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Joint Committee on Public Service Oversight and Petitions debate -
Wednesday, 12 Jun 2013

Strategy on Suicide Awareness: Discussion

I welcome Minister of State at the Departments of Health and Justice and Equality with responsibility for disability, equality, mental health and older people, Deputy Kathleen Lynch, her officials, Ms Geraldine Fitzpatrick, assistant secretary, and Ms Sandra Walsh, assistant principal, and Mr. Gerry Raleigh, director of the National Office for Suicide Prevention. The Minister of State is here today to discuss her strategy for suicide awareness.

I remind members and those in the Gallery to ensure their mobile telephones are switched off for the duration of the meeting as they interfere with the broadcasting equipment even when on silent mode.

By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of the evidence they are to give this committee. If they are directed by the committee to cease giving evidence in relation to a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any persons or entity by name or in such a way as to make him, her or it identifiable. Members are reminded of a long-standing parliamentary practice and long-standing ruling of the Chair to the effect that Members should not comment on, criticise or make charges against a person outside the House, or any official by name in such a way as to make him or her identifiable.

I invite the Minister of State to make her opening statement.

I apologise in advance for something that was arranged just last week. I welcome the opportunity to address the committee today. I will not give the entire official speech because members might like to spend more of the limited time we have asking questions. I know a briefing note has been circulated to the members and I hope it has been helpful.

Mr. Gerry Raleigh, on my left, is the new director of the National Office for Suicide Prevention and he will take questions on the new strategy for the office. Members are probably very familiar with Ms Geraldine Fitzpatrick, as this is her fourth time to be here this year. Ms Sandra Walsh has a specific brief in the mental health area and Ms Fitzpatrick has overall responsibility in the Department for the area of mental health.

As members will note from the briefing document, the numbers for suicide have actually reduced. We will not have this year's numbers until next year. That is the mechanism for how we gather our statistics.

We have several campaigns running, such as Safe Talk and Assist. I will only mention items I believe will be new to members in respect of what we intend to do. Mr. Gerry Raleigh will take members through the new strategy. We have had several representations in regard to introducing Safe Talk into secondary schools and are looking into that - that is not in the briefing note - and considering, first, whether it is appropriate to do it and, second, whether it is logistically possible. Ultimately, given we have introduced a system in co-operation with the Department of Education and Skills regarding a whole-of-school approach, it seems the next step would be to consider whether we should introduce Safe Talk to an appropriate age group within the second level system.

The launch of Reach Out by the HSE's national office for suicide prevention has worked to raise suicide awareness by developing a wide range of awareness and training programmes which include the development of the Safe Talk and Assist training programmes that train participants to become more alert to the possibility of suicides in their community. We were discussing this earlier and it seems we are now training up to 3,000 people a year. Naturally, those people will have an effect on those around them. We are making progress. The Mind Your Mental Health and Let Someone Know awareness campaigns highlight the need to look after mental health. We are not where we need to be but are making progress and moving in a positive fashion, with the movement always being forward.

The programme also funds campaigns targeted at specific groups within the community, for example, the farming community, through farm television. These programmes have been well evaluated in terms of impact. The focus of these national campaigns is to assist the individual to understand the importance of looking after his or her mental health and to seek help at times of stress. Once these campaigns are up and running, however, it is essential that when people reach out for that help, it is available to them, especially so when they find themselves in distress. I thought it very interesting that yesterday Senator Norris spoke about his mental health after the presidential election, saying he found it very difficult to realise he was so distressed and actually needed help. That is also an issue. Where does one turn when that happens? The message has to be very clear, with a clean line, as to where the access point is and where people can be delivered on to a more appropriate service. Sometimes this may be very low level. Perhaps the GP can do it or counselling or psychology will work. However, there are other times where more intensive interventions are needed. We are looking at all these approaches.

The Headstrong and Jigsaw programme is available at ten sites throughout the country. This innovative youth mental health programme works with young people, communities and local services to change the way Ireland thinks about youth mental health. People may know this programme in their own area. The Chairman has one in his area and so does Deputy Nolan. There is also one in Tralee. Anybody who has this service realises its value. There is self-referral from the street, and no matter who one meets on that premises, they are people who have training in mental health. The person giving the cup of coffee or answering the telephone has that training. The more intensive appropriate service is available afterwards.

