I welcome Deputy Derek Keating who is accompanied by members of the Clondalkin community action on suicide group who are attending to listen to our discussion on suicide prevention. I also welcome the Minister of State at the Department of Health, Deputy Kathleen Lynch.
Suicide Prevention: Statements
I am not certain that one can discuss the issue of suicide enough, particularly when one considers the scourge it has become in communities. For this reason, I appreciate the opportunity to make a statement on suicide prevention. The importance of exploring the causes of and ways of dealing with suicide cannot be over-emphasised. A suicide is a tragic and shattering occurrence that not only brings a life to an untimely end, but also has a devastating impact on family, friends and communities. The increasing number of deaths by suicide is of great concern. While discussion around suicide tends to be dominated by statistics, it is important that we remember the human factor. Each death is someone's loved one and statistics cannot capture the grief and desolation of those left behind. The unanswered questions of "Why?", "What if?" and "If only" will always remain.
There is not a community that has not been affected by the trauma and despair that surrounds suicide. We know that reducing suicide rates requires a collective, concerted effort and, most important, a collaborative approach. The Government is committed to fostering and building on the existing levels of all-island co-operation in the interests of promoting positive mental health and tackling the issue of suicide. In saying this, it is impossible to have a debate about suicide prevention without recognising the number of people who have died by suicide. Provisional data for 2009 shows a record number of 527 recorded suicides. When I see this number I always close my eyes and think of a small town because it equates to the population of a small town being wiped out. While there was a slight decrease to 486 in the provisional figures for 2010, the number of deaths remains unacceptably high.
Suicide is not only a mental health issue. Many factors contribute to the rise in suicides, including the economic downturn, unemployment, the breakdown of relationships and financial difficulties. One study shows that a 1% increase in unemployment leads to a 0.79% increase in suicides. It is important that we recognise that since 2007, there has been a particularly high increase in the number of deaths by suicide of men in the 35 to 54 years age group. While there is an increase in the number of women dying by suicide, the numbers are still significantly lower than in the male population. The current economic circumstances are undoubtedly having an effect on mental health and well-being. Our young adult population who grew up in a time of prosperity when work and opportunities were plentiful are particularly affected by this downturn in our financial circumstances. One readily understands the devastation that can occur when one considers the relative speed with which the recession hit and its severity and very high impact on lives, particularly of those with young families who acquired large mortgages in the preceding years and then suffered the hardship of unemployment. In such circumstances, the shock to the system for many was overpowering.
As Minister of State with responsibility for mental health, I am working closely with the Health Service Executive and voluntary agencies to introduce initiatives to address much more effectively and appropriately the issue of mental health and suicide. The total funding available in 2011 nationally through the HSE for suicide prevention was about €9 million, of which €4.1 million was available to the National Office for Suicide Prevention and approximately €5 million was available regionally to fund resource officers for suicide prevention, self-harm liaison nurses in hospital emergency departments and local suicide prevention initiatives. The funding provided in this area in 2011 included a special allocation of €1 million specifically to target initiatives to address the increasing incidence of suicide and deliberate self-harm which allowed the HSE to focus on further developing skills-based training and awareness programmes in suicide prevention, improving the response to those who deliberately self-harm, developing the capacity of primary care to deal adequately with those presenting with suicidal behaviours and enhancing interagency co-ordination.
The challenge of suicide prevention is one of the most urgent issues facing society. However, it is important to acknowledge the suicide prevention initiatives that are in place and which are being developed.
Since 2004, approximately 25,000 people have been trained in the two day ASIST, applied suicide intervention skills training, programme in suicide first aid, which is an internationally recognised effective course. This training programme is provided to health workers, teachers, community workers, the Garda, youth workers, Defence Forces, veterinary organisations, volunteers and people responding to family friends and co-workers. A half day training programme called Safetalk, which prepares participants to identify persons with thoughts of suicide, has been provided to over 3,000 participants.
In response to the economic downturn the HSE National Office for Suicide Prevention, NOSP, has launched a "tough economic times" programme following requests from organisations such as citizens advice and the MABS for information and training for staff because of the increasing numbers of people presenting in distress. Farmers' marts were targeted with similar information as well as the major National Ploughing Championship event. At first this seems an unlikely area to target but given that farmers in the main work in isolation, they are probably the one group who have less contact with others and, therefore, it was important to target them.
Mental health awareness campaigns including the Mind Your Mental Health and Let Someone Know awareness campaigns and the See Change and Make A Ripple stigma reduction campaigns are being ramped up with the objective of achieving a significant change in attitudes to mental health, to encourage people to be more aware of their mental health and, above all, to seek help.
The HSE clinical care lead for mental health is working with key stakeholders to develop a uniform approach to self-harm assessments in emergency departments in order that patients can receive the best care and treatment available. A pilot project is also under way in the Cork hospital group to train all appropriate clinical staff in self-harm-suicide management and it is hoped that this will be in all other hospitals in due course.
The HSE National Office for Suicide Prevention has also funded a number of suicide community assessment nurses who work within primary care to provide an effective and co-ordinated response at health care professional level in that setting to deal with the issue directly and to avoid admissions to hospital. These projects are being evaluated. The National Office for Suicide Prevention also supports a number of voluntary organisations working in the field of suicide prevention.
The Jigsaw programme, developed by Headstrong, is another example of an initiative aimed at making mental health services more accessible to those who need them. The programme creates safe spaces in communities where young people can access a wide range of mental health supports for free. It works by engaging young people, organisations, families and other support agencies in the community in order that we are all better able to respond to the mental health and well-being needs of young people aged from 12 to 25. The most important thing I can say about this project is that it works.
The Jigsaw programme is up and running in five counties — Galway, Roscommon, Kerry, Meath and Dublin in Ballymun — and the HSE in partnership with Headstrong will progress six new sites, Donegal, Offaly, Clondalkin, Tallaght, Balbriggan and Dublin 15 through the allocation of €1 million in innovation funding.
Following on from the special consideration which was given to mental health in budget 2011 with a maximum reduction in funding of 1.8% for this sector, budget 2012 provided an additional €35 million for mental health services in line with the programme for Government commitments. Details of how the funding will be apportioned are still being worked on in the context of the HSE's draft national service plan for 2012 which is under consideration. Final decisions on funding of individual care programmes will become clear when the Minister approves the national service plan for 2012 in accordance with the Health Act 2004.
Funding from the special allocation for mental health will be used primarily to strengthen community mental health teams in adult and children's mental health services. It is intended that the additional resources will be rolled out in conjunction with a scheme of appropriate clinical care programmes based on an early intervention and recovery approach. Some of the funding will also be used to advance activities in the area of suicide prevention and response to self-harm presentations and to initiate the provision of psychological and counselling services in primary care specifically for people with mental health problems. Some provision will also be made to facilitate the relocation of mental health service users from institutional care to more independent living arrangements in their communities, in line with A Vision for Change.
I am committed to ensuring mechanisms are put in place to ensure the funding is used only for the purposes for which it is specified in the HSE national service plan. Members will be aware that the Government has already approved the drafting of legislation to give effect to changes in the governance of the HSE. This involves radical reform of the health service generally which will see the introduction of universal health insurance. Significantly, the new system of governance will involve seven directorates, including a separate directorate for mental health which will have full responsibility and accountability in that area.
In this context, my colleague, the Minister, Deputy Reilly, intends to bring forward detailed proposals at a later date for the reorganisation of the HSE at directorate, regional and local levels in a manner which facilitates a smooth transition from the current governance arrangements to the proposed new structures. This is a significant step forward for mental health and puts it on a par with all other health care services. It is equally important — in fact, I would argue that it is possibly even more important. This is a critical move in the right direction and one I have fought hard for since taking on responsibility for this area on assuming office last year.
We need to get best value for our available resources. Duplication of mental health services and suicide prevention initiatives need to be avoided in order to provide a more streamlined service. We need to co-ordinate our efforts and work together to stop the tragedy of the loss of life through suicide. I recognise the many challenges that lie ahead and I am aware that there are no easy interventions that will guarantee success. However, I can assure this House that I am totally committed to tackling the high incidence of suicide and deliberate self-harm and to working with the HSE and voluntary organisations to introduce initiatives that will reduce the number of deaths by suicide. We have no choice but to do that.
I join Members in welcoming the Minister of State to the House. I am pleased to have an opportunity to speak on the issue. I welcome the representatives of Clondalkin community action on suicide group. We received their paper and congratulate them on their work in suicide prevention.
There are many reasons for failure but there are no excuses. Collectively, the Houses of the Oireachtas have failed society on the prevention of suicide. The Minister of State said this issue cannot be spoken about or assessed enough in the search for answers to provide the help society needs to deal with suicide prevention and the wide variety of mental health issues. When I speak of failure I am not directing it at the Minister of State but at the collective because resources in this area are not sufficient for the work being carried out.
I am a novice to this issue in the sense that I have not spoken on it previously. In my research for the debate I learned a couple of small points. In other debates on more general mental health we have acknowledged some of the good elements within A Vision for Change and the individual projects and initiatives that have started in the mental health area, such as the positive advertisements on television and so on. We are great at writing reports, assessing the problem and what might be done, but we are not good at implementation.
Once we assess the problem and come up with a solution, we leave the report on the shelf assuming that by the time we next convene the work will have been carried out. Of course, one definition of stupidity is to continue saying the same thing and expect a different result. I think that is where we are at in the context of suicide prevention.
