Dáil Éireann debate -
Wednesday, 4 May 2005

Vol. 601 No. 5

Private Members’ Business.

Suicide Levels: Motion.

Mr. Connolly

I move:

That Dáil Éireann:

—notes the following matters of grave and urgent concern;

—the latest statistics reveal that suicide now accounts for 50% more deaths annually than road accidents — 444 last year as against 293;

—suicide is the most common cause of death among 15-24 year-olds in Ireland, and the highest in this age group of all 25 EU states;

—the suicide rate in Ireland is rising faster than in any other EU country, and the rate among young females doubled between 1992 and 2000;

—the highest rate of suicides over the past five years is among young men in the 20-29 age group;

—in 2003, 11,200 parasuicides, or attempted suicides, presented at hospital accident and emergency departments across the country;

—the correlation between suicide and factors such as unemployment, living in poverty, bullying, relationship break-ups, legal and work related problems, alcohol and drug abuse, physical or sexual abuse in childhood and social exclusion;

—student counselling services in third level colleges across Ireland are stretched to capacity, with lengthy waiting lists over the past two years despite having extra staff employed;

—the slashing of the mental health budget to 6.8% of the total health budget from its 1997 level of 11%, despite continuing to claim more lives annually; and

—there are only 20 inpatient beds with specialised services for adolescents with mental health problems, despite a Government-commissioned report recommending in 2000 that at least 120 such beds are needed;

calls on the Government to:

—immediately implement the 86 recommendations of the 1998 report of the national task force on suicide on ways to prevent and reduce the incidence of suicide or parasuicide;

—establish a national suicide prevention agency to coordinate the services provided by various authorities throughout the country;

—provide a comprehensive programme of multi-disciplinary research and investment in suicide prevention strategies;

—improve awareness of suicide by ploughing extra resources into educational programmes and mental health services;

—address the problem in second-level schools by the inclusion of mental health and psychology in the curriculum;

—increase funding for student counselling services at both second and third levels, and diminish the aversion and stigma attached to seeking counselling, particularly among young males; and

—develop an effective strategic action plan for both the prevention and reduction of suicide as an urgent national priority.

I propose to share time with Deputies Cowley, McGrath, McHugh, Cuffe and Crowe.

To date, a considerable part of the suicide debate in Ireland has centred on horrifying statistics, with the use of which I feel increasingly uncomfortable. It is almost as if the shocking road traffic death toll is being legitimised to make a comparison with suicide deaths. Neither type of death is acceptable, nor is there an acceptable level of death in either circumstance. Sudden death in any form has devastating consequences, no matter what house it enters.

Death rates from suicide are not driven home to the same extent as road traffic deaths, regarding which we are presented with a weekly head count, regular bank holiday warnings and road carnage being reported faithfully in the media. Do we have the same weekly pattern of carnage with suicide? Nobody knows, because we do not have the same preoccupation with this silent killer, merely receiving an annual summary. Again we are back to the issue of statistics.

Regarding the road traffic mortality-suicide comparison, we have no forewarning of a road traffic death, but we have warning signs of suicide. The real tragedy is that society is failing to note the warning signs and symptoms which should enable preventive measures to be taken to help reduce the incidence of suicide. I call for a full audit of each recorded suicide to enable us to understand the full circumstances of each suicide and to prevent further suicides.

Hard questions need to be asked. Did an individual seek professional help? Did he or she present at an accident and emergency unit, or show signs or symptoms of depression? Had there been a previous parasuicide or self-harm incident? Did he or she express concern to an individual or family member, or seek psychiatric assistance? If so, what was done about the problem?

Currently, a suicide is followed by a post-mortem, and later a hearing at a Coroner's Court. That is all, in effect. One moves on to the next business. That is not acceptable. We need an audit. If people need to be held accountable, so be it.

Regarding funding, how can anyone justify the expenditure of a mere 8% of a road safety awareness budget on suicide prevention programmes? That is not enough, nor is it logical. Does a correlation exist between the alarming increase in suicides, now running at ten per week, and the steep reduction in the mental health budget from 11% to less than 7%?

I can offer a concrete example of underfunding in the case of an eight year old child whose parents were concerned and knew the child needed an assessment. They sought a psychological assessment of their child, only to be told that only absolute emergencies, involving an immediate risk or threat to the child's life, could be catered for at that time. It is not acceptable for an eight year old child to be left in such a situation. Must we wait until a child's life is clearly at risk? Early detection, early treatment and better outcomes are needed.

A German project has recently been tested in Cork and Kerry and is to be welcomed. It has four dimensions. An enlightened GP workshop points out the warning signs and symptoms of suicide. People who have been involved in self-harm are targeted first. Key professionals are then trained. They can be social workers, gardaí, priests or teachers. A public awareness campaign is then instituted. This project was introduced in Nuremburg in Germany resulting in a 26% reduction in self-harm incidents while in Würzburg, over the same period, there was a 24% increase in such incidents.

An Australian project involved different initiatives which led to a 30% reduction in self-harm and suicide incidents in Australia. A Canadian project also resulted in a reduced incidence of suicide. There are projects in operation which have worked, yet we are testing them on a pilot basis. It is as if we are unsure that they will work in Ireland even though they have worked worldwide. I do not see why they should not work here. It is like suggesting we re-invent the wheel. If something works in Germany, Australia or wherever, let it work here. We should implement the Cork-Kerry programme nationwide.

Most of us think of health as a physical manifestation in terms of people looking well, but there is also a mental dimension. Physical health can be quite apparent. We can see when someone is ill, or has a broken arm. We wish such people well, and they get our sympathy. We can also see when people are not looking well, and quite often, before people go to a doctor or seek help, prompts come from a spouse or family member. It is older men who need such prompting. In the mental health field, however, signs and symptoms are not seen. How can one prompt someone if one cannot see if he or she is well or not? One cannot know what is going on in a person's mind and one has no way of telling a mentally unwell person to seek help. The motivation of such people to seek help is greatly reduced.

I call on the Government to take some action which will save lives and to take the Cork-Kerry project countrywide. The media are doing a good job in recent times — I have been monitoring them in terms of how they highlight suicide.

Dr. Cowley

I am grateful for the opportunity to speak on this important motion. The Government's primary care strategy envisaged a comprehensive primary service which among other activities would help prevent suicide. However, the Government has failed miserably to invest in the primary care strategies promised, and the cost is the loss of young and old lives.