Schools are a key setting for the promotion of mental health and well-being of young people and they are in a position to identify young people experiencing emotional difficulties. The Department of Health and the Department of Education and Skills work closely with the HSE and the national office to develop guidelines for mental health promotion and suicide prevention in post-primary schools. These guidelines, published in January, provide a clear framework, with information for schools and agencies supporting schools on how to address issues of mental health promotion and suicide prevention. That whole-of-school approach must be the way to go. We cannot foresee which person in that school is the one the young person in crisis finds most appropriate to approach. It may not be the teacher or the guidance counsellor and it may not be the principal, so everyone in the school needs to have that training so that when the crisis occurs, they will know how to respond.

I acknowledge the tremendous work being carried out by many of the voluntary and statutory agencies in providing services for those who may be experiencing a personal crisis. That crisis may very well be severe, in other cases it may not be, but nevertheless it is a crisis for that person. We cannot dismiss any of the circumstances in which people find themselves. In these difficult economic times, with increasing demands on services, it is important that we work together and link our resources in an effort to tackle this serious issue and create an environment that is enabling rather than disabling for people in distress. Mr. Raleigh will talk about the number of groups we have that are prepared to help in any way. These are groups that usually arise out of personal or community tragedy. Co-ordination is key. There are the national groups, such as the Samaritans, Console, Aware and others, which all do tremendous work, under contract, for both the HSE and the Department of Health. We have all that but there are also the smaller groups. Everyone must have the same message. The Government will never be able to be in every town at every street corner, so it is these smaller local groups that do such a tremendous amount of work. We must ensure they have the support and the single message, and that they can link into the other services when more than their support is needed. That is very important.

Last year we launched a programme with the Samaritans which will roll out very shortly - I believe at the end of June-----

Ms Sandra Walsh

In the next few weeks.

Eventually we got the five mobile telephone providers together. Up to now the Samaritans had a lo-call number with Eircom, but the organisation was carrying the cost and clearly could not continue to do so. The other thing we discovered was that very few people are now using landlines. Anybody in distress, young people in particular, were using mobile telephones so that number was of little benefit to them. We got the five mobile telephone providers together and they have agreed to fund the single number, 123116, the Samaritans' new number, which will roll out on a pilot basis for a few weeks in a particular area. The service will then be stopped and evaluated. That is the internationally recognised number and will be a signpost for other services. Sometimes we do not see what is going on behind the scenes but the five mobile providers have been very helpful in this regard. They see it as something that is good for them too.

We have doubled the budget for the national office. A figure of €8.1 million had been available and now €5 million has been provided by the HSE to fund resource officers for suicide prevention, a self-harm liaison nurse in hospital emergency departments and local suicide prevention initiatives. Public and political concern has increased around suicide and there is a perception we are not being sufficiently active in suicide prevention. In this regard the HSE and the national office have been reviewing the activities of the office to ensure we make the most of available resources, including looking at best practice internationally to inform evidence-based decisions. Recently, as a result of enormous public interest, I contacted the national office for suicide research for discussion. I never take that public interest as a criticism. I believe it is a good thing. It encourages all of us to do better. I wanted to talk to the office representatives. We had heard Germany and Scotland were doing much better than us.

I asked the office what we were doing wrong. Its answer was clear - we were doing the same as the countries I have cited. For example, our Reach Out strategy is identical to the German and Scottish strategies. We need to give it time to bed in. We need to be more open about this issue and co-ordinate. Dr. Ella Arensman asked me not to interfere with the strategy and to give it time to work. We may need to do something different in terms of promoting the message and the contact number, that point of clean access. If one is in distress, there are so many doors now that one could become confused. Mr. Raleigh will discuss the clean access and I will happily take questions. I may have left some matters out. I always view these occasions as an opportunity to interact with the committee.

