Other Questions

Suicide Prevention

Timmy Dooley


76. Deputy Timmy Dooley asked the Minister for Health the way he plans to deal with the increasing problem of suicide; and if he will make a statement on the matter. [30426/13]

Éamon Ó Cuív


131. Deputy Éamon Ó Cuív asked the Minister for Health the way he plans to deal with the rising numbers committing suicide; and if he will make a statement on the matter. [30447/13]

I propose to take Questions Nos. 76 and 131 together.

Suicide is a tragedy that we are constantly working to prevent, and we are also working to give more support to the families affected. Dealing with the current high levels of suicide and deliberate self-harm is a priority for this Government, and significant additional funding has been provided in recent years to address this issue. Reach Out, our national strategy for action on suicide prevention, makes a number of recommendations, including fast-track referrals to community-based mental health services, effective responses to deliberate self-harm, training, reducing stigma and promoting positive mental health, initiatives aimed at helping young men, and further research. The National Office for Suicide Prevention, NOSP, has implemented most of the Reach Out recommendations in a four-way strategy: delivering a general population approach to mental health promotion and suicide prevention; using targeted programmes for people at high risk of suicide; delivering services to individuals who have engaged in deliberate self harm; and providing support to families and communities bereaved by suicide.

Funding for suicide prevention is provided to the NOSP by the HSE from its overall budget for mental health. The annual budget for suicide prevention increased this year to €13.1 million. Of this, €8.1 million is provided to the NOSP to fund voluntary and statutory agencies delivering services in the areas of prevention, intervention, postvention and research.

The remaining €5 million for suicide prevention measures is available regionally to fund HSE resource officers for suicide prevention, self-harm liaison nurses in hospital emergency departments and local suicide prevention initiatives.

The National Office for Suicide Prevention, NOSP, has been reviewing its current activities to make the most of available resources, including looking at best practice internationally to inform evidence-based policy decisions. This review will result in a revised strategic approach to suicide prevention for the remainder of 2013 and inform the final phase of the Reach Out strategy which runs until 2014. I expect the HSE will approve the revised approach in the very near future.

To get maximum benefit from the investment in suicide prevention measures and ensure a co-ordinated response to the needs of those at risk of or affected by suicide, the NOSP will continue to co-ordinate the work of the many voluntary, statutory and non-statutory organisations working in this area. By promoting cross-organisational collaboration, the development of networks and partnerships, skills sharing and service development, the NOSP hopes to maximise the impact of suicide prevention measures and support networks to ensure it reaches and responds effectively to people who are vulnerable. It is working to integrate current programmes to reduce duplication within the sector and provide a strategic framework for the co-ordination of the extensive range of actions in this area.

Priority suicide prevention initiatives identified for this year include the further development of existing national mental health awareness campaigns to promote help seeking, increased training for general practitioners and practice staff, building the capacity of communities to respond to suicide, implementation of the clinical care programme on self-harm which will include the funding of nursing posts in hospital emergency departments, training of acute hospital staff on suicide and self-harm intervention measures and the development of the SCAN, suicide crisis assessment nurse, model which allows for crisis interventions at primary care level and continued investment in voluntary agencies providing front-line services.

The Minister of State is well aware of the significant problems posed by suicide. It is a silent crisis facing every community. In 2011, 525 people died by suicide. There are alarming statistics and something needs to be done quickly about it. I do not question the Minister of State’s commitment or knowledge in this area, but we certainly need to do more. It is time we looked at establishing a mental health authority in the same way that the Road Safety Authority tackled the issue of road deaths. We need such an overarching authority which could direct Government policy, request resources and act with an independent remit to address the issue. Up to 550 people will die by suicide by the end of this year. We have to do more, yet, for example, the number of counsellors in schools was reduced. Although there is a commitment from the Minister, I do not believe we are getting traction in terms of delivery on the ground to ensure there is a focus point. Many voluntary organisations have been established on an ad hoc basis in communities where there has been an increased prevalence of suicide. We need to harness all of these groups into one organisation under the umbrella of a mental health authority whereby there could be genuine direction and a focus on suicide prevention. It should be a statutory authority, just like the Road Safety Authority, to really make an impact and save lives.