There is significant prejudice and discrimination against people with mental health issues or facing personal challenges which society stigmatise as negative. Members of these Houses are not immune from that level of prejudice or discrimination. A Millward Brown survey last year of Members highlighted that more than 60% of Members believed that people with mental health issues should not have children. Is it not shocking that the representatives of the people in Dáil Éireann and Seanad Éireann hold that view? It is indicative of the magnitude and scale of the problem that faces us. If there is this level of stigmatisation, how can we begin to offer assistance to people? That is not to say that organisations such as Community Action on Suicide or the initiatives, the training, and the Assist and Jigsaw projects and the other initiatives are not worthwhile and making a contribution but they are fragmented and non-penetrative in getting around this problem in order that real progress can be made. When one considers the magnitude of the problem and the results of the Millward Brown survey of Members which shows our approach to mental health and how we are prejudiced and discriminatory we are to mental health issues, it begs the question as to how Government, going back to 1984, can preside over such low levels of funding towards suicide prevention? The figure in 2011 was €9 million, I accept that €35 million will be provided for mental health services generally this year, but how much is allocated for suicide prevention? One of the things that struck me, which the Minister of State so rightly pointed out, is that the 2009 figure of 527 people, is the population of a small town. That figure was 24% up on the previous year. The provisional figures for 2010 are 486, but many groups say that the real figure is substantially greater; there are no figures yet for 2011.
The allocation of €9 million is disgracefully low in the context of what we are allocating to try to save lives. The Road Safety Authority is charged with saving lives and while this is a completely different issue, I think it is instructive to compare the level of resources and the approach that has been taken. They too had to deal with the numbers killed on the roads. In 2006, 368 people were killed on our roads. The Road Safety Authority has achieved a 59% reduction in the deaths on the roads since its establishment. The Road Safety Authority had a budget of €32 million in 2010. That budget of €32 million helped to save a significant number of lives. Senator Sheahan made a point on the Order of Business that the Road Safety Authority has been a great success. I remember when it was being founded, I was critical of Mr. Gay Byrne as being the person to head it up, and how wrong I was, in light of the exceptional job that organisation has done. The point is that the RSA is an integrated, cohesive national organisation with a joined-up approach and resources of €32 million.
In making such a comparison, I am not trying to disenfranchise any of the groups working hard on the issue of suicide prevention throughout the country but I feel we need one national entity to deal with it. The issue of multi-disciplinary community mental health teams has been agreed and is national policy through consecutive Governments since 1984, yet they are still not established. Presumably that is a resource issue. This should be done as a matter of urgency. I reiterate that I do not doubt the Minister's personal commitment, but if it is a question of resources that is preventing these steps being taken, then pressure from all sides of the House must be brought to bear on the Government, regardless of how scarce resources are throughout other Departments. The people who die by suicide and as a result of mental health issues are no less important than those killed on the roads.
When one compares the advertisement on television for road safety and mental health, I recall the mental health advertisement but not as much as the various advertisements for road safety. That is down to two issues, resources and the fact that a national authority is focused exclusively on the issue of road safety.
I would like to see the destigmatisation of mental health issues. We have a serious problem with prejudices. One in 20 people will have suicidal thoughts throughout our lives, and one in four of us will suffer from mental health issues. Is it really the view of Members that 25% of people should not have children? A Vision for Change includes many good ideas, but we need to take an integrated approach to mental health and provide adequate resources and destigmatise mental health issues.
I wish the Minister of State well and hope she will take some of these observations on board. Some people in the Visitors Gallery are from organisations dealing with mental health issues and their views are important. What I wish to highlight is the need to provide adequate resources and to take an overall integrated approach and to undertake a public education campaign starting from the beginning of secondary school right through to destigmatise mental health issues, because they are as common as the common cold. People who suffer from these ailments are entitled to the full resources of the State in assisting them to deal with their difficulties.
I welcome the Minister of State, Deputy Kathleen Lynch, and thank her for her comprehensive speech. I have worked with her in Cork North Central for a number of years and know that when she takes on a project, she sets her mind on achieving an outcome. I hope that by the time she finishes her term in the Department, the targets she has set will be met. The Minister of State is dedicated and committed to dealing with this area. I welcome Deputy Derek Keating and the group from the Clondalkin community action on suicide who are in the Visitors Gallery and thank them for the work they are doing. I thank all the voluntary groups around the country who are working on this issue. It is important to give public recognition to the work of Deputy Dan Neville who has worked in this area for a long number of years as president of the Irish Association of Suicidology and thank him and all who work with that association.
The tragedy of suicide affects every family and community in some way or other, in every part of the country. It also affects every health care professional at some stage during his or her working life. When a person passes away from a medical complaint there is an explanation as to the cause of death, but in cases of death from suicide there is no explanation in the vast majority of cases and it leaves unanswered questions. Unfortunately it is a problem that remains unanswered. When a death from suicide occurs it has a knock-on effect on at least a minimum of ten other people. We have seen in some rural areas a series of suicides, where a death from suicide triggers a number of others. We need to be extremely careful in dealing with this topic, because like a falling deck of cards, discussion of the death can generate other problems. For that reason we must be extremely careful in dealing with this topic.
The Minister of State outlined the suicide incidence rates. While there was a very slight reduction in 2010, it appears from the evidence available for 2011 that the reduction might have been temporary. Unfortunately, the economic downturn is having knock-on effects, and the Minister of State mentioned that aspect. The OECD produced a report which showed that out of 30 developed states, Ireland has the second highest rate of suicide among young people. That is the challenge we must face. It is a problem and we must deal with it.
Senator MacSharry raised how we dealt with the road deaths issue. We dealt with it in a comprehensive way, through changes in the law and taking a more serious view of drink driving and the road worthiness of vehicles. We also took on the speeding issue. In addition, we had a single person to lead that campaign and we conducted a major advertising campaign in the process. We must look at the issue of suicide prevention in a more comprehensive way, through co-ordination of all the services both in the voluntary sector and under the HSE and the Department of Health. We must see how we can develop a programme similar to the way we dealt with road deaths. The Minister of State has outlined how she proposes to deal with that, but we must keep it under constant review as regards how to improve getting the information out to the public in order that we can ensure it is a case of prevention rather than dealing with families after the event has occurred.
While it is not directly linked to this issue, it is interesting to note the report on child and adolescent mental health services for 2010-11 and the figures for the number of cases that come into those services. The report shows, for example, that up to September 2011, there were 16,080 cases being dealt with. That is 1.55% of the population under 18 years of age coming under the care of the child and adolescent mental health services. There was a waiting list of 1,897, which is a reduction compared to a year earlier. In fairness to the services, they are giving priority to the urgent cases.
It is also interesting to examine how the service has developed. In the period from October 2010 to October 2011, over 7,700 of those cases were able to be referred back to their general practitioners, GPs, or other care providers. They did not stay within the system. The care was provided and after improvements in their well-being, the young people were able to be referred back to their GPs for further care. This shows how well the matter is being dealt with. However, these are people who are within the system. The problem with suicide is that the vast majority are outside the loop, which is why we must conduct a comprehensive programme of education for young people.
The recent Irish Association of Suicidology conference had four working groups. The first dealt with how the statutory and voluntary organisations can work together to support positive mental health in their communities. The second group dealt with how voluntary organisations can support families in the community and the third dealt with how GPs can support families in the community. That is an important issue. One of the issues relating to GPs is that their surgeries can sometimes be under a great deal of pressure due to numbers attending, especially in the winter months, and the time given to people might not always be sufficient. When we talk about an education programme we must realise we are all involved in that programme, be it young people, adults or health care professionals, with regard to the need to be careful and to take on board the concerns people have when they want to talk. That is very important.
It is also important to examine how this issue is being tackled. When conducting my research I examined the situation in Scotland and the issues on which the Scots are being proactive. When journalists are reporting on suicide cases, the Scots insist that details about a help-line be published with every article. If the article affects somebody or raises an issue for them, therefore, there is a help-line available. It is very important that when an article deals with this issue, information is attached to the article for people who have concerns so they can make contact about it.
There is a need for more co-ordination between all the statutory services and with the voluntary organisations. The voluntary organisations are doing a huge job and they must be encouraged, supported and given every assistance possible to ensure we get the message across that there is somebody available to provide the help when it is necessary. I again thank the Minister of State and wish her well with her programme in the next four years to deal with this matter.
I thank the Minister of State for coming to the House today and giving us a comprehensive review of the plans she has for her Department to deal with this issue into the future.
We are increasingly becoming aware of the extent of the problem of suicide in this country in all its painful and heartbreaking reality. I will not get into the statistics other than to point out that it happens across the age groups, from ten to 14 years olds right up to those in their 80s and beyond. Most shockingly, it is now the most common cause of death among 15 to 25 year olds. The impact of suicide on those who are bereaved, and this is a range of people caught up in the aftermath of a suicide that includes the family, friends, neighbours, colleagues, health and other professionals and entire communities, is shattering and closure can be hard to find. None of us has the answers or, perhaps, even the right questions as we struggle to confront the challenge of what must be done.
Suicide thrives only in places of taboos and terror. It is incumbent on all of us to try to address the confusion and despair that underlies it. We all place a great deal of emphasis, for ourselves and within our families, on intellectual and educational development and on sporting, recreational and social skills. We try to look after our physical health and take care of our appearance in order that we look our best. We should be encouraged to give equal importance to the development and awareness of our mental health. This might not be easy to do. It is easy to say, but the challenge is how to do it and how to explain to our young people what it means.