The primary care strategy promised €1.3 billion over ten years, or €130 million annually. That was to be a tenth of the overall health strategy budget. The Government recognised, correctly, the structural and human resource deficit in primary care and that funding of €1.3 billion was realistic. However, it only gave €18 million over three years compared with the €1.3 billion or €130 million every year for ten years that was proposed.

The primary care strategy envisaged a comprehensive primary care service whereby general practitioners would not act in isolation but as part of a team. Clinical psychologists and counsellors would be part of the primary care team within a primary care setting. This would act as a safety net or sentinel service to pick up people showing danger signs such as the desire to commit suicide.

Suicide in older people is a serious matter. Older people who say they will commit suicide are likely to be successful. They do not mess about but kill themselves. There is a terrible scarcity of psychiatric social workers, which is due to a lack of resources. I put down a parliamentary question on this issue and was horrified by the reply. There are few social workers for older people; they are as rare as hen's teeth. The cost is terrible.

General practitioners are catering for the majority of the population but funding deficits are costing lives, both young and old, through suicide. While communication between the general practitioner, the public health nurse and the community psychiatric nurse is well developed in rural areas, it is not so well developed in urban areas. There is insufficient access to counsellors. There is no direct general practitioner access as the GP must go through the psychiatric service. Try getting access to the psychiatric service on a Friday evening. These personnel should be part of the primary care scheme.

General practitioners and district nurses are under pressure from the large volume of work relating to chronic illness, due to earlier discharges from hospitals. They are trying to keep people at home to avoid the terrible calamity of trolley chaos in the hospitals. General practitioners need time to focus on the young, particularly young males, to identify those under pressure. These can be referred directly to a counsellor in the area. This would create a culture of caring, where people have time to care and to listen. However, that cannot happen when there is a lack of resources to enable general practitioners to carry out these tasks. It is important to have a system that allows access to paramedics for people under pressure.

We need resources but we are not getting them. We need an increased number of general practitioners, paramedics and allied health professionals, such as counsellors. When one looks at the graph showing the alarming increase in suicide incidence in Ireland, particularly among young people, from 1972 to 2000, as reported by the strategic task force on alcohol, it is exactly mirrored by a graph showing the increase in alcohol consumption. Alcohol abuse is a significant risk factor in suicide and compounds other risk factors.

There has been a sharp increase in male suicides, especially among the 15 to 29 years age group. Overall, it is the main cause of death in men from 15 to 35 years of age. Alcohol disorder continues to be the main cause of admissions to psychiatric hospitals, especially for males. If this upward trend in alcohol consumption continues, Ireland will have the highest rate of consumption in Europe and the suicide rate will go through the roof.

A coroner told me recently that in seven out of the ten recent inquests he had conducted on young people's suicides the deaths were alcohol related and many of the people had no history of depressive illness. They tended to be impulsive. Few of the deaths were anticipated and the relatives suspected nothing. Suicide often occurred after a disco when, after some late night drinking, the person threw himself over the bridge because he was refused a dance at a disco. That is what we are dealing with. The coroner also blamed extended licensing hours and exemptions. This is about buying time. Closing time was 11.30 p.m. but it is now 1.30 a.m. There must also be enforcement of the off-licence regulations relating to tracing drink sold to under age drinkers.

There are no longer any religious scruples about suicide. People drink at a younger age. When I was young, if a young man was drunk on a bus it was a sensation. We did not have the money for drink. These days, young people have the money.

We do not have the money we need to do the job that must be done in primary care to prevent suicide.

Mr. F. McGrath

I am glad to have the opportunity to speak on the motion put forward by the Independent Deputies. I thank and commend my Independent colleagues, especially Deputy Connolly, for their work on this urgent issue. Once again, we have shown that Independent Members can work together on important issues that matter to the public.

Suicide is a huge and complex subject and we must unite, regardless of political affiliation, to do something urgently for the families directly affected. I clearly remember attending the funerals of three of my past pupils in a ten day period. The sad thing is that this did not make the headlines. Imagine three young men dying as a result of suicide and drugs related problems in a period of ten days in a small community on the northside of Dublin. That is the sad reality for the families.

In our motion, we demand action from the Government to address the issue of mental health in a realistic, relevant and age appropriate manner. It is simply not good enough that there were 444 suicide deaths last year and 11,200 attempted suicides. It is also not good enough that people do not have access to support and back up services. We now have the scandal of the slashing of the mental health budget to 6.8% of the total health budget from its 1997 level of 11%, despite the problem continuing to claim more lives annually.

The tragedy of suicide and the scale of its incidence has been prominent recently. All the evidence and the advice of experts point to the urgent necessity for a comprehensive mental health promotion strategy. I welcome the fact that such a strategy is currently being planned. Information and support for children, parents and teachers in identifying emotional and behavioural problems and early intervention services and programmes, as promised in the national children's strategy, are also urgently required. It is essential that the Government and the Minister for Health and Children give this issue priority.

We need to challenge strongly young people's attitudes to and misconceptions about mental illness. We also need to critically examine society's attitudes to mental illness and the factors that influence such attitudes.

This is an important motion and I urge Deputies to unite behind it. We are putting this issue on the political agenda and we support Deputies in other parties who feel strongly about it. It is most important that all Deputies support the motion.

Mr. McHugh

I thank the Independent Deputies and the Technical Group for putting forward this motion. I particularly thank Deputy Connolly for his work on it. I also acknowledge the work Deputy Neville has done on this issue over many years and I welcome his attendance at this debate.

Much of the discussion this evening relates to statistics. However, in the case of suicide, when a person becomes a statistic it is too late. No amount of talk will bring a person back. For that reason, I wish to highlight the importance of identifying the warning signs and symptoms. In many cases, these signs and symptoms are clear in hindsight but that is of no use when the person's life is gone. How often have we heard relatives of suicide victims say that before the death occurred they did not notice anything unusual in the person's behaviour? On reflection, however, after the tragic event, they see there were events, utterances or actions which were signs and symptoms but they did not recognise them as such at the time. That is the tragedy.

In many cases, the signs and symptoms are visible but the caring, loving parents, partners and relatives, through no fault of theirs, just do not recognise them. The fact that close associates miss the warning signs illustrates the great and immediate need to focus on those signs and symptoms, to conduct research and to prepare programmes, both visual and audio, for presentation to people in peer groups spanning all ages at various suitable locations in a co-ordinated manner. Such programmes would be informative, educational and stimulate discussion not only among people who have been affected by suicide but those who have not been affected by it. They might have more to gain from such programmes.

To provide programmes for health professionals and people working in this area on signs and symptoms is only one approach. Equally important is the need to make this information available to parents, guardians and the general public. Many of the people who commit suicide did not present before health professionals.

