to take on board. We must all act together and work collectively to target this emergency in society.

One of the priority policy proposals is that we look at suicide prevention as an area of co-operation under the all-Ireland Ministerial Council to give the issue the strategic co-ordination it requires. We must frame and implement a fully resourced, comprehensive all-Ireland suicide prevention strategy, including actions to promote mental health among the general population, and deliver it through the schools, youth services, workplaces and the media. We must develop mental health promotion actions targeting specific sections of the population, incorporating their needs into tailored suicide prevention sub-strategies, and develop mental health promotion and suicide prevention actions targeting groups identified at higher risk of suicide.

We also need to see action to assist individuals identified as being at risk of suicide and those bereaved through suicide. We need to see investment in further clinical and community based research on suicide prevention and develop national mental health awareness and anti-stigma campaigns to help tackle the issue of suicide. We need to include the people at risk of suicide in all of this. We must also include the families of people bereaved by suicide and of those at risk of suicide in policy making on this issue.

We agree with the Joint Oireachtas Committee on Health and Children on its call for targets to be set for a reduction of the rates of suicide in the country. Unfortunately, County Donegal has witnessed a high level of suicide, particularly among those of my age group, young males. We need to work collectively to address the issue and get to the root of the problem. The Government's policy is welcome, but it needs to go much further. Senator Norris asked whether we were going to take the issue seriously. If we are only going to spend €8 million per year on suicide prevention, the answer is we are not taking it seriously. I ask the Minister to take on board the recommendations my party and I have made, with those of other Members.

Déirdre de Búrca (Green Party)
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I welcome the Minister of State at the Department of Health and Children, Deputy Devins, to the House and thank him for his presentation. I also welcome the opportunity to discuss the important issue of suicide and the adequacy of the Government's current strategy on suicide prevention.

Senator Doherty used the word "emergency" in the context of suicide. It is increasingly clear that suicide is an urgent public health issue and a serious problem. Senator Corrigan mentioned the true statistics for those who die by suicide here each year, somewhere between 400 and 500. The research I have looked at suggests the figure for recognised suicides is close to 500. It is a grim statistic that this number of people choose to end their lives through suicide. Ireland has the fifth highest youth suicide rate in the European Union. Suicide accounted for 22% of all deaths in the ten to 17 years age group in 2004. The phenomenon of this increasing level of suicide has a marked impact on our young people.

There are marked gender differences in the levels of suicide. Men under 35 years of age make up 40% of all suicide deaths, which is a fact we cannot ignore when trying to make an adequate response to the issue. Some 11,000 cases of deliberate self-harm are seen in hospitals every year, 21% of which are repeat acts. However, many of those presenting in these cases do not receive any form of psychiatric assessment or aftercare. This is something to which we must attend. We must not allow them leave hospital to rejoin the community without some form of aftercare. Half of the 800 drownings that occurred in the Republic of Ireland between 2000 and 2005 were attributed to suicide. We can only guess at the number of suicide attempts involved in single vehicle crashes that result in death or injury. The statistics are grim and compelling and we need to take the issue seriously.

In examining the impact of suicide on society we must not just look at the individual impact. When an individual chooses to take his or her life through suicide, the immediate impact is on the family and the extended family. Having been a member of the Bray Suicide Support Group, I am very aware of the recovery process for families who are left grieving and in denial about the fact that one of their family members may have chosen to end his or her life. It is a long and tortuous process requiring high levels of support, the right information and advice at the right times and the integration of other services. The Coroner Service was mentioned earlier, as was the long period many families bereaved by suicide must wait until the inquest when all of the issues surrounding the death of the family member through suicide are raised and gone through in a forensic way. That is very difficult for the family members. We must try to design those services in such a way as to minimise the negative impact.

As well as the families we must mention the peers. We have talked about young people. We can only imagine the impact on the network of peers of any young person who chooses to end his or her life through suicide. Young people engage in copycat suicides, and the phenomenon has been recognised. When one member of a gang or a group of young people decides to end his or her life through suicide, it has a powerful effect on that individual's peers, and we can expect to see more of that in coming years. Unless we can design the right kind of prevention strategies, young people will emulate each other's behaviour and go on to attempt suicide themselves.

We cannot ignore the fact that there is also a wide impact on the community. For every person who chooses to end his or her life through suicide it has a wider impact on all of us who register that death because, in a sense, it is a verdict on a wider society. If we find there is a growing trend towards young people, especially young men, choosing to end their lives through suicide, that is in some way a reflection on the society in which they live. We must examine the kind of society in which we live where there are dominant, consumerist, market-led values and where life, in a sense, is not valued in the same way as it used to be.

