Deputy Connaughton is sharing time with Deputies Mulherin and Kyne.
Suicide Prevention: Statements (Resumed)
I thank the Ceann Comhairle for the opportunity to make a statement on suicide prevention. There simply is not enough time in the five minutes allowed to speakers to go over all the specifics and complexity of this immense issue.
Suicide is an area of great interest to me, as it is to many others in this Chamber who will know of someone or a friend of someone who has committed suicide. Unfortunately, a friend of mine with whom I lived in college and with whom I studied for four years took his own life only 12 months ago. All that his family and friends are left with are questions. Could anything have been done? Did they miss something and did they ever ask him how things were going? The question can be asked: is this story sad? It is, and, unfortunately, it is becoming all too familiar. I fear that we are beginning to treat suicide as merely another problem in the country. Trying to find a solution to such a massive problem is not easy and we should not think it is. The time has come for meaningful effort to solve this problem.
In recent years, I have noted that the number of suicides here is often compared to the number of lives lost on the roads. Both are tragic occurrences, both destroy families and communities, and yet the way we react to each is very different. If someone is killed in a road accident, the story will almost certainly be carried that evening on the news, the area will be sealed off and there will be a detailed investigation into why the accident happened and how we can make the scene of the accident saver to ensure an accident does not happen again. However, when a suicide happens, there is an outpouring of grief over a few days and weeks, and then the commotion dies down. The family, friends and community are left to pick up the pieces and the total number of suicides has gone up by one. Instead of going on about statistics and figures over the next few minutes, I would rather concentrate on the ways in which we may be able to start to solve this terrible problem.
At this point I compliment and thank the groups and individuals who continue to work on this area, many in a voluntary capacity and on extremely low funding, without whose help and support this problem would probably be a great deal worse.
Before being elected to this Dáil, I was a youth worker for four years with Foróige, which is the national youth organisation. In the role, I worked with young people from many different backgrounds, but all of whom faced the same challenges. Youth mental health was a challenge that came up repeatedly. This also included the areas of self-harm and potential suicide.
In that time, I became aware of two excellent services that I believe are going a long way to help solve the issues of youth mental ill health. The first is the big brother big sister programme with is a mentoring programme which partners a young person with a volunteer for up to a year. This opportunity allows the young person to meet once a week with someone in a friendly and safe environment. It allows that young person an opportunity to bring up any issues he or she may be going through, express himself or herself to someone from outside the family, but to enjoy himself or herself. This programme is becoming popular, but, more importantly, has a proven track record in helping build the confidence of a young person and his or her self-esteem.
Jigsaw is a service which was set up in Galway in 2008 and is a collaboration between Headstrong, the HSE and Mental Health Ireland. It is aimed at prevention and trying to alleviate the many issues before they become problems. It is run in a professional manner with excellent staff. This service was established when it became obvious that youth mental health has needed its own department for many years. It allows people to drop in for a chat and when they arrive, they are met by friendly staff who are equipped to deal with whatever issues they may have. The Jigsaw service is about listening. It is about find out where a young person is at, but, more importantly, to where he or she wants to go. It understands the concerns of young people in areas such as school or college; work or unemployment; family, friends and other relationships; sexuality and sexual activity; and maybe drugs and alcohol abuse. The areas I have described cover the areas of youth mental health but, unfortunately, as we all know, mental health issues affect persons of all ages and backgrounds. I welcome the developments of late that have brought this area away from the old style of thinking and that, for instance, better premises are being built that correctly highlight the importance of this problem, but also that someone who suffers from mental health issues is seen not as a burden on the State, rather as someone who is simply looking for help.
Finding a solution to this problem will not be easy for many reasons. It is complex and difficult. Sitting on our hands waiting for another report will not solve the problem. We must use every possible tool at our disposal to help solve it. I believe in a community-based approach, involving local community groups, youth groups, the GAA and any kind of youth club, to help combat the problem of suicide. This country has the people who have the skills and capacity to help in this area, but they need help to organise properly. They also need funding to make them effective. The one thing parties from all sides of the House can do is show that the Thirty-First Dáil is serious about helping to combat the problem of suicide in our communities.
There is a terrible sense of isolation in rural Ireland, especially in Connacht, and this is reflected in the high rates of people taking there own lives, which is now compounded by the added stress and despair caused by the recession.
Since prevention is the title and point of this discussion, I commend the work and initiative of self-help groups addressing the question of social inclusion and I urge the Minister to prioritise and invest in the formation of more such groups, which create networks of support for vulnerable individuals. I am familiar with the work of such groups in my town, such as Ballina Migrant Health Forum and The Dolmen Clubhouse, which seek to bridge the gap between the vulnerable and professionals. The emphasis is on getting those affected to appropriate professional help where necessary and creating a platform for various care professionals to help train and inform local members.
I congratulate all those proactive groups around the country, many of which are born from the loss of a loved one where family and friends choose to make a stand in combating this malaise which does not discriminate across social classes. All is not lost. Aside from professional views of suicide, there is always personal loss. It takes many deaths before we become aware of what death really means. Someone said that while it ends a life, it does not destroy the relationship we had with that life — a father remains a father and a brother remains a brother, and the same applies to a sister, a friend, a lover and so on. They take something of us from the earth. So the questions as to why and the multitude of reasons given by professionals who try to make sense of the psychology of it, and by priests on the spirituality underpinning the dreadful decision that brings an individual to this very lonely and dark place, for this is an act that invariably takes place in secret — perhaps we all know this place to a certain degree — helps to comfort those left behind but it never diminishes the loss. To those left behind, we absolve them from guilt; to those contemplating it, we say, "Reach out and talk to someone". For my own part, my office will always welcome anyone seeking help.
I am grateful to be afforded the opportunity to address the House on such an important issue. There is not a Member of this House who has not been affected by suicide or other mental health issues.
Since the House discussed this issue two weeks ago, 25 more people in Ireland have taken their own lives. This is the statistical rate at which people in Ireland are succumbing to the scourge of suicide and is based on the 2009 figure, which showed that 527 people died by suicide. That figure was a staggering 25% increase on that of the previous year for the number of people who died by suicide, and yet it was only the "recorded" figure. Experts believe the actual suicide figure is much higher. It is quite clear that the recession and the economic difficulties are having a direct negative impact.
Only today 1life, the suicide helpline, revealed that it received more than 700 calls over the Easter week and that half of these were callers presenting with serious suicidal thoughts. As shocking as the statistics are, they hide the fact that each case of suicide reverberates throughout a community where families, neighbours, colleagues and friends must endure the horrendous pain the loss of a loved-one in this manner brings. Of all the questions with which family and friends are left, the primary ones are: why? Why did he or she do it, and why did I not see it coming? However, there are no easy answers.
Undoubtedly, the financial crisis and its effects have played a part. Unemployment, unpaid bills and unmanageable debts all place enormous strain and pressure on people, with, in some cases, tragic and fatal consequences. Loneliness and isolation are also factors which affect a lot of older citizens, particularly in more rural and remote locations.
One figure which particularly concerns me is the number of our young people, particularly young men, who take their own lives and again, we must ask why. Bullying, discrimination and abuse are just some of the reasons which drive our young people to self-harm or to take their own lives. Teenagers have many pressures in their lives, such as exam pressure, career worries, peer pressure to fit in or to rebel and issues of how they think they appear to others. It is well documented that some people are more vulnerable than others, such as gay and lesbian people many of whom have to contend with discrimination, prejudice and abuse, both mental and physical, in our towns, villages and rural communities.
In the United States, it was a succession of several teen suicides among lesbian and gay school students last year which prompted the "It Gets Better" campaign to reach out to gay and lesbian young people via YouTube and social networking and assured them they are neither alone nor without support. Such a campaign highlights why the Civil Partnership Act, as incomplete at it is, is extraordinarily important in sending out a positive message to Ireland's young gay and lesbian people. I would like to take this opportunity to commend GLEN, the Gay and Lesbian Equality Network, and other organisations whose efforts and work were so crucial in securing this significant step towards full equality.
We are very fortunate to have a strong network of community and voluntary organisations in Ireland which provide support and comfort to people suffering as well as focus and direction for Government and policy-makers. Numerous organisations work in the area of suicide prevention and mental health. Some, such as the National Office for Suicide Prevention and Headstrong, the National Centre for Youth Mental Health, are statutory organisations. Many more are non-governmental organisations or community groups such as Aware, Console, Shine and 3TS.
In my constituency of Galway West, as Deputy Connaughton stated Jigsaw is a wonderful organisation which is a support service for young people. It is a partnership between Headstrong, the HSE and Mental Health Ireland which has been providing support and information via its drop-in service in Galway City since 2008 and recently moved to larger premises. It is imperative that every community in Ireland has access to such a service which, l am in no doubt, can save lives.