I thank the Minister of State for her presentation. Some of the reports have cited a number of causes of suicidal ideation. For example, there tends to be a greater level of suicidal ideation among the unemployed. There is only so much that can be done on the suicide prevention side. Have there been studies of how much it can achieve? The Minister of State's office will not undo the unemployment crisis. Are their limits to what she can do in her role?

The Minister of State referred to the organisations, many of which are located in Galway. Normally, the people involved come together and set up their organisations out of good will and terrible experiences. How can the plethora of organisations be co-ordinated? Often, the people involved have stepped forward because they believe a gap is not being closed. How can the Minister of State work with them?

I thank the Minister of State for her presentation. This issue should be more to the fore. Although it has been discussed more frequently in recent years, this is regrettable, as there has been an increase in the number of suicides for a variety of reasons. Good work has been done. For example, and as Deputy Nolan mentioned, people can come together with the best will in the world and try to set up helplines. In my area, I spent a night clashing with locals who wanted to set up a helpline because of the tragic case of a 14 year old girl. I tried to persuade them that there already were helplines and that they had not thought it through. The worst thing in the world would be for a helpline to be set up only to have it fall away two years later. I tried to persuade them to negotiate or liaise with existing providers to determine whether an additional helpline could be set up under the latter's remit. Eventually, that is the route people took. They channelled money through existing services. Sometimes, the best will in the world is not the most practical approach.

The remit of Reach Out: National Strategy for Action on Suicide Prevention is from 2005 to 2014. Is it intended to review this strategy? Has a group been set up to ensure that there is no gap in it? We have moved on a great deal since 2003 and 2004, when the strategy was being drafted. We have more services and information on the situation. The earlier we put together a follow-on strategy, the better. The service problems we have mentioned could be highlighted so that communities could have a greater understanding of the shortfalls in services, how those services should be funded and how suicide prevention can be better integrated into the education system, sporting bodies and everyday society.

We will never reach a point at which we will eliminate death by suicide. There may be years in which it does not happen or suicide deaths do not flash on the radar. Suicide has been an issue across the world. We simply did not count incidents well or acknowledge them to a great extent.

We need to capture information on who is dying by suicide, most notably large numbers of young men. Unemployment and the recession have had an effect, in that the age groups involved have moved from the 25 year olds to the 45 year olds. This pattern has settled again. All of the research tells us that there is a brief period in which we can do something for people who are in distress, lack hope and do not believe that they have anything worth living for. It is important that they know where to get help.

Deputy Ó Snodaigh was dead right. If something has happened in a family or community, people may believe that it happened because services were not available and, therefore, they must produce those services. We must get the message out that a service is available, there is a clear line of access and people do not need to set up their own groups or helplines. One can understand why they do this, but a major concern is whether their message is right. One needs to be careful when advising people who are in a vulnerable state and when directing them towards another party. I could not agree with the Deputy more. It is awkward when a Member must tell someone who has stepped up to the plate and offered to help that the person's proposal would not help.

I thank the Minister of State. I do not have much to add. From what I can see, she is taking the issue seriously and analysing it to determine how best way to minimise the incidence rate. As she stated, this problem cannot be eliminated. I agree with her comments on streamlining and easy and correct access points. This is a major issue. Generally speaking, people are somewhat intimidated by the prospect of engaging with the State, bureaucracy and so on. If they are in a vulnerable situation, it is even more of a problem. An easy, widely recognised and trusted point of access through which they can get help and support would be key.

Nothing will ever eliminate the issue completely, but if we have that, hopefully a significant number will know there is a place to go when they feel that sense of despair. We must work on that and co-operate to achieve it.

With regard to the impact of the recession, there are two categories closely connected, namely, those affected by the impact of the recession in terms of unemployment and those affected by the disproportionate impact of unemployment on young people, young men in particular. They may be more affected by the perception that if they are out of work, they are somehow useless and have nothing at all. We must focus on this area. In the context of the unemployment crisis, this goes way beyond the Minister of State's Department. The focus is on young men in particular, but also, due to the impact of the recession, it is on people who have lost their jobs who now face financial pressures and wonder what is the purpose of their lives. We must also focus on this group, which is being hit disproportionately, and consider how we can engage with them. This means there must be some integration with social protection services to ensure consideration of this issue in people's engagement with those services. The mental health and suicide prevention services available must be flagged and must feature strongly in people's engagement with the Department of Social Protection.

