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Seanad Éireann debate -
Wednesday, 18 Jan 2012

Vol. 212 No. 11

Suicide Prevention: Statements (Resumed).

I thank the Minister of State, Deputy Kathleen Lynch, for returning to the House to hear our statements on suicide prevention. Members have highlighted the various sections of the community that are at major risk. It is now proven that alcohol is a contributory factor in some deaths by suicide. The issue of gambling is not often mentioned but I believe it is a major contributory factor in some cases and will continue to be a problem in the future with the significant increase in online gambling, in particular. That will increase in the years to come. Many, both young and old, are accruing large debts and the worry and stress they endure is certainly driving them to the brink. This should be investigated and researched.

A significant number of lesbian, gay, bisexual and transgender, LGBT, people are vulnerable to suicide because of the stresses they face in coming out. The key findings of Supporting LGBT Lives: A Study of Mental Health and Well-Being, which the Gay + Lesbian Equality Network, GLEN, commissioned, showed that 27% had self-harmed at least once; over 50% of those who had self-harmed did not seek any form of help and 18% had attempted suicide. It is clear from these findings that Irish LGBT people can still experience significant distress related to their identity.

The Minister of State engaged in discussions on mental health on the television programme "The Frontline" this week. It was excellent and, as she stated, we need more such programmes to allow people to speak openly about suicide prevention and to rid ourselves of the stigma which still surrounds it. Recently I listened to a son speak of his mother at her funeral. He spoke of the darkness and pain she felt when his brother died by suicide in the late 1980s. At that time nobody spoke about it, people avoided the subject but the stigma was clearly there. Society has changed since then but we still have some way to go in that regard.

We have wonderful organisations and individuals dealing with suicide prevention nationwide. We need to take a more co-ordinated approach that would pool resources for research to enable us to unite to tackle this major problem in a cohesive way. There is now the public momentum and political will for the Minister of State to deal with the issue of suicide. Society must make it clear to everybody that emotional and mental health issues are no longer taboo and can be dealt with openly, healthily and without judgment.

With the permission of the House, I wish to share my time with Senator Mark Daly.

I cannot say I am glad to speak on this issue, but I welcome the debate and I congratulate the Minister of State, Deputy Lynch on her performance on "The Frontline". I agree with the Leader of the House who stated this is the type of debate we need to have because people engaged sincerely with it. I would give the Minister of State a score of 11 out of ten for her performance and for fighting for the allocation of €35 million. We know from statistics that 22,000 people were admitted to psychiatric units last year. How many more people suffer from mental health issues but are never admitted? I was very moved by Senator Katherine Zappone's contribution when she spoke from her heart last week. We need to relate to those types of experiences. I was one of the members who called for this debate in the Seanad. Le cúnamh Dé, I hope we will have a further debate on the issue of suicide prevention.

I have known several people who have died by suicide. Unfortunately, it goes in flows, with three, four or five deaths in a short time. These are some of the funerals which I hate having to attend. As a society, we have not got rid of the stigma of death by suicide. Less than a year ago, I visited a family bereaved by suicide. I knew the person's grandmother and called to offer condolences because I would not be able to go to the removal or the funeral. She held my hand when she said the person did not die by accident. I knew that, but to her, it was a shame on the family.

I do not know what we can do to change that, but being more open about the problem could help to rid us of that stigma. I acknowledge it takes money to deal with issues, but we know from the experience of the previous Government that throwing money into health, when the budget soared from €8 billion to €20 billion, did not achieve the expected results. If I make one point, it is that we, as Members, should focus on our communities, talk about and visit those who are depressed and try to open up the notion of stigma and shame in families. Unless we do this as a society, the money we pump into the issue will never bring about success.

I thank the Leader for having the debate and the Minister of State for attending. If not before the summer, perhaps next autumn we could have another debate on our progress. The more we stand up as a society to discuss the issue, the better. I compliment my colleague, Senator Gilroy, on his statement. I have listened to him speak on local radio and read what he wrote in the Irish Examiner. I encourage such action. Although none of us has the answer, together we might formulate a solution for what is an awful sore on our society.

I welcome the Minister of State to the House and compliment her on her performance not only on "The Frontline" but around the negotiation table in the run-up to the budget. As we know, an estimated 600 people committed suicide in 2011. I mention this as an estimate as many road traffic accidents are actually suicides. The number of deaths caused by motor collisions has been lowered to approximately 200, the best figure we have seen in 30 years, but it comes at a cost. People are not going out or to the pubs as much, preferring to stay at home, perhaps isolated and drinking on their own. In some instances we have replaced one form of death with another.