Given the constraints on funding, it is more important than ever that we work together to combat the problem of suicide. I urge greater co-operation, and more sharing of resources and tasks to achieve what are common goals. As a people, we must ask ourselves what is the point of fixing the banks and the economy if so many of our people are suffering. We must prioritise the needs of our people. We must all remember that it costs absolutely nothing to be supportive, to listen, to be compassionate and to be there for family and friends who are suffering.
The old Irish phrase, ar scáth a chéile a mhaireann na daoine, is as relevant today as it ever has been, and with that in mind, I will take this opportunity to ask the Minister for Health and Children to ensure that mental health funding be protected and directed towards primary mental health care where it is most needed, which is in the community.
I am glad of the opportunity to say a few words on this most important of subjects. It has come into public focus and debate in a much sharper way in recent years for very obvious reasons. Suicide is not someone else's problem, it is everybody's problem. An individual dies but the whole community suffers. A loss of life affects all strands of the community. Effective action is needed to approach the stigma of suicide and, in turn, help people become more aware of suicide and its impact.
In 2009, there were 527 deaths by suicide, and 527 families and communities all felt the huge loss which suicide brought to the area. This is a major issue which needs to be dealt with. The more support networks we have, the better the chance for people to talk about how they are feeling and the more lives will be saved.
The HSE National Office for Suicide Prevention is responsible for overseeing the implementation of Reach Out: A National Strategy for Action on Suicide Prevention 2005-2014. The main vision of Reach Out is of a society where life is valued across all age groups, where the young learn from and are strengthened by the experience of others and the needs of those going through a hard time are met in a caring way. Reach Out calls for a multi-sectoral approach to the prevention of suicidal behaviour, in order to foster co-operation between health,education, community, voluntary and private sector agencies.
In the most recent budget an additional €1 million was provided for the programme for 2011 which will enable the office to build on initiatives to date and bring momentum and new impetus to their activities. The areas to be targeted are developing both the number and range of training and awareness programmes, including the ASIST programme, to reach the most vulnerable in our communities; improving and standardising the response to deliberate self-harm presentations; developing the capacity of primary care to respond to suicidal behaviour and considering new models of response; and ensuring that helpline supports for those in emotional distress are co-ordinated and widely publicised. In each of these four areas an emphasis will be placed on the most vulnerable groups identified in Reach Out and more recent research. The details of these initiatives will be discussed and agreed with the office.
An initiative established by the former Minister of State, John Moloney, is See Change, run in co-ordination with the national stigma reduction campaign. The aims of See Change are to reduce the stigma associated with mental health problems and challenge discrimination in society; create an environment where people are more open and positive in their attitudes and behaviour towards mental health; promote a greater understanding and acceptance of and support for people with mental health problems; and empower individual people with experience of mental health problems to gain equality, respect and rights.
The total funding for mental health in 2010 was approximately €970 million. Innovation funding of €3 million was provide to Genio through the HSE to support the transition from institutional to person-centred care. A further €5 million will be provided for Jigsaw, an innovative community-based support service for young people.
When in government, Fianna Fáil established the office for mental health and disability. Special consideration was given in the budget to the mental health and disability sectors, which will ensure a maximum reduction of only 1.8% in the 2011 allocation for the sectors. The relatively lower reduction, compared to that in other health sectors, was an indication of the priority which the then Minister for State, John Moloney, afforded to this most important area.
It goes without saying that in areas of economic or health problems, research programmes are vital to finding longer-term solutions to many of the issues, and those affected have varying levels of mental health issues. The Minister of State will bear in mind the importance and necessity of ensuring co-ordination at European level between research programmes here and those under way in other member states. Perhaps such co-ordination and availability of information will give hope to those who live night and day with mental health issues and the threat and worry of suicide that a solution may be found, if not in all cases at least in a percentage of them. At this point in time, we could ask whether stem cell research holds out any prospect of better days ahead for the families unfortunately affected and afflicted by mental health issues and the threat of suicide.
Ba mhaith liom buíochas a ghabháil le muintir Phort Láirge as an tacaíocht a fuair mé i rith an toghcháin. I have not had an opportunity to thank the people of Waterford as my maiden speech was on the very important matter of the nomination of the Taoiseach, and I would like to take this opportunity to thank them for their support.
I welcome this opportunity to speak on this matter and it is with mixed emotions that I do so. Suicide is every family's worst nightmare and traditionally it is rarely discussed. The public attitude towards mental health and suicide must change if we are to be able to provide for those who need help and for people to be able to accept help. One in four people in Ireland have a mental health difficulty, which is an alarming statistic, making it an issue of national importance. Since my involvement with Labour Youth and as I moved through the ranks in Dáil na nÓg, I have always spoken out on this issue. I have attempted to shine a light on an issue which has been allowed to stay hidden in the shadows for far too long. I saw first-hand in my work as a child protection social worker and later in my work with Barnardos how suicide and mental health issues affect not only an individual but entire families, particularly children. It is welcome that €35 million has been ring-fenced in the health budget to develop community mental health teams and services, such as psychologists and counsellors in primary care teams throughout the country.
The programme for Government states: "We will endeavour to end the practice of placing children and adolescents in adult psychiatric wards." I have been outspoken on this issue for several years. There are no services for children between the ages of 16 and 18 because they fall through the net of services for children and adults. This is a barbaric practice which needs to be addressed immediately. The problems caused by the admission of young people to adult mental health wards were such that a report was commissioned by the Mental Health Commission in 2010 to investigate the inappropriate care of young people aged between 16 to 18 and examine the factors contributing to their admission to adult wards. Alarmingly, in the first six months of 2010 the young people who were admitted to adult approved centres included 11 children aged 15 or younger. In some cases, the children concerned did not even have mental health problems and would have been more appropriately cared for by social services. A young person should only in exceptional circumstances be considered for admission to an adult psychiatric ward. The report identified confusion within the psychiatric community in regard to who is best placed to look after young people with mental health problems, particularly those aged 16 and 17 years.
The State's mental health watchdog has expressed concern about the occupation of scarce beds in child and adult mental health wards by patients who do not have mental health disorders. What is happening at present is akin to the practice of the past whereby people were inappropriately placed in institutions. This practice needs to be discontinued. Young people without diagnosable mental health disorders or with social problems have reportedly been admitted to child and adolescent units simply because there is nowhere else for them to go. This is a terrible indictment of our system but I am heartened by the new Minister for Health and Children and hope he will work in partnership with the Minister for State at the Department of Health and Children, Deputy Kathleen Lynch, to address this issue as a matter of urgency.
The children who are admitted to psychiatric wards are among the most vulnerable people in our society. Greater investment is needed in community resources if we are to address this problem. We have to invest in the mental health of our young people and think outside the box in terms of acting to prevent these problems from arising. The problem will not be solved by individual Ministers because it requires co-operation from the Departments of Health and Children, Education and Skills and Community, Rural and Gaeltacht Affairs. By pooling their resources, they can ensure the social and emotional needs of our young people are put to the fore over the lifetime of this Government.
Many of the speakers during this debate have focused their remarks on adults but if we are to prevent suicide we need to be proactive in investing in children from the age of three. A study commissioned in America in the 1970s, the Perry preschool project, invested in young children between the age of three and five and followed them until they were in their 40s to find out how the investment paid off. The quantitative and qualitative evidence from that study has categorically shown that the investments made an improvement in the lives of the individuals concerned. Every euro invested in young children provided a saving of €16 later on. Social scientists in America often base their work on the objective of keeping people out of prison and in this House we have been discussing community service orders over the past several weeks. If we invest in quality preschool programmes that address the social and emotional development needs of young children alongside the services required to address their concerns as they grow up, they will be given the language they need to seek help and we will no longer have to deal with an unfortunate group of people who on reaching adulthood find themselves in such despair that they chose to take their lives.
I have the courage of my convictions on this issue and the statistics are available to support my argument. We have an opportunity to think differently about mental health. I am keenly aware from my work in the community and voluntary sector over the past ten years that we need to get the most that we can out of the money we are given. I appeal to all the Ministers involved in this area to push for quality and evidence based programmes that deliver happier and healthier outcomes for our children and young people. If we invest in the happiness and health of young people, they become more productive workers and people. The US study indicated that people who received preschool investment went on to be more productive members of their communities, had better relationships in adulthood and were less likely to engage in anti-social behaviour and crime. If by investing early we can prevent young people from reaching a dark place, it is a no-brainer that we should endeavour to do so.