I have concentrated on the absence of visible or recognisable signs and symptoms, which is hard to deal with. Sometimes those signs are visible but parents and relatives are reluctant to broach the subject with the person concerned in case it would make him or her more likely to commit suicide. We need to send the message out loud and clear this evening that to talk to people at risk of suicide can help, not harm. Studies show that it appears to ease distress and it might make some people less likely to act on suicidal thoughts.

Suicide accounts for 50% more deaths annually than road accidents. Last year there were 444 suicides compared to 293 road deaths. The lack of action by Government in regard to suicide is inexcusable. I urge that the recommendations of the 1998 report of the national task force on suicide be implemented immediately.

Mr. Cuffe

I commend the Independent Deputies for bringing this motion to the House. Sadly it is a timely one but it is also an appropriate one to remind us that much research has been done in this area and conclusions have been drawn, but the resources in terms of finance and staffing are required. It is high time the Government gave more resources to assisting the various agencies that assist people who may be vulnerable or families who have suffered from suicide.

There is incredible pressure today, especially on younger people. As people look around them very often they see success stories, they see young people who have done well in life, who have got the right job, a car and a home, but there are many people left behind in today's Ireland. There are many people who find it difficult to confide to their friends that they have not been a success, that they have not succeeded in college, work life or social life. I suspect that the resources are not there for these young people who find it difficult to express themselves socially. There can be great financial pressure on those who have not been lucky enough to get on to the housing ladder when the time was right. When they see success stories all around them, it can lead them into a cycle of depression and despair. It is crucial that we provide resources and reach out to those young people.

It is important for society to think long and hard about the needs of people in their teens and early 20s. We should not put too much pressure on them to behave fully as adults. If we put too much pressure on young people in this way we will not allow them to be themselves. Young people should be healthy and happy and we should allow them to live their lives in this way. We should not pigeon-hole them, whether it be by gender, culture, socio-economic status, sexual orientation or otherwise.

Pressure also comes from other angles. The advertising industry bombards us with message upon message saying that one can have that car, one should have that drink and one can use money to achieve success. We must look at the various areas where pressure is applied. We should tone down some of the advertising that tells us that success is based on material goods. We should also tone down some of the messages that are coming at young people from society.

We must examine carefully the research that has been carried out. We should ensure that there are people to listen when times are tough and we should look at the groups who are most vulnerable and give them assistance. We should put forward the idea of a healthy lifestyle free from alcohol and other drugs. We should make sure that if people are using drugs such as alcohol they have a helping hand available to them.

Much work remains to be done in the area of resources. The State must provide more sporting facilities and amenities for young people. The young people in my area are crying out for a skate park but it is an uphill struggle to get funding for it. It is far easier to get funding for roads or other issues than to get for the things this particularly vulnerable group from their mid-teens to their early 20s require. I accept that transportation is crucial in ensuring that, among other things, people have ways of accessing their social life.

There is great pressure on young people to live up to the expectations that come through the messages from advertising and other areas. I applaud the wording of the motion. I urge the Government to live up to the recommendations of the task force that were made six or seven years ago. We need to see more progress in regard to them. In particular, funding must be provided to deliver youth services in the areas of arts, sports and education to give younger people a better chance in life. The Green Party supports the motion.

Mr. Crowe

An OECD study in 2002 placed Ireland second in the world's league table of people under 25 taking their own lives. As the motion states, it is the most common cause of death among young people between the ages of 15 and 24. Ireland has the highest suicide rate in the EU for this age group. The number of people killed on the roads has often been described as a national emergency, but suicide rates far exceed road deaths. The suicide rate is a significant social problem which must be addressed by public representatives and service providers in a concentrated and co-ordinated way.

The motion calls on the Government to implement the recommendations of the 1998 task force on suicide. The fact that the report contained 86 recommendations shows the complexity of this issue. While mental illness is the single biggest factor involved, there is no common cause of suicide. Two things strike one on looking at the statistics. First, the concentration of suicide among young boys and young men is remarkably high, which is disturbing. Second, while there are common factors among this age group the circumstances, personal and social issues of the victims are many and varied. What is clear is that social factors play a huge role in many cases. For many young people, unemployment, alcoholism, physical and sexual abuse and relationship breakdown are factors which have been shown to contribute to this tragedy.

It has been noted that suicide rates tend to be higher outside the Dublin area. Various theories have been advanced to explain this but the most plausible one is that while services for people in need of counselling or those experiencing crises in their lives are thin on the ground in Dublin, they are more accessible there than in other parts of the country. Surely this shows the stark need for better and more accessible services.

The phenomenon of copycat or cluster suicides has been recognised. This is where one tragedy leads directly to others within a group of young people. I am aware of a recent example of this. Only last week, relatives bereaved by the devastating legacy of suicide held a protest outside a health trust meeting in west Belfast to highlight the alarming rise in suicide incidents. These families stated that the problem has become increasingly severe in recent months and pleaded with health officials to provide support for this crisis. According to local community workers, at least 15 people have taken their own lives in north and west Belfast in the past three months. Support organisations have been inundated with calls from frightened families requesting further information, support and referrals.

One of the latest victims is young Stephen McComb who was only 19 years of age when he took his life on Tuesday, 26 April. His loss is the latest tragedy for the McComb family who have endured a series of terrible and traumatic deaths in recent years. Stephen's 15 year old cousin, Debbie McComb, was struck and killed by so-called joyriders as she crossed the Springfield Road in west Belfast in March 2000. In May of last year, Debbie's grieving 19 year old brother, Michael, took his own life.

His 18 year old girlfriend, Fiona Barnes, also died at her own hands, soon after the burial. In a statement last week, members of the devastated family said they were suffering terrible and inexplicable agony. For this community, it is another tragic loss of life, the statement said, and they prayed that Stephen's passing could, in some way, be a source of benefit to others "in that it will finally force a meaningful response to deal with the crisis of self-harm".

North and West Belfast Health and Social Services Trust has been repeatedly criticised for not tackling the issue of self-harm and suicide in an effective way. Again, we can mirror that with criticism of the services here. Last week, many of the bereaved families turned up at the trust's monthly meeting to highlight their demands. The Lenadoon Community Forum, west Belfast, estimated that there have been at least 15 suicides in the past three months in north and west Belfast. These are only the cases that are known about. The forum runs a local community counselling project and before Christmas there were 100 clients coming in each week, about 80% of whom were referred by general practitioners and psychiatric nurses. This project has lost three of its workers due to cutbacks in funding.

