I welcome the Minister of State, Deputy O'Dowd, to the House. I call on Senator MacSharry to speak and he has ten minutes.
Suicide Prevention and Mental Health Fund Bill 2014: Second Stage
I welcome the Minister of State to the House. I am glad of the opportunity to put forward the Bill this evening and thank Senators Leyden and Darragh O'Brien for co-sponsoring it. The issue is very close to all of our hearts. At least Senator Gilroy, who has done a great deal of work with regards to the health committee and is a health professional, is no stranger to the issues that I shall raise here today.
I know that the Minster of State, Deputy Lynch, is not available. I wish her well and hope she is recovering well. I am sorry that the Minister for Health was not available to attend. In fairness, he is very good at coming here. He does make himself available to us very regularly and was here earlier today. Given the importance of this issue I would have preferred that he attended. Notwithstanding that I am delighted to have the Minister of State, Deputy O'Dowd, in attendance. I know that he will take the Bill on its merit and in the spirit in which it has been put forward.
Last year I published a document that Senator Gilroy will be familiar with, called Actions Speak Louder than Words. The common denominator of my policy document was an admission that politicians do not have the solutions to this silent crisis. We all participate in the endless rhetoric that takes place in these Houses when there is an incident of suicide, a loss of life through suicide or a report, as there was in recent weeks, on the national mental health service. The indignant rhetoric of all us demanding that action be taken, how this crisis cannot continue and so on is deafening at times. However, when it comes to political leadership and political will to take the appropriate measures we all fall short, which is not to overly criticise this Government any more than it is to absolve previous Administrations.
My document put forward a structure and resources that we believe needs to be put in place so that the experts, such as people from Senator Gilroy's profession, the people in the National Office for Suicide Prevention, the people in the Samaritans, Console and the various other organisations, both voluntary and professional, throughout the country can begin to peel back the blindfold that is on the phenomenon of loss of life through suicide. The measures were estimated to cost in the region of €90 million. Where would one possibly find that amount of money at a time when we are trying to nurse so many deficits throughout all the Departments and so many cutbacks?
The first thing we need is the political will and courage to say that we are losing the population of an entire village every year through suicide. It is the same as saying two jumbo jets filled with people are going to crash next year but strangely we know where and, to an extent, when they are going to crash. We know what the problem is yet we are not prepared to tangibly do what is required in order to prevent suicide. That is inexcusable in everybody's book yet we continue, and again I am not overly focusing criticism on the Government or absolving other Governments, to commend ourselves on all the good work that we are doing and say it is great.
We have the policy framework called A Vision for Change which is a great plan that we all signed up for. There is scarcely a policy in the history of the State, other than corporation tax, that has such support yet it is the first target when it comes to gathering up a few shillings to fill a hole in another aspect of a Department or in another Department. Over the years we have ring-fenced moneys for mental health and suicide prevention measures. However, buried within the bowels of the HSE, the policy is subservient to the budgetary constraints and challenges of that organisation and, inevitably, is ranked lower in the pecking order than it should be.
It was suggested in our policy document that we would look at an area with scope such as the off-sales area. The Bill does not precisely mirror the proposal in the policy document but reflects its spirit. It was proposed that a levy could be applied within the off-sales sector that is based on volume and strength but applied by the retailer, collected by the Revenue Commissioners and put specifically into the mental health fund to be established under this Bill. That money would then be available for the roll-out of policy measures such as those suggested and the accelerated roll-out of A Vision for Change. The €90 million was only some of the money and, therefore, the balance would be very significant. We have calculated that up to €200 million would be available for the accelerated roll-out of A Vision for Change.
I know this is not specifically the Minister of State's portfolio but I need hardly underline the challenges throughout this area. For example, we had a report on hostels in recent weeks, the Mental Health Commission and a report into the Galway and Roscommon issues regarding mental health services in the region. Senator Gilroy would be a lot more fluent than I about the individual cases but each corner of the country has its own story to tell in how we, collectively, have failed in this regard. We have tried to come up with an innovative way to raise money, not to impose a tax on people, not to beat up the retailer who is working so hard, and not to beat up the alcohol trade generally. It can be said that alcohol is a contributing factor in terms of mental health issues and suicide but there are others such as relationship breakdown, losing one's job, depression and many other social factors.
We, with the co-operation of the drinks industry and the retail off-trade sector, would like to harness what has been shown in our research and I refer to the goodwill of individuals. Research shows that when people seek to enjoy themselves responsibly they may be prepared to pay that little bit more in the knowledge that the money would be specifically ring-fenced. Unfortunately we do not have an example to point to in this regard. There is no precedent within the Exchequer to say that funding goes directly to an issue and that is where it stays but so what. Why not test it? Why not try it? Why not put it in place? If we did we would reap the benefits.
Naturally, retailers feel challenged by the proposal. In our own area of the north west, where the Acting Chairman comes from himself, we have the Border area. If Committee Stage of this legislation was accepted then additional measures could be made to give added protections to retailers in the area who must deal with competition from across the Border and its different regime. Of course such a provision would have to be made.
People are definitely at their wits end and at the pin of their collars from an economic perspective and the effects of austerity, so they are entitled to enjoy a glass a wine at the weekend if they want.
They do not want to have to pay more for it, but an extra 25 cent on premium lager, an extra 80 cent on a bottle of wine and an extra 16 cent per measure of whiskey or vodka would be a relatively modest amount in the context of the overall price, yet the contribution it would make in terms of the mental health service, the infrastructure and staffing required and the measures outlined in Actions Speak Louder Than Words in creating that new structure and other measures aimed at suicide prevention would be immeasurable in terms of savings for the State. Instead we have had haphazard funding for mental health services, uncertainty as to whether funds will be available and the fact that A Vision for Change remains an aspiration and, despite the best efforts of the Minister of State, Deputy Kathleen Lynch, and her colleague, as she had to admit on "Morning Ireland" this week, will not be implemented in the lifetime of this Administration. That is not acceptable. We can make a difference here and can choose to do this. I agree that the best we can hope for is to bring about half of the people with us on Facebook. I was subjected to scurrilous attacks from certain quarters and received great support from others, but this a tangible measure that could be implemented to ring-fence funding and society as a whole would thank us for it. It is not about being popular but doing the right thing.