Given that I also worked in mental health services during my time in social services, it would be remiss of me not to state that some of our most committed people work in this area. People who have mental health difficulties deserve to be treated in palaces and given the best of services. They should not be locked away in the dungeons I visited while I worked in mental health services. We need to open the doors of community services to our people.
I ask the Ministers concerned to think outside the box by investing in our young children and ensuring they grow up to be happy, capable and productive members of society.
I welcome the opportunity to speak on suicide prevention. Members on all sides of the House made many excellent contributions on the issue and I will endeavour not to repeat points which were previously raised. I will focus on younger children, how this society is failing to protect their mental health and what we must change to ensure we intervene at the earliest opportunity to protect the most vulnerable.
This country has returned to the days of high unemployment, mass emigration and social despair. The most tragic by-product is the increasing rate of suicide. This tragedy is not confined to any particular class or corner of the island but is affecting rich and poor, old and young, male and female. In 2009, the rate of people taking their own lives increased by a startling 24%. These are people who see no way out of the despair they feel, whether because of negative equity, addiction issues, unemployment, discrimination or depression. They took their lives because they could see no hope for their future.
We can address this national emergency by creating a better society that provides people with the best of services, education, social protection and health care. However, what about the children who are the victims of circumstances beyond their control and are growing up in households ridden by despair? They are fragile, impressionable, easily corruptible and can be permanently damaged by the environment in which they live. What interventions are available to us to care for delicate minds or childhoods filled with nights in which heated words are exchanged by financially crucified adults so close to the brink that they see no way out?
What about children who live in areas where the only viable economic activity is the drugs trade? Older siblings get sucked into a hopeless spiral of street corner loitering and low-level anti-social behaviour and often on to full-scale membership of violent gangs, incentivised by easy money, street credibility and a perverse sense of empowerment. Communities such as these are rarely understood, chronically under resourced and frequently stigmatised with outlandish generalisations by media outlets. If we accept that it takes a village to raise a child, is it any wonder that children of such a village will grow up with a poor sense of self-esteem, negative self-image and feel totally disempowered and disconnected from the mainstream of Irish society?
Our education system is charged with the responsibility of identifying, diagnosing and treating children who display a variety of emotional behaviour disorders. As currently constituted, the system outrageously misplaces resources in a manner that inevitably benefits children from middle-income backgrounds and not those more in need. Our education supports for those most in need of help are misplaced and poorly structured.
This happens in two main ways. First, the allocation of resource teachers is based on the general allocation model introduced by the previous Government, which allocates teachers on the basis of the school enrolment number and not on the basis of need. As a result, children who attend schools with a smaller enrolment do not receive the same level of support irrespective of the level of need. This is a crude, blunt and indeed cruel arrangement that must be amended to ensure that our most vulnerable children are supported.
Second, in the allocation of resource hours sanctioned by the special educational needs organiser, SENO, schools with access to private psychological or clinical assessments receive more resource hours. Those who depend solely on the under-resourced National Educational Psychological Service, NEPS, receive fewer. School leaders, teachers and school principals are left in an almost impossible position when attempting to provide supports for children who present with specialised care needs. They have to juggle referral forms and representations to the National Educational Welfare Board, NEWB, NEPS, agencies such as the Mater Child Guidance Clinic, the relevant social worker, the home school community liaison service and, if they are fortunate, supportive parents. I have been the principal on the telephone to agencies being told that the child is not suicidal and that I am wasting my time.
If a parent or parents prove obstructive or difficult, the school is powerless to proceed. This is just one more glaring example of why our children's rights referendum is so sorely needed. Our children now live in a society that is at breaking point, in a culture that shortens childhood to maximise corporate profit, in a country that purports to cherish every child equally, but only punishes our vulnerable rather than liberating them. We must liberate our children from the dark clouds that hang over their minds. We must empower them with the ability to express their feelings, to understand their circumstances and encourage them to believe that they truly are more powerful than they could ever contemplate.
We cannot fail them at the earliest stage, the stage when they depend on us the most. The risk of internalising the hurt permanently is too great, and the potential of becoming another suicide statistic too real.
I propose to share time with Deputy Clare Daly. Sometimes we are damned with statistics when they are put in front of us but statistics are important on the serious issue of the severity of suicide in Ireland. The latest statistics show we have the highest recorded rate in our history. This amounted to 527 deaths in 2009, representing an increase of over 4%. Anecdotal evidence suggests the figures in Ireland continue to rise. Some 127 deaths from suicide were registered with the CSO in the second quarter of 2010 and the increase is mainly in men in the middle age category. Many experts throughout Europe have said there is a sharp rise in people taking their own lives and self-harming over the past year and that this is linked to the recession. The term recession depression has emerged. International research indicates that during an economic downturn, suicide numbers increase markedly. Since the economic crisis occurred in Ireland, there is a clear spike in deaths among people between 25 and 44 years of age. Social welfare cuts, cuts to invalidity pensions and disability payments hit the vulnerable sections of society disproportionately. The incidence of suicide is at its highest in these sections. As mayor of Waterford, I addressed a conference in Waterford on taking the stigma out of mental health.
The statistics were startling, showing that between 300,000 and 400,000 people were presenting with problems, from mild to medium to severe depression and many of those presenting to a general practitioner felt suicidal at one stage. In Ireland, suicide has become the principal cause of death of men between the age of 15 and 34. Ireland now has the fourth highest rate of suicide among young men in the EU, behind Lithuania, Finland and Estonia.
Successive Governments have displayed a distinct lack of urgency in dealing with this problem. The budget in 2010 was €5.6 million, which is a drop in the ocean compared to what is needed. The HSE moratorium on recruitment had a devastating impact on an overstretched health service. Over 700 members of staff left mental health care services from 2009 and only 65 were replaced. That had a major impact on the suicide rate. Incredibly, more lives are lost to suicide than to road tragedies. However, the budget to reduce road traffic deaths is almost eight times the budget dealing with suicide.
The Government and Opposition parties should examine a case study. Scotland had one of the highest rates of suicide but has managed to reduce significantly the number of people taking their own lives by spending €25 million on preventative services. This shows that resources and allocating money into prevention can reduce the number of people taking their lives. Scotland has been internationally recognised for its "Choose Life" programme and the education and awareness programme called "see me". It is internationally recognised that Scotland was able to reduce a high rate of suicide. Statistics from Scotland show that 600 people took their lives last year, of whom 450 were men. This was reduced by 87, which is almost a quarter. This is attributed to the resources and services available. Officers trained to deal with suicide intervention have been employed in every local authority in Scotland. They reduced the suicide rate and the number of people presenting themselves with mental health problems. This has reduced the amount spent on health and mental health services and the prevention of suicide in Scotland. The budget can be reduced because the death rate and the number of people presenting with mental health problems is reducing.
The causes of suicide are multifaceted and complex. Some argue it is a fundamental human right to take one's own life. That is a worthwhile debate. However, for most people, suicide is not chosen; it happens when pain exceeds resources for coping with pain. These are not my words, although I would like them to have been. This is a matter of resources. I urge the Government to examine the case history of Scotland. A small amount of money out of a substantial budget has helped to reduce the suicide rate. I passionately urge the Government to deal with this point. Let us consider the number of people dying from suicide compared to road accidents, given the amount of money spent. It is only right that we should put substantial amounts of money towards reducing the number of deaths on our roads but if we put half the amount of money into suicide prevention, going by the Scottish example, we could at least reduce the number of deaths by one third.
I want to make some brief remarks. Like other Deputies I, too, appreciate the opportunity to discuss this important issue. It is appropriate that the House has spent so much time on it because a discussion must take place in society and awareness be raised about these issues. That is important, but the discussion must be purposeful and have an outcome. In that sense, regarding some of the remarks made by some of the Government spokespersons in particular, cognisance should be taken of the fact that they are the Deputies who are in power. It is their Government that has the ability to implement measures which can make the difference in terms of dealing with some of these issues which have blighted so many lives and which are a growing problem in the country.
The point was made during the debate about the way road traffic deaths are treated and the funding that is allocated to that area compared to the lack of funding for suicide prevention, given that suicide results in many more deaths than those from road traffic accidents. That is true. It is the case that advice and investment in trying to reduce road traffic accidents has developed here, and we must do something similar in regard to suicide.
Removing the stigma is important. There is a value even in discussing the issues. That is important, but it must be linked to the overall position of funding from a number of aspects. Mental health is an area that must be invested in and the question of overall funding must be dealt with because it is inadequate. There must be implementation of A Vision for Change. There must be a development of community-based services but to be honest, we must not laud an expenditure of €35 million as being enough. It is not nearly enough. It is hardly five euro per person. We need resources to back up the services that are necessary but the reality is that we are moving in the opposite direction. The implementation of severe cutbacks in health, education, social welfare, public sector recruitment and so on will succeed in having a negative impact on dealing with the current suicide problems. It is not good enough to just talk about the problem. We must implement measures that assist in dealing with it.