North and south of this island, mental health services and suicide prevention awareness programmes are being disgracefully neglected and underfunded. Gerry Adams, MP for west Belfast, in response to the problem, said:

If suicide is a national disaster in Ireland we urgently need a national disaster plan. That must be a priority. The health Departments in Belfast and Dublin must begin to realise that the public want urgent strategic action on suicide prevention.

I echo that call tonight. I have spoken about Stephen McComb. From my own experience, I know of the case of Darren Bolger in my area, a 17 year old who committed suicide. There were other young people in the Kilnamanagh area who went down the same route. The Bolger family and a group of friends have come together to set up an action programme, Team Line. Young people can ring the team line and possibly speak to someone their own age who has been through a trauma, and I hope that will help. This initiative has brought that community together. Supports have been put in place. The group has premises and so forth. If young people find themselves in those circumstances, there are places they can go and people whom they can contact. I appeal to them to contact the relevant services. There are services in Cork and other centres as well.

The other night in Jobstown another elected representative and I attended a meeting of 60 people. The stories were all similar, all the people were grieving and looking for supports, trying to move beyond their tragedies. A friend of mine killed himself last year. Were it not for the work that he and others in that community did for me, I would not be in Leinster House. He was coming around to me that morning. I spoke at his funeral and we discussed the "what ifs", what if one had done this or that. One of the messages to emerge from that meeting with the local people was that the "what ifs" need to be put in the grave with the person who has killed himself or herself. There is no understanding what has happened. Clearly people need help.

My friend who killed himself had tried to commit suicide the week before. He would not take a tablet if his life depended on it. However, he took tablets and drink on this occasion, ended up in the local hospital and was released, for some strange reason, the next day. There were no resources or back-up services. His family tried to keep him in the house and so on. We are still suffering and trying to live with that grief. His wife and family have to live with it.

I urge the Government to support this motion. The point must be made that the problem can effectively be addressed. Suicide, of course, can never be completely eliminated, but experience in other countries has shown that with proper planning, resources and services, and determination on the part of policy makers, lives can be changed and many families spared the grief of the death of a loved one.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"notes the many initiatives undertaken by Government and by health service providers since 1998 aimed at reducing the incidence of suicidal behaviour including, for example:

—the placement of liaison psychiatric nurses in accident and emergency departments of general hospitals;

—the provision of training to relevant health care personnel in matters relating to suicidal behaviour;

—the development, in each health service area, of a directory of services, both statutory and voluntary, which are available to those concerned about or at risk of suicide;

—the introduction of restrictions in the availability of paracetamol, which can be harmful in overdose;

—the establishment of the national suicide review group and the appointment of suicide resource officers in each health service area;

—the provision of additional funding for research into suicidal behaviour and the prevention of deliberate self-harm;

and welcomes the development of a national strategy for action on suicide prevention, which will be published later this year."

I propose to share time with my colleague, the Minister of State at the Department of Health and Children, Deputy Seán Power.

I thank the Independent group for tabling this motion. As Minister of State with responsibility for mental health services, I believe that the more focus there is on this issue the better. As many of the speakers from the group have said, the whole area of suicide is very complex. The more we focus on it and can convey its seriousness to the public, the more effectively we can get to the heart of the problem in terms of putting the message across.

I stress at the outset that the Government shares the concern expressed on the opposite side of the House and among the public generally about the level of suicide. The problem of suicide has indeed become a serious one in Ireland. Suicide is in every case a tragedy, for the life that has ended and the family, friends and community left behind. It is a serious social problem. We cannot ignore or be complacent about the growing incidence of suicide and self-harm. Suicide prevention is an issue with which we must all be concerned. The challenge of preventing and reducing the rate of suicide is one of the most urgent issues facing Irish society at present and I welcome the opportunity this evening's debate presents for me to make a statement on the matter.

In 1998, the year in which the report of the task force on suicide was published, the number of deaths by suicide registered by the Central Statistics Office reached an all-time high of 504, reinforcing the need for sustained and co-ordinated action in response to the ongoing problem. Five years later in 2003, 444 deaths from suicide were registered. While this drop is encouraging, it is too soon to draw any firm conclusions from the reduction. What the figures indicate is that no effort can be spared to reduce what is still a major cause of death, particularly among young people. There has been a significant increase in the rate of suicide among young males in the past decade, with 305 such deaths in 1994, rising to 358 in 2003.

However, it is important to point out that, contrary to what is stated in the Opposition motion, youth suicide in Ireland is not the highest in the EU. The most recent analysis suggests it is fifth highest. In terms of the overall suicide rate, Ireland ranks 17th in the EU. Recent figures suggest that the rate has stopped rising, but we experienced probably the fastest rising rate in Europe during the 1980s and 1990s, albeit from a low base rate. These are all worrying trends which require further research so that better strategies are developed to help people who are particularly at risk.

The health strategy, Quality and Fairness — A Health System for You, included a commitment to intensify the existing suicide prevention programmes over the coming years. Work is now well under way on the preparation of a national strategy for action on suicide prevention. This strategy is being prepared by the project management unit of the HSE in partnership with the national suicide review group and supported by the Department of Health and Children. Work was initiated on the development of a national strategy for action on suicide prevention two years ago. Since that time, nearly 700 people have attended regional and national consultation meetings. Submissions were sought in the national press and 68 submissions were received. A national and international expert group of 16 people reviewed the strategy during the past two weeks of April and their analysis is currently being incorporated. The extent of consultation, the input of the external reviewers and a dedicated writing team will result in a high-quality, action focussed, evidence based strategy which will highlight immediate priority actions, targets for implementation in the medium term and longer term objectives for suicide prevention and mental health promotion in Ireland.

A fundamental aim of the new strategy will be to prevent suicidal behaviour, including deliberate self harm, and to increase awareness of the importance of good mental health among the general population. Ongoing 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 will identify expected outcomes and set targets that can be measured, monitored and revised. Continuous quality control and ongoing modification and improvement of the strategy will be central to its implementation.

Since the publication of the report of the national task force on suicide in 1998, the Government has provided a cumulative total of more than €17.5 million towards suicide prevention programmes and for research. This includes funding to support the work of the health boards, the national suicide review group, the Irish Association of Suicidology and the National Suicide Research Foundation for its work in the development of a national parasuicide register. My Department also supports the ongoing work of many organisations such as Mental Health Ireland, GROW, AWARE and Schizophrenia Ireland in raising public awareness of mental health issues. The figure of €17.5 million does not encompass funding provided by other Departments such as the Departments of Education and Science, the Environment, Heritage and Local Government and Justice, Equality and Law Reform in addressing areas within their responsibility, as identified in the report of the national task force on suicide.