In regard to unemployment, the Minister of State has said that the figures have decreased slightly recently. A recent study suggested that Ireland and Greece in particular had been hit very hard and that, since 2007 and 2008, there had been a 17% increase overall in suicides in Greece and a 13% increase in Ireland. It is welcome news that unemployment is stabilising and decreasing slightly, but are we only coming down from the peak rather than the pre-recession period?

I will return first to Deputy Ó Snodaigh's question regarding what comes next. Reach Out as a strategy is part of A Vision for Change, which is supposed to conclude in 2014, but that is not set in stone. The previous plan we had for mental health was a 1983 plan and the one previous to that was a 1940 plan. I do not intend to maintain a similar gap and shortly we will put together a group of people who will look seriously at what should come after A Vision for Change. Now we have put in the resources, we must consider what exactly we want. This strategy will include a review of Reach Out. The review has already started and Mr. Gerry Raleigh has done an in-depth analysis of it.

In response to Deputy Boyd Barrett, there is good research informing us that for every 1% increase in unemployment, there is a 0.75% increase in the suicide rate. We have the figures and in 2003, for example, suicides numbered 497, of which 111 were female, which is significant because women do not usually follow through. This figure reduced slightly in 2004 and again in 2006 and 2007. However, it rose again in 2008. Therefore, Deputy Boyd Barrett's point is relevant, because it was in 2008 when the bubble began to burst. The figure rose again in 2009, but reduced in 2010. It rose again in 2011 and reduced again slightly in 2012. The Irish population is very small compared with that of Greece, France or other European countries, and if anyone from those countries looked at our total numbers, they would probably not be very impressed, but for us the figure is unacceptable. It is a fluctuating number.

The amazing thing regarding young men committing suicide is that until recently, they were usually students and recession was not a significant factor. The benefit of research is that we can look at the figures. We were all quite shocked to see how many students were involved. These were people whose whole lives were ahead of them. They were at college and living the dream, but there appears to have been an absence of hope and a feeling that there was nothing worth living for. Suicide is quite a complex issue and is not one that lends itself to just one strategy or a one size fits all approach.

Mr. Gerry Raleigh

The highest recorded figures were in 1998, but there has been a downward trend. A strategy was developed in 2004 and then Reach Out began and this saw a decrease in the trend. However, the figures then moved in the wrong direction and in recent years the highest rates came in 2009. As the Minister of State has said, these higher figures raised particular concerns around young and middle-aged men. While it is a small comfort, we are seeing a stabilisation in suicide rates across these age groups in the past couple of years. The most recent official figures we have are for 2010. We suspect, on the basis of the provisional figures, there will be a slight increase in the figures in 2011 and a slight fall again in 2012.

There is a modest parallel reduction in the rates of self harm being reported in our accident and emergency units. Over the past couple of years we have seen a stabilisation of the figures and some reduction. We take no comfort from these figures because they are still too high.

On the question of a national strategy, a recent WHO document begins on a positive note and states that suicide is largely preventable. The document speaks about the international evidence regarding the importance of community. One factor we have seen in recent times, arising perhaps from the economic situation, is the strengthening of communities. From my perspective, the community is one of the key positive tools we can use to support vulnerable people and help them get over the crisis they face.

As the Minister of State noted, we are in the process of reviewing Reach Out which, in its time, was a visionary document. There is nothing in it, or nothing omitted from it, that does not appear in the German, Scottish or New Zealand strategies. I have taken time in recent weeks and months to try to see what is working well for us. We will evaluate the document before it expires and are looking to develop a framework for a thorough evaluation. In comparison with Scotland's Choose Life programme, and the German programme in particular, weight is given to implementation planning. One thing we are examining in the office is how, at local level, in an effort to reduce the level of fragmentation and ensure services are evidence based, there will be standards of safety around what actually happens when a person looks for help. That is framed in the context of a local plan. Defining "local" is a challenge we must get to, but it should be as local as local needs be. We must base our service planning for the future on that basis, on a bottom-up, top-down approach which reflects local needs but has a framework that allows for the commissioning of services that are safe and are evidence-based in the community. Behind that we must support local communities so that people are clear about where to go when they need help. There must be a very strong and robust communication strategy.