It is obvious that suicide is a growing problem in Ireland. That the only dedicated suicide helpline does not get any funding is a poor indication of our approach. That organisation takes thousands of calls every month. On average, it takes 100 calls a day. It is an indication of the scale of desperation people are experiencing that 100 people make the call. How many more hundreds are thinking about it but do not know that the resources are available or that they can access them? Promoting these helplines and the resources available, albeit limited, is important.
There is no doubt that the rising suicide figures are linked to the economic downturn and the devastation being experienced by many people throughout this country. As Deputy Halligan said, this is not just a problem of mental health. For many people suicide is a rational decision on the part of the people who make it. The scale of their problems, be it some personal catastrophe or a severe economic crisis which they see no way out of, leads them to believe that is the only way out for them.
The cases of suicide among taxi drivers was well highlighted by the taxi drivers' unions. Many taxi drivers took their own lives because economically they were pauperised as a result of decisions that were made including the freeing up of licences. These people were on the road from morning to evening without being able to eke out any sort of a wage for themselves or their families. The problem of their mortgages was getting on top of them, and if they give back their taxi plate they are not entitled to any social welfare payment because they were self-employed. That is severe pressure to put on anybody's shoulder. They cannot see a way out because we have not given them a way out, and economic policies have not been put in place which deliver for those people a standard of living that enables them to keep a roof over their heads and provide for their families. Unless we address these issues we will have a continuation of the problems.
The key problem is for the people left behind after suicide and the questions people ask such as "What could I have done? Could I have intervened if I had known the severity of the problems? Was there something I could have done that would have made a difference in terms of the decision the person made to take their own life?". We must avoid the situation where those questions have to be asked. Everybody needs to know where they can access the support that is available. The problem is that there is not enough support available and people do not know about the support that is available. If this debate assists in that regard, it is welcome but it is not enough on its own. There must be a massive investment in education and in personal development for our young people in the existing health services.
Crucially, this debate is linked to the overall economic position facing ordinary people because as a result of the policies being pursued and the fact that taxpayers' money is being poured in to bail out the banks and so on, our services are being cut and people's livelihoods being devastated. Unless we invest in people's social, personal and overall economic well-being, we will be returning to these issues and finding that the position has not altered at all, rather worsened.
I wish to share time with Deputies O'Donovan and Doherty.
There are five minutes available per Deputy.
I take this opportunity to congratulate the Minister of State, Deputy Kathleen Lynch, on her appointment. I have not had an opportunity to do so to date. I welcome the opportunity to speak in this important debate on proposals to tackle suicide levels within our society. I take great encouragement from the scheduling of this debate which shows the intention of those on all sides of this House to prioritise mental health. I am encouraged that we are talking about suicide in terms of tackling the problem as that is exactly what we must set about doing.
I agree wholeheartedly with Deputy Clare Daly on this issue. It is not enough for us to just speak about the issue today, tick a box and say, "job done" and not return to it. I do not believe anyone on the Government side and, I presume, on the Opposition side of the House looks at it like that. We will certainly not shirk our responsibility on it.
We cannot have a discussion on suicide without a discussion on our mental health services as a whole and the way those services are provided in a community as well as a clinical setting. I recently met an impressive campaigner, Caroline McGuigan, who is the chief executive officer of Suicide or Survive, a charity based in Arklow, County Wicklow, in my constituency. She had an interesting and simple way of comparing how we think about mental health to the way we consider dental care. She asked three simple, mundane questions. Where do we first learn about dental care? The answer was that we learn about it in our schools. Do we brush our teeth every day? One would hope the answer is, "Of course". If something happens to our dental health such as a toothache or needing a filling, are we embarrassed? Again, the answer is "No". These are the issues children learn about in regard to their dental health in our schools on an almost daily basis. We teach them that it is something that must be looked after every day. We give them the tools to look after their dental health and they know that if there is a problem or something that needs attention, it is nothing to be embarrassed about. We must give our children from the youngest age possible in our school system the same tools to deal with their mental health. We must get to the point where school children see mental health care as part of their development and overall schooling.
I want to put a few points to the Minister of State for her consideration in regard to the way we will serve the mental health needs of our community. As I know she will be aware, we must be sure that the involvement of service users is not just tokenistic. It must be a vital part of the planning process, and anyone I talk to involved in suicide prevention or mental health groups is very keen on this idea. Those at the coalface of our mental heath service with direct and personal knowledge of its impacts, strengths and weaknesses must be recognised as key stakeholders. In that regard I am encouraged by the work of the See Change initiative and the support given to this group by the previous Minister of State, John Moloney, and now by the Minister of State, Deputy Lynch.
We need transparency of funding in our mental health services. Having served as the chairperson of my local Health Service Executive regional health forum, I am only too aware of the current difficulties in this regard. It is imperative that we are able to work out how much this State spends on promoting positive mental health each year. This is a huge problem and at a time when we see the HSE board being asked to stand down we must try to clear these lines of miscommunication and get to the bottom of how much this State allocates to mental health on an annual basis. I implore the Minister of State to contact the HSE and insist that we are provided with a greater breakdown of the way mental health services are funded each year.
In any case, it is clear that the annual budget for mental health services can best be described as dismal. Nobody likes comparing one tragic cause of death to another, but as other Members of the House have said, the success of the Road Safety Authority in reducing the number of deaths on our roads highlights the impact that targeted resources can have. Mr. Gay Byrne has proved to be a successful and highly effective chairman of the RSA's road safety campaign. I ask the Minister of State to find a similar champion, advocate or series of advocates for the cause of mental health promotion in Ireland, thus giving a strong and coherent voice to the many stakeholders, advocacy groups and clinicians working in this area.
We also need to examine seriously the after-care provisions being offered to people who present themselves to our health services. I am not referring solely to mental health services in this respect. UK statistics indicate that up to one third of suicide deaths occur among people who have interacted with the health service in the previous 12 months. These are people who have turned up in hospitals, in community or clinical settings, presenting with some illness, yet within 12 months they took their own lives.
A successful system is currently operating in Belfast whereby people presenting at hospitals who exhibit any of the potential indicators of suicidal behaviour are immediately given a referral card. We should examine the potential for introducing such a system here. I encourage the Minister of State to examine the legislative perspective of this matter with a view to amending the Health Act 2004 and the Mental Health Act 2001. Both the Green Paper in 1992 and the White Paper in 1995 recommended that any legislation must deal with outpatient services, but this is not reflected in the current legislation, which focuses on the provision of inpatient care. I urge the Minister of State to consider this matter when the legislation is reviewed next November. Let us bring accountability back to this House and the Minister of the day. The HSE should set a statutory plan each year so that it is accountable to the Minister who, in turn, is accountable to this House. We can then take political responsibility, once and for all, for mental health services in this country.
At the outset, I want to congratulate you, a Leas-Cheann Comhairle, on your appointment and wish you well in that role. I also wish to congratulate the new Minister of State, Deputy Kathleen Lynch, who has responsibility for mental health services. As a Deputy representing County Limerick, it would be remiss of me not to pay tribute to my constituency and party colleague, Deputy Dan Neville, for his contribution to the debate on suicide prevention. Since his time in the Seanad, he has championed the cause of decriminalising suicide, thus destigmatising it and placing the debate on a national platform whereby people can speak openly about the subject, as we are now doing. Great credit is due to Deputy Neville for having done that.
I want to discuss the impact of suicide on families. There is a temptation to trivialise the issue by categorising people according to statistics, including how they died and the possible causes. In fact, however, we will never know the reasons that most suicide victims die because in many cases they do not leave notes or other communications. We are, therefore, left to agonise afterwards and wonder why they felt it necessary to take their own lives.
According to a study by the Family Therapy Association of Ireland, mothers experience intense and prolonged grief, along with many psychological and physical symptoms, following a suicide in the family. Several participants in the study experienced strong suicidal thoughts, while one such mother had attempted suicide herself. The misuse of medication and alcohol was also identified by some women as a coping strategy. Other findings of the study concerned the participants' reasons for wanting to die in order to be with their children, as well as the impact of guilt and blame on their belief system.
Unfortunately, suicide affects every community, which is why so many Deputies have participated in this debate in recent weeks. The National Suicide Research Foundation has found a worrying trend of suicide clusters in Ireland. A cluster is a chain of suicides by young people in a particular geographical area over a short space of time. Experts believe that such suicide clusters are becoming more common. In one instance, a group of 17 young adolescent men from one area committed suicide within 18 months. The National Suicide Research Foundation has produced a report with information to map suicide in Ireland. This is operating on a pilot basis in Cork in collaboration with the region's coroners.