When we were much less a competitive society dominated by the issue of economic growth, we had more time for each other and for building community. Religion was stronger in society and we placed a much greater value on each individual human life. With the secularisation of society, there is not a sufficiently robust value system to help and comfort young people who sometimes struggle with serious existential issues. As a community and society, we must examine how we can change that and promote a different value system to allow us to help young people to recognise that even when they are going through psychological difficulties and experiencing extreme psychological distress, their lives have a value and that it is worth seeking help.

There are problems in the system. As we discuss the strategy — it is positive that we have a national suicide prevention strategy, the National Office for Suicide Prevention and a comprehensive programme — we must recognise that we must put more funding into our mental health services. It has halved in the past 15 years. We must at least double the amount we are spending on our mental health services. I hope that by having this debate and recognising suicide as a priority for attention, it will encourage all of us in government and in opposition to support the increase in the mental health budget.

Phil Prendergast (Labour)
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I welcome the Minister of State and wish him well with his brief.

Suicide is the single most distressing subject of our time. To take their own lives people must overcome that tremendous urge everyone has to live. People must be so overcome with despair that they see no other option. It overcomes all their instincts — personal, familial and parental — and the option of suicide takes on the appearance of a viable alternative. That is desperately difficult for us to understand, yet approximately 500 people every year succeed in doing it.

Some commentators claim that those who take their own lives are selfish, that suicide is a selfish act. Those who suggest that fail, at a fundamental level, to understand the nature of suicide. They are simply wrong. Suicide is a difficult and complex issue and our society's challenge is to find a solution that will bring about a meaningful intervention for those at risk.

As a public health problem, suicide is recognised as one of the most intractable issues we face. Fifteen out of every 100,000 people die by suicide each year. The highest rates are reported in the 15 to 24 and 24 to 44 age groups, while youth suicide in Ireland is ranked fifth highest in the 25 countries of the European Union. Male suicides exceed those of females in this age group by a factor of 7:1. Behind those stark figures lie the personal stories of 500 Irish people, their families, friends and communities.

We appear to be a society in crisis, yet we appear to be in denial as well. I acknowledge the work of the National Office for Suicide Prevention. I note the range of pilot activities throughout the country, which are welcome, but I despair at the pitiful budget we allocate to suicide prevention.

In 2005, there were 399 deaths on our roads and €29.45 million was spent by the Department of Transport on road safety initiatives. That was very welcome but when we compare that figure with the €500,000 spent on suicide prevention in the same year in which 431 people died by suicide, it shames us and confirms to me that we are in denial. Money will not solve everything — it never did — but without resources we will achieve nothing.

In 2006, €1.8 million was allocated for the purpose of suicide prevention. In Scotland, with an annual rate of suicide of 600, £18 million sterling was allocated over three years to support a similar strategy. We must increase our spending to achieve real results and demonstrate that we, as a society, are serious when we speak of suicide prevention.

Suicide is a complex issue, a point made by many speakers this afternoon, and if there were easy answers, we would find them. The causes are multifaceted and involve an interaction of biological, psychological, social and environmental risk factors. More than 100 years ago, a French sociologist, Emile Durkheim, identified the sense of detachment from society, which he called anomie, as a major risk factor. Today, as our society undergoes immense change, statistics show that between 1980 and 2002 the rate of suicide in Ireland doubled, something mentioned by other speakers.

There is a link between mental illness and suicide but it cannot be definitely stated that mental illness is the cause of all suicides. Figures suggest that the majority of those who completed suicides had no prior contact with the mental health services. One recent study has shown that of those who completed suicide in Ireland, 33% had been known to be referred to the mental health services at some point, of whom less than half had been diagnosed as suffering from a depressive illness. That is not to deny the reality that depressive illness is a major risk factor in suicide. We must remember that two thirds of people who are depressed do not consult their general practitioner while just 8% contact mental health service providers. Those figures clearly point to a difficulty in accessing mental health services.

We recognise the historical under-investment in the mental health services, especially in suicide prevention, and we see that people are reluctant to access or have difficulty in accessing the existing services. We must also see that changes at societal level have seen a doubling of suicide rates in 20 years. We have put in place the National Office for Suicide Prevention and suicide prevention strategies. That is a good start but I am not convinced we are doing enough to tackle the problem. When depressive illness and suicidal ideation are such individual and personal experiences, we can ask the despairing question of what to do and where to start in seeking an answer.