I do not want to pre-empt what the Minister of State will say, but there may be suggestions that there are European directives that may, in some way, impede the possibility of the Bill being implemented. I agree that some of the measures might be debatable. We sought legal advice from senior counsel and believe the Government should test the Bill. We also believe it is possible to implement its measures. Let me give one example in terms of betting. We had the potential to apply a tax in a betting office but not at the dog or race track. Equally, we are looking to apply something to the off-licence trade where, in fairness, there is scope to do so. I reiterate it is not to hammer the alcohol retail sector, but there is scope to do so in that area, given historically low prices. If the Bill is passed on Second Stage, we could on Committee Stage examine whether a proportion of the excise paid by on-trade publicans or a proportion of their commercial rates bill could be ring-fenced and put into this fund also.
A great deal of work has gone into the Bill and the Actions Speak Louder Than Words document. We have tried to come up with a tangible solution that the Government could embrace. There is nothing I would like more than for the Minister of State and his colleagues to accept the Bill on Second Stage, make changes to it, some of which I have outlined, and bring the wisdom of the likes of Senator John Gilroy and others to bear to improve it. It would be pioneering legislation but also worthwhile and innovative in that it could reduce the incidence of suicide by 30% in ten years. Unlike the prediction made by the Minister of State, Deputy Kathleen Lynch, through no fault of her own, earlier in the week, it could accelerate the roll-out of A Vision for Change, which means that the Government could take full credit for its completion, instead of depending on the goodwill of the next Government to carry it forward.
As one of the signatories, I am honoured to support Senator Marc MacSharry's Bill. It would provide substantial funding for the implementation of a range of measures to reduce the rate of suicide in Ireland. It is broadly based on the Senator's policy document, Actions Speak Louder Than Words, which was published last year. I compliment him on taking the initiative to try to reduce the level of suicide, which is appalling. He has outlined his case very well and used imagination and research which is based on the document he published.
I welcome the Minister of State, Deputy Fergus O'Dowd, and hope the Government will give serious consideration to the Bill. It is a good, solid suggestion because funding is always an issue in this area. As a former chairman of the Western Health Board and a former Minister of State in the Department of Health, I know that the effort made during the year is restricted because of the amount of money available. The Bill would provide a stream of funding for the Department to assist in reducing the incidence of suicide. Reducing its incidence is all that is possible at this stage, although its elimination would be the ideal.
Far too often suicides are alcohol related. In many cases, people do not drink responsibly, but alcohol might be an added aspect when young people commit suicide, which is a tragedy for families. There is nothing worse. We cannot compare deaths, but suicide causes utter shock and devastation for the family and friends of the person involved. The total loss of life through suicide on an annual basis represents the equivalent of the population of an entire village. That puts the issue in stark terms. Mental well-being and suicide prevention policies and initiatives have always been starved of the resources they need to have a penetrative impact.
The Bill would deal with the gap between the licensed trade and off-licences, including major supermarkets, in the price of drink sold. The Government has done nothing to try to level the playing pitch in that regard. It constantly increases excise duties on drink sold in licensed premises which are controlled environments in the sale of alcohol, while ignoring the position in supermarkets. People are buying excessive amounts of alcohol in supermarkets at a very cheap price. The Minister of State may not realise that rural publicans cannot buy Jameson or other spirits from their wholesalers at less than the price it is sold in Tesco, Dunnes, Aldi, Lidl, SuperValu and Londis. It is extraordinary. Having an involvement through the Castlecoote Lodge Bar and Lounge in Castlecoote, County Roscommon, I realise it more than ever having seen the level of competition in that regard. The public house is a controlled drinking environment.
I was particularly disappointed when I read the Intoxicating Liquor (Amendment) Bill 2014, the signatories to which are Senators Imelda Henry, Maurice Cummins and Colm Burke. It would allow for the drinking of alcohol in pubs 365 days a year.
One would not have to serve it.
Two days a year, on the birth of Christ on 25 December and the day of his crucifixion, Good Friday, are marked by Christians throughout the world. Surely we could observe them by the closure of public houses. I oppose that Bill not as someone who is a shareholder in a pub but on a personal basis. Publicans may have different views, but I believe Good Friday and Christmas Day are two days on which publicans can come together to pray or engage in recreation. I was amazed when I read the Bill this morning and could not believe someone would publish such a Bill.
That is not relevant to the Bill before the House.
It is very relevant because it would allow for drinking on days when it was previously restricted; it would remove the restriction on Good Friday. I hope the Minister will not be tempted to back his colleagues in the Fine Gael Party. The Leader of the House is a signatory to that Bill.
That is not the Bill about which we are talking today.
I believe the Acting Chairman seconded the motion when the Bill was brought before the House yesterday.
I am talking about the Intoxicating Liquor (Amendment) Bill 2014, published-----
That is not what we are talking about today. Senator Leyden is making a mockery of Senator MacSharry's Bill.
No, I am not. The point I am making is-----
Sorry; the Senator's time is up.
Encouragement of the sale and consumption of alcohol does not contribute. All I am saying is that people have a chance and opportunity to reflect on Good Friday.
I second the Bill and commend Senator MacSharry on his initiative in this regard. He has put a lot of work into this and I hope the Government accepts his Bill and rejects the other Bill mentioned.
I welcome the Minister of State to the House and welcome Senator MacSharry's Bill. I know from my involvement in drafting that there is significant work involved in drafting any Private Members' Bill and I pay tribute to him and those who worked with him in producing the Bill. It is important to remember that the introduction of a Bill creates debate, and the Senator has certainly put forward the arguments in favour of the Bill.