January has seen a shocking litany of suicides in Ireland. There were five on 1 January, three on 2 January, two on 3 January, four on 4 January, three on each of 5, 6 and 8 January, two on 9 January, with another two last Tuesday. That is just one month. We must ask, as a society, what in Ireland causes so many people to die by their own hand. I spoke to a friend of mine in the United States about attending funerals of friends who had committed suicide, recounting how many I had gone to. He told me he did not know anybody who knew anybody else who committed suicide. There is an endemic problem in our society involving those from the elderly abroad to the young people who see no future.

I know the following is not related to the Minister of State's brief but she might raise the issue as it relates to guidance counsellors, who play a very important role. A guidance counsellor walking through a school yard in December noticed one of the students acting strangely and spoke to him in the teacher's office. The student explained how he had planned suicide. Not only was he going to kill himself but his two friends were also entered into a pact. Only for the actions of that guidance counsellor, those three students could well be dead today. Such counsellors play a very important role and nothing can compensate a family for a loss so horrendous as the loss of a loved one. Counsellors play an important role in preventing suicides, which is what we are here to discuss.

I welcome this debate, although like previous speakers I wish there was no need for it. I regret that I could not participate in the debate last week but I was in Cork, attending the humanist service for my late cousin, John McCarthy, founder of Mad Pride. I know he was very supportive of the Minister of State's role.

As I studied the transcripts from last week, I will not relate all the statistics and figures, rather I will focus on a few select points. Suicide rates in Ireland began to decline in 2005 with the launch of the national strategy, but we have witnessed a significant increase in the rates with the downturn in the economy in 2008. The Minister of State indicated in her opening statement last week the significant increase in the number of deaths of men between 35 and 54. I also learned this morning at a briefing on the economy hosted by the Oireachtas Library and Research Service, as did many of my colleagues, that the at-risk group in Ireland comprises those between 30 and 39, as they are most likely to be unemployed, in negative equity and have other debt issues. That is a result of their position in the life cycle.

I flag this point in light of international studies which show that for every 1% increase in unemployment, there is a 0.79% rise in suicide rates. Employment offers people a sense of purpose, improves their self-esteem and allows them to provide for themselves and their families. That is why the particular age group of males aged between 30 and 39 worries me. Every effort must be made towards job creation and retention. We should also support initiatives from the money advice and budgeting service, MABS, which I know is working with the National Office for Suicide Prevention in identifying and providing support. A leaflet has been designed on dealing with tougher economic times. The Irish Association of Suicidology is working with the Society of St. Vincent de Paul to identify and support vulnerable people.

I also raise the issue of reducing access to minor tranquilisers, which is essential. Research has shown that with 12,000 deliberative self-harm presentations to accident and emergency departments, almost one third, or 3,900, involve an overdose using a minor tranquiliser. These drugs, which provide relief for people with diagnosed medical conditions, are oversupplied through prescriptions and very widely available over the Internet. Greater controls must be put in place regarding the excessive reliance on prescribing these drugs, and alternative therapies such as counselling should be offered, where appropriate.

There is also the issue of alcohol consumption, an issue on which I have spoken and voiced concern previously in the House. We know 41% of self-harm presentations in accident and emergency departments in 2010 involved the use of alcohol. Reading the transcripts from last Thursday's debate and listening today, I note that a number of fellow Senators made a link between tougher drink-driving laws and an increased incidence of suicide among older men living in rural areas. I state categorically that a depressive illness cannot be cured by increasing alcohol consumption, and I regret any links being made in that regard. The answer is not to revisit the drink-driving limit, which has shown a demonstrated impact in reducing fatal and serious motor collisions, but rather in focusing on other initiatives, such as the rural transport issue debated earlier in this House. We can also consider work done by organisations such as the GAA, the IFA and the Men's Shed project to tackle isolation, which must be done.