My Department has also made significant additional funding available in recent years to develop further mental health specialties such as liaison psychiatry, child and adolescent psychiatry, adult psychiatry and old age psychiatry services. These services can assist in the early identification of suicidal behaviour and provide the necessary support and treatment to individuals at risk. Figures recently published by Comhairle na nOspidéal indicate that a total of 87 additional consultant psychiatric posts have been approved since 1997.

The Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive is required to manage and deliver health and personal social services. In accordance with the legislation, the allocation of funding for suicide prevention and research is now a matter for the Health Service Executive. An additional €15 million revenue funding is being made available this year for the further development of mental health services including suicide prevention measures. Details of this allocation are being finalised by the Health Service Executive at the moment.

Since the publication of the report of the national task force on suicide in 1998, there has been a positive and committed response from both the statutory and voluntary sectors towards finding ways of tackling the tragic problem of suicide. The former health boards played a major role in coordinating efforts to help reduce the level of suicide and parasuicide here. Following the publication of the task force report, resource officers were appointed in all the former health board areas with specific responsibility for implementing the recommendations of the task force. The resource officers also engage in the promotion of positive mental health, the de-stigmatisation of suicide and provide information on suicide and parasuicide within their area. The health boards established the national suicide review group in 1999, in response to the recommendations of the task force report. Membership of this group includes experts in the areas of mental health, public health and research. Its main responsibilities are to review ongoing trends in suicide and parasuicide, to coordinate research into suicide and to make appropriate recommendations.

The annual report of the national suicide review group meets the requirement of the Health (Miscellaneous Provisions) Act 2001, that the Minister for Health and Children will report annually to this House on the measures taken to prevent suicides in the previous year. The report outlines the measures taken by health service providers and other agencies in the previous year to help prevent suicide and reduce the impact of suicidal behaviour. The aim of the report is to facilitate the sharing of information across the health and other sectors regarding suicide prevention projects and to provide accurate and current information on the patterns of death by suicide in Ireland. The report draws attention to the many initiatives being undertaken around the country in the area of suicide prevention.

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

The importance of exploring the causes and ways of dealing with suicide cannot be over emphasised. A suicide is a tragic and shattering occurrence that not only brings a life to an untimely end but has a devastating impact on family and friends. It is important to ensure that the public are informed about the high rates of suicide, especially among young people, as well as ways of preventing it. Preventing suicide means, in a corrective and constructive way, influencing a person's development and their own resources at different phases of life. An important aspect of suicide prevention is to promote self-esteem and self-confidence and to ensure that all young people develop personal and social skills. Children and young people need support in gaining control over their lives and coping with their problems. There are numerous regional initiatives currently being run by the Health Service Executive in conjunction with non-statutory organisations, which focus on mental health issues like stress management, depression, stigma reduction and suicide related matters. These are issues of paramount importance, which require further attention to ensure that positive mental health and the well-being of people is promoted.

Many of the recommendations of the task force require continuous development particularly in the area of training and in the development of services relating to suicide and suicide prevention. The work to date in this area has been reviewed in the context of the preparation of the new national strategy.

Best international practice currently 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 for action on suicide prevention will provide specific recommendations for action in this area.

I would like to touch on the issue of support for those who are bereaved by suicide. We need to do all we can to make it as easy as possible for those people who are bereaved by suicide to confront and deal with the situation so that they can learn to get on with their lives. People often do not want to ask for help as they may feel that this will be perceived as a sign of weakness. Looking for and expecting practical help is not a sign of weakness, it is confronting one's problems. Everyone can learn to cope with a tragic loss, but for some people this can be a long and difficult process. The encouragement and support provided by the various organisations that work with those who suffer the intense trauma of bereavement through the suicide of a loved one is of immense importance. This has been recognised by the Government through the provision of financial support for groups active in this area.

The National Suicide Research Foundation was founded in January 1995 by the late Dr. Michael Kelleher. It consists of a multi-disciplinary research team with contributions from a broad range of disciplines, including psychology, psychiatry and sociology. The primary aims of the foundation are to define the true extent of the problem of suicidal behaviour in Ireland, to identify and measure the factors which protect against suicidal behaviour and to develop strategies aimed at preventing suicidal behaviour. Much of the foundation's work to date has involved the monitoring of parasuicide.

International studies have found parasuicide to be one of the most significant risk factors associated with suicide. Those who engage in parasuicide are 20 times more likely to eventually kill themselves. Studies have shown that at least one third of all suicides have a history of parasuicide. The National Parasuicide Registry is a national system of population monitoring for the occurrence of parasuicide. This important project is undertaken by the National Suicide Research Foundation, with funding from the Department of Health and Children. As a result of the National Suicide Research Foundation's reputation for high quality research, it has been invited to participate in several important international studies, among them the WHO-Euro multi-centre study of parasuicide.

In December last year I launched the third annual report of the National Parasuicide Registry. The findings in this report indicate that approximately 8,800 individuals presented to hospital due to deliberate self-harm in 2003. Some of these people presented more than once, accounting for the total figure of 11,200 presentations in 2003. The report indicates that, as in 2002, drug overdosing was the most common method of self-harm, representing more than 78% of all parasuicide acts registered in 2003. While it was common for several drugs to be taken in the same act, it is interesting to note that minor tranquilisers, paracetamol and anti-depressants were involved in almost all these cases.

Legislation restricting the sale of medicines containing paracetamol was phased in following enactment in October 2001. The registry has shown that paracetamol-containing medicines were involved in almost the same proportion of intentional drug overdose acts in 2003 — 31% — as in 2002 — 30%. However, the report notes that further detailed analyses are required to assess the effects of the Irish legislation on the use of paracetamol in deliberate overdose acts.

In Ireland, the level of discussion and openness on mental health issues, including deliberate self-harm and suicide, has increased in recent years. This is a welcome development. However, we need to ensure that public discussion and media coverage of suicide and deliberate self-harm remain measured, well informed and sensitive to the needs and well-being of psychologically vulnerable and distressed individuals in our society. In particular, we need to continue to work as a society to create a culture and environment where people in psychological distress feel able to seek help from family, friends and health professionals.

I reiterate that the Government shares the public concern about the levels of suicide. The national strategy for action on suicide prevention, to be published later this year, will provide us with a targeted, measurable action plan for tackling this serious social problem in a coherent and integrated fashion, involving all relevant stakeholders. I assure the House that the Government will support the implementation of that action plan and will work with all concerned in achieving the desired results.