In terms of prevention and early intervention, the area which might have the greatest impact is that of building mental health resilience. It makes a great deal of sense to create the circumstances and the opportunity, particularly for young people, to build and develop their mental health resilience. In this way they can grow to believe in their own resourcefulness to cope with life's challenges, rather than be overwhelmed by them. When mental health resilience fails a person, he or she becomes vulnerable to slipping into a dark or black place. Those of us who have not felt the despair of depression or suicidal thoughts can only imagine what is going through the anguished and tortured mind. This must also include the inevitable fears about how family, friends and work colleagues would react to knowing the truth.
We all know the seanfhocal, "ar scáth a chéile a mhaireann na daoine". It is normally used to demonstrate the reliance we place on one another but that most reassuring of phrases — we live in one another's shadow — may take on a darker and more sinister meaning for those grappling with the horrors of depression. We can imagine their dread of telling others for fear they may react in such away that the vulnerable person might be regarded as letting the family down or being flawed in some way, as causing shame or embarrassment, as being weird or strange in the eyes of their friends, as being worthless or valueless or as being less reliable, less dependable and less trustworthy in the workplace.
Unfortunately, as long as a sense of stigma endures around mental illness, in some cases the answer to some of these questions may sadly be "Yes". To a person in emotional distress, it must feel like pieces of life built with such care and effort being taken away as though a life and a person are being dismantled slowly brick by brick. Surely, there is an obligation on all of us to try to understand and educate ourselves in respect of the experience of emotional distress.
When faced with a person suffering such pain, the risk is that those who do not understand may invoke a defence mechanism and appear detached or uncaring. Those who listen and respond to vulnerable people need to be fully engaged, sympathetic, understanding and never judgmental. They must not be afraid or give the impression that they would rather be anywhere else.
Like everyone else here, I do not pretend to have even a fraction of the full answer but I urge the Minister of State, when addressing this complex and difficult issue, to place special emphasis on three main areas, namely, preventive measures, in particular measures to assist young people to strengthen their mental health and believe in their innate resilience; finding ways to give those experiencing depression or suicidal tendencies the reassurance and comfort of knowing that whatever they need is available without stigma or suspicion; and perhaps most challenging of all, to start to change the culture in the country in order that we come to regard emotional distress and mental suffering as a very real part of many people's lives but equally to see that it is possible to come through those experiences and recover a good and full life for oneself.
I join Senator Burke in urging all those involved in suicide intervention and prevention — State agencies, health professionals, academics, support and advocacy groups and individuals — to work together on this issue. Perhaps the National Office for Suicide Prevention should not only encourage but should incentivise creative and effective collaboration. Pooling experience and expertise will mean that we are best placed to find at least some answers and to give hope not only to those who are vulnerable but, critically, to their families and communities.
We have already had several remarkable awareness campaigns, about which we have heard, that have helped to begin to lift the stigma and shame surrounding mental ill health. Now we need to step up these campaigns and encourage greater openness, honesty and understanding around the issues of mental ill health and suicide but as we do so, it is critical we find the right words to reduce fear and to give those who are vulnerable the confidence and the courage to come forward at an early stage to talk about their feelings rather than allow a crisis in their life to become a suicidal crisis. This is no easy task but we all have a duty to do our absolute best to find the right questions and the right answers.
I wish the Minister of State well as she grapples with this difficult issue. She should be assured that she has the support of the country.
I welcome the Minister of State, the group from Clondalkin and Deputy Derek Keating, who is doing tremendous work in this area. As Senators, every day we hear about people dying by suicide — it is sometimes one person but it is sometimes several people. It is very easy to feel helpless in the face of that but it is important that, as policymakers, we do not allow ourselves to be overwhelmed.
I have worked in the mental health service for 27 years. I was a psychiatric nurse and spent approximately six years working in the voluntary and community sector. I claim no particular expertise in this area apart from the fact that I have seen at first hand the consequences of suicide and suicidal behaviour for families, individuals and communities. Suicide is the greatest challenge facing Irish society.
I have a great deal to say about suicide but I will confine myself to making one or two points. I have been appointed rapporteur on suicide prevention to the Oireachtas Joint Committee on Health and Children and I will bring a report to the committee in due course. As part of this, I have spent the past six months meeting stakeholders from the voluntary, community and statutory sectors as well as individuals who believe they have something to say.
I am rather critical about the way we are approaching this problem but before I give a critique, I must acknowledge the great work going on in many areas. It is necessary for us to be clear in our prescriptions and analysis. Our methodology of collecting information on suicide is rather unsatisfactory, so much so that the real levels of suicide are not clearly known or understood. Garda Form 104 is the document used to collect data. As far back as 2007, questions were raised about whether it was the most appropriate way to gather information.
I will not give a lot of statistics except to note that in the five years before the publication of our national policy, Reach Out, on average, 493 deaths by suicide were recorded each year. In the five years since the publication of the policy, on average, 461 deaths by suicide were recorded each year. When we consider the population growth since, there seems to be some evidence to suggest our policy is working. However, there are many ways to read statistics and if we are to include deaths recorded as being of undetermined intent, the statistical difference in the numbers before and after the publication of the document is very small. Therefore, we must ask whether our policy is working.
The figure for 2009 of 527 people dying by suicide is the highest on record and we must ask what is going on. Can we say the rise in the number of deaths is due to some dynamic associated with the economic recession? We might be able to answer "Yes" but then again, we might well answer "No" because we just do not know. There is no research in this area.
When we have a suspicion something might not be doing what we hoped it would do, it is prudent and necessary to review it. The one omission from the policy is the lack of a review date. It is a ten-year policy and it seems strange there is no provision at all for any type of review. I understand the policy has been under-resourced and perhaps it is unfair to say it is not working when we have not provided the resources to make it work. This might be another good reason a review is due, that is, to ensure the same circumstances pertain now as in 2005.
Reach Out contains 96 recommendations for action on a broad range of prescriptions. However, of the 96 recommendations, 41 require some sort of a review — a survey, a determination, a revision, a evaluation or an audit. They are fairly standard desk top research operations which could be done fairly quickly at minimal expense, yet they have not been done almost six years after the publication of the policy.
One reason for this failure is a lack of clearly identified roles and functions and the failure to assign responsibility for these functions inevitably means that the work will not be done. As has been said by many commentators, when there is a conflict between political convenience and evidence-based initiatives, political convenience always wins. I hope that will not be the case with this policy.
Another difficulty with the policy is the manner in which some of the objectives relate to the proposed outcomes. I will choose one objective to illustrate the point but I could choose any number. I refer to objective 18 in the policy which is to support the development of services and programmes for unemployed people and to help increase resilience and reduce the risk of engaging in suicidal behaviour. There is evidence that there is an increased risk of suicide associated with unemployment but the vagueness of objective 18 and its lack of specificity makes it very difficult to see how we can realise its aims. The untargeted approach of the policy renders the policy objective and many other objectives unworkable.
While I do not wish to appear excessively critical or to voice criticism for the sake of it — none of the criticism I make is directed at the Minister of State whose commitment on this issue is not in doubt — I must make some critical observations. In 2007, it was recommended that the National Suicide Research Foundation develop a model to obtain detailed information on suicide and possible suicide deaths. In consultation with the Coroners Society of Ireland the suicide support and information system, SSIS, was developed and piloted in Cork. The service identified deaths at an early stage and offered to support families and friends of people whom it was suspected had died by suicide. The scheme, which was internationally recognised as a proven life saver, identified an emerging cluster of 18 young men in one part of Cork who had died by suicide in a period of two years and introduced the necessary supports for families and communities affected by the cluster. Without the SSIS, the cluster would have remained unidentified. Despite this, funding for the service ceased in January 2010 and the service is no longer in operation. This is a case of decisions being made in one policy area which have a direct and contradictory effect on decisions in other areas.
I also query whether the document contains a publication bias by over-emphasising the biomedical model at the expense of the psycho-social model. This question needs to be asked and while I do not have an answer, I suspect there is such a bias. A major study by 80 suicidologists across the world found more research and a better understanding of the pathways that lead to suicide and suicidal behaviour were required. It is clear from the literature that there is a lack of an evidence base on which policy in Ireland and across the developed world is built. A great deal appears to be based on observed experience and intuition, which is not to say the various initiatives are not working. While some clearly are working, the manner in which they work needs to be better understood. One strategy that has been shown to work because it is an intervention that can be directly related to a positive outcome is the training of general practitioners. Studies have shown that GP recognition of the earliest symptoms of depressive illness, which may include sleep disturbances and an early diagnosis and treatment plan, has reduced the number of suicides in some countries, most notably, Sweden.
Other research has found that depressive illness, diagnosed and undiagnosed, may account for up to 90% of deaths. If one takes the broadest definition of depression, one can see how this could be the case. Under this definition, depression is viewed as more than just being low in mood. Instead, feeling low in mood is considered a symptom of depression. The essence of depression may well be feelings of low self-esteem and self-worth. If this is the case, we can see another dimension of depression which may not be considered an illness but is something that arises from life experience. If this theory is correct, we must combine the biomedical model with the psycho-social model to achieve a comprehensive policy response grounded in strategies which help people cope with life's adverse advents. Such a strategy must be introduced in primary school or even earlier. Coping skills, building resilience and dealing with loss and failure must be viewed in the context of normal living.
As this is a vastly complex area which is not fully understood, I hope the Minster of State will continue to make funds available for research as well as actions. I ask her to instigate a review of the position we have taken on the policy response. I am aware of her personal commitment to addressing the issue of suicide and wish her well in her work.