Another issue relates to the lesbian, gay, bisexual and transgender community. I join a number of colleagues, particularly Senator Zappone, who spoke about the significant number of lesbian, gay and transgender people vulnerable to suicide because of the stress they face in coming out and the homophobia and transphobia many experience when they do. In that regard, I commend the work of the Gay + Lesbian Equality Network, GLEN, which has worked over a number of years with the support of the HSE and the National Office for Suicide Prevention. There are also initiatives taken by organisations such as BeLonG To. Such invaluable work is done by many organisations but we must consider how to accredit that work to ensure services are safeguarded and that organisations can be encouraged to foster partnerships and collaborate. I know the Irish Association of Suicidology is working with the HSE in these initiatives, and I support that action.

There is no quick fix as the problem has no one cause. No two stories leading to death by suicide are the same and the only way to have a meaningful and effective strategy is to implement it in a cross-departmental fashion. We must make the links between employment, physical and mental health and equality, to name a few. I assure the Minister of State of our support and agree with Senator O'Donovan that this issue must be revisited. We must continue to support the Minister of State in this important work.

I wish to share time with Senator Coghlan.

I have a few comments to make. I welcome the Minister of State to the House and although I did not see "The Frontline" programme on Monday night, my wife did. She was so impressed with the performance of the Minister of State, Deputy Kathleen Lynch, that I went to the trouble of watching it on RTE Player afterwards. Eleven out of ten does not even justify the performance but that is what we expect from the Minister of State. We know she is capable of that.

It is great to see a combined all-party effort in this regard. In fairness to the previous Government, it made tough decisions when it came to issues such as drink-driving legislation. That approach has worked as road deaths here have fallen dramatically. We must take the same approach to suicide. Senator White produced an interesting document in recent years on the issue and, likewise, Deputy Dan Neville and others have campaigned tirelessly on it. We need a focused all-party commitment to deal with the problem head-on. We must provide resources and ensure that they are made available where necessary. We must also go to schools and ensure that mental health and suicide are not taboo issues in schools. We may need to go to primary schools to identify vulnerable young people.

I fully agree with the sentiments on gambling. The number of people who might have committed suicide as a direct result of gambling is probably unknown but I suggest that it is significant. I am also interested in learning the alcohol and drug consumption levels from autopsies carried out on suicide victims. Unfortunately, they are probably very high. Every person knows someone who has committed suicide and is aware of the devastation it has caused their families.

I thank Senator Conway for sharing time with me. I too welcome the Minister of State to the House and compliment her on her recent performance.

Every suicide case is different but, interestingly, recently in Kerry the coroner, Mr. Terence Casey, referred to road safety legislation. In a sense he is blaming it for increased suicide rates among the older generation. He made the point that the increase in social isolation has been exacerbated by the drink-driving laws. He indicated that they are part of the problem. I do not say we should revisit the legislation but we must do something about rural isolation. He stated that drink-driving laws may be reducing the number of deaths on the roads but they are leading to increased suicide rates among older people. He outlined that more than one third of all suicide cases heard at inquests in Kerry in 2011 involved people aged over 60 and he highlighted rural isolation as a major contributor. The cases usually involved single or widowed men. Living alone is exacerbated by the gap in the social life in rural Ireland due to the closure of traditional meeting centres which is increasing isolation and driving suicide rates up. He highlighted the closure of post offices, bars and even creameries. With the newly lowered drink-driving laws now being enforced he believes that the problem could escalate.

Mr. Casey made the point that while he dealt with three fatal road traffic accidents last year, he dealt with 11 suicides. Alcohol was a factor in the road deaths but it was not a case of a person having one or two pints. If records were examined all over the country one would find that the number of road traffic accidents involving farmers on rural roads is minimal. Most serious road traffic accidents are on main roads. One pint could now put someone over the limit and therefore people are not going out for a drink as they are afraid of being caught. People are used to going out and having one or two pints with friends but they feel they cannot do it anymore. Statistics since 2005 reveal a worrying trend among older people committing suicide. Of the inquests heard, there have been 67 suicide victims in that period, 41 of whom were over 40 years of age, representing a shocking 61% of all suicides. The coroner in Kerry also said that post mortem examinations revealed that it was a common misconception to blame alcohol or drugs for the high level of suicide. During last year alone there were just two cases with traces of alcohol. In practically 90% of reports there were previous signs of depression and treatment for depression. We must address rural isolation.

I welcome the Minister of State, Deputy Kathleen Lynch to the House. I welcome also the heightened publicity on suicide awareness. I thank the Minister of State for being so determined in highlighting mental health issues since taking office.