Minister of State at the Department of Health and Children (Mr. S. Power)

I thank my colleague, Deputy Tim O'Malley, for sharing his time, thereby providing me with the opportunity to speak on the important issues of suicide prevention and mental health promotion in Ireland.

Some time ago I received a copy of the book Echoes of Suicide. It is an excellent read for anybody with an interest in the subject and gives a great insight into the different aspects of suicide and the devastating effect it has on those left behind. I acknowledge the interest in the subject of Deputy Neville, who contributed to this book. He mentioned in his article that it was in the 1990s that we discussed the matter in detail for the first time in the Oireachtas.

I thank the Deputies who have contributed to this debate. There is broad agreement on the need for further development of suicide prevention initiatives and for further improvement in the delivery of our mental health services.

As we are all aware, suicide is a serious social problem. The report of the national task force on suicide, published in 1998, marked the completion of a detailed examination of the incidence of suicide and attempted suicide, and outlined a comprehensive strategy to reduce these in Ireland. The report outlined 86 areas where interventions should be targeted to reduce suicide levels. This highlights the complexity of the issue of suicide prevention. There are no simple solutions.

Taking action to prevent suicide must involve a combination of efforts across many aspects of life, such as improving health and educational services, but also addressing issues such as social exclusion and tackling poverty and inequalities. This action must involve people from a range of different organisations and professions with sustained effort over a long period of time.

With regard to improving health services, the task force report recommended that steps be taken to make mental health services more accessible to the public, particularly young people. Concern was expressed at the risk of suicide in older people. In this regard significant additional funding has been made available to further develop consultant-led child and adolescent psychiatry and psychiatry of later life services to assist in the early identification of suicidal behaviour and provide the necessary support and treatment to individuals at risk.

The level of capital funding which has been made available by the Department for the development of community based mental health facilities has increased significantly in recent years. Community services such as home nursing, day centres, family support, hostels and day hospitals will continue to be developed to make services more accessible to people who may be at risk.

The prevention of illness and the promotion of healthy living is the key to improving the quality of life of all Irish people. The promotion of positive mental health is a vital part of this process. Many people try to buy their way out of the unhappiness brought on by not having enough time to spend with families and friends or doing things they enjoy. Investing in one's mental well-being is as important as looking after one's physical health.

Statistics show that the ratio of male to female suicide is approximately 3:1. However, when we look at the figures from the point of view of depression, far more women suffer from depression than men. We must bring about a major change in this area. From the point of view of depression, if men or women have something like the flu they have no difficulty in seeking medical assistance, but if they suffer from severe depression males are much more reluctant to share those feelings with people much less seek medical help. A major change must take place.

Prevention of illness and promotion of healthy living is the key to improving the quality of life for all Irish people. They must be encouraged to invest in their mental health as much as in their physical health. In this regard, a key task of the health services is not only to treat mental illness but more importantly, using the principles of health promotion, to try and improve the mental health of the population. We are all aware of the pressures on young people such as bullying, emotional distress, addictions, peer pressure and exam pressure. We tend to think people are weak if they suffer from anxiety, depression, inability to cope, or have suicidal tendencies but it is widely acknowledged that one in four women and one in ten men will experience depression during their lifetime. Many are successful people, role models or celebrities whom we all know.

Promotion of positive mental health will also contribute significantly to combating the ignorance and stigma that surrounds mental illness. Better understanding of mental illness encourages people to access professional help sooner rather than later and this facilitates early recovery. Eventually, with time and education, the stigma associated with mental illness may fade further away, allowing sufferers and their families to participate fully in society.

The World Health Organisation's European section, in partnership with the European Union and the Council of Europe have adopted an action plan that will drive the policy agenda on mental health for the coming years. This action plan, signed by Ministers from 52 countries, including Ireland, sets out the commitments and responsibilities of both the WHO and Governments on this issue. It has 12 priority areas, with a strong public mental health focus, including the promotion of mental well-being, incorporation of mental health as a vital part of public health policy, reduction of stigma and discrimination, prevention of mental ill health and suicide and access to good primary health care. The national strategy for action on suicide prevention to which my ministerial colleague Deputy Tim O'Malley referred earlier and the forthcoming report of the expert group on mental health policy will take full account of this plan in its recommendations.

There is increasing awareness and concern among the public about good mental health. The National Health Promotion Strategy, 2000-05, in conjunction with the health strategy, Quality and Fairness - A Health System for You, views good mental health as being equally as important as physical health in the overall well-being of a person. Increasingly, good mental health is being recognised as a major challenge facing health services in the 21st century and my Department recognises the need for positive mental health promotion.

Mental health promotion is a broad concept, as it emphasises promotion of the psychological health and well-being of individuals, families and communities. At national level, priority is being given to education awareness and to promoting a better understanding among the public towards mental health. The stresses and pressures associated with every day life combine in many cases with difficulties in coping with significant life events such as bereavement, unemployment and interpersonal relationship problems. Almost every family in Ireland has had or will experience mental illness. Mental illness does not just affect the sufferer it also affects the person's family, friends, employer and colleagues. To experience a relative, friend or employee who suffers from a mental illness can be confusing and traumatic.

As my ministerial colleague, Deputy Tim O'Malley, stated, the expert group on mental health policy was established in 2003 to prepare a new national policy framework for the mental health services. In the course of its work, the expert group will consider all areas of mental health policy. It will pay particular attention to the areas of mental health promotion and the importance of raising public awareness around the issues of stigma reduction and suicide prevention. The group will make recommendations on these issues when it reports later this year.

As many of the activities in the area of suicide prevention relate to raising public awareness, responding to local needs and providing support in the aftermath of the occurrence of suicidal behaviour, the health services work closely with local voluntary and community groups in a number of ways. It is often the case that people are more comfortable engaging with these local groups. It is, therefore, essential that the statutory services work in partnership with the voluntary groups rather than developing competing services.

I emphasise the importance of voluntary organisations in supporting and promoting positive mental health among the population. My Department is fully committed to working with voluntary groups to promote positive mental health among the public. Close links between the mental health services and voluntary organisations are of the utmost importance and every health area has a development officer who liaises between the statutory health services and the local mental health associations to provide an integrated and comprehensive service. Numerous regional initiatives also focus on mental health issues like stress management, depression, stigma reduction and suicide-related matters.