Earlier in this debate, reference was made to the role of social networking, including comments that are left by people in the aftermath of a friend's suicide. The UK police have examined the social networking activities of young people to try to discover their reasons for committing suicide. It has become common for bereaved friends to set up memorial pages on social networking sites, such as Facebook and Bebo. Research by the department of epidemiology at Bristol University has shown a connection between media reports of suicide and copycat deaths. In addition, the research stated it was likely that discussions on websites would have a similar effect.
I urge the Minister of State, in conjunction with her colleague, the Minister for Education and Skills, to address this problem through the schools system in particular. In that way, young people could be encouraged to understand the seriousness of what they are doing in leaving messages on social networking sites. We may find it difficult to comprehend but some young people feel it is possible to communicate with the dead through social networking. Sometimes, this is a mechanism for them to cope with the grief and mourning they are going through. It is a cry for help from them, which needs to be addressed, and I think schools are the best venues in which to do this.
In recent weeks, Facebook launched a facility in association with the Samaritans that allows people to get help for a friend whom they believe may be suicidal. It allows friends to alert the Samaritans through the Facebook help centre where they can provide content that suggests a friend may be suicidal. The Samaritans have also launched an awareness campaign on their Facebook page that tells people how to recognise risk factors for suicide among their friends. These factors include a family history of suicide, easy access to means of suicide, a previous suicide attempt, a history of behavioural disorder, drug abuse, alcohol abuse, family dysfunction, marital status, physical illness, imprisonment and unemployment. Unfortunately, in most cases, it is scarily obvious that the bulk of deaths by suicide involve young men.
In primary schools, the SPHE course encourages children to talk about their physical health and well-being. Teachers should also be exploring mental health issues at a much earlier stage, as well as bringing them up at second level. Children and adolescents are under massive pressures, including economic ones. We should not pile any further pressure on our young people, but mechanisms are required to let them discuss such problems in order to relieve them.
I wish the Minister of State well in her new portfolio. In addition, I acknowledge the work of my colleague, Deputy Neville, in this respect.
I wish the Minister of State the very best in her role, which is an extremely important one for our society as a whole. Ireland is a small nation, yet we have one of the highest incidents of registered deaths by suicide in Europe. There is not a community in the country that has not been affected by suicide.
The programme for Government has set out proposals to develop and improve mental health facilities, starting in the community. It is proposed that €35 million will be ring-fenced from the annual health budget to build community mental health teams and services for adults and children. The programme for Government also sets out plans to strengthen the training of general practitioners to deal with mental health issues that may arise in the community. This is vitally important because a GP may be the first person with whom someone suffering from depression engages. If GPs cannot service that need or open the door to other services that are available, therein lies the biggest initial problem.
It is always said that a general practitioner should be the first port of call for physical illnesses, but we must make it the same for mental health issues. A review of the Mental Health Act 2001 and the Mental Health (Amendment) Act 2004 will take place under the new Government. The promise we made to introduce a mental capacity Bill, in line with the UN Convention on the Rights of Persons with Disabilities, must be delivered upon.
Recent studies conclude that instances of suicide have increased since 2009. One reason attributed to the increase in such deaths is the economic downturn and the pressure under which people have found themselves. It is wholly unacceptable that people should be committing suicide due to a lack of money and resulting pressures. The stigma attached to depression, however, often prevents people from asking for help. We desperately need to change this situation. The greatest sadness concerning suicide is that is it totally preventable.
Amnesty International states that four fifths of mental health service resources remain tied up in hospital-based treatment, which in itself has negative connotations. We must move away from that and deliver on our promises to give people the option of having access to the services they need at a local community level.
We must implement A Vision for Change, the implementation of which has been promised to the people for so long.
It must be borne in mind that the issue of suicide affects people of all ages. Perhaps in more recent times our attention has been drawn to the issue among young people by the Think Big campaign launched by Headstrong and, more recently, the Get on Board campaign to increase the awareness of mental health and push the issue to the fore of the political agenda among new and existing politicians.
Alarmingly, 60% of young people said they would not seek help from a health professional if they experienced mental health difficulties. This is testament to the old Irish attitude of not complaining and getting on with things. As a Government, we must support voluntary groups such as Headstrong, Aware, Amnesty International, Reach Out and the many other groups which exist to help to bring to an end the stigma attached to depression. Almost twice the number who die in road accidents die by suicide. As previous speakers said, the funding for the road safety campaign amounts to €20 million, while that provided for the suicide prevention campaign is €5 million. Therein lies a big problem. It is not my intention to make a comparison in the loss a family suffers in either case, but this illustrates the difference in the funding provided for the campaigns and the level of public awareness of the issues involved. This has to change.
Education on mental health must start in the community, particularly in schools by improving SPHE programmes; among support groups and voluntary organisations by improving their funding and facilities; and among GPs by strengthening their training to enable them to deal with issues that arise. Each one of us must take responsibility for the campaign to prevent death by suicide by ensuring we start at home and talking about it to our children, families, friends and work colleagues. Only when we remove the stigma from depression and the sense of failing and the lack of self-worth for those who suffer from it and replace these feelings with ones of security, hope and trust will it be more acceptable to ask for help.
I congratulate the Minister of State and wish her well in her new position.
I have listened to the contributions of my fellow Deputies on the incidence of suicide in Ireland with sadness and dismay. It is an important issue and their contributions are valuable. However, we cannot afford mere posturing on the issue. We need action and effective measures to ensure that, as elected representatives, we will use our influence to create an environment in which there will be greater understanding and acceptance of people with mental health issues and a reduction in the stigma attached to them and the associated discrimination. I am lucky to have a platform to say my piece in the Chamber, but we need to remember that we have a responsibility to help to remove the stigma and discrimination associated with mental health problems. That goes for all of us.
The incidence of suicide in Ireland is at an all-time high. Ted Hughes once wrote a poem about Sylvia Plath who had taken her own life. It was entitled "Last Letter" in which he addressed the issue of her death. The opening line has always stayed with me: "What happened that night? Your final night." I often think of it when I hear of suicides and what happened to the people concerned on their final day or night, as well as the loneliness and isolation they must have felt and their sheer desperation. The final night for many is the result of a combination of factors, including mental health issues, reduced self-esteem, discrimination and social stigma becoming a barrier in accessing services and a lack of support.
There may be a sum of €8.7 million available to support suicide prevention initiatives which is a good start, but more needs to be done. The strain imposed by financial difficulties is increasingly becoming a factor in suicides. It is one thing to give €8.7 million for a suicide prevention programme but another when people's financial difficulties are being magnified tenfold by having to pay the universal social charge. While it is part of the Government's responsibilities to address this issue, we have a collective responsibility to address it. Ní neart go cur le chéile.
It is estimated that 40% of undetermined deaths are suicides. A total of 527 people took their own lives in 2009, which is astonishing. It would make one's heart break for the people who were driven to this, as well as their families and friends. When people attempt to access services, they are faced with an archaic mental health system. More than 20 years ago the Government ratified a legally binding international treaty guaranteeing everyone in Ireland fundamental human rights — the International Covenant on Economic, Social and Cultural Rights which Amnesty International has described as "one of the country's best kept secrets". I am not surprised it described it as such. Under the treaty, we are supposed to have a right to health care, but hundreds of children are detained in adult mental health facilities because there is insufficient child appropriate accommodation available.
The Minister for Health and Children has said a child should only be admitted as an inpatient to a psychiatric facility as a last resort. It would be preferable if no one had to be treated in a psychiatric facility and treatment was delivered within the community, but where that is an appropriate part of treatment, children should be treated in a facility suited to their needs. There is only a bed capacity of 52 within the child and adolescent mental health service infrastructure which the Government plans to increase to 58 by 2012. That means six additional beds will be provided in one year, which is inadequate. The Minister has said he envisages the plan bringing to an end the treatment of children in adult facilities. However, hundreds of children are in adult facilities. How, therefore, are we expected to believe this? Six additional beds are better than nothing, but they will not make the impact the Government believes they will. Service provision must be based on need. It is just plain wrong that people are not receiving the help and support they need because of the inadequacies of the health system and the inadequacies of a Government which will not recognise a person's right to health care.
We must also be aware of those who are at higher risk of suicide and having mental health issues. BelongTo is a youth organisation which does great work with gay, lesbian, bisexual and transgender, LBGT, young people. In its submission on the national strategy for action on suicide prevention its officers quoted extensively from research that demonstrated the high levels of stress experienced by LGBT youth. According to one Dublin City University research paper, 94% of teachers were aware of verbal homophobic bullying in schools. The old adage of "sticks and stones may break my bones but names will never hurt me" is categorically untrue. LGBT young people are five times more likely to be medicated for depression, two and a half times more likely to self-harm and three times more likely to attempt suicide. They are at huge risk. However, 90% of teachers were not able to find a single mention of homophobic bullying in their schools' policy statements on bullying.