In dealing with the issue of suicide, it is important that we realise the number of people both directly and indirectly affected. The figures for suicide from 2010 to 2013 and those for the past 12 months show that we have moved from a high of 554 people who died by suicide to 475. Suicide is not just about the people who die; it is also about their families and the difficulties the suicide causes for them. This is not something that lasts just for a week or a year but something that lives with them for the rest of their lives. Suicide touches families for ever. We must always be careful how we deal with this issue, because so many people have been directly or indirectly affected by it.
The Government is dealing with this issue in a comprehensive way. For example, the budget of the National Office for Suicide Prevention has doubled over the past three years, from €4 million per year to €8.8 million. This office is making an important contribution to dealing with the issue. Not only is it concerned with what is being done currently, but it is also planning for what needs to be done in the future. The mental health budget is a substantial budget. It is a huge slice of the health budget because of the huge number of people who receive and require assistance from the health service. This year, 2014, the budget is over €776 million, and over the past three years an additional €90 million has been provided for mental health care. We must continue to work on providing services in this area.
We have more than 1,100 additional people employed in this area and we are also developing and focusing on community health teams. These teams are not just about assisting the person directly affected, but also about assisting families. The whole purpose of the community mental health teams is focused on the community, rather than on admitting people to an appropriate medical facility, because admission does not necessarily mean the problems will be sorted. In the community mental health teams it is important to work not just with the individual but also with the immediate family. It is about ensuring everyone is involved and all of the issues that contribute to the problem are dealt with. This role of the community mental health team is important. I would like to thank the Department, the HSE and all of the medical and back-up support people for their contribution in turning around how we deal with mental health. I hope we continue to expand and develop the service with the result that we reduce the number of people who see suicide as the only solution.
The new strategic framework for suicide prevention and the Reach Out strategy are being developed. When dealing with the area of mental health, we must also concern ourselves with the integration of the services we provide. We must look not just at the people at the front line who are dealing with mental health but also at the backup support services, including social welfare and other areas. We must look at all elements that affect a person's life and ensure co-ordination between all services.
In the context of this Bill, a significant part of the debate relates to the connection with alcohol and to Senator MacSharry's proposals. We should, therefore, refer to the Public Health (Alcohol) Bill. Last October, the Government approved an extensive package of measures to deal with alcohol misuse, including a public health (alcohol) Bill. These measures were agreed in full, along with the recommendations of the steering group report on a national substance misuse strategy. The recommendations in the strategy are grouped under four pillars: supply, prevention, treatment and rehabilitation, and research. The aim is to reduce alcohol consumption to the OECD average - 9.1 litres of pure alcohol per capita per year - by 2020 and to reduce the harm caused by the misuse of alcohol.
In 2013, the average per capita pure alcohol consumption in Ireland for everyone over the age of 15 was 10.64 litres. The package of measures to be implemented will include provision for minimum unit pricing for alcohol products, the regulation of advertising and marketing of alcohol, structural separation of alcohol from other products in mixed trading outlets, health labelling of alcohol products and regulation of sports sponsorship. This is a comprehensive package and it is important it is brought forward, implemented and followed through on at the earliest possible date. This is the type of change we require in order to help all of the people directly affected by the misuse of alcohol and excessive alcohol consumption. There is a connection between these and suicide; Senator MacSharry is right about that.
I believe the Government is dealing with the issues in a proper and structured way. However, we need to fast-track some of the measures in regard to outstanding issues and I support what Senator MacSharry has said in that regard.
Cuirim fáilte roimh an Aire Stáit. I was just doing a quick mental inventory of the number of people I know personally who have taken their lives over the years, and I could make a list of 12. Suicide is a common problem, a tragedy for those concerned and an unbelievable tragedy for the bereaved. Anything we can do to highlight the issue and tackle the problem should be given priority. This innovative Bill is an attempt to ensure that much-needed services are developed for suicide prevention through the use of a novel funding formula.
All across our health service, we have critical deficiencies. This morning, we discussed patients who are being denied multiple sclerosis drugs that would decrease their pain and save money for the State. Patients are told they cannot have life-saving obesity surgery, although it could not only save their lives but save the State money. Cancer drugs have been denied to patients and breast reconstruction operations have been put on what may be indefinite hold for younger women who have had mastectomies for breast cancer. We have waiting lists for children who are going deaf and who need to see ear specialists. The longer this surgery is delayed and the longer they must wait for the appropriate remedial services, the greater the personal and economic consequences for these people.
We have problems everywhere and could whinge about them and say they are not our fault and talk about legacy issues and the rotten and miserable set of cards the current administration was dealt on coming into power.
The Minister for Health, Deputy Reilly, came in with a reformer's brief and zeal with good ideas for health service reforms but has found his hands tied by economic circumstances which occurred without his responsibility. If we find clever ways of raising moneys to deal with problems, then we should pursue them. There is no point in putting them on the long finger against some future nirvana where the wonders of economic recovery, universal health care and an integrated approach to all aspects of preventive medicine will kick in.
Maybe that will happen. However, my legislation, limited in its purpose, aimed to introduce a ban on smoking in cars in which children are present became glued up in treacle-like bureaucracy for two years. After a year and a half of going nowhere, we were shamed into doing something about it by the British when, more or less on the spur of the moment, they adopted our idea and rushed it through both their ancient Houses of Parliament in a short time. This leads me to believe that not supporting this Bill because we might get something better in the future is not a good strategy. Governments can easily get distracted, electoral considerations can get in the way, priorities can shift but, meanwhile, we have an opportunity to tackle this heavy burden of suicide with this legislation. It is clear from the number of psychiatrists, social workers, psychologists and support services we have that we are not doing enough.
In addition to this welcome opportunity to raise moneys for much needed suicide prevention services, it makes sense for us to stop to think about our relationship with alcohol itself. Any measure that puts a tax on a product also acts as a disincentive to consume it. We, as a society, must be absolutely unambiguous on the fact we need to drink less. We, as a society, drink approximately five times more litres of alcohol per person per annum than we did in the 1960s. Discretionary alcohol spending decreased on what it was a few years ago at the height of the Celtic tiger but we are still way above where we were in the 1960s. Despite our national reputation, we actually had a relatively low burden of national alcohol consumption then. Perhaps the figure was distorted because of the unusually large number of people who for social, cultural, religious reasons did not drink alcohol at all. In many other countries it would be typical where one did not have a drinking problem to enjoy a casual glass of wine or two.