There is a wide recognition that the problem has its source in society, yet our response seems to be primarily medical in nature. While it is undeniable that there is a major role for the health services to play in the prevention and response to suicide, perhaps we are overly reliant on the medical model. When 55% of those who die by suicide do so at their first attempt, medical attention is obviously too late. We must seek the answer in the problems faced by individuals in society and put in place a structure where the response is not just medical but embraces a wide range of other disciplines where high risk groups and individuals are identified and interventions can be made before it is too late.

We are familiar with the heart-wrenching story of the young man — it is disproportionately young men — who successfully completed suicide. He had been behaving as he normally behaved but was found dead by his distraught parents. What had happened to that young man who had taken his own life? We may never know but we cannot just console his parents, wring our hands and say that it was one of those things.

Every town and village has been visited by the spectre of suicide. Every person here knows someone who ended his or her own life. That terrible figure of 500 people every year represents 500 sons and daughters, mothers and fathers, our friends and, God help us, our family members. It is time for us as a society to take responsibility for this problem and as politicians we have a role to play. It is up to us to give priority to the issue of suicide and we need to place it at the top of the political agenda.

We can see in the story of the young man who took his life that there were no indicators that he was about to do so. Nobody had noticed that he was harbouring those darkest of thoughts and the first realisation came when he was found dead. It is clear that society failed this young man. There was no medical response to his needs whether the services were available, and if we had the most sophisticated health service in the world it would have made no difference. It is time for us to make a difference now.

I want to make a suggestion, which might form part of the solution. Currently, some 11 resource officers are employed by the HSE with responsibility for implementing the suicide prevention strategy. In an ideal world we would have a resource officer in every population centre. Let us expand the role and create the position of community support officer with particular responsibility for suicide prevention. Let us place this community support officer in each town, thus creating structures that mirror those of the public health nurse network. Let us pilot this scheme in a particular area. To illustrate the idea, I could cite the case of Tipperary as I know the area so well but I will not be parochial. The community support officer could be based in community office space and the role would involve liaising with schools, youth groups, voluntary bodies, sports clubs and all other formal and informal networks within the community. The officer's role might also involve liaising with GPs, public health nurses, community mental health nurses and community leaders. The community support officer would not replace health professionals but would complement their role.

A colleague recently told me that in his town there were four incidents of self-harm among young people in a three-month period earlier this year. Fortunately, none was successful but it really was a case of mere good fortune. This town is the location of a large mental health facility which employs 150 fully trained, highly experienced and dedicated mental health nurses. Not alone did the local mental health service have no response to these crises, it was also unaware of them until after the event. The GP was not aware of them either and they had not been picked up on in school. There seems to be no prism through which these events could have been seen sooner, so something is terribly wrong. A community support officer immersed in the community and working within local social networks might have provided an early warning system in these cases and perhaps also in the case of the young man about whom I spoke.

Let us take a cold and unpleasant look at the economic cost of suicide. It is estimated by the National Office for Suicide Prevention that the human and indirect costs of suicide in Ireland amounted to €871.5 million in 2001. Actuarial studies indicate a much greater economic cost given the young age of so many of the victims. While it is distasteful to refer to an economic cost in this context, it is necessary in order to illustrate the need fully to resource suicide prevention strategies. The provision of a community support officer on a pilot basis in, for example, four or five towns would cost only a fraction of the aforementioned figure. It is not an expensive idea when one considers that one cannot put a cost on a life. I do not know if the proposal is practicable, but I ask the Minister of State to examine it. I am available to discuss the matter further at his convenience. It remains to be seen whether the plan would be effective, but it is worth trying given that anecdotal and empirical evidence suggests mental health services are failing to reduce the incidence of suicide. I propose the introduction of a pilot scheme along the lines I have outlined and I thank the Minister of State for his attention.

Lisa McDonald (Fianna Fail)
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I greatly welcome the opportunity to contribute to this debate. We should continue to highlight the issue, rather than considering that our commitment has been achieved by concluding the debate today. In the past, society tended to sweep the suicide issue under the carpet, which led to it being stigmatised. Recently, a mother whose son is suffering from depression told me that if he was suffering from cancer or some other disease, counselling and other help would be available. However, as depression is a mental health issue she cannot obtain the required support. In essence, she feels stigmatised as the mother of someone suffering from depression. The stigma is such that it can drive family members to despair, as well as the person who is depressed.

In the past, not enough was done by society to discuss the high rate of suicide here, which is one of the highest in Europe. Suicide is one of the biggest killers of young people and young men in particular. The Minister for Health and Children, Deputy Harney, must put this to the forefront in dealing with such health matters. I welcome the Minister of State, Deputy Devins, to the House. He is the right man for the job and is seriously committed to placing suicide at the top of the political agenda. Our party's spokesperson, Senator Corrigan, will diligently deal with this serious issue.