Schools are harrowing places and life is grim for many gay teenagers. It is imperative, therefore, that action is taken to tackle this issue. We need to address the problem not only by directly funding suicide prevention programmes and strategies, but also by addressing the root causes of stress and depression. This is not just the responsibility of the Minister of Health and Children. The Minister for Education and Skills also has a role to proactively work on the issue and ensure the development of programmes to positively endorse diverse sexual identities in schools and increase support for organisations supporting LGBT youth and their parents. If the State is not going to provide services, it is critical that the voluntary sector is supported in what it is doing. Our collective responsibility to address and prevent suicide means we must use our knowledge to propose meaningful and constructive solutions.
I support Amnesty International's call to use the opportunity presented by the forthcoming review of the Mental Health Act to consider broader legislation to provide community-based mental health services. International evidence shows this not only improves mental health outcomes, but is also associated with lower suicide rates. Sinn Féin fully supports this position. It is an awful reflection on Fianna Fáil, its former Government partners and now the Labour Party and Fine Gael, as well as the HSE and the Department of Health and Children, that Amnesty International, a campaigning organisation for human rights, has to lobby for better mental health service provision because the service provided by successive Governments represents such an outrageous breach of people's human rights; it is a scandal. The National Office for Suicide Prevention has stated that the increase in suicide is linked to the current economic climate in this country, stating that it is likely to be a "result of the impact of the economic downturn with substantially more people unemployed and suffering from personal debt".
Surely the Government can see now that its policies which are geared towards cutting the incomes of those who are lowest paid in society are increasing the level of suicide. It is hypocritical to speak in the Chamber of all the tragedies that have touched people's lives — we all know of someone who has taken his or her own life — and then to ignore the evidence that is presented by a body such as the National Office for Suicide Prevention, which is a part of the HSE.
It is important that the Government, during the review of the Mental Health Act, looks at the evidence. Evidence-based policy should be based on need and not the minimum that Fine Gael thinks it can get away with providing. Mental health is a significant component in suicides. The EU consensus paper on Prevention of Depression and Suicide has stated that the "adequate treatment of major mental disorders... decreases the risk of suicide and is an effective way to prevent suicide in healthcare".
Ireland still lacks a modern, adequately resourced community mental health service. Reform of mental health services must be part of a coherent response to suicide prevention. Better mental health services will mean fewer people dying by suicide. We need good community-based mental health services which have better outcomes when compared to traditional hospital treatment. The research proves that, yet four fifths of mental health service resources remain tied up in hospital-based treatment.
Implementation of the reform set out in A Vision for Change has been slow and uneven to date. Accountability for expenditure on mental health and transparent information on how such expenditure is used to reform the services in line with policy has been lacking. International human rights law demands that mental health services be continually improved in line with best practice in order to fulfil the right to the highest attainable standard of mental health and avoid social exclusion. As long as this country fails to implement reform, it will continue to fail to meet international human rights standards. These failings lead to enormous economic and human costs and needless individual suffering. The poor response to mental health is also contributing to high national suicide rates.
The forthcoming review of the Mental Health Act, as set out in the programme for Government, provides an excellent opportunity for the Government to change things for the better. We must examine what works. Everyone knows a family that has been devastated by suicide. Some families have been affected twice and others even three times. We must educate ourselves to recognise the signs. We must change things for the better. I call on the Government to listen to the evidence, and it is being told by the people affected by suicide, and to do something meaningful in order to address the problem.
Cuirim fíor fháilte roimh an Aire Stáit, Deputy Kathleen Lynch. Listening to Deputy McLellan I cannot help but wonder whether Sinn Féin seeks an increase in bed capacity and hospital facilities or a more community-based approach. Perhaps the party could indicate what it wants. This debate is probably the most important one we will have in this House because it deals with people, those we all know who live in our communities. At a time when more and more people are under pressure — tá siad faoi bhrú — it is important that the Government and everyone else would recognise the fact. It behoves all of us to work together to ensure that suicide and mental health problems do not escalate.
In the past decade, there is not a single community or a single family in this country that has not been touched by the spectre of a death by suicide. Losing a loved one, friend, work colleague or neighbour leaves a thousand unanswered questions — the most common of which are, first, "Why?" and, second, "Could I have done something to prevent it?" Those questions shake us to the core of our being. The possibility of hope and of things improving lie at the essence of our humanity and spirituality. For many hundreds of people, at a time of deep emotional and psychological trauma in their lives, there does not seem to be a belief in life, there is a loss of hope and there is despair that things will not improve or get better. The reality is that it can. It is important that support is provided and that people talk, listen and reach out.
Recently, theEvening Echo reported on 202 deaths in Cork city and county over the past 30 months, as indicated by the Central Statistics Office, of 170 men and 32 women. At times it appears as if suicide is a single, homogenous act that is becoming endemic across society. Reporting and presenting on suicide makes it seem as if it is beyond control, predictability or intervention. The analysis of the statistics and research suggests otherwise. Certain sections of communities are more vulnerable to death or harm from suicide. With careful screening and appropriate mental health and community training it is possible to become aware of potential precursors and triggers to some cases of suicide. It has been proven locally, nationally and internationally that appropriate intervention can and does reduce the number of fatalities from suicide.
For too long suicide has been a taboo subject which people have been afraid to talk about. It is important that we seek out reasons rather than seek to deny. Raising the issue and discussing suicide in this debate increases the opportunity for people to seek help and support. It is time for politicians and those involved in the mental health area to open the doors and pull back the veils of secrecy and denial so as to allow light and rational debate into this particularly difficult and sensitive subject. It is essential that we have an open and honest debate about the extent of fatal and attempted suicides and the response of the State at a national and local level.
According to WHO data, in 2009 Ireland was ranked 20th out of 26 European countries with a total suicide rate of 10.6 per 100,000 population. While significantly below that of Lithuania which had a rate of 30.4 per 100,000 we were significantly higher than our neighbours in the United Kingdom which had a rate of 6.4 per 100,000 and Greece which had a rate of 3.5 per 100,000. The same WHO data reveals that we have a youth suicide rate that is the 4th highest in Europe, which is a worry. Further analysis shows that in Ireland, over the period of 2002 to 2006 the highest rate of suicide was for young men in the 20 to 24 year age group. Those and other data clearly show that suicide and suicidal behaviour is a complex, multifaceted societal issue which while individual in focus appears to be responsive to societal and personal risk factors and indicators. The data also inform us that we must take an individualistic and holistic approach to suicide at a community, regional and national level.
I do not believe a one-size-fits-all solution can work. To be fair, neither does the Government. To be effective and meaningful, intervention must reduce both the level of attempted suicide and completed suicide. I agree with Deputy McLellan that there is a need for joined-up thinking between the various agencies, statutory and voluntary local bodies, education and social services, business and voluntary or community organisations and agencies committed to positive mental health promotion as well as participation by and acceptance of the role of the ordinary person who is often the first to become aware of the potential of risk or the likelihood of harm arising from suicide.
The establishment of the National Office for Suicide Prevention was an important advancement in the struggle to respond to the level of deliberate self-harm and completed suicide behaviour in society. In Cork, we are fortunate to have a mental health resource officer who oversees and delivers valuable and essential community supports and training, helping develop skills in individuals, organisations and the community that enable them to respond to suicide. In addition to general and specific suicide helplines, peer support education programmes for young people in a community-based setting is provided so that young people can offer support to other young people. We also have the applied suicide intervention skills training, ASIST, which is a two-day skills building workshop in suicide first aid.
In essence, there are three basic elements to our strategy for dealing with suicide — at primary, secondary and tertiary places of education; in the workforce; and through local community, voluntary and statutory agencies. Our first strategy is to support positive mental health promotion; second, to respond in a supportive way when individuals are under stress or strain, for whatever reason, such as alcohol problems, bullying, gay or lesbian issues and money pressures; and, third, it is important to develop protocols of response when suicidal behaviour occurs, aimed at helping to minimise the negative impact.