Every time a Member stands up to discuss the issue of suicide, he or she refers to an overarching authority like the Road Safety Authority. The Road Safety Authority has done an incredible job and I have no particular issue with it. However, we have a statutory overarching authority already, the National Office for Suicide Prevention, which develops policy and is now co-ordinating the activities of all the different groups that are desperate to help, a measure which should have been taken several years ago. These groups grow organically, usually from either a personal or community tragedy. However, this is different from the Road Safety Authority which can introduce laws that state that if one drives recklessly, one will receive penalty points. In this regard, I am conscious of the Members opposite. This is a criminal penalty, but we do not want to do that in the case of suicide.

We are investing enormous amounts of money in a focused way. People tell me that the Germans are addressing the issue this way and that the Scots are addressing it that way. Our suicide prevention plan is exactly what the Germans and the Scots have. We needed co-ordination. The one thing I discovered on taking up this job was that the one piece that was missing was co-ordination. We cannot have one agency delivering the service people want in their community in every village, but we have the service. We need to ensure people stay in their community, but we also need to co-ordinate the service and ensure, above all else, that the right message - the one message - is given. That is what the National Office for Suicide Prevention is doing. The Deputy saying he does not question my commitment is a type of backhanded insult. That does not work anymore.

I do not question the Minister of State's commitment-----

I know the Deputy does not, but it is as if commitment is not enough.

-----but this is not about her on her own. The point I am making is that I do not question her commitment, but some time ago the Minister for Education and Skills cut the number of career guidance counsellors in schools throughout the country. They are front-line staff working at the coalface in dealing with people who have difficulties. That is a fact. Therefore, I question the Government's commitment. This was an appalling way in which to try to reduce what was a key component in providing for an effective response in schools for vulnerable pupils.

That is not true.

It certainly is true. I have met career guidance counsellors who have told me that they are very concerned about this. We were waiting for one year for the appointment of a director to the National Office for Suicide Prevention. If there was a sense of urgency about this issue, one would have thought that decision would have been made well in advance of having to wait one year to make the appointment. These are two areas to which I can point in which the Government's commitment is questionable.

I will take questions from Deputies Caoimhghín Ó Caoláin and Luke 'Ming' Flanagan.

I draw the Minister of State's attention not to what is best practice in Germany or Scotland, although I recognise that we have similar issues to our Scottish neighbours, but to the fact that today the outgoing mayor of South Dublin County Council, with representatives of the HSE and Comhairle na nÓg, is launching a smart phone app entitled MindMindR. I have seen it and I am hugely impressed by it. It has been developed by South Dublin County Council and acts as an information port with all of the salient details of local mental health services. I commend it to the Minister of State as something that is an example of a powerful initiative and best practice. Will she take the time to inform herself of it and consider its potential for roll-out nationally, suitably adjusted to local area needs? If she has not done so already, would she or her officials be prepared to meet its initiators? I have no doubt that those who are behind this initiative would very much welcome a positive response from her today. It is what they and the rest of us deserve, namely, that it be adopted and released nationally.

I am sure the Minister of State is well aware of the tragic suicide that took place in Roscommon psychiatric hospital and the calls made by many people in the area for an independent investigation into it and what it might reveal, rather than having an internal investigation which is never very satisfactory. Will the Minister of State seriously consider this request to increase confidence in the area?

I call on the Minister of State for a final reply.

I wish to reply first to Deputy Caoimhghín Ó Caoláin's point about the app. Last year when we discussed how to reach people - they are not sitting down to watch the "Nine O'Clock News", as the Deputy and I know, rather they are in different places - one of the suggestions made was that an app be developed to give people, whether they were living in County Donegal or Dingle, at the press of a button telephone number to ring, details of where services were to be found and what was available. If the Deputy has seen that app, he will know that the range of services available is incredible. It is a question of co-ordination. I would love the people concerned to come and show us exactly what they are doing. It is something that could be transplanted or moved to any other area, with details of the relevant information.

In response to Deputy Billy Kelleher's point on schools, we conducted research into what was made available in schools because we were interested in reaching young people where they are.

We discovered that a whole-of-school approach is required and that is what we launched and developed. The entire school is trained in what to do if a young boy or girl approaches a member of staff. When I had this discussion previously with Deputy Boyd Barrett he nodded profusely, probably because he had had a similar experience to mine. What if a student does not get on with the designated person? What if the principal put him or her outside the door with an instruction to approach the designated person and the student is feeling down because he or she feels unable to speak to that person? Surely the caretaker and the secretary should also be involved.