Medication for some people with mental health problems can be vital in their path to recovery. I urge non-qualified people to speak with caution when they encourage people to come off their medication. Recently, I listened to one person practically urging people to come off anti-depressant medication. I urge caution because that can be extremely dangerous. We all know that one should come off anti-depressant medication over a considerable period. In a perfect world it would be preferable for people not to have to take medication but for people with mental health issues this is not a perfect world and sometimes it can be vital for them on their road to recovery, as well as to engage in cognitive therapy for whatever length of time it takes, be it in the short term or over several years.

I repeat the call I made previously in the Seanad that people on long-term medication for mental health difficulties be provided with a long-term medication card as sometimes the cost of anti-depressant medication can be exorbitant and add a further unnecessary strain. Since I raised the issue previously I have been contacted by several people. I recently learned of a case where a person stopped taking medication because of the expense and, sadly, committed suicide several weeks later.

I thank the Minister of State for listening to some of the points I raised in the Seanad previously about the unsuitability of some psychiatric institutions. I am delighted that she acknowledged the vital need for mental health services to be provided within the community. I mentioned previously about trying to get emergency help for someone and being told that there was a four and half week waiting list. We should not have to wait one minute to get help for someone who needs emergency care. The key is a community workshop.

Perhaps it is time for the Minister of State to consider legislation to underpin A Vision for Change. We all agree with the strategy and the issues that have been raised. There is urgent need for the provision of mental health services in the community. A person in need of help must first build a relationship with the person treating him or her. In many cases that does not happen in institutions. We need somebody to build up trust and a relationship with those with mental health difficulties. Very often the best place to do that is in a community setting. I urge the Minister of State to consider the implementation of legislation.

It is with some trepidation, anxiety and reluctance that I speak to this issue. I listened to the debate last week and the discussion this evening. It is a huge learning curve. It is such a delicate and sensitive matter that I am concerned in case one would hurt or cause offence to anyone. Although we have the best intentions it must be borne in mind that we are lay people and very often we speak in an ill-informed way and can sometimes make ill-judged comments. Suicide remains a mystery that torments and traumatises our society. I am glad we are discussing it. In itself, this is progress. We are not covering it up nor are we afraid to speak the word. When I started out in journalism, the instruction was that suicide could not be mentioned when doing a report. These days, journalists are encouraged to report the fact that it was a suicide and, under the guidelines, are instructed not to eulogise people as heroes, given that such eulogies can apparently trigger copycat suicides.

I am glad that the Minister of State, Deputy Kathleen Lynch, has made herself available to the House for the second time in a week. That mental health has a champion at the highest level in Government is vital, as this issue needs to be addressed there. Securing €35 million for staffing, counselling and awareness-raising programmes was no mean achievement. I commend the Minister of State and the Government in this regard. I pay tribute to my colleague, Senator Gilroy, who has expertise in this field and has conducted much research that has helped inform my opinion on the issue.

As regards progress, it is commendable that coroners across the country are speaking out on the matter openly. The coroners in counties Offaly and Laois have put on the public record the trauma experienced by families and themselves in dealing with four, five or six suicides in a single sitting of a coroner's court. Given that suicides were under-reported for years, this is an improvement. However, under-recording remains an issue globally. For example, when forensic tests are conducted following single-vehicle accidents and individual drownings in New Zealand, the suicide rate can increase by as much as 20%.

After being elected to the Seanad, one of the first briefings I was lucky to attend was on mental health. The briefing was organised by an all-party group and presented by Amnesty International, which I commend for strongly recommending that the issue of mental health be embedded in the primary school curriculum. Since Amnesty International is having some difficulty in advancing that cause, I call on the Minister of State to use her good offices and influence to ensure that the Department of Education and Skills does not resist such a move. If people are not to be afraid to speak the word or need not pretend to be hunky dory all of the time, we must start with young children. We must educate them on their mental health. The old adage mens sana in corpora sano, that is, a healthy mind in a healthy body, springs to mind. I commend Senator Eamonn Coghlan for his work in this regard, as his Points for Life programme has a role to play.

Do I have one minute remaining?

Less. The Minister of State will be called to respond at 7.25 p.m. Given that five speakers remain to contribute, everyone should be precise.

We have the best of intentions, but too many agencies are addressing this issue. I cannot believe that there are more than 350 agencies dealing with suicide prevention and support. We need to consolidate our resources and include the topic of mental health in the curriculum. The Minister of State could appoint a mental health tsar much as Gay Byrne was appointed as a road safety tsar.