All the following would happen if for some reason the good Lord Jesus appeared to us all tomorrow morning and told us to stop drinking. Trust me, I speak as someone who likes a drink as much as the next person and probably more than some. Liver disease would become extremely rare. Pancreatitis would go down. Cancers of the mouth, tongue, tonsil, larynx, pharynx, oesophagus, pancreas, liver, colon and breast would all decline dramatically in frequency and the burden on our health service and mortality rates would also decline. Hospital waiting lists would be slashed. Accident and emergency departments would become far less busy. Overall, there would be much less spending on health. There would be decreased violence, domestic violence, rape and unplanned pregnancy. There would be fewer murders and road deaths, as well as foetal abnormalities. There would be far more discretionary spending available to families to spend on their children’s clothes, education, food, etc. Suicide rates would also go down.
I have been accused of having a somewhat inconsistent approach to the various substances with which we have a problem in our country. The inconsistency stems from the fact I do not believe there is a one-size-fits-all approach to all of the different problems with which we need to deal. Tobacco is an absolutely special case which we need to eradicate. We need the tobacco companies to be put out of business and that those who sell it to understand they are participating in an international conspiracy to deal death to young addicts. That means everyone from the mom-and-pop shop on the street corner to the garage must realise they are part of that deal. Tobacco is a special case.
Taken to its extreme, people say that if one wants to eliminate tobacco so much, why not limit junk food. Junk food is, per se, not bad for one; excessive consumption is. If a demented philanthropist sent containers of McDonald’s Big Macs and fries to a Darfur refugee camp, he would save lives. It is the excess use of such foods is the problem.
Alcohol falls in the middle. There is no doubt that it should be society’s goal to greatly decrease alcohol consumption to 1960 levels and deal with the minority who have tremendous alcohol problems. Taxation affects behaviour. We do it all the time through forms of social engineering trying to persuade people to have smaller cars, opt for diesel engines, not to smoke cigarettes. It is justifiable for us to adopt a similar approach to alcohol consumption.
I will be supporting Senator MacSharry’s innovative Bill. It looks at two great social problems in this country, attempting to use revenues from one to reduce the other but, in the process, will actually reduce both. In the unlikely event that we get to debate this Bill on Committee Stage, I will propose some amendments. For one, I do not buy into this theory that alcohol purchased in a shop or garage forecourt is somehow more dangerous than that purchased in a pub. Different people can abuse alcohol in different ways. If we are going to deal with the problem of alcohol abuse in this fashion, we need to deal with it consistently across different sectors.
I commend Senator MacSharry and his hardworking team for introducing another health care Bill for which he deserves great credit.
Senator MacSharry’s Bill is very welcome in so far as it gives us the opportunity to discuss this important issue. We will not be supporting the Bill for several reasons, however. In doing so, I do not want to be seen as being at odds with Senator MacSharry. I commend him on his good and useful report on suicide for his party.
Section 2 provides for the Minister to make regulations that allow for a levy at point-of-sale, payable by the licensee and to be collected by the Revenue Commissioners. It is accepted there is a significant correlation between alcohol consumption and suicide. In the early part of this century, rates of alcohol consumption were high and suicide rates were correspondingly high. From 2007, consumption levels dropped with a parallel drop in suicide rates. However, new evidence shows the rate of suicide is again creeping upwards. When we debated this at the health committee when I published a report on suicide, the Central Statistics Office did not really agree with me on it. The point is that whatever position one takes to start will determine whether it is increasing or decreasing. If we say the rate of suicide is increasing and start from 1960, it can certainly be shown to be the case. The real point is not to get involved in an argument about the process, as there are other dynamics at work, for example, the recession. The National Suicide Research Foundation has recently published figures which showed between 305 and 560 extra deaths by suicide in the past five years may have been caused by the recession.
Senator MacSharry’s Bill wants to get a little beyond revenue-raising. We need to examine this with regard to the proposed minimum-pricing legislation for alcohol. We need to be cognisant of the effects of one on the other to ensure that one does not negate the effect of the other to such an extent as to make both meaningless. That is the single reason I will not support this Bill.
As a Government spokesperson on health, I am expected to state the great job we are doing with mental health services. I got a briefing note earlier today to say exactly that. However, I will not because I do not believe we are making a good job of mental health services at all. We are very poor at policy, expecting to feed in policy at the top and find it oven-ready at the bottom without mediating steps in between. Our ten-year policy on suicide prevention, Reach Out, will expire this year with having had no interim reviews to analyse changing circumstances over a decade.
I refer to the 560 extra deaths that occurred in the past five years, a period halfway through the Reach Out policy, which did not take into account changed circumstances. It is not good enough for us to stand here and say that we are doing a good job with mental health services when we are not. Senator Darragh O'Brien referred to geographical areas where there are serious problems in the mental health services, including Galway, north Dublin, Kerry, Carlow and Kilkenny. I have been a psychiatric nurse for 28 years and was a trade union representative for much of that time. Many of my former colleagues phone me in exasperation at the state of the health services. We cannot say we are doing a good job. Ninety young people were admitted to adult psychiatric wards last year, which is unacceptable.
The recently published report by the Mental Health Commission contains nine fairly damning charges against our policy. These reports are written by civil servants who couch their language in a particular way. The report says that policies are implemented inconsistently and that there are shortfalls in filling posts, notwithstanding the money that has been allocated to it. There are nine criticisms of the Minister of State in the report of the chairman of the Mental Health Commission, and we must sit down and reflect on it as a Government.
The Bill proposed by Senator Marc MacSharry is welcome and needs discussion. Even though we will not support the Bill, I urge the Senator to send the proposals and his policy to the National Office for Suicide Prevention for consideration in the new suicide prevention framework later this year. I have confidence that the National Office for Suicide Prevention will produce a comprehensive policy for reducing suicide. I have much more to say about this but, as indicated by the Leader, we will have a further debate in September and I look forward to making a contribution at that point.
