I thank the Chair and members for the kind invitation to appear before the sub-committee. I feel somewhat naked in comparison to the previous group of five, as I sit here alone. I wish someone was sitting beside me to hold my hand.
I should state at the outset that while I am not an expert on suicide per se, I have spent the last 15 years researching, lecturing and working in the direct area of social care provision for the most marginalised and vulnerable children, young people and adolescents. This afternoon, I will limit most of my observations to three particular areas, namely, social care provision in Ireland, the midlands, as there is some interest in that respect, and the third level environment. I have brought some statistics which I believe will be discussed at a forum like this for the first time today.
I am also pleased that a number of areas on which I wanted to focus have already been raised. Specifically, I wish to discuss the role of males. The members all have a copy of one of my books, Where Have All the Good Men Gone: Exploring Males in Social Care in Ireland. It was a national study and I want to discuss some of its findings relating to self-harm and suicide. I also wish to note that my opinions are my own and do not necessarily represent Athlone Institute of Technology as an institution.
Having listened to the last couple of speakers' contributions, I will begin at the end of my paper. In the time which I will have taken to travel to Dublin from the midlands and back again by train today, eight people in Ireland and the United Kingdom will have died by suicide. Approximately one suicide takes place every 82 minutes in the United Kingdom and Ireland. It is an extremely serious issue. There have been a number of common threads in the conversations, meetings and work which I have carried out over the last 15 years, with regard to children, youth at risk, adults involved in prostitution, adults involved in heroin misuse and males and females involved in social care provision. If pressed to prioritise those categories of people, I might state that the most common threads I have found are loneliness, isolation, a perceived inability to cope, being fed up with life and fear of change. Each attribute runs across different areas to different extents.
The tragedy with suicide is that much more could be done to hold individuals back from the edge of darkness. I feel we must be unambiguous in our messages to people at risk from suicide. While there is a feeling in society that suicide is in some way heroic, it leaves a significant void for those left behind. A number of options exist. While it is easy to tell suicidal people that there are options, they simply do not see them, which must be taken into account in terms of providing resources for mental and physical health.
In my career as a researcher and academic, I have encountered suicide and parasuicide quite frequently, although one might not expect to witness it in that setting. However, third level students are no different to other populations of Irish people. I now take the issue of suicide so seriously that I trained myself in a programme called ASIST, applied suicide interventions skills training, which has been rolled out by all the health boards. I recommend this training programme to anybody with an interest in the area of suicide. It is a two-day programme and it is very interesting in terms of giving us the skills to deal with people who are suicidal at a particular moment in time.
Psychological stress was mentioned in the last presentation, and there was much talk about stigma. If we consider one survey, for example, of 1,000 adults in Ireland aged 15 and above, 73% have had some experience of mental illness in respect of people to whom they are close, many of those either themselves or their direct family members, yet there are many misconceptions and misperceptions around mental illness and these need to be challenged. Some of the worst misperceptions are that the most challenging concern are those for males under the age of 25 and over the age of 65. In other words, it is difficult to convince young and older males about positive mental health. There are a number of reasons for that to which I alluded earlier.
The comedian, Denis Leary, who comes to the festivals here on regular occasions, used to make a joke that when he first came to Ireland, people on the streets of the capital city were exploding around him, so pent up were they with emotions and frustrations. It is fair to say that, traditionally, the Irish drank away their troubles or sorrows and it has required a significant world-view change for us to look to alternatives. To give an example, nine years ago, 5,000 people were admitted to psychiatric care for alcohol-related disorders alone. The airways, the Internet and counselling therapy have largely replaced the Catholic confessional with the unrelenting secularisation of Irish society but they have proven to have many challenges.
I state again that suicide should not be a taboo subject in our school system. Children and youth now have access to immediate information on suicide, on ways of killing oneself, on groups that are supportive of suicide and on means of hiding suicidal thoughts and feelings from parents or care-givers in a way that is new, ever-changing and largely invisible to those of us who are not conversant with chat rooms, message and bulletin board phenomena. At the same time, fewer and fewer youth are interested in attending and participating in Mass and religious ceremonies and we know from historical evidence that whatever else religion does, it acts as some form of social cement for people.
Following on a thread from that, one of the ironic findings from a study I co-authored on heroin misuse in the midlands is that a number of users are falling through the cracks of duplicated service provision, about which I want to refer briefly. One of the experiences in the midlands, and I am talking specifically about the towns of Athlone and Portlaoise, is that between 70 and 300 people were misusing heroin at various levels. Quite a number of those had expressed suicidal thoughts in the past. A number of people in the study were reported as having overdosed on purpose by injecting heroin. Although the death was recorded as a heroin-related death, the family members to whom we spoke said it was suicide.