If I know anything about suicide, it is that there is no cure. The only policy that will work is prevention. It is on this that our resources must be focused.

I will pick up on a comment made by my colleague, Senator Whelan. Many of us are discussing a matter we know nothing about. With this debate in mind, I visited a local counselling centre to educate myself. I compliment the Minister of State on ring-fencing €35 million for counselling services, and so on.

I will provide a few statistics for the Southwest Counselling Centre in County Kerry. It provides a free emergency counselling service for people who have attempted or are actively contemplating suicide. It provides affordable counselling for a range of issues, such as depression, anxiety, panic attacks, abuse, job loss, bereavement, separation, suicide, self-harm, relationship and family problems and childhood trauma. It is the only service in Kerry providing a low-cost counselling service to individuals, couples, families, adolescents and children under one roof. No other service adopts such an inclusive approach to working with children, adolescents and families.

The centre is meeting more people who are in distress. Figures for 2011 show an increase over 2010. The centre has witnessed an increase in the number of people experiencing financial strain and struggling to cope, all of which can take a serious toll on people's mental health. The centre provides a professional service on a tight budget and every donation to the centre goes directly to providing the service. Currently, 56 people are on its waiting list for counselling. Kerry has seen a dramatic 25% increase in suicides in recent years, with suicide being the leading cause of death for young men in the county. International research shows that the current economic conditions are a factor in this increase, but a large percentage of the centre's clients are older adults experiencing depression, anxiety and suicidal feelings. Many of these individuals are also experiencing financial and-or social disadvantage. This age group is ignored in the provision of counselling and psychological support. As Senator Paul Coghlan stated, of the 11 suicides in south Kerry last year, four of the people were older than 60 years of age and three were between 40 and 60 years of age. We must take cognisance of these facts.

The centre has the professional skills to provide a counselling service throughout County Kerry. The Minister of State has ring-fenced €35 million, yet the centre is only seeking €80,000 to provide its service. Will she consider this request? The majority of the centre's clients are adults, yet it receives no Government funding for adults presenting with mental health problem, nor does it receive funding for suicide prevention, the topic we are debating.

Having examined this issue, I now believe that 1,000 people per annum die by suicide. Between 500 and 600 are recorded as suicides and the majority of the 150 to 200 deaths by drowning are suicides. A few nights ago, a female coroner stated on a programme that coroners' hands were tied in terms of what they could legally call a suicide. We regularly hear the phrase "death by misadventure", yet many of those deaths could be suicides.

An issue I have been raising for some time sticks in my craw. Last year, 186 people died on our roads, 45 of whom were pedestrians and nine of whom were cyclists. It is not suicidal, but anyone who walks or cycles at night without a high-visibility jacket is crazy. Doing that should be a criminal offence.

I do not have much to offer, as much has been stated, but I will give my experience. I am not a counsellor, I have not been trained and I do not know what to do in such situations. One night seven or eight years ago, at about 10 p.m., I visited a man who told me that he had just had a call from a friend who told him that he felt his life was over and that he planned to commit suicide. I did not know what to say. It was quite late at night in a lonely country townland and I did not know the friend in question very well. Nevertheless, I got into my car straight away and went to this person's home, where the woman of the house invited me in for tea and a chat. I could not tell the man where I had come from in case he realised that his friend had told me of his difficulty. This guy had been a great footballer but, for some reason, had stopped training. I could not tell him what I knew so, instead, I brought the conversation around to football and urged him to return to training as he was such a great footballer and captain of the team. He said I was not a bad player myself and we continued talking like this without him knowing what his friend had told me five minutes earlier. I cannot say that this conversation changed the young man's decision. I have spoken to him several times since but have never said anything to him. Nor has he said anything to me. However, I am glad I went to see him that night.

Everybody here can play a part in the battle against suicide. In particular, I compliment the Acting Chairman, Senator White, on her efforts in this area for several years. I also congratulate the Minister of State, Deputy Kathleen Lynch, on her commitment to action in this regard. I saw "Prime Time" on Monday night and all I can say is "Well done"; the Minister of State scores ten out of ten for that. When I went to visit the young man to whom I referred, I did not know why he had stopped training, but I decided to urge him to return to something at which he excelled and where he worked well with others. Thankfully, he is well now and is married with two children. His is a success story. We all must do whatever we can, as politicians and in our own lives, to support those suffering from mental distress.