I welcome the Minister of State to the House and I welcome the initiative of Senator Marc MacSharry in bringing forward this Bill. It is an innovative and welcome initiative. He launched his policy last year and this is a positive step to see what we can do.
I acknowledge the great work of organisations such as Headstrong and the Jigsaw initiative. Others include Dáil na nÓg and Comhairle na nÓg, whose 200 delegates discussed mental health last year. I had the pleasure of attending part of the meeting as one of the link people with the Oireachtas. They discussed mental health, bullying, peer pressure, sex education, drug and alcohol abuse and social isolation. These issues are all interlinked and they decided to have a gathering on mental health.
I also acknowledge the work of SpunOut, particularly the Ditch the Monkey series of five videos by the Irish animator Eoin Duffy and the National Office for Suicide Prevention. It outlines the five steps to wellness and is a set of evidence-based actions that promote positive mental health by encouraging people to choose to get out in the world, to connect, to contribute, to be healthy, to accept themselves and to be aware so that they can stay on the path to wellness. On that point, most of the people I have had discussions with in this arena have cautioned me about overusing the term "suicide" instead of having a broader discussion about mental health and wellness. In my volunteer life, I am doing a series of consultations with young people in the Irish Girl Guides. I was in Macroom on Saturday and the young people were talking about trends, the pressure on them from trends and how their physical health is so connected to mental health. We need to build up self-esteem that protects us, mental health and mental wellness. Anything we can do to ensure this should be welcome.
I have a specific issue to raise with Senator MacSharry, which makes me hesitate to support the Bill. Looking at the legislation, I fear it may breach EU law. Any proposed levy on off-licence sales would be in breach of the EU excise directive concerning the general arrangements for excise duty. Council Directive 92/83/EEC provides for the taxation of alcohol on the basis of volume and content and breaks alcohol into specific excise duty categories for various alcoholic drinks. These rates are applied to all alcohol, making no distinction between on-trade and off-trade. I have no doubt that Senator MacSharry has looked at this. I support an increase in the pricing of alcohol, so this is an issue I have looked at, but we cannot do it only for the off-trade. Applying a levy appears to be in breach. Applying a levy to a container in which alcohol is sold while not applying the same tax rates to the on-trade does not satisfy the provisions of the directive. It would affect competition. I would welcome if Senator MacSharry could give me advice on that provision in the Bill.
Cuirim fáilte roimh an Aire Stáit. Tá ábhar an-tromchúiseach agus an-tábhachtach á phlé againn. Aithním go bhfuil brí an Bhille atá á chur chun cinn ag an Seanadóir MacSharry tábhachtach agus go bhfuil an reachtaíocht seo á moladh aige le toil mhaith. Tá deacrachtaí beaga againn leis, áfach.
We acknowledge the good intentions of the Bill presented by Senator MacSharry, focused as it is on the need to enhance resources for mental health services and suicide prevention. In the Dáil, Sinn Féin has a comprehensive Private Member's motion that seeks progress in the development of mental health services and suicide prevention. This is particularly the case with regard to increased staffing, which is seriously deficient at present. The motion has secured all-party support, a welcome development.
However, with regard to this Bill, we do not favour the central proposal. Funding for mental health services and suicide prevention should be allocated directly from the health budget and should not be dependent on the sale of alcohol, no more than funding for primary care or physiotherapy or any other aspect of health care should be so dependent. I acknowledge that we must address the issue of below-cost selling of alcohol as a matter of urgency. The position of Sinn Féin is that it should be banned and we favour increased taxation of alcohol. If a portion of this is to be ring-fenced, it should be devoted to awareness raising and education on the dangers of alcohol, directed especially at young people. On the Sinn Féin Dáil motion in the Chamber, Sinn Féin health spokesperson Deputy Caoimhghín Ó Caoláin pointed to the report of the Mental Health Commission published two weeks ago, which makes alarming findings. The report of the Mental Health Commission shows that only 44% of psychiatric hospitals and mental health facilities are compliant with staffing level regulations. The report also makes clear that since 2007, staffing in mental health services has been reduced by the implementation of recruitment embargoes and the employment moratorium. Such policies are endangering the delivery of competent and responsive community-based services, as envisaged in A Vision for Change, the Government's mental health strategy. It is of huge concern that the commission reports that children are being admitted to adult units. Some 91 admissions, representing 22.3% of all child admissions, were made in 2013.
Suicide is a complex issue that demands a national, cross-departmental co-ordinated response. There are many risk factors for suicide. A 2008 review of the evidence suggests that living in an area of socioeconomic disadvantage and being unemployed are risk factors, as is having a diagnosis of a mental disorder, including depression, schizophrenia, personality disorder or a childhood disorder, which can increase the risk of contemplating suicide. Misuse of alcohol and drugs is a known risk factor, as is having previously self-harmed. Adolescents who have experienced sexual abuse are at high risk. In general, the national suicide prevention framework will require a cross-departmental response and it is vital that Departments outside the Department of Health, particularly the Department of Education and Skills, the Department of Children and Youth Affairs and the Department of the Environment, Community and Local Government, are involved in developing the actions under the framework.
A key priority for suicide prevention is the development of an adequate 24-7 crisis support service for people experiencing severe mental or emotional distress. A Vision for Change states that a protocol for crisis intervention should be agreed upon for each area by the local community mental health team and that the agreed response should be available 24-7. The policy also recommends that each mental health service area should have the facility of a crisis house that offers brief respite to those suffering a crisis where hospital admission is not appropriate.