The figures for suicide are significant. A total of 400,000 people throughout the world kill themselves on an annual basis but suicide has always been a very difficult subject to discuss and we need to be wary of the figures that are thrown around. If we take a pan-global perspective, for example, we realise immediately that precise statistics on suicide are entirely problematic due to, for example, the methods in establishing death, the varying registration and coding procedures, and indigenous social and cultural practices. I presented a paper at a Samaritans conference in Waterford a number of years ago where the county coroner started his paper by saying that he disregarded a number of traditional ways of reporting suicide and formed his own opinion, which I thought was rather ironic in terms of figures. From the various sets of statistics we now understand that approximately 5% under-reporting occurs in the country.
It was mentioned earlier that suicide is the most common cause of death in Ireland among those aged between 15 and 24 and the statistics illustrate that nearly a quarter of all Irish suicides just five years ago involved people between those ages. In 2001, there were 448 suicides and in 2002 there were 451. The figure is staying in the 400s — over one suicide per day.
To refer briefly to male suicide, there is no doubt that young Irish males are at particular risk, with the national suicide review group noting that the suicide figure for males between the ages of 15 and 19 is now 19 per 100,000. In fact, the risk of dying by suicide for young males is four times that of their female counterparts. It is a fact that more females attempt suicide; fewer males attempt it but they are more successful. It is also worth mentioning that rural male suicide is on the increase as compared to urban male suicide, and few statutory or voluntary agencies are focusing on the problem of suicide among men in rural areas.
In 1990 in Ireland, 366 males died through suicide but a decade later, in 2000, that figure had risen to 471. Despite the many advances in Irish society over the years, young Irish males continue to report difficulties in attempting to articulate their emotions or asking for help. We heard that from the last delegation.
In 1998, seven times as many men as women took their own lives in Ireland, which at the time was the highest ratio in the world. It surprises many people to hear that twice as many females attempt suicide but that males are more successful. In a national study I conducted with some colleagues a couple of years ago, out of 2,500 students in the Higher Educational Training Awards Council, HETAC, and the Dublin Institute of Technology, DIT, sector only 129 were males. The most vulnerable in Irish society will typically end up in care of the State. Because of the low number of males registered to be front-line child and youth care workers and social care workers, a number of male and female children will have no positive male role models in their lives. Because of the way the system is constructed, they will experience only female care givers, gardaí and probation workers. Their experience of men will be as absent or poor fathers, violent men, men taking multiple partners into the home and a culture of dependence and unemployment. In the next five to ten years there will be a significant problem with the young children currently in the care system coming out with few positive male role models to change things for them.
Looking back to my school career in Galway, my male peers were largely socialised to appear to be in control, to be mentally and physically strong and to take risks. One of the delegates mentioned sport in this context. Little has changed. Males still dominate the same professions they did 20 years ago. There are far more males in psychiatric nursing than general nursing, in secondary school teaching than primary school teaching, and there are few males involved in early learning environments. The lack of male role models is such a serious issue that the Department of Education and Science is considering allocating male applicants percentages based purely on their gender. Males in school are often streamed into contact sports where they learn to "be the best they can be" and where active competition is encouraged. Males engage in more risk behaviours than females, for example men consume three times as much alcohol as females, they binge drink more often and have greater adverse consequences than their female peers. Many male suicides take place with alcohol present.
The social construction of masculinity has been shown to play a role in their substance misuse, and that was the case with a number of interviewees in the midlands regional study on heroin misuse. The male fascination with and respect for violence is often tied with proving their manhood. The Samaritans organisation in the UK and Ireland has 70% female and 30% male volunteers. This is not an area that males are moving into.
Returning to the midlands regional heroin abuse study, another common thread we found was an absence of positive male role models, in this case father figures. Consistency, mutuality and reciprocity are crucial in helping a child develop secure attachments. If strong attachments are not made, it is more difficult for a teen or young adult to find their path in life. This issue of missing males plays a strong role in self harm and suicide in males. Research has shown that even more deaths could result from deliberate intentions, for example late night single car crashes involving particular males. One estimate for this is 20% but the Foundation for Suicidology puts the figure closer to 6%.
Male suicide deaths are typically violent ones, the preferred methods being hanging, followed by poisoning, firearm use and drowning. There are issues around access to means. I wonder if more work could be done with DIY stores, builders providers and pharmacies and their staff. Is there any screening when young males buy certain types of products? My own research into at-risk behaviours over the years illustrates that suicide leaves an incredible vacuum in the lives of survivors, namely family members, friends and colleagues.
I have worked in third level college environments for the last 15 years. The 18 to 25 year age group is particularly vulnerable. Third level students are at a particular stage of transition in their lives. They face several significant new stresses such as being away from home, locating and securing accommodation, meeting and fitting in with new peer groups, managing finances, attending classes and undertaking assignments in a new and impersonal environment. There is a sea change in the daily life of a leaving certificate student when he or she comes in to a third level environment. The Association of University and College Counsellors noted the increasingly diverse profile of the student population in Ireland which now includes "an increasing number of students from backgrounds where they have struggled with particular challenges such as physical, learning and mental health disability, socio-economic disadvantage, membership of highly marginalised communities and refugees."