I thank the Minister of State, Deputy Kathleen Lynch, for coming to the House. This is not a political matter. We all care deeply for those around us, as is obvious in the concern shown in this House for those suffering from mental illness. I am the Seanad representative on the cross-party committee on mental health, which is ably assisted by Amnesty International Ireland. The committee made a submission to the Minister of State prior to the budget asking that funding for mental health be ring-fenced. We welcome the positive outcome in that regard. The very existence of a cross-party committee communicates the message to those outside the Oireachtas that this is an issue which is above politics.

The Minister of State will be aware that there has been an increase in the incidence of suicide among those under 35 years, including children aged 15 and 16 years. The number of children engaging in self-harm is also growing, with 11,000 presenting to hospitals and GPs in 2010. Unfortunately, that number does not even represent the full extent of the problem. Many speakers have referred to the importance of community-based initiatives for suicide prevention. As my colleague, Senator Whelan, said, there is only intervention and prevention when it comes to suicide. I know this issue is close to the Minister of State's heart. As she moves forward with implementing A Vision for Change, I urge her to focus on putting facilities into communities. It is the only way to go.

Like Senator Whelan, I urge that space be made in the school curriculum to teach pupils the importance of emotional literacy. Children and young people should be guided in understanding that life is difficult sometimes, things change and end, and they can learn how to cope with those difficulties. One of the problems we have with urging suicide into the open and encouraging people to talk about it is that we often, unfortunately, do not have the facilities to accommodate that type of engagement. Allocating greater responsibility to the education system in this regard would be a step forward, perhaps through the civic, social and political education programme. The Government must give a clear commitment to action in this area.

Members may be aware of the Lived Lives exhibition, a collaboration between Seamus McGuinness, a Clare-based artist, and Professor Kevin Malone, professor of psychiatry and mental health research at UCD. They put it well when they said they wanted to combine their methodologies to find a new language to articulate the presence of suicide in Ireland. The idea of a new language is interesting at a time when we are coming to terms with the rise in suicide, across the board but particularly among young people, and seeking ways to cope with it. Sixty-two families came forward to give a part of their life to that exhibition. Now the organisers want to bring it on a nationwide tour in order that more people can experience this new articulation of language. As Senator Whelan observed, it is an issue which people find difficult to understand and discuss. Given the work and commitment involved, we have a responsibility to find a way to bring that exhibition around the country. The organisers are struggling to find a way to do so. Perhaps we can assist them through the co-operation of the Minister of State, the cross-party committee and others, including Senator White.

I thank the Minister of State for her work thus far. She has long been a champion of mental health. We are bound to return to this issue again and again. It is through community-based initiatives that we can increase awareness of suicide and seek to reduce its incidence.

I welcome the Minister of State to the House. As Senator O'Keeffe rightly said, any action on suicide prevention will be sure of cross-party support. It is not a political issue. The Minister of State had a great regard for her predecessor, my good friend, Mr. John Moloney. She is carrying on the work he did in bringing forward A Vision for Change while bringing her own initiatives into play.

Of the 100 psychiatric posts that were sanctioned outside of the moratorium, how many have been filled? Is the pause put in place by the HSE still in operation? As Senator Sheahan observed, mental health issues are not as tangible as physical health issues. All of us have had experience within our families and communities with people of various ages who have died by suicide, many of whom suffered in silence for a long period without receiving the assistance they required. All Governments endeavour to do their best in this area. I urge the Minister of State to continue the work begun by Mr. John Moloney in order to give a specific focus to this issue.

I will not engage in the scaremongering that went on earlier in the week, but I draw a minor parallel and ask colleagues to think about it. We have been talking about the increasing level of suicide among younger people and we all acknowledge that counselling is crucial. Guidance counselling in schools is also crucial. I will not reiterate the political points ventilated in the other Chamber. If we believe that counselling services are paramount in terms of preventing suicide — Senator Whelan stated suicide can only be prevented and not cured — how then do we square rowing back on career and guidance counsellors who are not mainstream teachers but to whom many young adults go to speak about issues affecting them, not alone in terms of their education but personally? We must examine our education system in terms of support for our young people.

I agree with Senator O'Keeffe that we must continually seek to change attitudes towards mental health issues, including depression and various other illnesses. Initiatives introduced by this and previous Governments, including mental health awareness week, have been helpful but we still have a long way to go. I welcome the ring-fencing of funding for this area and the proposed upgrade of our archaic mental health facilities. St. Ita's Hospital, Portrane, has had a good track record for more than 100 years. Unfortunately, this facility was not greatly improved down through the various years by various Governments, including those in which I have been involved.