It has been established, through both national and international research, that following a death by suicide, there is an increased probability that a family member or friend will attempt or complete an act of self-harm or suicide. This is known as a "clustering" effect. The Irish Association of Suicidology has reported that the media coverage of mental health issues and of suicide can be important determinants and influencers of possible behaviour. In general, the print and broadcast media have taken a responsible attitude and approach when dealing with these issues and I would like to take this opportunity to commend the work of theIrish Examiner in this regard. It has published an important booklet, entitled, Let’s Talk Suicide, which is a valuable asset and tool which should be available to every household. Perhaps the Minister of State will liaise with the Irish Examiner to arrange for that booklet to be made available to schools. The booklet forcefully and sensibly highlights the issue in a way that brings home the stark reality of suicide and its consequences. It also explores the options and supports for people contemplating suicide.
I would also like to pay tribute to Deputy Dan Neville, who through his sensitive work, commonsense approach and deep humanity has helped and influenced many people. As a public representative he has done the State a great service and should be complimented on that. Much of what he has done has been done quietly and below the radar, but he has helped and supported our fellow citizens.
The Internet is a source of much comment as its power and usefulness have transformed and shaped the lives of individuals, families and communities. Its influence is generally positive, but there is a potential dark side to the Internet that can manipulated by those who prey on the vulnerable and those in need of support. Some sites on the Internet actively promote and encourage self-harm. These sites are nihilistic and fatalistic and should be monitored or shut down. We have learned with child abuse that the Internet is difficult to police and to monitor on a 24-hour 365-day basis, but we must use it to channel positive and realistic messages on mental health and show that there are alternatives to suicide.
Reference has been made to Facebook, Twitter, Bebo and other social media sites, which are of huge importance with regard to the development of technological interventions to responding to suicide and in communicating positive messages about mental health. We must offer vulnerable people avenues of help which are accessible. I hope the Government will provide a strategy that will be immediate and offer interventions when people need them most. As we know, people who commit suicide do so deliberately at a time when helplines and out-of-hours supports are not available. Smart phones, mobile Internet access and Wifi must be used as a resource to reach out to people.
I understand there is not uniform availability of resources across or between HSE regional areas. Therefore, I call on the Minister of State to undertake a review of the implementation of the recommendations of the Reach Out strategy to ensure that all communities can be supported. I also call on the Minister of State to call on the HSE to undertake a rigorous review of best practice to determine what measures are most effective with regard to intervention and responding to suicide. We must do more than just respond to crises so that we feel better. We must do more than say we need more resources, beds and money. Given the current era of limited resources and reduced personnel, we must ensure that all interventions put in place are targeted, specific and effective. We must know what works and why it works. It is important that when we identify people at risk, they are supported. We must adopt a proactive and targeted approach to individuals deemed to be at high risk of suicide.
It is important to recognise the need for consistency in our response and intervention throughout the country. We must have flexibility in service provision to ensure interventions can be delivered where and when they are needed, rather than be restricted to office hours. We must also have a regular audit of statutory, community and voluntary groups that provide interventions in order to ensure quality control. I ask the Minister of State to follow up on this. We must look at the Internet as a way of promoting support and informing young people they are not alone. We must increase training and awareness among first responders, gardaí and social workers. We must also ensure we have a fast-track referral approach, from primary care services to community-based mental health services for those identified as being at risk.
I thank the Minister of State for her presence at this important debate. This debate is about people, not about a cold, calculated print-out of statistics. It is about our fellow citizens.
I now call Deputy Nicky McFadden. I understand the Deputy is sharing her time with Deputy Brendan Griffin.
I welcome the opportunity to speak on this serious matter. Like Deputy Buttimer, I would like to acknowledge the great work Deputy Dan Neville has done in this area and his sensitivity in dealing with people and the issues. I also acknowledge the positive approach the Minister of State is taking towards this issue. In talking about suicide, we should consider families throughout the country who have lost a member through suicide. I extend my condolences to all of those people. The facts and figures on suicide are sobering to say the least.
As the Minister of State, Deputy Kathleen Lynch, has stated previously, provisional figures for 2009 show an increase of 4% in suicide to 527 deaths. In this era of constant number crunching, it is easy to get bogged down in facts and figures, but 527 is not just a number. It is the death of 527 Irish men, women and young people who felt there was no other way out but to take their own lives. This is a sobering thought. Not only should we be troubled by this fact, we should also consider the families of those people and the profound effect these deaths have on them and the community.
The increase in suicide rates is mainly seen in men in the middle age group. There is no doubt that unemployment and serious financial difficulties account for many of these deaths. The prevalence of suicide in middle aged men is a fact that needs to be addressed without a moment's hesitancy.
Of course, younger and older people are included in these tragic figures. It is estimated that suicide rates have increased in the past two years by 24% and self-harm rates by 11%. Family difficulties, bullying, stress, anger and isolation are also serious contributory factors to suicide rates. The first step in decreasing suicide rates is to get rid of the stigma attached. Until quite recently, up to 1993, suicide was considered a crime. We must urgently remove the phrase "committing suicide" from our vocabulary. Mental illness should be discussed openly and frankly without any sense of sensationalism or scandal. Access to mental health services must be readily available to anyone who experiences mental health difficulties. Having worked in a GP practice, I believe the first port of call for people suffering from mental illness is their GP. It is important that GPs are readily accessible to people who are in trouble, and receive training on how to deal with suicidal thoughts and related issues.
It is not just in GP surgeries that this training should take place. Schools, youth clubs and other community organisations should be educated in this area. Discussion and open debate will create an environment where those who are depressed or having suicidal thoughts will be more inclined to talk openly about their feelings, thereby improving their chances of receiving the necessary help and advice. In schools there should be a greater focus on life skills education. Students should have access to self-esteem programmes, and learn assertiveness and resilience-building skills to equip them for the future.
We need a societal change in how we approach the issue of suicide. Openness, understanding and professionalism are needed to help those at risk. Greater observance is also needed and we need to know the telltale signs of depression or suicidal thoughts. I recommend that everyone should attend the suicide ASIST workshop. I did and it was probably one of the best things I have ever done. It outlines the telltale signs and gives participants the skills to deal with people at risk of suicide. Dr. Jacky Jones, a former regional manager of health promotion with the HSE, described the course as the mental health equivalent of neighbourhood watch.
I commend the National Office for Suicide Prevention website. To members of the media I recommend reading the media guidelines for reporting suicide and self-harm published by the Irish Association of Suicidology and the Samaritans. A number of organisations do great work in this area. Representatives of 1life campaigned outside Leinster House before Easter. It has a 24 hours a day, seven days a week dedicated suicide intervention and prevention helpline on 1800 24 7 100. That organisation helped 36,000 callers in its first year and receives more than 3,000 calls every month. I also recommend the organisation Suicide or Survive which can be contacted at 1890 577 577. Suicide or Survive provides a range of educational and therapeutic programmes that increase understanding of suicide and play an active role in its prevention in Ireland.
People should know that they are not alone and that help is available. On an individual basis, people should be aware of friends, family members or work colleagues who may be dealing with mental health difficulties. A simple action like just being a friend to somebody can be the most important thing in the world. I hope that all the contributions to this debate will help in tackling the risk of suicide.
I appreciate the opportunity to speak on this issue. I acknowledge the many contributions to this debate made by Deputies from all sides of the House in recent weeks. I hope some of the very positive suggestions and ideas mentioned here over the course of the discussion can some day be implemented where possible. Unfortunately, like every Deputy, I have known many people who have died as a result of suicide. I recently considered the very shocking statistic that three out of 120 from my secondary school year group have died as a result of suicide and most of us have not reached the age of 30 yet. That is just one example and there are similar examples from throughout the country. It is a very sad and tragic situation. I hope that through these statements, along with the actions of the Government and various State agencies, this problem can be tackled and we can see an improvement. Unfortunately, each death is one too many and any improvement needs to be built on.
It is an issue that affects every part of the country, crossing geographical and social boundaries. It will take a very comprehensive approach to tackle the issue. Our approach to the problem of suicide needs to incorporate actions from every Department and is not simply a problem for the Department of Health and Children. Many aspects of the problem relate to other Departments and we need a comprehensive approach to the issue. For example the Department of Transport, Tourism and Sport has a major part to play. The links between physical activity and mental and physical well being have been well proven, and that needs to be improved and worked on. Sporting clubs and organisations that do fantastic work for their local communities have a role to play in helping to tackle this problem. The Department of Education and Skills has a major role to play in shaping attitudes to the problem, informing our young people and helping to eliminate the stigma that, as many speakers have mentioned, is still a large aspect of the problem.
As Deputy McFadden said, the media need to report suicide incidents in a very sensitive and appropriate manner at all times regardless of the individual involved. Unfortunately, when a celebrity or well known individual is involved, there seems to be a deviation from the best practice code, which needs to be tackled.