The HSE should ensure that 24-hour, seven-day crisis intervention is available in every mental health service as a matter of urgency. It is also important that such 24-7 crisis services are culturally competent so that they are accessible to people from minority ethnic communities, including the Traveller community. Finally, it is important that there is an effective 24-7 crisis service available to people who are homeless. There is a need for all sectors and groups working in the area of suicide prevention to share resources and work together more effectively and efficiently. The National Office for Suicide Prevention also needs to co-ordinate its funded programmes towards agreed strategic priorities and ensure the programmes are funded to a level that can meet identified population risks and needs. For example, initiatives should be available throughout the country and targeted at higher-risk groups. The suicide prevention framework should prioritise marginalised groups, all of whom have a higher risk of experiencing mental health difficulties. It should also prioritise children and young people, given the clear evidence that early intervention is cost-effective. The framework should incorporate clear commitments from the Department of Education and Skills and the Child and Family Agency on mainstreaming mental health promotion within schools. The HSE should ensure that all community mental health teams provide a 24-7 crisis intervention service as recommended in A Vision for Change. The Sinn Féin motion in the Dáil this week seeks to refocus the Oireachtas and public opinion on mental health and suicide prevention and the need to implement A Vision for Change by ensuring sufficient resources and firm political commitment. We are seeking all-party support for our comprehensive motion.
I note that Senators on both sides of the House are critical of Government implementation of policy at present. I remind Senators that we will be debating budgetary issues in the autumn. I hope they will show the same resolve when we are discussing the budget for mental health when the time comes. Proper funding should be put in place to roll out the services we have called for.
I welcome the Minister of State, Deputy O'Dowd, back to the House this evening. I commend my colleague Senator MacSharry on the spirit of the Bill and the intention behind it. The Bill as proposed is not in accordance with Council Directive 92/83/EEC, which deals with alcohol taxation and taxes on related products that are applied in respect of their nature and strength. The Bill seeks to introduce a levy on alcohol products from take-away facilities, which would represent a clear violation. I commend the spirit of the Bill but cannot support it for these reasons.
I agree that the Minister of State, Deputy Lynch, has made every effort to provide better mental health services throughout the country in the past three years under limited and difficult circumstances. It is important to highlight this aspect when we debate the matter.
Health, especially mental health, can be a contentious topic not only in this House but in many forums. I have stated previously that it is important that we as public representatives reach out to the groups and members in our local communities to continue the campaign to erase the stigma around mental health. In Dundalk, along with service providers and representatives from the town, we created the Dundalk positive mental health forum, which facilitates discussions and events for the public on a regular basis. We meet to discuss the mental health issues in our community. At the start of this year we got great support from our local radio station, Dundalk FM, which allocates a one-hour slot once a month to discuss positive mental health issues. It is very good because we need to bring this out into the community and do all we can to reduce the stigma. I am aware of many excellent groups and individuals throughout the country who engage with their local communities in a variety of innovative and necessary ways, and they have made a very real impact. However, as we are all aware, the mental health services are not up to par. I say this with the utmost respect for the Minister of State, but the truth is the truth. We have children who are being completely left out of the picture because they are in an age bracket in which they are too close to adulthood but not close enough. There is a major problem for children between 16 and 18 years of age who are not being looked after. The Child and Adolescent Mental Health Services programme seems to stop at 16 years of age. The services maintain that they take children of that age, but I can talk about umpteen cases in which people are not being seen. In an Adjournment debate some months ago I raised the particular case of a child with an intellectual disability who could not be seen because he fell within that age group. Every child matters and every child should be afforded the same level of support when it comes to their mental health, whether the child is one year old or 17 years old. It is most unfortunate that children with an intellectual disability, particularly in that age group, do not have access to the support services available. We need to ensure that we look after these children as best we can at the earliest possible age so that they can have the best start possible before the additional weight of adulthood is placed on them.
I can confirm that in my area in County Louth no child psychiatrist is available for children with an intellectual disability in the age bracket from 16 to 18 years. This is something I have brought up continually. CAMHS will not see children in this age bracket. This means that for two years the service fails this group of children. They must wait until they are 18 years of age to receive the supports they deserve. Furthermore, once a child reaches the age of 16 years, the paediatric services stop. Again, the child is lost for two full years.
Whether a child has an intellectual disability does not matter. People do not seem to understand that we have a major problem in this area. I realise the Minister of State, Deputy Lynch, is not in the House but, as a fellow Louth man, I call on the Minister of State, Deputy O’Dowd, to take this matter further.
Last week saw the publication of the Mental Health Commission's annual report, which detailed the good and, unfortunately, the unacceptable aspects of our mental health services, particularly with regard to children. Last year there were 408 child admissions, 91 of which were admissions to adult units. I adverted to this point in my maiden speech in the House when I said I was keen for change so that children with mental health difficulties would not be placed in adult units. I for one am very sorry that three years later we still have children being placed in adult units. Only 31 of the 91 admissions were admitted to child and adolescent units. Again, a total of 68% of these admissions refer to children in the 16-to-17 age bracket. It is the same problem. We are failing these children. I can categorically state that children in this group and their families leave the care of paediatricians and are then lost to the system for two full years. At that stage, we have an entirely different set of problems when those children are admitted back into the system.
The question of what happens while they are in care is important. I have visited some institutions where I have witnessed a lack of consistency in treatment. After a patient is discharged, one week she might see one doctor and the next week she might see a completely different doctor who is in place to deliver the same function as the previous doctor. I am not a mental health expert but anyone who knows anything about trying to deal with people with mental health problems, as far as I am aware, knows that consistency is vital and key to improving their health. Consistency and trust are vital in providing mental health services, not least for all our children. The report also highlighted that less than half of the services met the standards for therapeutic services and programmes, that staffing only reached a level of 44% and, more worryingly, only 60% of services provided individualised care plans.
The Bill seeks to raise funds through the levy to enhance the functions of the National Office for Suicide Prevention. Funding for this office has increased since the Government took office from a level of €4 million to €8.8 million. Since its establishment in 2005, the office has made strides in terms of the national strategy document Reach Out. The overall mental health services budget for the year stands at approximately €766 million. I recognise that every cent is utilised, although perhaps not as effectively or efficiently as we would wish. It is our job as legislators to see a better return and better provision for our euro.