We must ensure people, including physiatric patients with mental health issues, are assisted in the return to living in their communities. I was struck by Senator Brennan's remarks in this regard. All of us have a role in this area. Issues such as loneliness and isolation were frequently mentioned in the debate. We must, as individuals, reach out to people to ensure they are not isolated. The Minister of State, Deputy Lynch, will have the full support of this side of the House in addressing problems in this area. I acknowledge that her heart is in the right place on this and ask that she attempt to have her colleagues come on board and prioritise this issue, which is a plague on our people. Improvement of the services we provide must continue. The Minister of State, in reply, might inform us of progress in relation to the appointment of the 100 posts sanctioned in this area.

I welcome the Minister of State to the House. I also welcome this debate, the contributions to which have been important in terms of how we go about addressing this problem confronted by all of us in our communities. As stated by previous speakers, it is to be welcomed that coroners are now speaking out more freely at inquests about this issue.

I welcome the part being played by family members in terms of their speaking publicly about the trauma they are experiencing. A friend of mine, Mr. Peter Roche, a councillor in Galway, lost his son over a year ago through suicide. He has recently taken on the public role of ambassador for Console and is doing Trojan work visiting schools and youth clubs highlighting the trauma and hurt experienced by himself, his wife and their children as a result of his son's suicide. I spoke to him recently and asked what issues I should highlight during this debate. He told me that many young people reach crisis point at 2 a.m. or 3 a.m. but they have nowhere to go for help. He asked me to urge the Minister of State to support financially organisations that are providing a 24/7 service. Console is one such organisation. There are many other organisations doing great work with people in difficulty. These services need to be on the high streets: they need to be visible. We must also publicise what help is available.

Much has been said during this debate about medication and so on. I was recently told about a group in County Wicklow, the Institute of Complementary and Natural Medicine, which recently won an award in the UK and provides a service to people with mental health issues and suicidal tendencies. It, too, is an organisation worthy of support. The purpose of this debate is to highlight the issue of suicide. We have done a good job in doing so. The Minister of State, plays a key role in this regard. I welcome that an additional €35 million has been ring-fenced for mental health services. It is hoped a reasonable proportion of that money will be targeted specifically towards suicide prevention.

I thank all contributors to this debate. Suicide is an issue about which we can never speak enough given the low base from which we come in terms of public understanding and our ability as a people to speak about issues of emotional distress. Our belief that emotional distress and mental well-being are not part of the entire person or human condition is unique. They are clearly part of the human condition. We have no difficulty in acknowledging our ability to solve unique problems in the world — we shine at that — but we have huge difficulty talking about the distress we sometimes experience. I am conscious of John's recent demise and the importance of the language used around this issue. We have an inability to define what causes us mental and emotional distress. We find defining ourselves difficult.

Many issues have been highlighted during this debate, including that there is no one cause or trigger of suicide. However, we must remain conscious that, as sensitive human beings, anything can trigger or cause a person to commit suicide. We must be prepared to be the nosy neighbour and to step in and ask people if everything is alright, when we perceive them to be in distress or experiencing difficulty. I agree with the comment that governments alone cannot solve this problem. It is a societal issue. We must be conscious that people sometimes find themselves in distress and we must be able to step up and ask them if there is anything we can do to relieve that distress. When one finds people respond in a way that confirms one's suspicions, one must then be able to point them in the direction in which a service is available. The additional €35 million that has been ring-fenced in this respect will flesh out the community psychiatric teams and put in place the psychological and straightforward counselling services to which a GP will be able to refer. In this regard, GPs will be key as they are the medical professionals within the community who everyone first approaches. A total of 90% of all those with mental illnesses approach their GP in the first instance. Heretofore, GPs have had two options, namely, to prescribe or to send someone to the acute unit, but this is not the point at which we should be. While psychiatrists may not like it if I suggest the last person in front of whom one should find oneself is a psychiatrist, that is the case. There should be many steps in between because not everyone needs such intensive treatment. Some simply wish to talk to someone and although others will need a little more, that is what this is about.