In regard to the repeated accusation that we waited a year before appointing a new director, that office was never vacant. A women called Catherine Brogan did an incredible job in dealing with much of the development work, the outcome of which we are now seeing. We now have a new director who is making further progress on that work. It is not as simple as finding the right person for the right job. The work moves on and the different groups with whom we must deal also move on. This will not be the last Government to deal with the issue. It is a community issue and all of us must play a role. It cannot be left up to one person in an office in a school.

The Minister of State did not answer my question.

I apologise. I have received several reports on the matter. I have discussed the issue with a number of professionals, not all of whom are employed by the HSE or the Department of Health; nor were they all from Roscommon or Galway. All of them have said that awful things happen when one is dealing with very vulnerable people. That is why we provide the services in the acute unit. Without any request for an inquiry, the HSE critical incident unit commenced an investigation. The Mental Health Act required that an investigation take place, and an investigation is never carried out by the staff of the unit.

Health Services Staff Numbers

Seán Crowe


77. Deputy Seán Crowe asked the Minister for Health the number of the 414 community mental health services posts committed to in the HSE's national service plan for 2012 that have been filled; the number of these positions that have been filled by existing HSE staff members; the action being taken regarding the back-filling of the positions these staff members have vacated; and if he will make a statement on the matter. [30408/13]

In 2012, a special allocation of €35 million was provided for mental health, to be used primarily to further strengthen community mental health teams in adult and children’s mental health services, to advance activities in the area of suicide prevention, to initiate the provision of psychological and counselling services in primary care and to facilitate the transfer of mental health service users from institutional to community-based care in line with A Vision for Change. A total of 414 posts were approved to implement this €35 million package of special measures. As of 31 May 2013, 385 of the 414 posts have been filled, are under offer or are awaiting clearance. The national recruitment service, NRS, of the HSE creates national panels in anticipation of vacancies. On occasion, however, it is difficult to fill some posts for various reasons, including geographical location and international shortages of some grades, notably clinical psychologists. The NRS is currently working to ensure that the remaining posts will be filled as soon as possible, subject to the availability of appropriately qualified candidates. In some cases, alternative arrangements may be necessary for posts that cannot be filled in the normal way.

Candidates for these new posts were asked on application to include details of their current employers. However, at the appointment stage this data may not be current and cannot be validated. Accordingly, it is not possible to indicate the number of the successful candidates who were already employed by the HSE.

It is currently the responsibility of the HSE's regional directors of operations to decide within the context of their current resources whether to fill vacancies that may arise as a result of the appointment of an individual to a mental health development post from 2012. Each director has been asked to consider favourably the back-filling of posts vacated by the appointment of individuals to new mental health development posts to ensure that the objective of enhancing general adult and child and adolescent community mental health teams will be maintained.

The figure changed by just two between April and May.

I based my preparation for today's Question Time on the figures for April of this year. The broad position in April was that 383 of last year's promised 414 staff positions had been filled, were under offer or were awaiting clearance. It appears from the April HSE census that the net increase in the number of staff in the mental health services is much lower, however, and that the actual increase in the number of posts is 188, or just short of 200 fewer posts across the mental health service. Therefore, the figure of 383 is not what it seems to be. As the Minister of State mentioned in her reply, it had increased to 385 by the end of May. I am seeking a clear explanation from her. As a result of the delay in delivering the 414 posts that were promised, very little of the 2012 allocation of €35 million has been spent. Even when these new posts are eventually filled, our mental health services will still be staffed far below the level recommended in A Vision for Change. If posts are being vacated and not backfilled, this is a case of the Government giving with one hand and taking with another. It is not living up to the expectation it created when it promised 414 new additional posts. When will these posts be filled? They are all needed.