My Department funds and supports in a variety of different ways the efforts of mental health organisations such as Mental Health Ireland, AWARE, Schizophrenia Ireland and GROW. I pay tribute to the voluntary organisations. Much of their work goes unnoticed. The nature of the work means it must be handled sensitively in private. Many people are giving their time voluntarily as we debate this issue to answer telephones, listen to people's problem and provide them with comfort. Very often, people only want a listening ear so that they can share a problem. It is important that people are prepared to give their time in an unselfish way to assist others who are less fortunate than they are.

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

The success and effectiveness of the policy to develop a comprehensive community-based mental health service is dependent on the active involvement of voluntary organisations concerned with the welfare of the mentally ill and those at risk of suicide and attempted suicide in the community.

I welcome the opportunity to emphasise the Government's commitment to encourage in any way it can, the activities of our many voluntary organisations both at national and local level. The commitment and dedication of independent, voluntary organisations is to be commended and their input is invaluable, not only in providing support for those most vulnerable in our society, but in heightening awareness of the difficulties encountered by those suffering from mental illness, depression or feeling unable to cope with everyday life.

I assure the House that the Government is committed to addressing the number of suicides. It is a worrying trend and we are fully committed to the further implementation of suicide prevention initiatives and the further development of our mental health services to prevent and reduce further tragic loss of life. I am delighted to have had the opportunity to contribute to the debate. I hope it will send a message to people who are feeling suicidal that suicide is not the avenue to take. While it might seem to people who are in a black hole that it is the only option open to them, unfortunately, suicide creates greater problems than it solves. Groups and organisations are willing to listen them, take their hands and lead them through the difficult time they face. There is always light at the end of the tunnel.

Mr. Neville

I welcome the opportunity to contribute on this sensitive and delicate subject. I commend the proposers for tabling the motion. The suicide epidemic is serious. The most recent statistic was that 444 people committed suicide in a year. The Ministers of State will accept that is a conservative figure and the true figure is higher. However, it is not as high as many people say. It is probably between 10% and 20% higher. Estimates have been made putting the figure at two and three times higher but that is not the case. There were 50 undetermined deaths in the same year. There are also suicides that cannot be recognised as such because of the circumstances of death. On a conservative estimate, 500 people take their lives annually. The road accident issue is important because it reflects the approach of the Government to road safety campaigns, which are under funded. A sum of €22 million is provided but on average only 10% is devoted to suicide prevention, according to the Minister of State.

Every suicide affects approximately ten people and 5,000 people are deeply traumatised by suicide each year. That is not an insignificant effect on the community as in a ten-year period more than 50,000 people will be directly and deeply traumatised by suicide. However, as the Minister of State hinted, we must put the issue in context. Each community, such as Wexford, refers to difficulties such as the contagion factor and there may be a cluster and copycats in many communities. Every community will state that it is a major crisis, and while that is true, we must remember that approximately 2% to 2.5% of deaths are from suicide — out of 30,000 deaths, 500 are from suicide. We must not take the issue out of proportion, but put it in the context of total deaths. Suicide is by far the most significant cause of death of young people. It is a crisis among young males — the ratio is 8:1. It is of urgent importance that the Government invests in suicide research and prevention.

I commend the President of Ireland, Mary McAleese, for her recent initiative in bringing together the organisations involved to discuss and co-ordinate their work. Most of these are non-governmental organisations. That had the effect of raising the profile of this concern and the interest of society and the media. The President has always been involved in this issue. One of the first actions she took after her election was to meet the Irish Association of Suicidology, of which I am a director, in its headquarters in Castlebar and spend several hours discussing this issue.

The Minister of State spoke on parasuicide figures which are of extreme concern — the latest figure shows that 11,200 people presented at accident and emergency units. We do not know the figures for those who presented at their GPs or who did not present for assistance. It is conservatively felt that the true figure for attempted suicide is approximately 60,000, which is a serious issue. It is significant that among young people more girls than boys attempt suicide, as the most recent figures show that approximately 57% are female and approximately 43% are male.

Urgent research into attempted suicide is necessary because, as the Minister of State rightly stated, approximately one third of people who committed suicide had previously attempted suicide. That is a significant risk factor. The work of the National Suicide Research Foundation has been commended and I also recognise it. Since it was founded by Dr. Michael Kelleher it has done excellent work and it has much expertise.

Psychiatric patients are ten times more likely to take their lives than the community average. In the four weeks after discharge from a psychiatric hospital, people are between 100 and 200 times more at risk of suicide. Psychiatric services are crucial in the prevention of suicide. Some 80% to 90% of the people who take their own lives suffer from a psychiatric or emotional condition requiring intervention. In young people, it is often undiagnosed depression and we must encourage, promote and educate them to recognise when they are in crisis, despair and trouble because sometimes they do not do so. They see it as failure, that life is against them or things are going wrong and they are unable to cope, but they are suffering from depression and intervention is needed.

It is important that we destigmatise psychiatric illness so that parents do not tell their children who have attempted suicide not to tell anyone about it, to keep it quiet and let nobody know, as I have seen. Parents still do that because of fear of stigma. We should be more open and accepting as one in four people will suffer psychiatric illness at some stage of their lives. To destigmatise psychiatric illness is a long and difficult road, and I will return to this issue later if time permits.

The reduction in the level of investment in our psychiatric services has been pointed out. In 1997, 13% of the total health budget was spent on psychiatric services and that is now down to6.9%. In 1960, up to 20% of the health budget was spent on psychiatric services. It was correct to reduce the numbers of people in psychiatric hospitals as many were there for social reasons, but we did not reinvest that money in community services. The figure should still be 20%, but the money should be put into community services. We do not have a community based psychiatric service and it is internationally recognised that to deal with psychiatric services in the community we need multi-disciplined psychiatric services. Investment is required to have a team of psychologists, psychotherapists, occupational therapists and other therapists in the community as a visible and immediate support to people in crisis.

The Minister of State mentioned an investment of €15 million in psychiatric services this year, but with all due respect — perhaps the Minister for Health and Children does not support him in such spending — that figure is derisory. It is less than what was spent on Punchestown last year. The total spent on electronic voting was €60 million, and a quarter of that has been spent on developing psychiatric services. The Minister of State often quotes that approximately €90 million has been spent since 1997, but that is derisory in the context of what is required. The Irish College of Psychiatry informed the Oireachtas Joint Committee on Health and Children that 70% of psychiatrists do not have a psychotherapist available to them and 30% do not have the support of an occupational therapist. We need investment in the professions.