One of the challenges we face in the office is a call from the political system and from society and communities. We understand this; it is a very strong campaign. We will act but the actual campaign needs to signpost people in the right direction, where help exists and is readily available. That is the challenge. There are three pillars to what we are considering. One is around help seeking. We must do this in the context of understanding our mental well-being, as individuals and as a community. What does our mental health look like? When it is compromised how might we feel? Where do we go to look for help? It may be that some people do not have the capacity to make that call for themselves. We must have people in the community who can put their hand on their neighbour's shoulder and say, "I think you're struggling and you need help". That is why the importance of programmes like Assist and Safe Talk are so relevant when they are used appropriately and are available.

Help seeking is about encouraging people to ask for help when they are compromised. There is a second aspect but I will jump to the third, which is about health giving. This is about when people knock on the door and seek help, ensuring the help is there in a co-ordinated way. This could be going to one's GP and saying one is feeling a bit off, asking what one should do. The GP must have the time and the capacity to understand this. GPs are excellent. They see the majority of people who are in distress or coming into stress, much more so than any of the second level services. They must be equipped and supported to signpost and assist people along the way. It goes on. The continuum of services develops in an integrated way. Although there may be a lot of fragmentation in the system, I believe everybody has a role to play, be it in the help-seeking domain or in help giving.

The third frame, mentioned by one of the voluntary service providers in the context of our developing our communications strategy, is around help taking, or receiving help. For men in Irish society that is a particular challenge. Much academic research has been done on masculinity and the preservation of the self. There are different catch phrases. It is about how to access the male population, young or old, in a way which allows people to ask, comfortably, for help. There are two straplines that appeal. One is about face to face communication, which many men do not do well. They do side to side, or shoulder to shoulder. These may be clichés but they are important. The use of community and the development of community groups must be used. I refer to sporting clubs, the GAA and different community groups where men interact. I do not wish this to predominate as a male issue, because it is not one, but there are challenges in how we present services to people so that they will be comfortable in accessing them. We will try to build a new national strategy around those three platforms.

I will take Deputy Mulherin followed by Deputy Healy-Rae. We will have two further questions from Deputies Luke "Ming" Flanagan and Noel Harrington. I ask the speakers to keep their comments succinct because there are only ten minutes left. For the same reason I ask for sharp responses.

I will try to do that.

I ask the Deputy to go easy on the subject matter.

I thank the witnesses for attending. I know the Minister of State takes this issue seriously. Too often, at least where I am from, it is a tragic situation and seems to happen across the demographic, including gender, etc. We all have experiences in life of dark periods so we try to fathom how a person gets to that point. One point the Minister of State noted is that it is hard to see this. My gut feeling is that suicide is preventable, as Mr. Raleigh said, but it will be with us, for the very simple reason people choose it. That ties in to the concept of help taking mentioned by Mr. Raleigh. The witnesses will hear opinions from us. We grapple with this issue but we are not experts. However, when one sees what happens in the wake of a suicide - a wife left to rear children by herself, families devastated - I sometimes wonder about it, though not from a point of view of guilt or anything like that. I am familiar with the work of Console and all the brave families of bereaved people and their friends who come forward to battle this, to say this death will make a difference, this person did not die in vain, they are going to reach out to people and tell them to reach out and get the help they hoped their loved one might have received.

The situation is many-pronged. We have described different people, whether they are from a particular age group, as mentioned by Deputy Boyd Barrett, or others who find themselves in all kinds of circumstances. Therefore there must be different ways to reach out to these people and elicit a response. Sometimes I wonder if it is more empowering to be told something, that even if right now I have a feeling, that feeling will pass. I can make a choice and be told it is my choice and that, no matter what my bank account is like, or my job, or what anything is like in this life, there is always hope. That should be reinforced in people. It is always darkest before the dawn, as the Minister of State remarked. There is a darkest point and then it passes. We know about the dark points.