No, we have not reached what is recommended in A Vision for Change. I do not think we will reach it for the next two years either. We need to move step by step if we are to make progress in this area. The community mental health teams were badly staffed. We have to make progress and we are making progress. I would like to respond to what was said about the back-filling of posts when people leave and the creation of additional posts. The people we are employing are taking up different posts. For instance, we are employing psychologists, social workers, occupational therapists, nurses, speech and language therapists, child care workers, counsellors and co-ordinators. That is not the average cohort of mental health professionals. These are different types of posts. To a great extent, the people who have left the service worked as nurses, etc. I am being careful in what I am saying. We are developing a different type of service that may not need the volume of posts we had in the past. We may need different types of posts. We are recruiting an additional 50 nurses, 27 speech and language therapists, 35 child care workers, some counsellors, ten co-ordinators, 120 occupational therapists, 78 social workers and 96 psychologists. We are providing all of the pieces that were missing from a well-rounded and properly developed mental health service. This service will be provided in the community rather than in institutions.

The Minister of State played a good game in her reply, with all respect to her.

That is what I am paid for.

I would like to remind the House of what she indicated in her initial reply with regard to the back-filling of posts and what the HSE confirmed in May. She said that responsibility rests with "the regional directors of operations to decide within the context of their current resources [that is it] whether to fill vacancies that may arise as a result of the appointment of an individual to a mental health development post from 2012".

It is all being done in the context of the so-called resources available to these directors, and not in the context of the needs of the services themselves or those who present themselves because they need care and attention. The Minister of State can call these posts what she likes and explain them as she pleases - as she has described, some of them are enhanced positions and are welcome in that context - but if we leave vacancies behind as we move people in to fill these posts, there will not be a net additionality and there will be a major problem in relation to backfilling.

As I have already said, it is a case of giving with one hand and taking with the other. There is no other way to look at it. It is not being done.

The Deputy should conclude.

Finally, a further €35 million was ring-fenced for mental health services this year, 2013. How much of that ring-fenced €35 million for mental health in 2013 - the second €35 million - has been spent and what has it been spent on, if at all?

When I say the RDOs will decide what is essential or what post they will need, I make the point that we are delivering a different service and some of the posts may not be essential. For example, if we are moving people out of big, old institutions, then we need to deliver a different type of service.

With regard to the €35 million for this year, we did exactly the same as last year in that we asked the RDOs to send in their business plans and asked them where the gaps are in regard to intellectual disability, old-age psychiatry, psychology services and counselling. Until quite recently only three of the RDOs had submitted their business plans, so we knew where the gaps were in their services and what they needed, but one region had not submitted a plan, so we only got it relatively recently. It has now gone to the recruitment agency that operates on behalf of the Government, and the agency will put a mechanism in place, which should not be that difficult this year as it knows how to do it from last year.

I have also spoken to the national clinical lead in old-age psychiatry and told her what we intended to do. She is quite happy. What amazes me is that, apart from Roscommon, which we have heard about for the last two weeks, I do not hear these complaints from any other part of the country. The people who have this service delivered to them - the service users and the people at the centre - are actually quite optimistic about the new service and how it is going to be delivered.

We must move on to the next question.

May I respond to that?

We are on the cusp of the second half of this year and the Minister of State is talking about what she has learned from 2012, yet no new positions have been filled for 2013. This is unacceptable. If people have stopped complaining to the Minister of State, she should ask herself why. They are certainly complaining to Deputy Kelleher, myself and others because there is great concern within the mental health services. I am concerned that they may have given up on the Minister of State as well as the colleague on her right.

I always think that when people resort to insults, they have clearly lost the argument.

There is no insult in facing the truth.

We are delivering a new service. It is true that we are on the cusp of the second half of this year but A Vision for Change has been in this House since 2006 and the time limit for it is next year. While I do not dismiss what previous Ministers have done - I have always recognised that - we have done more in the last two years, so, cusp or no cusp, we are making progress.

Obesity Strategy

Dara Calleary


78. Deputy Dara Calleary asked the Minister for Health the measures he is putting in place to tackle obesity; and if he will make a statement on the matter. [30421/13]

The House will forgive me for a degree of repetition, as we have dealt with this already to some extent. As Members know, as Minister for Health, I have made excess weight and obesity a public health priority and have established a special action group on obesity, SAGO, with which I meet regularly to make further progress on the obesity agenda. SAGO comprises key stakeholders and is chaired by my Department. The range of measures being implemented by my Department seeks to promote a healthy lifestyle, to encourage people to make healthier food choices, to become more active and to take the first steps towards reducing obesity. SAGO is working on a combination of priority actions which, taken together, should make a difference in the long term. These measures include the following: calorie posting in restaurants; healthy eating guidelines; addressing the marketing of food and drink to children; treatment algorithms; opportunistic screening and monitoring for excess weight and obesity; addressing the issue of vending machines in schools; and a physical action plan. SAGO is also currently examining ways to promote healthy eating in accordance with this Department's healthy eating guidelines.