I welcome the Minister of State, as I always do when she attends the House. I have a few thoughts on the issue before us. On the first quarter numbers for 2011, while I do not know what role seasonality plays in the incidence of suicide, the figures from January to March 2011 indicate some improvement. During this period, the number of recorded suicides stood at 95, which would produce an annual incidence of 380 for 2011, which is lower than the figure cited by the Minister. Perhaps some of the issues on which the Minister of State has been working are starting to have effect.
The figures also show that of those who died by suicide in the first quarter of 2011, none was aged up to 14 years, 17 were in the 15 to 24 years age group, 20 were in the 25 to 34 years age group, 20 were in the 35 to 44 years age group and 22 were in the 45 to 54 years age group. The incidence of suicide then slackens off in subsequent age groups. It appears, therefore, that the main factors are those to which the Minister of State referred, namely, unemployment, poverty and the impact of the recession, especially on men. As Senator Gilroy noted, substantial research is needed on suicide to identify what approaches work and which measures could help the Minister of State achieve her laudable ambitions. I support his call for more research in this area. A targeted programme studying all the suicides that occur each year should report back to medical researchers and the Minister of State.
I, too, welcome Deputy Keating and the group accompanying him to the House. I note also that Deputy Dan Neville has acquired a considerable reputation for his work in the area of suicide over a long period.
We have a history of massive institutionalisation of those with mental illness. This approach, which have since learned did not work, dates back to before independence when large mental hospitals were constructed in Ballinasloe, Killarney, Portrane, Grangegorman, Mullingar and elsewhere. The query that academic colleagues have put to me is whether building smaller units amounts to nothing more than moving to another form of institutionalisation. Whereas under British rule, large institutions were built on the edge of towns, we are building smaller units as part of a policy that almost amounts to another form of locking people up. Should the more psychological approach discussed by Senator McAleese be invoked?
In the past when we tackled mental or psychological problems by building large mental hospitals a psychological approach was taken. One must ask whether the wrong medication featured as a cause in some suicides? Electric shock treatment has always seemed controversial to me. As we attempt to come to grips with the problem of suicide, should the Minister of State's office examine the consequences of locking people up, giving them electrical shock treatment and treating their condition as a pharmaceutical problem? How best can we help? Are we taking the correct approach? As the Minister of State will have gathered from this debate, the issue of suicide has generated considerable interest, a surge of good will and a desire among all Senators to assist in any way we can. This must involve asking serious questions of some of the policies we have inherited.
I welcome the Minister of State, my party colleague, Deputy Derek Keating, and the group from Clondalkin which is accompanying him. Their interest in this matter has been recognised by numerous speakers. This is a welcome debate because the issue of suicide needs to be discussed in general and specific terms in the Houses and community at large. We need to be aware of the importance of simply talking to someone who has a difficulty that may lead to mental illness. This is a cultural and societal issue. The difficulties that people suffer daily can develop into a very serious problem. The stresses in society, including as a result of unemployment and financial issues, are causing major problems for families which can culminate in suicide. Practically every family has been touched by suicide in some way. The problem of suicide has gone unreported for many years, although I am aware the issue is being addressed.
One major issue I have raised before in the House is that in the media suicide is not glamorised — that may be the wrong word — but on many occasions, especially recently when a high-profile footballer took his own life, the media coverage is somewhat inappropriate. Other speakers have spoken about how it can be contagious. The over-glamorisation of suicide is a real difficulty. Media guidelines state that every time something is mentioned in the media contact details for adequate support services should be placed at the end of a story, something which has not been done. It should be re-emphasised to the media by the Minister of State and her Department.
I would like to make two main points on suicide. I was very interested in the statistics provided by Senator McAleese. The idea of ten to 14 year olds committing suicide is incredibly sad because they have yet to become the people that they are and the idea of that has resonated with me today. The fact that 40% of suicide victims are young men between the ages of 18 and 28 is a stark proportion and shows that suicide is the biggest killer of young men in Ireland.
I have a particular bugbear about alcohol. Studies have shown that the consumption of alcohol seriously increases the risk of mental illness. If the risk of mental illness is increased the risk of suicide is also increased. There is another cultural problem in the country we need to address very carefully. We need to realise that the consumption of alcohol at the level we in this country consume it is very dangerous. It is something which is being worked on and we had a Private Members' motion on it in this House recently. The debate was very constructive but it will take a lot more than increasing the cost of alcohol in supermarkets to address the prevalence of alcohol in society. Not just the potential of suicide but many other problems are linked to that and it should not go unmentioned today.
Suicide and unemployment is an issue, as other speakers have mentioned. International studies have shown that for every 1% rise in unemployment there is an 0.79% increase in suicide rates, which is something we must be very concerned about. There is no doubt that the Minister of State is addressing this in her Department. The recession has left more young men out of work then any other demographic. They are doubly at risk in this country.
Employment offers people a sense of purpose and improves their self-esteem. Other speakers have spoken about self-esteem and its link with depression. I agree with Senator Barrett. The result of a lack of self-esteem and self-worth has to be depression. In 2007 President McAleese hit on a particularly prescient point. She pointed out that a sizeable proportion of victims of suicide had been dealing with problems of sexuality. It is something that, along with depression, is not discussed in this country. It is a huge issue. It is a fact that for young gay teenagers, particularly those from rural backgrounds, adequate supports are not available, despite huge efforts by certain organisations. It is another area that has a taboo attached to it and we must include it in any discussion on suicide in this country.
The way suicide is treated, spoken about and reported has to be done carefully. The contagious effect of suicide has been documented. In a place called Micronesia the suicide rate in the 1970s soared from virtually 0% to 800%, which is an extreme example. I have touched on the contagious nature of suicide before and it needs to be addressed. This does not mean that we should be afraid to speak about it. We should consider our words and make sure support is available for people. Every one of us needs to be willing to embrace the subject. It is a difficult one to talk about but in our daily lives we must be very aware of it. I wish the Minister of State well with her work.
Like many other speakers, including Senators Noone and McAleese, I would like to focus on youth mental health, something we as a society have not given nearly enough attention to. HSE services are still very underdeveloped, as the Minister of State will be aware, yet all the statistics show that unfortunately, the high rate of suicide among young people, particularly young men, means people are being let down.
From the point of view of long-term prevention, positive mental health amongst young people needs to be promoted to give people the coping skills they need. There needs to be awareness of how important it is to look after one's mental health, be aware of signs of distress in others, realise that everybody will come up against obstacles and that there is nothing to be ashamed of. People should be able to put their hands up and ask for help, whether one is a primary schoolchild or a teenager. Often of course people do not need to ask for help unless, for example, they lose their job in their forties or fifties. Giving children a level of awareness is important.
As spokesperson on education, I would like to focus on the role of schools in that respect. We have had excellent debates in this House on social, personal and health education, SPHE. While some schools are doing an excellent job there is a lot of inconsistency and I would like the Minister of State to work with the Minister, Deputy Quinn, particularly at the current time. It is an area on which we need to place a much greater focus. Schools are under a lot of pressure. Young people want to get points to go to college but personal development is as important if not more so than acquiring academic skills and passing tests. We need to give people the personal skills they will need for the rest of their lives to be able to face whatever challenges they encounter, whether in their personal lives, workplace or anywhere else. There needs to be a lot more focus on promoting SPHE in schools.
Senator Noone referred to the difficulties among certain groups of young people, particularly lesbian, gay, bisexual and transsexual young people. The statistics are scary. While one in four young people in general report that they have suffered from extreme forms of bullying, the figures amongst lesbian and gay teenagers are much higher. Those who have reported bullying have said they considered suicide or have already harmed themselves. Groups like BeLonG To and others are doing amazing work.
As a Senator rightly pointed out, not nearly enough is being done and as a society we need to be more aware of the issue. Schools have a particular role. One of the particularly alarming facts in the research BeLonG To did last year was that some of those who have made inappropriate comments which made young people uncomfortable are their peers and teachers. Such comments may not be made out of malice but people may not be aware of what is or is not appropriate. A quick remark might wound someone to the core and it is important that we make sure teachers have the skills to support young people, particularly those who are at special risk of bullying.
Focusing on schools, I would like to raise the issue of guidance counsellors. I am not sure if the Minister of State was consulted by the Minister, Deputy Quinn, before the decision in that regard was made but I hope it is something she has discussed with him since. Guidance counsellors are the one group of staff in our schools who have a special role in supporting young people. Often the job is seen as helping people to fill in the CAO form and know abouttheir career options and what courses they should be picking, but as we are all aware,that is a minor part of the job in many respects. A guidance counsellor is the person a student can go to if there is a problem at home such as parents breaking up, or if something else is causing him or her distress. They are there to help students. I thought it was a particularly cruel cut in the budget, especially in a recession when so many families are going through difficulties. I hope the Minister of State will discuss this with the Minister for Education and Skills, Deputy Quinn, and highlight the importance of that role from the point of view of her own portfolio.
I am aware of excellent services provided by local groups such as the Sphere 17 youth service in Darndale. Such groups are now also facing cuts, which is a shame. I appreciate the budgetary constraints, but survey after survey shows that rates of mental health problems are much higher in areas such as Priorswood, Darndale and Bonnybrook in Dublin 17. Much progress has been made in recent years with all the extra resources that were provided to establish services. Such informal supports, if they get kids out of a house where there are difficulties and allow them to play football or get involved in youth projects, are just as important as any of the formal services provided in schools or through the HSE. We need to be careful to ensure that by making short-term cuts we are not creating long-term problems for ourselves.