I believe the stories of the families are important. Of course they do not proclaim the heartbreak involved but they might talk about the facts and figures. I can only imagine that the situation comes down to what a person answers to the question, "How is my mental health - what does it look like when it is good, when it is bad?" This depression becomes a reality, it does not become, "Well, I am like this, but there is something else". It becomes the person's life. There is a vortex he or she seems to be drawn towards, the inevitable. That is a lie, however, because there is a choice. The reaching out part seems to be about the person knowing help is available. I cannot profess to know the ins and outs of all the services in my area but it seems they are there, and there are groups around. The reaching out and the acceptance of this appears to me to be a particular problem.

I agree with the Minister of State that it is a loss of hope which has fractured our society. We may be able to understand this loss in the context that as we become more modern and cosmopolitan life is more and more about the individual and individual successes.

I can see how, with people going to college, it is in many ways great to get an education, but there are so many other facets to the human being aside from a career, car, family or job. These are external factors and anything else is being lost. It is a consequence of the Celtic tiger, which was not just an economic phenomenon, but rather a belief system. As a result people believed they had no value if they could not pitch themselves in any of the areas I have outlined. That is also a lie.

That is the issue and it is exacerbated because of the way things are in a recession. In life and politics we may strive towards excellence but we will never be perfect, so we must consider the positive aspects. I would like people, even those in the Opposition, to say that we must work on those. Politicians and community leaders have a powerful platform and if they choose to dwell on despair, the vulnerable people who only hear messages on the radio or in the newspaper will be sacrificed, sometimes just for quick political gain. I am not trying to be naïve about the way politics or opposition works but sometimes we should be able to say we have a lot going for us in the country, and we only have to look outside the island to see how valuable is the freedom of our democracy. In the Third World we can see real problems.

I appreciate that this is a very difficult subject.

I welcome the Minister of State and her officials, who will be glad to know I will be very brief. When this Government engaged in the cuts affecting our career guidance teachers in schools, I met representatives of many groups. I was shocked. My understanding was that these people guide students in their career but it was frightening to see the number of young people who had psychological issues and mental health problems and who saw these teachers as the first point of contact. What upset these people was not that they were in many instances to lose their jobs, but rather that they were being redirected to mainstream teaching, leaving a void in many schools around the country. The young people used to be able to turn to a person for a chat. In many cases, the young person did not go to the teacher for career guidance but rather because the teacher had the luxury of time, he or she would use that time to engage with young people, notice them and spot issues that a busy teacher running to a class would or could not. This is an important aspect that the Government should consider. The cuts were too tight to the bone and I was not being sensationalist when I stated that at the time. I said what I did because I believed, having listened to the teachers, that the move could cost young people their lives because they could miss early intervention when a problem arose.

It is time for a process like that used by the Road Safety Authority, RSA, to deal with the problem, as has been mentioned by others. When intolerable numbers of people were dying on our roads, it was deemed correct to set up the Road Safety Authority to tackle the issue. Much money and resources were put into tackling the problem and, overall, it has worked and brought down the number of deaths on the road. Considering that the number of people using the roads is increasing, the initiative has worked far more successfully even than people might realise. There are many agencies doing excellent work and we have come a long way but it is time for a system based on the RSA, with publicity being provided and bringing all the agencies together under one umbrella, to get them to work together. That is really important.

It may take me half a minute to tell this story but it would be good for a Minister of State to hear it. I appreciate she does her clinic work but it is always good to hear a story from the ground. As an example of what people are going through, today I had a telephone call from an individual suffering from lifelong mental health issues. The person receives excellent care three or four days a week but must travel to the counselling himself. It keeps him together. He told me he is missing many days of treatment and when I asked him why that was so, he told me that I know where he lives and where he must go. It is a round trip of perhaps less than 40 miles. His problem is that he does not have money to run his car and he had often hitchhiked because he could not put petrol in the car. If he could not get anybody to carry him to his appointment, he would stay at home, meaning it was a bad day for him. It is nice for the Minister of State and her senior officials to hear this as it is a true story which I only heard today. It is frightening what people are going through. There is help available for that person and people rang him to see why he could not make his appointment. He operates on the tightest of budgets and could not afford to travel to get help. It is nice for the officials to hear that story as it conveys the impact of the current crisis and the financial constraints on people.