Previous speakers have referred to the figure of 500 people per year committing suicide in the Twenty-six Counties. Behind every such tragic tale there is a grieving family. Recent evidence has shown that children as young as six are now attempting to take their own lives. In addition, they are being taught how to do so by sinister websites that have been mentioned. All of this indicates that we are dealing with a national crisis. I welcome the Reach Out programme but we need to go further by putting in place prevention strategies, with the required services. We should ringfence an appropriate part of the health budget for mental health to guarantee sufficient resources to revamp the suicide prevention strategy. To this end, community-based initiatives must be expanded as they are making a real impact. In addition, further investment is needed in clinical and community-based research on suicide prevention.

A public awareness campaign is required to highlight the dangers of Internet websites. However, sites such as Bebo and MySpace do have a role to play in promoting and highlighting services to help young people when faced with such problems in their lives. Parents need to be aware of these sites and should know what their children are viewing on the Internet.

I acknowledge the work that has been done so far by the Reach Out programme. While I congratulate the Minister on opening the first centre for the prevention of suicide and self-harm this year, we should now try to establish such centres in every county. Pieta House, the community-based facility in Lucan, County Dublin, is doing sterling work. Its aim is to assist the growing number of people affected by suicide. I was speaking to the director of that facility last week and it is clear that we need such centres in every county. Whether they are to be provided by the State, grants should be made available to groups that wish to establish such facilities. Perhaps we can liaise with local authorities in providing such accommodation in premises that are currently not in use.

Suicide statistics are stark. Worldwide, more people die by suicide than murder or war. In Ireland, approximately 600 people take their lives annually. The official figure is 500, as has been stated, but there are far more cases that we do not know about. These include people who die in road traffic accidents, but we will never know for sure. That is why research is vital in getting to the nub of the reasons for suicide. Some 11,000 people per annum currently present themselves to accident and emergency units having deliberately harmed themselves. It is believed that approximately 70,000 people deliberately harm themselves but do not seek medical attention as a result. A far greater number have suicidal thoughts.

The most recent figures that I have obtained for my own county of Wexford are frightening. From 1990 to 2000, approximately 163 deaths by suicide were registered by the Central Statistics Office, which is much above the national average. During the same period, many more people were admitted to the accident and emergency unit at Wexford General Hospital as a result of self-harm. The figures speak for themselves. We have had many upsetting, high profile cases in the county, which have been well documented by local and national media. In the aftermath of such cases, people are frustrated and fearful, although trying to help but not knowing exactly what to do. In considering pilot projects, there is no more deserving county than Wexford and I am not being parochial in saying so. Wexford Creamery is holding its Halloween milk run to raise money for the suicide prevention group Aware. That move is to be welcomed but it shows the extent of the problem when the business community feels obliged to become involved at a local level. More people die by suicide than in road traffic accidents, yet large sums of money are pumped into road safety campaigns. We need to make people aware of the research to help secure appropriate funding.

I agree with Senators Fitzgerald and Norris that sexual orientation is a cause of suicide, especially among young men. We need to consider how to bring community facilities to these people. Drug and alcohol abuse, bullying, workplace stress, money problems, social pressure, isolation, loneliness and being unable to contact support are other causes of suicide. Mental health problems are only one factor. While the Samaritans play a strong role it is sometimes necessary to have a community base, a person who is continually available. As a politician I often feel I am that person which proves that a community contact is vital in addition to the excellent role played by the Samaritans which must continue. Ringfenced money needs to be invested in providing a helpline in every county, 24 hours a day, seven days a week.

Suicide affects every part of society and where it occurs in clusters it bereaves families, friends, neighbours and communities, leaving a legacy of hurt, confusion, insecurity and fear. It is said that suicide is a permanent solution to a temporary problem. Even one suicide is one too many and a failure of society. We need to focus our energies on this crisis and I urge the Minister of State to redouble his efforts to tackle it.

Maurice Cummins (Fine Gael)
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I wish to share time with Senators McFadden and Donohoe. We will speak for one minute each. It is ridiculous and unfair that we do not have sufficient time to discuss this subject when so many speakers are offering.

There is no comparison between the amounts of money rightly being spent on road safety, and on suicide prevention. This is a disgrace and shows a lack of seriousness in dealing with this problem in recent years.

There are 96 recommendations in Reach Out and the Minister of State will be judged on the progress he makes in implementing them. We look forward to a further debate on mental health and suicide a few years from now, to see how much progress we have made. The Minister of State will be judged on his actions rather than his words. We hope that there will have been significant progress and that targets will have been achieved by the time we have that debate.