The Minister of State also referred to the fact that there has been some expansion in psychiatric services and in the number of psychiatrists. We need quality psychiatrists but we also need support. It is recognised that we do not have sufficient numbers in the support disciplines. Psychiatrists have stated clearly that proper management and a range of therapy services are required.

The Minister of State mentioned that €17.5 million has been spent on suicide prevention since 1998, but €22 million is been spent on road accidents each year. The figure of €17.5 million represents less than €2 million per year. It is difficult to be critical in such a sensitive area, but how does one justify the spending of only €2 million each year on suicide prevention out of a total health service budget of €1 billion? We are informed that much of that €2 million is being invested in the psychiatric services. It is not directly invested in suicide prevention. I put down questions on that comparing it to the year when we got €600,000 — the Minister referred to €2.6 million or some such figure — and the reply was to the effect that the same activities took place in every health service, that there were no new initiatives and that there was no difference in the allocation. It was just a different amount of money. Much of that money has been hived off into the general psychiatric services, and the Minister is probably aware of that.

I have dealt with the medical aspect but there is a danger of "over-medicalising" the response to the rising levels of suicide and basing all our arguments on the need for additional personnel, resources, hospital places and early intervention services. Those are vital but we miss the point about the societal influences that engender suicidal thought and actions. Leadership in identifying and addressing those societal influences is the duty of the State and, by extension, the Government. We must focus on the wider sphere. The pressure points in Irish society must be taken into account when examining the human tragedy of suicide. It is also a societal tragedy.

There is merit in the argument that we must examine and debate the way the cultural and economic changes that have taken place in Ireland over the past decade may disorient people and detach them from traditional values and supports that may never have had any formal link with mental health or suicidal behaviour. Ultimately, influencing the way individuals react to changes in their social life will be central to the prevention of suicide. The changes in society have been extremely dramatic in the past two decades, and we have all lived through that. To quote George Bernard Shaw:

Youth, which is forgiven everything, forgives itself nothing.

Age, which is forgiven nothing, forgives itself everything.

Youths are very hard on themselves. Success is an increasingly important goal in society. In previous times the way we interacted with and supported each other was important but individual success has become important. There is a belief that anything can be achieved if we work hard and are smart and attractive enough but over-reliance on the individual as the arbiter of success or failure and reliance on the subjective judgment has clear implications. If I am in control of the elements that dictate success or failure, when successful the glory is mine but when there is failure it is my failure and I must take responsibility. Society no longer helps those who fail or those who perceive themselves as failures.

That is evident in the era of the Celtic tiger. Perhaps there are more margins to live on than previously and the core is getting weaker. The uncertainties of life are increasing. Who we are? The core of life and being is dictated by what we can own and what we can buy. One is only as good as what one can own and the brands one wears. In a world where there are fewer certainties, young people are faced with choices that would have been unthinkable in previous generations. At the same time many of the cultural icons of the past are debased in the eyes of the young, such as the church and our own political establishment.

Are adolescents more vulnerable to perceived failure today or is it just that they are less likely to ask for help? The Exploring Masculinity programme of 2000 clearly recognised that the cultural, social and psychological impacts of change demand careful attention and analysis. These are important factors in reducing suicide yet the rate has continued to increase. Are we making best use of programmes such as these? Are we supporting teachers who deal with these issues or are we losing it all in the points race and the pressure to succeed academically at all costs? In that respect I hope we will hear tomorrow from the Minister for Education and Science and the Minister for the Environment, Heritage and Local Government, who have key roles to play in suicide prevention. Suicide prevention is not just a health issue, it is an educational and an environmental issue.

Research, understanding and analysis of the pressures on young people are vital if we are to address the epidemic of suicide. That must not be shirked by the Minister or the Government but run parallel to the resourcing and development of these services. We must regard suicide prevention as a multi-dimensional area that requires promotion and investment.

The relationship between alcohol consumption and suicidal behaviour has been well established by robust research internationally. There is a clear association between the per capita consumption of alcohol and the suicide rate in any country. The higher the level of consumption of alcohol, the higher the suicide rate. Alcohol consumption levels can explain the difference in suicide rates between countries and between different areas in each country.

Alcohol impacts on suicide rates in a number of ways. Alcohol consumption leads to depression, which is a major factor in suicide and suicidal behaviour. In addition, depressed persons frequently turn to alcohol in the mistaken belief it will improve their mood. In many people alcohol has a biphacic effect, initially causing a feeling of well-being but soon to be followed by dysphoria. Traditionally, the lifetime risk for suicide in alcoholism is thought to be between 3% and 7% and the risk for major depressive illness is approximately 15%, although the latter figure is now believed to be somewhat over-estimated. The core morbidity of depression on alcohol abuse greatly increases the risk of suicide and suicidal behaviour.

A third factor is that alcohol impairs judgment, reduces inhibition, increases risk-taking behaviour and may result in impulsive suicide and suicidal behaviour, most frequently in the young. Alcohol causes cognitive constriction and reduces problem-solving abilities. There is a direct relationship between the increase in alcohol consumption in Irish society and the levels of suicide. A campaign about alcoholism is very important in respect of many of the societal difficulties we are facing, including violence and so on, but alcoholism also has an impact in terms of psychiatric illness, suicide and related matters.

The National Suicide Review Group was set up in 1998 following the report of the national task force on suicide. The job of the review group was to oversee the implementation of the recommendations of the national task force on suicide. The Minister's amendment contains six of the 86 recommendations of the national task force on suicide that have been implemented. That is a fair representation of the position.

Seven years after the national review group was to oversee the implementation of the recommendations, a national strategy group was set up which was to report this April. Three weeks ago, in his reply to my question on what was happening in terms of the implementation of those recommendations, the Minister said he was awaiting the report of the strategy group. There are 86 recommendations. It is extremely frustrating that we have had mental health reports and now a strategy group report, which will have to be examined and on which there will have to be consultation. When will we see action in this area?

I am a director of the Irish Association of Suicidology. We have an excellent board made up of three professors of psychiatry, two consultant psychiatrists, including a former chairman of the college of psychiatry, a bereaved person, a lecturer in sociology, a counsellor for the bereaved, a member of the Samaritans and a member of the national task force on suicide. It is a diverse and very experienced 32-county group.

The Minister spoke about his contribution to our organisation. He gave us €75,000, for which we are extremely thankful. We asked the Minister of State for a meeting this year but he failed to meet us to ask about our level of experience and the ways we could contribute. I was reluctant to raise the matter in the House previously as we wished to progress matters otherwise, but we are very disappointed.

Debate adjourned.