The Department of Health and the HSE have begun work on the new strategy for suicide prevention managed by the NOSP, and it is expected to be completed by the end of the year. I eagerly await the publication of this strategy and hope that this will provide a better overall strategy for a problem that has been locked away for too long. I have many problems with the mental health services in our country.
Finally, I wish to raise an issue I have raised previously during the past three years, that is, the case of those who have been on antidepressants for a considerable period and who are likely to continue on such medication.
I am aware that another conversation is taking place about the pros and cons of antidepressants. However, there is a serious need to consider making long-term illness cards available to those who have been informed that they will be obliged to take medication for life in order that they might retain their equilibrium. Medication required to maintain one's medical health is just as important as that required to maintain one's physical health. We cannot draw distinctions on these matters any longer. I understand the difficulties and hope to discuss the matter further with the Minister.
I congratulate Senator Marc MacSharry and Fianna Fáil on bringing the Bill before the House. We are all aware of the need for road safety. While some of the television advertisements relating to that matter in recent years have been extremely upsetting, we must consider how an entire culture has been changed. It is for this reason I commend Senator Marc MacSharry. We cannot discuss the matter to which the Bill relates enough. In 2011 €50 million was allocated for road safety measures. In the same year €8.8 million was allocated to the National Office for Suicide Prevention. That is quite a difference. The number of deaths by suicide is practically double that caused by road accidents. I am not in any way trying to say the budget for the Department of Transport, Tourism and Sport should be cut. I am merely making the point.
We must continue to do everything in our power to help to create a country in which citizens can feel that, as a result of their sadness and emotional and other difficulties, talking to other human beings is an easy and healthy step to take. The prevention of suicide is not the exclusive responsibility of any one sector of society. The media, families, educators, health providers and the HSE, workplaces and employers, schools and colleges, doctors and primary care providers, the Irish Prison Service, social clubs, the church, the Garda, youth organisations, legislators and those who decide how taxpayers' valuable money is spent all have a responsibility to prevent suicide which is a silent killer. It is welcome that Senator Marc MacSharry has made provision in the Bill for alcohol, particularly as it is one of the main reasons young people are taking their lives.
Younger people are suffering more mental health problems than their predecessors. I accept that poverty, inadequate education and unemployment may be factors in this regard and that their lives are filled with hopelessness and that there is a lack of purpose and a family history of suicide. In that context, alcohol abuse is a problem with which we are not dealing. We pay lip service to the subject, but Fianna Fáil has brought forward this Bill in order to try to actually do something about it. Two previous speakers referred to a particular EU law which might act as a roadblock, but let us try to find a way to circumvent it. I really want to support the Bill and was extremely saddened to discover the existence of this EU law, with which we must concur. It is welcome that Diageo has removed Arthur's day from the calendar. It was another occasion on which young people could get absolutely plastered. When they woke up the following morning, they were left with a hangover and feelings of low self-esteem and nothingness. According to the World Health Organization, the risk of suicide among young people who drink is eight times the norm. Some 40% of self-harm cases arise as a result of alcohol abuse.
There is a need for the Government to introduce legislation to combat cyberbullying because it is having a major impact on young people's mental health and self-esteem. They are being targeted by silent bullies who can get at them through social media sites such as Instagram, Facebook, Viber and Snapchat. These are the ones about which I know because I have a 14 year old but there are lots more. Older people are also committing suicide as a result of poverty, social isolation, depression, poor quality housing and physical health problems.
We owe a huge debt of gratitude to all of the people and volunteers who have established charities and other organisations and are working endlessly to combat the problem of suicide throughout the country. I do not wish to criticise any of these amazing people, most of whom had loved ones who committed suicide, but there are 500 suicide charities. The National Office for Suicide Prevention supports approximately 20 of the charities in question. Most of the 500 charities to which I refer are not regulated and an audit has not been carried out of them. They are spread throughout the country and no one has joined the dots. A large number of people have made a massive effort in this area. However, there is a need for someone to come up with a way to bring all of the various charities to which I refer together, garner the energy of those involved and provide them with more funding. There is also a need to create synergies and introduce proper auditing, particularly in respect of counsellors. In that context, there are many unregulated counsellors.
There is a need for the media to act responsibly in this matter. In addition, we must seek to educate people because what we really want to encourage is suicide prevention. I employ 160 people at my company and realised earlier today that I had never put in place a mental health programme. We all know the cost which accrues to the economy as a result of people being obliged to be absent from their place of employment as a result of work-related stress. However, it must be recognised that people in certain workplaces are being bullied. I encourage all employers to conduct seminars and education and well-being sessions for their employees in order that they might feel better and recognise the signs of mental distress among their work mates which might lead to their contemplating suicide.
I welcome the Minister of State. I congratulate Senator Marc MacSharry on the work he has done in drafting the Bill which deals with a very important issue. Anything we can do to prevent people from committing suicide is absolutely vital. I support the provision under which it is proposed to raise €200 million in funding for the National Office for Suicide Prevention. Like previous speakers, I am of the view that EU competition law must be imposed both in pubs and off-licences and that there are decisions of the court which apply in this regard.
We must recognise that the rate of alcohol consumption is falling. The younger generation is much more responsible than that of which I am a member when it comes, for example, to drink driving. There has been a massive reduction in the number of road fatalities caused by drink driving. The next reduction will result from vehicle adaptation. For example, Matthews bus company in the Minister of State's constituency has installed alcohol locks on all its buses. The installation of the relevant devices adds relatively little to the cost of buses and the devices could also be fitted to other vehicles. It would also be possible to fit devices which monitor eye movements in order to detect when drivers are exhausted and which automatically stop the vehicle as a result. We could do a great deal more in dealing with this matter and I have informed the Minister, Deputy Leo Varadkar, that we should participate in and promote the relevant programme. Safer vehicles will be the next stage in the process.