I will finish by raising one more issue which I have mentioned in the House previously and written to the Minister of State about. Eating disorders have the highest mortality rate among mental health disorders, but this is an area that has been totally neglected, and services are poor. There is a centre in Sutton, as the Minister of State is aware, that provides an excellent private service but cannot get support from the HSE, which has been slow to avail of the service. This is an area in which a lot more work needs to be done.
I welcome the group from Clondalkin, although they have probably left the room. I know many people are listening in on the Internet and I am delighted they have taken the time to do so.
I extend my sincere sympathy to any family in this country that has been affected by suicide. I know exactly the traumatic and devastating effect it has on families and I can guarantee I know exactly how they are feeling.
Rural isolation has a major impact on the number of suicides, especially among older people, particularly older men. I am taking a slightly different line from other speakers, who talked about younger men, but the statistics from rural areas vary somewhat from others. The coroner in south Kerry has stated that tougher drink-driving laws are leading to more suicides among older men who are already suffering from isolation in rural areas. This same coroner previously highlighted a growing incidence of suicide among elderly males and said that while new road safety legislation might be reducing the number of deaths on the roads, it was leading to more suicides. These people are often widowed or single and living alone. They cannot go the local pub for a pint because they are afraid they will be caught drink-driving. They are used to going out for one or two pints a night and meeting their friends, but they are not doing that any more. While I do not condone drink-driving, there is no doubt that in some cases the law is leading to rural isolation.
I help deliver meals on wheels in Killarney to the elderly and disabled and I know for a fact that in some cases we are the only people they will see during the day. While they would love us to spend a bit of time chatting with them, we cannot do so because the meals for other recipients are going cold in the car. It just goes to show that people are lonely and isolated. With the closure of post offices, shops and creameries, there is a major gap in social contact in rural Ireland. I will speak about south Kerry because that is the area I know best, but of course this applies to every area of the country. There were 67 suicides in south Kerry in the period from 2005 to 2011; of the victims, 41 were over 40 years of age. There were 11 cases of suicide in the area in 2011. Of the 11 people who took their own lives, two were aged between 22 and 30, two between 31 and 40, three between 41 and 50 and four over 60. The overwhelming majority were men.
Isolation can come in many forms. I know a young girl who was attending secondary school but was very unhappy because she felt isolated. She fell in with the wrong group when she started school and over the years, the group, while they did not bully her, cut her off. She would go into school on a Monday morning and hear that the group had been at the pictures on Saturday night but that she had not been told. She was always hanging on the edge of the group, only spoken to if she asked a question. She noticed them whispering and became paranoid, thinking they were whispering about her. This girl had a very good relationship with her parents, and when they heard what was happening they immediately removed her from the school and put her in a new school, where she blossomed. She made steadfast friends there who are still her friends to this day. Who knows what would have happened had that girl not been able to speak to her parents. Perhaps she would have gone for counselling; I do not know. She did go to her parents and, thank God, they rectified the situation, because she was in a bad state when she came to them.
There should be a media campaign to highlight the services available to help prevent suicide, along the lines of the campaign to reduce road deaths. I was delighted to read in the Minister of State's report — I was listening on the monitor when she came in first — that the advertising campaign is being ramped up. That is welcome news.
In south Kerry the only organisation that offers counselling to children and adolescents is the Southwest Counselling Centre. It receives funding from the HSE for children and adolescents, but this is not particularly for suicide prevention. However, it does provide an emergency counselling service for people who may have attempted or who are actively contemplating suicide. It also provides affordable counselling for a range of issues such as depression, anxiety, abuse, bereavement and separation, self-harm and relationship or family problems. We all know that nearly every one of those can lead to suicide. Most of the funding for this counselling centre, which offers a fantastic service to the people of south Kerry, comes from fundraising and donations. I understand that Console, the national organisation for suicide prevention, is to provide free services in Killarney town from next month. This is thanks to a local businesswoman and former nurse who led a project to create greater suicide awareness in Kerry. The clinical director of the counselling centre has advised me that its members are meeting and dealing with more and more people in distress. They have witnessed an increase in the number of people experiencing financial strain and struggling to cope, which can take a serious toll on mental health.
International research shows that the current economic conditions are a factor in increased suicide rates. It is now time for a co-ordinated approach to suicide prevention. It is time for all individuals and groups with significant and varied experience in suicide prevention, education and awareness, research, support and intervention to work together to maintain community-wide suicide awareness and work towards prevention. This is the approach taken by counselling centres such as the Southwest Counselling Centre. If we are really serious about suicide prevention, especially during a time of recession, we will have to consider serious funding for centres such as the Southwest Counselling Centre and all the other centres and organisations throughout the country that are actively working on the ground, day in, day out, doing their best to save lives and give people the confidence and the will to live. They are making life a little brighter for people who are constantly in a dark place. I commend all these organisations that are literally taking people's lives into their hands and that may be the last port of call for people who are in a desperate state.
I ask the Minister of State and the Minister, Deputy Reilly, to do all in their power to ensure the HSE and the voluntary organisations receive adequate funding to enable them carry out the invaluable lifesaving work.
I welcome the Minister of State to the House. I commence my contribution with the words of a gentleman in his late 20s, reflecting on his youth. These words appear in a research study commissioned by the Health Service Executive in 2009, entitled, Supporting LBGT- lesbian, bisexual, gay, transgender lives. It reads:
It was not the being gay that made me feel suicidal, it was all the bullying, the name calling, the negative ideas about being gay that I was full of from growing up in a homophobic society and the fact that I never heard one person say, in all my childhood and adolescence, that being gay was okay or even good.
These negative ideas about being gay also match my experience several years ago in the US, although I did not experience any over-bullying. I often felt shame. I felt shame for my feelings, my actions and who I was discovering myself to be. What I know now is that shame is never generated from within, it develops as others who are not like us suspect that one is different and, therefore, treat one as inferior. It also develops when somone comes in contact with laws and systems fashioned by state or religious leaders who keep a person outside the mainstream of human worth or worthiness. Sometimes such a sense of shame can lead to attempts to end one's life brought on by the conditions or the culture or ethos within which a person grows up or as a result of bullying and name calling in a homophobic society. Such a society is still alive and well in 2012 in 21st century Ireland. The previous President, Mary McAleese, in one of her final speeches in office, spoke about the need to dismantle the noxious apparatus of homophobia.
One of the prime questions we are here to address is why people commit suicide. My comments will focus on one specific dimension, namely, the link between people with minority sexual and gender identities and suicide. I am grateful to Senators Noone and Power who have already raised this issue. Senator Power referred to a couple of statistics. LGBT youth, in particular, are at an elevated risk of suicide. Some 50% of these young people under 25 years of age have seriously considered ending their lives and 20% have attempted to, at least once.
Research suggests negative reactions to or portrayals of these young people's lives impact on their ability to form a positive self-identity. Different sexual and gender identities are perceived as deviant, not normal, and, therefore, not good. Senator Power referred to the BeLonG To youth service which is at the forefront of work in this arena, especially with young people. It was recognised as best practice at the recent United Nations conference in Brazil on homophobic bullying in education, on which I congratulate it. The national strategy for action on suicide prevention also identifies LGBT people as a marginalised group who experience discrimination and as being vulnerable to self-harming behaviour.
Last year, the Minister for Education and Skills launched guidelines for principals on including LGBT students in school policies, as developed by the Gay and Lesbian Equality Network, GLEN, and BeLonG To. Therefore, we have the guidelines to prevent homophobic bullying but will they be implemented? Within these questions is the issue of ethos within educational settings. I believe the ethos issue is critical for a number of reasons but in this instance the issue of ethos is crucial for suicide prevention. As we are all aware, there is a dominance of the Catholic Church in the education system. Its approach, especially at primary level, is to integrate its ethos within the whole curriculum, as well as the overall school. There is a need to raise some critical questions as we look at the link between minority sexual and gender identity and suicide.
Members may be aware that Catholic doctrine, thus the Catholic ethos, is that homosexual practices are deviant, not normal, not good. While Catholicism teaches that the homosexual person is good, homosexual practices are effectively evil. In outlining this belief, the Pope is on record, in a document entitled, Unions Between Homosexual Persons, as writing that those who move from tolerance to the legitimisation of specific rights for cohabiting homosexual persons need to be reminded that the legitimisation of evil is far different from the toleration of evil. Those are his words, outlining explicitly the Roman Catholic doctrine that intimate love expressed between homosexuals is evil. It is rational to conclude that there is a blatant contradiction in efforts to implement guidelines to prevent bullying of LGBT young people in schools with a Roman Catholic ethos.
What can we do about this? That is a question we need to raise in our debate on suicide prevention. In June 2011, the Minister for Education and Science, Deputy Ruairí Quinn, said he proposed considering establishing a working group, comprising all relevant sections of his Department, NGOs in the arena, education partners to help draft a roadmap towards the elimination of homophobic bullying in schools. My office has been checking to ascertain if that group has been established. It appears as if nothing has happened. I recommend that the Minister of State bring to the attention of the Minister, the urgent need to establish the working group. As part of its terms of reference it should consider square on, the relationship between homophobic bullying and religious ethos. In light of the evidence this could be a critical step towards moving towards the prevention of suicide for LGBT persons. LGBT people are beautiful young people.
I will go through the speakers on my list. Senator Cáit Keane is next, followed by Senators Kelly, Cullinane and White in that order.