As I said earlier, during our Presidency we had an informal meeting at which childhood excess weight and obesity was a key element.

The European Union is drafting an action plan for member states to take this work forward.

Healthy Ireland, a framework for improved health and well-being, forms the basis of how a whole-Government and whole-society approach to health and well-being will be delivered. It sets out 64 actions under a number of thematic areas which provide for the development of inter-sectoral and cross-Government plans to address risk factors and social determinants of health. It provides a structured mechanism to engage all different sectors of society to channel measures and actions around individual health and lifestyle issues, and to measure, monitor and evaluate implementation.

Healthy Ireland describes supportive mechanisms to ensure effective co-operation between the health sector and other areas of Government and public services concerned with social protection, children, industry, food safety, education, transport, housing, agriculture and the environment. The implementation of Healthy Ireland is now focused on the development of an outcomes framework and a physical activity plan. In this regard the health and well-being programme in the Department of Health will work closely with relevant policy divisions in the Department of Health and with existing cross-Government and cross-sectoral groups, such as the strategic action group on obesity, SAGO. We have, for the first time, a director of health and well-being, Dr. Stephanie O'Keeffe.

Just to show the Punch and Judy politics is gone from this House, I congratulate the Minister on his proposal to ban menthol cigarettes throughout Europe. It is a very positive proposal.

The Minister has put obesity to the fore, but while we are talking about policies in this House, it is not happening in any real terms on the streets of this country. The statistics are alarming. Against any benchmark, country or statistics from the World Health Organisation, WHO, or the Organisation for Economic Co-operation and Development, OECD, it is clear we have an obesity epidemic in this country. We have had an alarming doubling of the number of people who are overweight or obese over the past ten years. As a practising GP the Minister knows the difficulties that will cause regarding cardiovascular diseases, diabetes and musculoskeletal difficulties. While we talk about it, families are not aware of the problems obesity will cause in the years ahead. There must be a very concerted effort targeted particularly in the schools. We hate always burdening schools with further obligations but there must be a healthy lifestyle commitment in education that encourages people and makes them aware of what they are doing and eating, and the outcomes of what they put into their bodies.

I thank the Deputy for his support for the tobacco directive in Europe. It was very important from the Irish Presidency point of view in health, along with the cross-border health threats initiative which will allow us to procure vaccines with other countries rather than being a small nation faced with multinationals. We could not get quite the same deal as bigger countries. That is resolved. The fact of 700,000 Europeans dying every year from tobacco is a major issue and I look forward, I hope, to the Deputy's support when we bring in the plain packaging Bill later this year.

I share the Deputy's concerns about obesity. We are working on this across Government for the first time. We have agreement across Government that we must tackle this issue. There is a need to stop paying lip-service to public health and pay for it. As politicians we must all take responsibility for this. It is much sexier to open a new MRI scanner or hospital wing than it is to promote a public health initiative which can save many more lives and much more money in the future.

The problem is that the result and payback happens not in the short term but in the long term when, perhaps, we will all have long left these Chambers for good.

The Minister is beating up smokers again.

We do not want to be repetitive. This was raised in a priority question also. We need serious action very quickly. Dr. Donal O'Shea has been clear about this for some time and has pointed out that we are in the middle of the epidemic. We already have it. We can examine the statistics of any other country; where it continually develops it creates huge societal and health problems and pressures on the health services in the years ahead. Any efforts to act now will save a lot in the medium to long term.

I join Deputy Kelleher in welcoming the progress on the issue of menthol cigarettes.

Will the Deputies give us a break?

I am sorry for the Deputy. It is tough luck.

Smokers are blamed for everything.

We are not anti-smoker or anti-Deputy Finian McGrath. We want to support smokers to become ex-smokers. We are anti-smoking and anti-tobacco industry, which is targeting our children and robbing them of the opportunity to make a full decision later in life. What choice does one have once one is addicted? None.

The Minister would blame us for the banking crisis.