Even local government has a role to play. It has been proven that pet ownership can help to tackle the problem of depression and yet, according to the ISPCA, 30,000 dogs are put to sleep every year. Britain has a scheme offering those suffering from depression the opportunity to avail of dog ownership with the thinking that people will engage in more physical activity by simply walking the dog and that interaction between humans and dogs can be therapeutic and helpful. This is only a very small suggestion but could perhaps be considered. It will not solve the problem but could certainly help. If but one life could be saved as a consequence, it should be considered.
I acknowledge the considerable contribution by Deputy Dan Neville, who has dedicated years to addressing this issue and who has done fantastic work on mental health. Much work on suicide and self-harm has already been done by the State and State agencies. When I asked a question about suicide statistics and the problem of suicide in the HSE south area at the regional health forum for that area in February, the response I received was very comprehensive and detailed. It proved that so much work has already been done in this area. Unfortunately, however, we seem to be losing the battle. We need to consider how best we can use our resources and the agencies of the State already working on this issue to try to improve circumstances overall.
Next Saturday morning I will be taking part in the Pieta House-sponsored Darkness into Light walk, which will take place at 4 a.m. in Killarney National Park. The walk symbolises the move from darkness into light and is in remembrance of a number of locals who died by suicide. The initiative and similar initiatives need to be welcomed and encouraged. They all help to eliminate the stigma that is, unfortunately, still associated with suicide in Ireland in 2011.
I will be delighted to attend the See Change campaign briefing on Wednesday, 11 May from 9.30 a.m. to 11 a.m. in the Oireachtas audiovisual room. I encourage all Deputies to attend. I know many will be attending, having spoken to them. The campaign is an example of a positive initiative that needs to be encouraged.
I sympathise with all those affected by suicide who may be watching this debate on the Internet or who may read the transcript thereof at some stage. Possibly every household in the country has been affected by suicide, a problem on which we all need to work together to solve.
I wish to share my time with Deputy Seamus Healy.
Is that agreed? Agreed.
I join Deputy Griffin in sympathising with all those affected by suicide. We must address the nitty-gritty of the problem. There is a distinct link between the economic downturn, especially the rise in unemployment, and suicide. Amnesty International has made this very clear. It seems likely that the increase in the suicide rate is primarily a result of the impact of the economic downturn with substantially more people unemployed and suffering from personal debt.
One of the main problems with which the Dáil must deal is unemployment because doing so will give people more hope and income and allow them to put their children through college, etc. The Government is not really dealing with this and will not be able to do so because it has accepted the diktats of the IMF and European Union. While my point very much concerns economics, it is a key issue. The suicide rate will continue to escalate under the prevailing economic conditions unless the problem is addressed with real drive by creating jobs. People Before Profit and my fellow United Left Alliance Deputies believe this should be achieved by putting thousands of people back into the workforce in publicly funded jobs. I refer to the building of schools, as mentioned in the budget statement, the retrofitting of homes and addressing the water crisis associated with the condition of pipes all over the country. A national employment programme would make a big difference in preventing the worsening of people's circumstances.
A key cause of suicide is the extremely poor quality of mental health services. I have experience of people having to rely on public health service psychiatrists, etc. What generally happens is that one receives an opportunity to sit with a psychiatrist once per month. The psychiatrist changes monthly, however, and there is no continuity. Many of the patients are older women and men. They may have to talk to young women doctors who are probably in the initial stages of training, and this does not help when dealing with the issue of depression.
Amnesty International has identified the poor quality of mental health services in Ireland as a key cause of suicide. Suicide is preventable and better mental health services would mean fewer people dying in this tragic manner. Amnesty International makes the point that adequate treatment of major mental disorders decreases the risk of suicide and is an effective way to prevent suicide in health care. Ireland still lacks a modern, adequately resourced community mental health service. The Government should address this. There is an absolute need to prevent suicide and this can only be done by investing in the appropriate services.
The need to move towards a well funded, properly resourced community-based mental health service is crucial. International evidence shows that good community-based services, by comparison with traditional hospital services, are linked to lower suicide rates. In Ireland, 80% of mental health resources remain tied up in hospital-based treatment. This is a model we must move away from. It represents another appalling failure of the HSE to carry out reform in this area. Amnesty International claims the failure to reform mental health services means Ireland continues to fail to meet international human rights standards. As a society, we must meet those standards, and this can only mean resourcing the appropriate services. How are we to resource the services in the current climate? The forthcoming review of the Mental Health Act 2001, committed to in the programme for Government, must result in legislation to force the HSE to implement urgent reforms.
Many of the people I have been meeting recently, particularly mothers and fathers of autistic children, who are trying to get their children into schools and have their disabilities assessed, are now being told there is no point in having them assessed because there are no special needs teachers to serve them. This is an absolute scandal. It is one of the economic and social issues we must address. We must be willing to step up to the mark in this regard, put resources where they are needed and impose taxes where we can. We know there is plenty of money within certain sections of society. The very wealthy in this country do not pay a cent in tax. If they were taxed and the money were invested where needed, we would have a way of moving forward. Until the Government meets this challenge, we will continue to experience the sorry economic circumstances we are experiencing at present and fail to step up to the mark with regard to suicide prevention.
I congratulate the Minister of State with responsibility for mental health services on her appointment and wish her well in her new office.
I agree with previous speakers about the effects suicide has had on families throughout the country. I sympathise with the families and relatives who have been through this experience. Unfortunately, many families have had experience of suicide over the past number of years. Some families would have been aware of mental health difficulties but others have seen suicide occur almost out of the blue. It is a very important problem to be dealt with as it is a matter of real concern for many people in our community.
I thank the many voluntary organisations working in this area, such as the mental health organisation, GROW, Aware and others. There are also many local organisations who are doing exceptional work on this issue on behalf of families and persons with mental health difficulties. As Deputy Collins said, funding is undoubtedly a serious issue for many of these organisations. According to today's newspapers, an organisation in Wicklow has indicated that unless its funding can be re-established it might have to close an important and energetic service it has been providing for many years.
Like other Deputies, I regularly encounter people at my clinics who are experiencing unemployment for the first time. These are people whose families have no history of unemployment. It can be hugely distressing for people to find themselves in that situation. I have met people at my clinics who are completely frustrated, distressed and simply do not know what to do. They have always worked, either in good jobs or in self-employment, and suddenly find that they are dependent on the social welfare or community welfare services. It is distressing and frustrating for them that they are unable to look after themselves or their families. The problem of unemployment must be tackled. If it is, it would deal with at least one aspect of the suicide issue.
Another matter dealt with by Deputy Collins is young children with special needs and the difficulties they have. Unfortunately, it appears that the special needs area is being targeted for cuts in the education sector. Again, if this is allowed to progress, a growth in the suicide figures will become evident. Obviously, where young people are already experiencing difficulties in a school, social or family setting, those difficulties must be dealt with early or a situation will develop later that will give rise to many social ills, including suicide.
The number of suicides in the past number of years is a cause of concern. It opens our eyes and certainly suggests the issue must be dealt with seriously and tackled on an immediate and ongoing basis. There were 527 suicides in 2009. It is a terrifying figure. The breakdown of the figures shows that substantially more men than women take their own lives, with the rate for young men being significantly higher than that for young women. Young men in the 20 to 24 year old age group are particularly affected.
Implementation of the A Vision for Change document is hugely important in dealing with the issue of suicide. Certainly, the development of community-based services is vital to ensure that services are available on a family and local basis, and not just through the HSE but also through local community and voluntary organisations. Some people who have mental health issues prefer to deal with non-statutory organisations. The implementation of the community-based services proposed in A Vision for Change is very important.
As Deputy Collins said, there are huge resources available to be tapped. Numerous reports have suggested that approximately €250 billion in assets are in the hands of a small number of very wealthy people in this country. There is no assets tax on those assets. If those assets were targeted, there would be huge amounts of money available to deal not only with suicide, but also many other issues.
I am delighted to have the opportunity to speak on this important issue. I congratulate the Minister of State, Deputy Kathleen Lynch. This is the first opportunity I have had to speak before her in the House. I acknowledge her commitment to dealing with this issue and what has been done already through the ASIST, applied suicide intervention skills training, programme and the See Change initiative. I also pay tribute to Deputy Dan Neville who, long before he became a Deputy, identified suicide as a major malaise in Irish society. I recall that as a Member of the Seanad he was one of the first, if not the first, to raise this issue and he has pursued it in the years since. Third, I pay tribute to all the voluntary organisations who are doing such good work, such as Pieta House, ASIST, Aware, the Samaritans and so forth.
Suicide is the silent killer in our society. It destroys lives, creates victims and causes devastation to many families in this country. As Members are aware, there are twice as many deaths by suicide as there are deaths on our roads. That is a dreadful statistic when one contemplates it. The two main causes of death among young people are either suicide or road traffic accidents.