The Clondalkin community action on suicide group, from my area, which has left was welcome. It has done massive work, as have Deputy Derek Keating and Deputy Dan Neville who spearheaded the issue, when people were not as vocal. I mention, in particular, Mr. John Quinn from Clondalkin, who was awarded the equivalent of the Dragons' Den in the business section, which was shown on RTÉ television recently. He spoke out recently at his son's funeral as nine people in Clondalkin had committed suicide in 2005. He just said, "I am here, if there is anybody who wants to talk to me." His service in a voluntary capacity has mushroomed and has been recognised in the media since.
The Minister has heard of groups such as Clondalkin community action on suicide group and Mr. John Quinn who are giving massive support and should be given support. All speakers mentioned the voluntary groups which get up and go and do something. The Minister of State listed all the supports that are available in a national capacity but some are only available in pilot project areas. The voluntary groups must be supported.
I welcome the work done in the primary care area of moving people out of institutions into care in the community. A Vision for Change, introduced in 2006, contains many excellent recommendations but implementation is slow. The Minister of State said she had reactivated a group which is trying to put an implementation strategy in place. Much is being done and much has been done.
The stigma associated with suicide must be recognised. The stigma is being lifted by the debate but some of the media coverage of the debate may not be helpful. We have heard about copycat suicides and how they are being dealt with. How we lift the stigma on suicide is important.
I spoke about the importance of education, including physical education. Education on suicide prevention is most important. Not everybody is happy all the time. I am sure everybody in this room has days on which he or she feels down. It is a question of learning how to cope with not feeling 100%. If the message on how to cope got out to young people in particular, it would be beneficial. One cannot be happy all the time. It is a question of being resilient and having the tools to deal with feeling down.
Senators mentioned the economic circumstances and stated a 1% increase in the rate of unemployment leads to a 0.79% increase in the suicide rate. Senator Gilroy mentioned the lack of serious statistics. The recommendation in this regard must be taken seriously. Statistics are one thing but it is a matter of how they are interpreted. Those who try to commit suicide and do not succeed should be included in the statistics but they comprise a separate body. The independent directorate for mental health about which the Minister, Deputy Reilly spoke, ought to be welcomed because it will participate in focused implementation.
Most Senators referred to loneliness. The buddy system in place in some areas should be considered in this regard. I refer to the old days when people were more supportive of one another. When there was visiting and card playing and when society was less formally organised, people were socially interconnected. This must be considered. We must ask what people can do for themselves and their communities and not ask all the time what the Government can do for them. This could involve dropping in on people and chatting with them, as Senator Moloney said. I refer specifically to young people because we see the trend in respect thereof.
When the Minister is examining this matter, the difference between the biomedical and psychosocial models must be examined. As I stated, community care and working on the ground are the way to go. There should be places where young people can drop in. Some have been opened. Local councils in various areas have what are called coffee bars for young people. There is somebody to whom one can turn.
The old church view that suicide was a mortal sin did nothing at all for suicide prevention. This led to the great stigma. People did not admit that individuals committed suicide and claimed they died for some other reason. I am thankful the stigma in this regard is gone. The modern approach of the church to suicide is similar to that proposed by St. Augustine in the fourth century in that it involves responding with compassion, love and pastoral care.
We could have a debate on the ethos in schools and the separation of church and state. Religious belief is important to some in dealing with suicide and should not be discounted at all. People find it important but it should not be interlinked with education. Religious belief, whether it involves meditation or religion, is a separate, personal issue. I heard Mary McEvoy state on television how Buddhism had brought her back from depression. Our ambit should be broader than a medical one; it is the psychosocial model that we should be looking at. I recommend it to the Minister.
I welcome the Minister of State to the House. I am very pleased this is one of the debates we were able to secure in the early stages of this year. I know it is very difficult for the Leader to arrange statements and debates on the first week of the term but our achieving it on this important issue shows the sense of purpose and interest across all parties and among Independents in doing more about suicide prevention.
Senator Gilroy stated there is cross-party support to ensure investment in education, prevention and intervention such that awareness will be raised not only of suicide but also of depression, with a view to dealing with many of the stigmas that are unfortunately associated with them.
Suicide, as Senators have said, has touched us all. Just before Christmas, somebody with whom I had a very close relationship died by suicide and left three young children behind. She was a single mother. We can all give examples of the trauma and hurt caused among affected families and communities. Senator Keane referred to all the unanswered questions. We need to ensure that we raise awareness of suicide.
I will deal with the issue of depression because I have experience of it in my family and among other sufferers. I have done a lot of work with a number of pioneering general practitioners in Waterford who have done considerable research in this area. One wrote a book about depression and spoke about the need for proper awareness raising in regard to the issues associated with depression. This leads me to a number of key points.
It is important that we highlight the context and the figures. It has been said that the CSO figures for 2009 show the number of suicides was 527. I appreciate that for each individual victim, there is a grieving family. We need to be cognisant of the human element but the figures are important for us to understand that suicide comprises a very emotive and important issue. Unfortunately, more people die from suicide than on the roads. That is a very difficult reality for us to accept.
In January 2010 the CSO stated there had been 127 deaths by suicide registered in the second quarter of 2010. Of those, 102 were male and 25 were female. In the same period in 2009, 122 deaths were registered, 94 of which were male and 28 female. Geoff Day, the director of the National Office for Suicide Prevention states in his office's annual report for 2009 that international research indicates that during an economic downturn, the number of suicides increases. He states the size of the increase, based on the provisional figures, is extremely worrying and that the the economic downturn in 2008 and 2009 in Ireland and across Europe has led to substantial increases in both self-harm and suicide numbers. It is a fact that when one loses a job and faces all the concomitant difficulties, including the pressure of trying to pay bills, there is an impact on one's mental health. Even if we do not have national research results to prove there is a correlation — there is international research to prove it – we can accept that the downturn leads to an increase in the rate of depression.
I thank Mr. Hanafin of Amnesty International for providing me with some information on what is happening in Greece. In that country in 2010, there was a 40% increase in the suicide rate. There was a 400% increase in the number of individuals calling support lines and call centres. We do not have the same increase in Ireland, for which I am thankful, but Samaritans has put on record that there was a 9% increase in the number contacting the organisation in 2011. One in eight of those calls was related to the economic recession. We can accept this is a problem.
The WHO states collaboration with the employment sector on mental health policy is vital. It has suggested that we implement measures, in co-operation with employers, to safeguard the mental health of employees.
Let me talk about employment and unemployment because a number of Senators have focused on a number of other issues and some of the target groups, including lesbians, gays, the transgender community and young people, including young males. A disproportionate number of young male Travellers die by suicide. The focus can be on unemployment and all the pressures associated therewith.
Many people in employment suffer from employment-related stress. In 2007, the health and well-being employment strategy was put in place under the auspices of the Taoiseach's office. It called for awareness raising and worked with employers to ensure an employee suffering from stress or depression would be given the supports he or she may require. Unfortunately, the stigma associated with depression lends itself to those individuals not seeking the support they may need. Awareness must also be raised among the general population as the families of people suffering from depression need support too.
Suicide prevention needs to be made an area of co-operation under the North-South Ministerial Council to give the issue the strategic co-ordination it requires. We need to frame and implement a fully resourced, comprehensive all-island suicide prevention strategy including actions to promote mental health among the general population delivered through schools, youth services, workplaces and the media. Mental health promotion actions need to be targeted at specific sections of the population while incorporating their diverse needs into tailored suicide prevention sub-strategies. We need mental health promotion and suicide prevention actions targeting groups identified as higher risk and assist those bereaved through suicide.
While I support the Government's efforts in suicide prevention, I hope we will move away from coming up with but not implementing good policies, such as A Vision for Change and the health and well-being employment strategy. If there is a need for a reorientation of resources in the health services for suicide prevention, I hope it will be achieved. I also hope the Minister will take on board some of the constructive proposals I outlined.
I compliment the Minister of State, Deputy Kathleen Lynch, on her efforts in tackling this important issue. I agree with Senator Moloney on the role of rural isolation, a real bugbear of mine, in suicide. I have worked in my community for 28 years and have much evidence that this is a real issue. While drink-driving laws are welcome in bringing down road deaths, they can have a negative impact on the social lives of single men in rural areas, leading to further isolation.
I greatly dispute the accuracy of the official figure of 527 deaths by suicide recorded last year. Everyday, we read newspaper reports of fatal single car accidents involving an individual male passenger. We have no idea whether it was suicide or an accident. Conscientious coroners may want to protect a young person's family by declaring their death to be through misadventure rather than being more specific.
The Road Safety Authority has gone as far as it can possibly go. It has reduced road deaths to an all-time low and it will probably not get better. The move by the authority to award penalty points for a dirty windscreen is not positive. It is interesting that as road deaths are coming down, suicides in rural areas are going up. A balance needs to be struck but I believe we have gone past finding it.
Recently, when I visited my local community development office I noted the sheer number of advertisements on the wall from organisations such as Headstrong, Living Links, Samaritans, One Light, Console, the National Office for Suicide Prevention, Aware, Grow, Childline, Teenline, and many more involved in mental health and suicide prevention. What is needed is one authority which will take on suicide prevention in the same way Mr. Noel Brett and the Road Safety Authority tackled road deaths head on. Mr. Brett could branch into this area. I know his father was a community psychiatric nurse, therefore, he would have the expertise and backup. The Minister of State should consider establishing a dedicated authority to deal with suicide prevention.
I congratulate the Minister of State, Deputy Kathleen Lynch, on her valiant efforts to keep social inequality on the Government's radar. As she is aware, in 2008 I published What We Can Do About Suicide In The New Ireland. It is available for download on my website.