I thank the Minister of State for the presentation. I am sure she remembers the Private Members' motion that the Technical Group moved in its first six months in the Dáil, which was not put to a vote. A marker was put down as to what we would like to see happen and we left it at that, although we indicated the issue would be revisited. I have an interest in this area from a personal perspective as I suffer from mental illness and I contemplated suicide at one stage. I have made it quite clear in speaking about this that one of my biggest fears was approaching the mental health services.

It is interesting that the Minister of State noted that "when people reach out, there should be help", and nobody can disagree with that. She continued that "the environment should be enabling and not disabling" and, again, nobody can disagree with that. She also stated that "all we can do is ensure people will know what to do or exactly where to go". I wish I did not have to say what I must say but people do not have that assurance in my county. People may say it is parish pump politics to speak about one's own county but it is not; it is the area I know best and it is the issue people are coming to me about. Far from feeling reassured, for the past three weeks in all the local newspapers, there have been true articles that do anything but reassure people. I will give the Minister of State a taste of what people are saying.

I am sure she has read the Roscommon Herald this week and she knows what is going on in Roscommon psychiatric unit. The paper carried the story of a person who had a family member there when the incidents took place, and I hope the Minister of State is aware of what those are. Can the Minister of State imagine what this is like for the staff, patients and families? We tried to bring this up in the Dáil but it was repeatedly refused a spot as a Topical Issue, including today. The staff are doing terrific work and we do not want them criticised but they are working in appalling and understaffed conditions. This must stop right now. The authorities were told there would be problems and there will be more of them. I am pleading with the Minister of State to get this appalling issue addressed immediately.

It may be the same across the country but in Roscommon people do not feel safe about the prospect of approaching the mental health services.

We have a situation where the local services are losing staff because they need them in the psychiatric unit and people do not have the service locally. We know the knock-on effect. They end up a little worse and in many cases have to go into that hospital, which they do not feel safe going into. I hate having to say this but they are right in not feeling safe about going there. Something needs to be done. The fears I had all those years ago have not been allayed. I wish they had, but it is clear that psychiatric services are still the poor relation in our health services. Nobody has contacted me to tell me that their brother, son or sister had been left on the side of a road and left for a year with a broken leg with nobody taking any care of them as their health deteriorated and they died. Yet that kind of situation is happening to people.

We talk about why people end up with mental health problems. We have a situation in the psychiatric unit of Roscommon County Hospital where the workers are starting to develop mental health problems because they are under such huge stress. There is a public meeting in Roscommon town tomorrow night to discuss all this. We do not really know where to turn. This is not picked up as a topical issue. It is not about me or Deputy Naughten, who also put in a request. It is about us trying to do something about this. It is an end-of-pipe solution. I would love to talk about the reasons people end up there but I do not have the time. When people end up at the end of this pipe it seems they are just being sent into the sewer. What is happening about this?

I come from a family some of whose members have had to undergo forced shock therapy in a variety of different scenarios and I am not seeing that this kind of situation is improving; it has not improved. I fear for anybody who has to use the mental health services in my county and I want to know that the Minister of State is going to do something about it. The last thing I want to hear is somebody suggesting this is some sort of political football. It is not. It affects me, my family and my neighbours. Up until now, I would have said the Minister of State talks an amazing talk. I do not know who is stopping her doing the walk I believe she wants to do. It is not happening and I would like something done about it.

I call the Minister of State.

Two seconds, if the Minister of State will allow me. This is very important. I forgot about it and I should not have. Does the Minister of State realise that we have a situation in the psychiatric ward of Kerry General Hospital where workers were recently attacked? Very unfortunately three people were seriously injured. In case the Minister might think that was a one-off occurrence, it has been happening since St. Finian's and St. Peter's wards closed and it is because we do not have a secure unit in the psychiatric ward of Kerry General Hospital. That situation must be addressed as matter of urgency. I thank the Chairman for allowing me.

I call the Minister to take whatever time she needs.