Suicide is a fact at third level. Last year, for example, three female students who were attending one university were reported in the local media as having killed themselves, one before Christmas and two just afterwards. In each of the three cases, a book of condolences was set up and student and staff representatives attended the funerals. This is heartbreaking for college communities.
In preparing for this presentation I asked a number of college counsellors what was the situation. An interesting reply I received was that given a student population of between 10,000 and 15,000 in a five year period, 14 to 15 student deaths would be expected, that is, two to three per year and of these deaths, suicide would probably account for one third. There is also an issue in the students who are dying from violent accidents such as road traffic accidents that these are suicide, deliberate deaths.
College counsellors in Ireland report that the three most common reasons they are consulted by their students on suicide are: personal suicide ideation-behaviours, concern about other persons' suicide ideation-behaviours and bereavement by suicide of someone in their life. At this stage we know what to look for, at least, within the third level community, and yet the resources remain scarce.
We also know that there are a number of student subgroups that are more at risk of suicidal ideation than others. These students include, for example, students who are gay, lesbian or bisexual. These students express being more depressed, being more lonely and having fewer reasons to live than their peers. This is a significant figure, depending on whose research one believes. The credible figure for the homosexual-lesbian population is between 3% and 10%. That represents many students.
From experience of working in three third level colleges not based in the capital, I can state that there are significant barriers to coming out if one is gay, lesbian or bisexual. Indeed, it takes a very strong person to declare this publicly. It is the students who live these unfulfilled lives who are tragic when we see how far this country has come in its sexual secularisation.
In the early 1990s I was involved in establishing a student phoneline service for students at the Waterford Institute of Technology. We operated a shift roster system within the college. We received calls and students came forward for individual counsel. Third level college communities are large places with a considerable student mix, including urban-rural, male-female, young-mature and working-non-working. It is unhelpful to merely think of them in terms of the college existence. All belong to some form of community, even if they have withdrawn or feel isolated from that community at that point in time.
It has proved impossible for me to collate national figures for suicide in third level in Ireland today. That is because the different colleges use differing methodologies in maintaining their statistical information. In my presentation, I give examples of statistics that I could collate. One will see that in two of the colleges, the number of clients or students presenting for counselling in the medium to high-risk categories have increased, in one college from 18 to 26 and in another from 26 to 59. Surprisingly, one would have thought, the third college saw a decrease in students coming forward for counselling with suicidal thoughts and feelings. Therefore, it is not true to say that all the colleges are experiencing this problem to the same extent. Each college is experiencing the issues around suicide in a slightly different format.
Statistics are excellent but I want to personalise the issue again. I mentioned that there is a suicide every 82 minutes. It seems reasonable to suggest that we have failed to engage adequately with many persons who have felt suicidal in this country. How can we explain the suicide of two male and two female Irish children under the ages of 14 just two years ago? I remember when I started my career in social care in 1992, I was told by a fairly eminent individual that children under the age of ten did not get clinically depressed. We have certainly learnt a great deal in the past 15 years in that regard.
As a sporting man, I will put some figures in context. Imagine if we just took the figure for male suicides between the ages of 15 and 24 in the period 1997 to 2001, which was 446. This is the equivalent of 42 soccer teams or 31 rugby teams simply missing from any tournament we might want to host. In the case of female suicides aged between 15 and 24 over the same period, we could have enjoyed eight ladies' soccer teams or six camogie teams, had these women lived and chosen another path. With the death of every person comes the loss of a lived library of life. A death through suicide can affect any one of us, although all of us hope that our families will not be the ones to suffer. Thankfully, suicide is now understood to be a very serious concern in Irish society.
My brief recommendations are as follows. With regard to the colleges, it would seem appropriate that a national database be developed which could be used across all third level counselling services, as is the case in the UK. Any public health strategy must be more flexible and age and gender appropriate than they have been to date. They should be proofed with what has been described as "the ordinary decent citizen" and made accessible in a language and medium that is understood by the people to whom the service is being delivered. Dedicated funding should be made available to college staff to undertake programmes such as the ASIST programme.
Effective communication lines should be generated between and within agencies involved in mental health and social care provision. I cannot overemphasise the number of times during the course of the midlands heroin study that we were told by service users of service agencies and family members of heroin misusers that they were continually missed and falling through the cracks. Families should be a major point of contact in addition to the presenting person at risk. To simply see each person as a person in his or her own right is to miss the wider ecological debate. Male peer group interaction with mental health themes should be encouraged on a regional basis. We know from research that fewer than one in five males present to a GP when feeling depressed or suicidal.