Much of the focus is on suicide and mental health problems caused by unemployment. It is important we keep cool heads at this time. Of those who lose their jobs, 99% will not die by suicide. There is a responsibility on employers and the trade unions, however, to support those who lose their jobs, particularly those in their 50s who may have problems getting future employment.
We have all seen the problems Greece has with its austerity programme. Until last year it had one of the lowest rates of suicide. Between January and July 2011, according to the Greek health Ministry, there was a 40% increase in suicides there. We must remain calm and give backup to people who lose their jobs. As the economic recession continues, along with the austerity programmes, there will be an increase in the numbers suffering from mental health problems, self-harming and suicide.
The National Suicide Research Foundation, based in Cork, indicated there has been an increase in self-harming rates in the past four years. It is now estimated 60,000 people self-harm with 12,000 such cases presenting at accident and emergency departments every year. Alcohol also plays a leading role in self-harming. Dr. Ella Arensman, based in the National Suicide Research Foundation in Cork, before Christmas in The Irish Times, sent a message that people should be more careful about what they drank and how they drank following the publication of figures from her organisations that indicated a link between alcohol consumption and self-harm. Some 70% of those who self-harm do it by overdosing on medication, with the remainder self-cutting.
It is all very fine before Christmas in that the holidays are coming, it is fun and people are inclined to take alcohol if they feel like drinking, but binge-drinking is the problem. In the Bible, Jesus Christ converted water into wine. I have no problem with alcohol, but each one of us has a serious responsibility to treat it very carefully. It is all right for most of the people who can drink——
Senator White has one minute remaining.
I draw attention to figures for self-harm. Over 40% of the 12,000 who turned up in the accident and emergency departments after self-harming had alcohol in their system. If a person is feeling depressed or vulnerable, or has problems, as SenatorZappone stated, such as sexual orientation problems or is worried about losing his or her job, and if he or she drinks alcohol to excess, he or she will feel worse and will not be able to get himself or herself out of this depressing situation.
As has been stated by colleagues, four or five times more people die by suicide than in road accidents. It is on the political radar. We have got the number of road deaths down. I would put much of that down, along with Mr. Brett, to Mr. Gay Byrne as a leader in society who demanded money for road safety to improve the figures of those surviving road accidents. We have developed the awareness that one should not drink and drive because of how dangerous it is. We must get the message out that one may enjoy alcohol but one should treat it carefully.
It is a serious issue. In my document, I drew attention to three areas that had been internationally proven as indicators of a reduction in suicides. The first was reducing alcohol consumption. The second was training general practitioners, GPs, in identifying depression when they met cases of it. The other was restricting access to lethal means. On the point about GPs, when I was doing my research I met families who told me that they had brought family members with mental problems who were feeling depressed, particularly young men, to GPs and the doctors said they would be all right, and they subsequently died by suicide. General practitioners are not up to scratch in identifying serious potential suicide or self-harming, or they are not up to date on adequate treatment.
I would make a final point on the issue of social exclusion.
Senator White is out of time.
I was drawing attention to the cuts in the programme for DEIS schools, particularly in west Tallaght. If a person is well off and his or her child has emotional problems, the person can pay for the medical or counselling help but if one does not have the money, one does not get it. Even in this issue of self-harm, those who are less well off have not got the resources to help their children who may have problems. I wish the Minister of State, Deputy Kathleen Lynch, continued success.
I welcome the Minister of State. This is a broad-ranging debate on the issue of suicide prevention and I thought I would confine my remarks to a few basic points based on some practice.
It is a difficult area. Despite so much being done in this area, we know we are still not managing to nip it in the bud. There are really, as yet, no definitive answers but I suppose what we do know is what we should not do. In the past few weeks, there has been an emotive debate on the issue of career guidance in the country given that the Minister for Education and Skills, Deputy Quinn, stated that the career guidance counsellor is a teacher like every other teacher and he or she will be within the teacher allocation. It has driven the career guidance organisation to an emotive level and some of its spokespersons, in particular, an eminent spokesperson who is sound in the area of career guidance, have made inflammatory comments on the issue of suicide. The spokesperson to whom I refer, who is a former president of the career guidance counsellor organisation, has stated that reducing career guidance provision will increase the incidence of suicide among young people. There is no evidence of that. In fact, the contrary is the case. In the past 30 years, there have been significant increases in the number of career guidance counsellors but yet there has been a considerable increase in the incidence of suicide.
It is a difficult environment.
There are many other factors. That is how complex it is. It is to do with societal change, societal pressure, etc. I condemn the remarks of Mr. Brian Mooney in that regard. I really admire the man on other fronts. He is an eminent speaker and commentator in The Irish Times, but this is not professional. It is not fitting for this man because he is too good to be using that type of language and it is not the way to deal with it.
In this regard, I ask the Minister of State, Deputy Kathleen Lynch, to ask the Minister, Deputy Quinn to issue a directive to all second level schools to ensure that the suicide prevention module in SPHE is taught to all students. Social, personal and health education, SPHE, is mandatory up to junior certificate, but I have been speaking to principals in second level schools in the past few days arising from these inflammatory comments and they stated that they have the wherewithal within subjects such as religion and SPHE to teach a module on suicide prevention. That would be a healthy move. The time to teach is when children are healthy, not when they are at risk. When they are at risk, one never knows what works. Everybody should be getting this information, and in each school year. I taught religion in New York state for a number of years very early in my career and suicide prevention was one of my topics. I also taught history. I started the day sometimes with religion and ended, depending on where it was timetabled, with history, and the kids were still coming to me during history to talk about suicide. This should not be the job only of a career guidance teacher. Mental health and positive well-being are so important that they should be the business of all teachers. The Minister can give a lead by issuing that directive to all schools.
I support what Senator Zappone stated. It must be part of the caring ethos of all schools and, to give schools their due, it largely is. Many schools have a care team, with year heads and tutors. Some schools, for example, have a letter box whereby a person can anonymously drop in the name of someone about whom he or she is concerned. These are positive measures. In many schools, there is also a pastoral care team.
It is not fitting for those comments to be made by the former president of the guidance counsellors' association. They are not fair and not accurate. I condemn them but I also ask the Minister of State to ask the Minister to intervene positively stating that this should be the business of all teachers and that the issue of suicide prevention must be part of the core curriculum.
Senator Zappone is correct that homophobia has caused some young people to have suicidal tendencies. As part of an early school leaving study last year, we interviewed young members of the lesbian, gay and bisexual community on this issue and they told us that they had contemplated suicide as a result of homophobia being perpetrated in schools. Therefore, it is important that those guidelines are implemented.
My third point concerns the courts. Several years ago a young man who had bipolar disorder committed suicide in a neighbourhood close to where I grew up. He had committed an offence and was brought before the judge but his medical records were not allowed to be presented in court. His family were adamant that they should have been taken into consideration because they believed they would have persuaded the judge to commit him to a psychiatric ward. He had stopped taking his medication. He committed suicide that night. I wrote to the then Minister for Justice, Equality and Law Reform, Michael McDowell, but he responded that he would not take those comments into account. This is an example of a direct causal link. As I do not know the current position I would be grateful if the Minister of State could indicate whether medical records are now being taken into account by the courts, particularly where psychiatric illnesses are involved.
My final point pertains to rural isolation. The drink driving limits have reduced the number of accidents on our roads, which is brilliant, but they also contribute to the problem of rural isolation among older men living alone. I have asked myself how I could support the non-implementation of drink driving limits. However, the statistics indicate that most drink driving related accidents involve younger men. Should we introduce different limits for older people based on these statistics? We could set the limits according to age brackets of, for example, ten or 15 years. We do not know for certain about causal factors but we should not contribute to concerns that can cause deaths in other ways.
I would be delighted if the Minister of State was able to follow up on the four issues I raised, namely, schools, courts, homophobic guidelines and rural isolation. It is a big job.
I thank the Minister of State for turning her attention and considerable skills to this troubling area. I am 54 years old and personally knew 14 people who committed suicide, including nine health care professionals and people who in some cases were known to suffer from mental illness. This is clearly a major problem and anybody who does this sad calculation will realise a considerable proportion of the people they know have been touched by this issue.
While I completely understand the problem of rural isolation, we should not in any way try to make the case for reducing the burden of suicide by increasing access to alcohol. Alcohol is an addictive cancer causing toxin which can depress people and lead them to suicide ideation. It is not a solution. I do not suggest my colleagues were arguing such a case and I understand they are trying to disconnect the notion of alcohol from social isolation. Perhaps we need to consider creative ways of increasing connectivity for older people in isolated rural areas while avoiding the impression that we condone increased alcohol consumption.
These are excellent initiatives but another issue lies at the heart of them. We need to find out how we compare to other jurisdictions in terms of the number of consultant psychiatrists employed in this country per head of population. The numbers are not as bad in respect of psychiatry compared with other specialties. We tend to have dismal and appalling ratios of specialists per head of population but we are merely bad in the area of psychiatry. We are at the bottom of the scale but a bit of effort would bring us to international norms.
We also need to critically examine medical school funding and resources to decide whether our six medical schools, which equate to one per 700,000 people, or twice the European average and three times the American average, are sufficiently resourced with full-time researchers and consultant level academic university employees who are conducting psychiatric research into the unique context of suicide in Ireland and can offer a critical educational grounding not only for young psychiatrists but also for GPs and other health care professionals.