I do not think we are going to go backwards in our mental health provision. The plan is, and A Vision for Change clearly states, that we will have a community-based mental health service as the big institutions that existed are to be closed. They have been closed and that is important. As Dr. Dermot Walsh told me when he came in to talk to me, we had 22,500 people in institutions in Ireland. We could not possibly have had that many people with that type of acute mental health issue. That could not have been the case. There must have been something else going on there and we do not want to leave that situation to continue or go back to it again.

We have a National Office for Suicide Prevention in the same way the Road Safety Authority, RSA, is the national office for road safety, but they are two entirely different areas. It would be lovely if we could introduce laws to prevent people from self-harming and dying by suicide. None of us wants to go there. The RSA can operate effectively within its remit. It can improve the road network and introduce penalty points. That has an impact on people's behaviour. We do not want to do that for suicide. We did that for too long. It was not beneficial and none of us wants to go back there. We have a National Office for Suicide Prevention and people must stop talking as if we did not. What works in the RSA would not work for suicide. If people would sit and think about it in an in-depth way, they would realise that. I would appreciate if people did think about it in a serious way. It is insulting to continuously talk in this fashion.

On career guidance teachers, we introduced a whole school approach. We recently had a group of people over from Sandwell to talk to the Irish College of General Practitioners, the ICGP. We have done research with the ICGP and it produced a DVD that will go to every GP in the country. It refers to depression, suicide, how to recognise it and what is the best approach to take. The people who came from Sandwell take a whole community approach to mental health. They bring in the churches, school, traffic warden, anybody in the community who has interaction with other people on a regular basis. They convinced us that it is a whole school approach.

If a student has a difficulty and acts out in class, as happens every day of the week, it may be because the student does not want to be in school, but it may be for another reason as well. There may be some underlying issues. Does a person in that situation really want to be going to the one office that is identified as the place one goes when one has a problem? Surely it should be about being able to approach anyone in the school. What if one does not get on with a particular individual in the school? Are we saying there is nowhere else to turn? Career guidance teachers have done an incredible job in this country, both doing their own job and being an open door to children who are distressed, but it must be more than that. There must be a whole school approach.

I am not certain I can give Deputy Luke 'Ming' Flanagan any answer to the issues he raised here today but he can take my word that I will take a serious look at it. Given that people sometimes find themselves acutely distressed, clearly incidents will occur. The professionals who work in the area are conscious of that. They are definitely well-trained in the management of those issues and when they go into this highly-skilled profession they know there are dangers associated with it. They are less than in some other areas. Deputy Healy-Rae also raised the point of assault, but the accident and emergency department of any hospital on a Saturday night could be equally dangerous. We must be conscious of that.

I dispute what Deputy Luke 'Ming' Flanagan said about warning people against approaching the services in Roscommon. I will look at the issues to which he referred.

The Minister of State disputes what the staff are saying. I am not saying it. That would make a great headline, would it not, that I am saying that? I am not saying this.

I have to ask-----

The Minister of State is not taking it seriously. There could be somebody dead out of this, so I have got to push it.

That type of rhetoric-----

They are the words from the Psychiatric Nurses Association.

The Minister of State did not have advance notice of this issue. Could she could undertake to get back to the Deputy directly?

And similarly on Kerry.

I cannot see how it is possible that she would not have known about this, and if she did not know about it that is even more worrying.

I am asking the Minister of State to come back to both Deputies when she has had time to examine the issues and we can deal with that another time.

What she said is appalling. She is not recognising the problem.

The Deputy is easily appalled.

I am not easily appalled. I am talking about a mother worried about the life of her child.

This is not going to work. I have given a chance for the issues to be aired and the Minister of State has undertaken to come back to both Deputies. We will deal with it in that way. I thank the Minister of State and her officials for attending.

The committee will meet again at 4 p.m. on Wednesday, 19 June when we will meet a petitioner, Mr. Thomas Kevin Walsh, representatives of the INOU and officials from the Department of Social Protection to discuss policy issues concerning the back to education allowance scheme. Is that agreed? Agreed.

The joint committee adjourned at 5.30 p.m. until 4 p.m. on Wednesday, 19 June 2013.
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