Nicky McFadden (Fine Gael)
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I attended a course in Applied Suicide Intervention Skills Training, ASIST, last Friday and Saturday in Athlone. It was an intensive course, provided by the Health Service Executive to equip members of the community to be the first person to intervene and give aid. Like Senator McDonald, I have met many people who are down on their luck, experiencing black days.

I was appalled and disgusted to hear that the HSE had cut funding to this worthwhile skills training course. Without the intervention of the Roscommon Lions Club the workshop would not have continued. I urge the Minister of State to investigate the funding for ASIST.

Paschal Donohoe (Fine Gael)
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The first time I heard of suicide was when as a young man I heard that Kurt Cobain had taken his life. In his suicide note he wrote that it was "better to burn out than to fade away". Many young men in our society learn about suicide through popular culture. We must examine how that knowledge is disseminated through Internet sites and music lyrics and act accordingly. I encourage the Minister of State to come down heavily on groups and websites which do not take their responsibilities seriously enough. While I know this is a problem for young women, there are too many young men who see these sites in an unregulated environment and receive the worst possible education and information on this subject.

The vulnerability of men and women who leave school between the ages of 16 and 18 increases intensely once they have fallen out of the network. I encourage the Minister of State to work with the National Educational Welfare Board and ensure that it has adequate resources.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I thank all the contributors to the debate. I am struck by their passion which reflects the feeling on the ground about suicide and its prevention. I agree with Senator Cummins that we should have more time for the debate. If the House wishes to have the debate in the future, I would be pleased to return.

While my brief encompasses disability and mental health I have priorities. I am targeting suicide prevention in the mental health area. Suicide is a multi-factoral problem for which there is neither a simple cause nor answer. I have noted the points made by each speaker but wish to deal with them globally first.

The Government has adopted A Vision for Change as policy but speakers are right to say that its rate of implementation is slow. That is why my predecessor set up an implementation body to assess its progress and report annually. The first report was published last May. I recently met the chairperson of the implementation body, Dr. Ruth Barrington. The next report is not due until January 2008 but I may not receive it before April or May. That is too long to wait and I have asked the chairperson to furnish an interim report. This is an issue on which we must all push for progress under the terms of A Vision for Change. I will be delighted to discuss the interim report with Senators.

There has long been a stigma attached to mental health and silence about suicide. When I was a general practitioner, my colleagues and I noticed that suicide was swept under the carpet. I was pleased to launch the mental health awareness campaign two weeks ago. This aims to make the community aware that we all have mental health and must not discuss it only in negative terms. Most of the time most of us have positive mental health, but unfortunately for some people it is negative. Research shows quite conclusively that if when people feel down or blue they are prepared to talk to their friends, family or workmates it will help their overall situation.

The Internet is a problem. Many of the sites are provided from outside the country and there are issues in international law. I am hoping to meet some of the service providers in the near future, but they are service providers in this country. Most, if not all, of them are very responsible and we will be looking to them for help in solving this problem. However, when it comes from outside the country, there are obviously issues that we might not be able to ease, but we will work on them.

Some speakers also referred to the issue of funding, to which there are two aspects. The first is related to suicide prevention. The National Office for Suicide Prevention was established in 2005. Its budget for 2007 is approximately €8 million, which is roughly a 30% increase on 2006, itself a 25% increase on 2005. I would love if more money were allocated for suicide prevention and when the new budget is announced next December, I hope that will happen, but that is dependent on the Minister for Finance and the Government.

The second aspect relates to mental health in general. One speaker made the point that the percentage spend on mental health has been reduced. That is true but it must be considered in the context of the amount of money that was being spent specifically on mental health. The money spent in 2007 is close to €1 billion, which is an enormous amount of money compared with the amount spent in 1997.

Senator Prendergast referred to a community support officer, which is a very interesting idea which I would be happy to discuss in more depth with the Senator. Senator McFadden referred to the course in Applied Suicide Intervention Skills Training, or ASIST. I congratulate her on taking this excellent two-day course, which is part of the Reach Out programme and organised by the National Office for Suicide Prevention.

I cannot solve the problem of suicide here today — neither can Members — but everybody in Ireland working together can help reduce the rate. Reference was made to the actual rate. I agree the official rate probably does not reflect the true figure. Unfortunately, deaths were recorded with the term causes unknown or other causes, which is not a true reflection. I am committed to doing my part and I will be very happy if we reach the Government target of a 5% reduction in the suicide rate by 2010. That is a huge challenge and I would love to see it bettered.

I thank Members who have contributed and the House for affording me the opportunity to speak today.