I thank the Minister of State for the hard work she has done in the area of mental health. In particular I commend her for her commitment to addressing the issue of suicide, which has blighted communities throughout Ireland in recent years. I welcome the opportunity to contribute to this emotive debate. My own community has been affected many times by the issue in recent years and it would have been remiss of me not to elicit and share the views of local people.
It is a sad reflection on modern reality that more than 500 people chose to commit suicide in 2011. However, I acknowledge that Ireland is by no means unique in this regard. The Minister of State indicated that the figure for Ireland is akin to the population of a small village. The worldwide figure is almost equivalent to the population of Dublin because 900,000 people worldwide died by committing suicide. This represents one death every 40 seconds. On a global scale suicide ranks among the three leading causes of death for those aged between 15 and 44. In the past 45 years suicide rates have increased by 60% internationally.
It would be foolhardy to suggest that all suicides can be prevented but we must be mindful that the majority of them can. A number of measures should be considered to ameliorate this societal scourge. We must ask what we can do to prevent people from believing suicide is the only option. People have to cope with myriad pressures in this economic climate. The increase in the provisional figures for 2011 is not a fluke because financial pressures have led to mental illness and, in many cases, suicide since the Celtic tiger's demise. A considerable number of people speculated or purchased property at grossly inflated prices, while others took on credit cards, store cars or bought second cars at the height of the boom. The American dream became quintessentially Irish and Ireland became a monetary utopia facilitated by easy money and aggressive marketing from the banks, a lack of Government intervention and blatant disregard for regulations. In 2012 these same people are now bearing the brunt of failed banking policies. They are in negative equity and some of them are unemployed while they fight to save their family homes and their families. These people cannot deal with the doom and gloom that have been foisted on them and they certainly cannot handle the increasing pressure from the banks and their debt collection departments.
I have been contacted by several individuals who are in despair over their treatment and the fact that they have no hope or light at the end of the tunnel. These people are on the edge and they believe they have no support. While I recognise that the corporate sector works on an entirely different basis to most others, we must seek higher standards from those who are tasked with debt collection. We must remind them they have a duty of care to their customers which extends beyond the contractual. In particular, I draw their attention to section 11 of the Non-Fatal Offences Against the Person Act 1997 which provides that a person who makes a demand for payment of a debt shall be guilty of an offence if, "the demands by reason of their frequency are calculated to subject the debtor or a member of the family of the debtor to alarm, distress or humiliation". We should be more active in securing convictions against those who breach this criminal code. Debt collectors must strive to be as compassionate as possible and for that reason I urge the Minister of State to liaise with her ministerial colleagues to investigate the possibility of introducing a suicide training programme for bank employees who work in the area of debt collection. This is important in light of the number of repossessions that have occurred for several years and the increasing number of people who are in default on their mortgages.
We also need to deal with suicide prevention issues at an early stage. Let us start at secondary school and ensure every teacher is trained in suicide awareness and prevention before our term in government concludes. It is imperative that teachers are assisted to identify early warning signs and to ensure our young people are educated that suicide is very much a permanent solution to a temporary problem. As part of this, schools should have an integrated programme with activities to help those with low self-esteem and social complacency.
As a Government, we must be mindful of the repercussions of cutbacks to essential services and reliefs available in schools. For that reason, we need more joined-up thinking between the various Departments to ensure decisions made in the education sector, in particular, give due regard to this issue. We also need to be more proactive with suicide prevention initiatives. We need to examine the implementation of a new communications policy whereby we liaise with the various mobile phone operators and ensure that, along with general customer care numbers, numbers for groups such as Console, Pieta House and Samaritans are also automatically stored on telephones sold in Ireland. Suicide spots also need to be identified. We all know where they are and perhaps signposts should be erected at these locations warning of the consequences of adverse action.
Our focus should be on a bringing about a lasting reduction in the number of suicides and suicide attempts. Factors that may result in young people taking their own lives need to be identified, assessed and eliminated at an early stage. We also need to raise general awareness of suicide and provide psycho-social support for people with suicidal thoughts or experiences of attempted suicide. We must be mindful that everybody is not happy or confident 365 days a year and most suicides do not happen without warning. We must listen for that noise and we must be sufficiently engaged with the services on offer in order that people can be diverted as required because one suicide is one too many.
I thank the Minister of State for attending. Senator White referred to money and resources. I am speaking from personal experience. A 24 year old approached me last weekend and said, "I wish I had money so that I can get my boyfriend treatment." She did not want money not to go out, travel or buy clothes. No 24 year old should have to say that. I will speak about a person close to me and her direct engagement with the health services. I commend Sosad Ireland because its voluntary contributions and services have kept this person alive. Senator Keane mentioned a buddy system. Such a system is inadequate. In my case, one 24 year old is supporting another 24 year old. The HSE need to provide that service; a young person should not to have to rely on herself to do that.
The boyfriend of the person to whom I refer is depressed and every day he battles to stay alive because he wants to die. That is the unfortunate reality. As an elected representative, I do not want to talk about statistics or rehearse the issues raised by previous speakers. I will read a written statement by this girl about her boyfriend and her experience of public services. It states:
I may not know all the statistics but I know depression and all the other forms it takes. I see depression every day. I see the man I love wake up every day in tears wanting to die, wanting to get away from the unbearable pain. I see his mental health deteriorate. I see his physical health deteriorate. I tell this 24 year old man that things will get better. I ask him to just hold on, one more day, one more week. I tell him that the help he needs will eventually come, that the doctors do care.
He has suffered from depression and anxiety for years and years. He has moved from doctor to doctor seeking help, each one pawning him off on another. Medication for depression and anxiety disorders is supposedly a short-term answer, yet medication is the only consistent treatment that he has gotten in four years. His psychiatrist is nothing but dismissive. When he tells his psychiatrist that he still feels suicidal on the pills, his psychiatrist does not reassess the situation; he just ups his dosage, up, up and up until it can't go any higher.
This man that I love had a breakdown seven months ago. There is no other way to describe someone collapsing so severely in themselves mentally and physically. After this breakdown, his first port of call was to his GP where he was told that everyone gets a little down sometimes. The dosage of his medication was upped and, within ten minutes, he was out the door. The sad reality is that even now when we know all about mental illness and suicide, people are still walking into their GP telling them that they're feeling suicidal and, within ten minutes, that person who has high chance of killing themselves is walking out the door with a prescription stopping them from taking that step.
Fortunately, he changed doctors and now he has a very caring, compassionate and proactive GP. Since his breakdown, he has seen his psychiatrist four times. He was referred to a psychologist and occupational therapist also and has seen her twice. This is a man waking up every day wanting to die, a man working out a suicide plan just waiting on the day to come when he will have to kill himself, a man pleading for help telling doctor after doctor that he's so depressed, that he wants help, that he wants to get better, that he doesn't want to die but the pain is so bad that it seems like the only way out.
In many suicide debates in this country, we hear about the people that have taken their lives and that didn't ask for help. Well here is a man that is pleading for help, proper help, not to be packed out the door with more medication that won't change his life. Here's a man that wants to be able to live his life like his friends, wants to be able to travel, to be able to get out of bed in the mornings and to be fit to work, a man who just wants to live his life and not feel like he is a burden to his doctors, to the very people who are supposed to be helping him. To them, he is a 15-minute appointment, 45 minutes if he's lucky.
I want my boyfriend to get the help he deserves so that he can be the amazing, talented and happy person I know he can be. I want us to be able to wake up and know that instead of having to reassure the man I love that adequate help will eventually come that we can get up and live a day with normal worries about money, the price of petrol, the amount of tax we are paying. I would trade anyone for their money debts if they could help him get better. I want to wake up in the mornings not having to worry if I'm going to call from someone to say that he's dead. I want to be able to wake up and know that I won't have to find his body somewhere.
That is her story and I want everyone to remember that. I would like the Minister of State to take it away with her.
All over the country, men, women and children face the most harrowing reality on a daily basis that a loved one has died by suicide. Somehow they have to find the energy to face this reality every day and to carry on into the future, a future very different from the one they once hoped for. The intensity of their grief is unimaginable. Their loss and the loneliness is often beyond words and it is awful that none of us, no matter how deep our compassion, can ever understand their grief in the same way they can never understand what drove someone they loved to a point of such sadness and despair that he or she could not carry on.
It is good that there are many volunteer agencies such as Samaritans, Console, Aware and others that do much to help them. Waterford County Council under the mayor, Mr. Liam Brazil, will hold a conference on mental health and suicide awareness next month in Dungarvan and its members are to be commended for their efforts in this regard. Speakers from Living Links, Suicide or Survive, Mind Your Mind, the Irish Society of Suicidology, the HSE and others will address the conference. Many organisations and individuals deal with this issue. More important, they do outstanding work to reduce the incidence of suicide in order that fewer individuals and families will be beset by this awful grief.
Suicide was a taboo subject in Ireland for many years. I fear that the problem was neglected by the State and, therefore, our understanding of suicide has only begun to grow in recent years. However, we need to do much more to bring public attention to the issues that lead to suicide.
There are things we can do as individuals, families and communities, but in this Chamber we can also play a role in bringing together all the strands of care, treatment and support for those who feel suicidal as well as the support systems for those whose lives have been traumatised by suicide.
To this end, like other speakers, I favour a co-ordinated national approach to this growing problem. The growth in the incidence of suicide in Ireland has seen the establishment of a number of organisations dedicated to the issue of suicide in one way or another. Many people have called for a strategy similar to the one on road safety.
As it is now 2 p.m., statements must be adjourned.
They can be resumed next week.
When is it proposed to sit again?
At 10.30 a.m. on Wednesday, 18 January 2012.