The Government is putting in place nurses within the community. There will be two in each of the 17 health board areas who will have specific responsibility for dealing with those who present with suicidal tendencies or self-harm. They will act as roving nurses who will travel to particular GP practices, as well as dealing with accident and emergency departments. It should be noted that each year 12,000 people present themselves at accident and emergency units having self-harmed. Moreover, this is the tip of the iceberg as I am informed that at least a further 60,000 do not present at all despite having self-harmed. We must move away from current perceptions on what constitutes self-harm. When I first thought about the issue, I thought of overdosing and a person cutting himelf or herself. Are people who drink to excess not self-harming? This possibility should be considered.

I recently visited an incredible service in Wexford where the big old psychiatric hospital is being closed down and the very few who still remain are determined to get out of it, even though there was resistance to this at the outset. Familiarity is comforting for all of us. There is a familiarity about working in an environment for 28 or 30 years and one is reluctant to move on. However, those who remain now wish and need to move on.

This process is about day hospitals and people's ability to walk in. It is about being able to pick up the telephone to contact a GP in the middle of the night when something serious happens and about that GP referring someone to the 24 hour service. In this context, the Government in still in consultations with the mobile providers. Heretofore, providers of listening services such as Samaritans, Console and similar organisations operated a landline-based service for which Eircom used to pick up the tab. Most distress calls are now made with mobile phones, for which there are five service providers in the State. The Government is engaged in negotiations to ensure this service also will be free. The negotiations are almost complete and dedicated numbers such as the 112 and 123 numbers which will have a specific purpose will be made available.

Above all else, we must begin to examine seriously what children are being taught about emotional health. I have four grandchildren, two of whom are grandsons who are at an age at which one can communicate with them. One could joke that as they are boys, it is uncertain whether one will ever be able to communicate with them properly. To be serious, however, from a very young age, they said things like, "You have hurt my heart," or, "You have hurt my feelings." Consequently, it is not as though one cannot communicate what feelings are with very young children as one can; it simply needs to be appropriate. In this context, we must begin to consider how we can begin this process. It should take place in primary school. Why should we wait until young people are 12 or 13 years old, even though they all develop at a different pace, to begin to talk to them about feelings, emotions and bullying? If we are to introduce such education, we must start very early and ensure it continues right into third level and beyond. The Government is working on these matters and a working group is giving them serious consideration. I hope to have such an education programme developed because people do not live in separate boxes and suddenly develop emotional distress. Although I am told that adolescence is usually the time when psychosis begins to develop, this is only because it is the time when it is visible and becomes evident. People are emotional beings and we need to begin looking at life in the round. We must consider the whole and how well we keep ourselves from a young age to when we become older.

As for the 400 posts the Government has managed to secure, I note that for the two previous years 100 posts were allocated in each. Some of them were filled in the first year, but thereafter there was a pause by the HSE. I do not blame the HSE for this as it simply reflected the times and apportioning blame is a futile exercise in such matters. We now have 400 posts that will not be subjected to a pause in respect of community teams, counselling, psychology services and so on. Moreover, the Government will put in place a director, or a directorate, of mental health. I am a great believer in ensuring that when one does something, one should not be obliged to do it twice. When that person is put in place, he or she will have control of the figure of €35 million and, I hope, in the future complete and total control of the entire budget for mental health services.

I am conscious that not everyone who dies by suicide has mental health issues. I am conscious that there are other issues and that this is a multifaceted problem. However, while meeting people as I travel around the country, one aspect I have noticed is the isolation felt in respect of mental health. Institutions are located on the outskirts of towns and usually isolated. While they are usually beautiful buildings, they are isolated. The director must bring mental health issues into the mainstream. Dealing with mental health issues must be as commonplace as dealing with kidney stones and should become part and parcel of what we are. That is what must happen and what I hope the aforementioned director will do.

Within the strategy set out in A Vision for Change there is an entire programme on suicide entitled, Reach Out, which is under constant evaluation. A working group of individuals who engage in research in, and have expertise of, this area are constantly engaged in updating and upskilling. Moreover, they make constant contributions in considering what must be done next in terms of what did not work and what will. We must be more focused because a message that will work for those aged between 15 and 19 years will not work for those aged between 35 and 45. Consequently, concentration on the focus of the message is required.

I take great heart from the fact that we have in a very short period become far more open on this subject. The only thing that really matters in the context of an issue which needs to be aired is ensuring the light is allowed to shine on it. Senators have my commitment that this will be the case.

When is it proposed to sit again?

Ar 10.30 maidin amarách.

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