Members of the younger generation are much more responsible in their use of alcohol; consumption levels are falling and at least one pub closes every week. We must engage in a wider discussion on the causes of suicide. For example, we must ask whether alcohol caused someone to commit suicide or whether he or she took to it after the rest of his or her life had fallen apart. We have been inclined, particularly in recent times, to place the blame on drink. The Economist Pocket World in Figures states we drink substantially less than people in most other countries and shows that in 2009 the figure for alcoholic drink sales per head of population in Australia, which was first on the list, was 99.4 litres, while in Ireland which was 23rd on the list, the figure was 63.5 litres.
There is literature which indicates that people who have three drinks are on a binge.
We looked up "binge" in the Oxford English Dictionary and one of the definitions was of a spree. I do not think anyone would regard it as a shopping spree if he or she bought three items. Some of this has developed a head of steam that is not often based on the research. Other countries consume more, particularly in the Mediterranean countries where they have wine with meals. It is part of their lives and they do not have the attitude of demonisation we do. Having said that, if there is a need for funding for suicide prevention, Senator MacSharry's proposals to the Minister for Finance, Deputy Noonan, are well worth supporting. I will support them here today. However, we need research on the causes of suicide but the budget, as Senator O'Brien said, is very small notwithstanding the increase from €4 million to €8 million.
Let us adopt a more comprehensive approach. Whether people have stopped drinking in pubs and are taking it home is not germane to the issue. In fact, one could argue that it is safer that they drink at home where they are not at large and all they can do is fall upstairs. I have looked up the numbers from the Garda Síochána reports and note that incidents of drunk and disorderly behaviour represent a small proportion of total crime. Let us control and manage this and listen to what Senator MacSharry has said, but let us not get it out of proportion.
The proposals the Government is considering on minimum pricing will affect low-income people much more than the rest of us. Do we want that kind of income distribution effect from Government policy? It will not affect the €100 bottle of champagne consumed in an exclusive club. Why do we pick on people down the line by insisting that something the market wants to produce for "X" becomes "2X"? The idea that any of the money should go to the drinks industry, which unsophisticated minimum pricing would lead to, is unacceptable. It should all go to the Minister for Finance, the Minister for Public Expenditure and Reform and those others who are in charge of the national finances.
I commend Senator MacSharry. We must address suicide and we need a more balanced approach to drink than has been common in the country in recent times.
The Minister of State is very welcome and I thank him for being here. I commend Senator MacSharry for doing a little bit more than talking about this issue. He has put deep thought in, taken action and is working this through to budget costs. I take it that he is saying the Bill if implemented would raise €200 million per annum. It is a lot of money and an interesting concept.
Usually, I agree with much of what Senator Barrett says, but this evening I will disagree with him regarding the links between alcohol and suicide having worked in health promotion for four to five years and as the mother of teenagers, which is real, hands-on experience. My children have a whole cohort of friends in that age group. I have also spoken to a psychiatrist who works in this area. There is no doubt that there is a very strong correlation between alcohol and mental health incidents, alcohol and accidents and alcohol and suicide. I take Senator Barrett's point that there needs to be more research into the causes of suicide, but the evidence I have seen is that alcohol is arguably the greatest contributor. I may be wrong, but that is based on my conversations and observations. The only answer here is a multi-pronged approach. That is always the case; it is never just one approach.
We are looking at new habits in this country when it comes to alcohol. I was surprised at the description of "binge drinking" as involving three or four drinks. To be fair, anybody on a night out is bingeing based on that description. However, my definition of "bingeing" is much more than that. I am seeing so many young people bingeing before they go out. It is common practice among my peers - the mothers of teenagers of 14 and 15 years - to check the ten or 12 children coming to dress in a house to see if anyone has alcohol on them. We also check them leaving the house to see if there is alcohol on their breath. This is happening in some of our homes. These kids are going into well-supervised discos so they cannot have drink in their possession there. However, they may have it on their breath. They burn out very quickly once they have alcohol and need lots of water. If they mix it with another substance, they are in real danger. There are new habits around and I find that young people are drinking to get drunk, not just to enjoy themselves. I was talking to a teenager recently. She is 19 years old and has moved to Canada. Having been there for four or five weeks, her feedback is "My God, Ireland is so druggy". We really binge here. The feedback is different from what Senator Barrett was saying.
I also take issue with my good friend Senator Mary Ann O'Brien who said that when people wake up the following morning, it is with feelings of low self worth. I disagree that they wake up with those feelings. They wake up with sore heads but do not consider it a reason for their lower self-esteem, rather they consider it normal. We have normalised alcohol into our culture to a great extent over the centuries, albeit we agree that there is a new type of binge drinking.
The following is something really dangerous. We all know we should get our kids into sport, but now "Get into sport" is synonymous with "Get into alcohol". This is because drink provides the large advertising support for sporting events. I favour breaking that link. I would love if some of the fund in Senator MacSharry's Bill would go towards that. Many of our children grow up and win and the celebration happens in the pub. So much talent is wasted because the transition for the 16, 17 and 18 year old is into the pub. In every town, there are pubs which specialise in serving the youth and are better for youth to frequent.
We must look at new ways to find out more about young people before they, sadly, take their lives. I have been exploring this a little as it is a huge concern. Approximately a month ago, there were seven suicides in one week in Galway. There were two alone in Moycullen. That was across a range of ages. In a period of two months over the last three months, two friends of my 19 year old son took their lives. This is visiting me and our families. It is so common and it has really gone overboard. One of the things I see in other communities is that wherever there is a river, there is a very significant risk. We have the River Corrib in Galway. I have seen in Cork there is a river watch, but it would take 1,000 people to man it. One might have two people on a night, who have to be debriefed. It is a huge amount of work. We need real, practical help. I spoke to someone who did a river watch and talked a girl down from taking her life but she was back three nights later to attempt suicide again.
Something we could promote is "journaling" at an anonymous level. If there was a safe place where young people could document their feelings it would be useful. We must learn more about them before they take their lives.
I was looking at some evidence from New Zealand and Australia.
The Senator is way over time.
I will finish on this. Contrary to what might have been said, we have wonderful child and adolescent mental health services in Galway which do great work with our kids up to the age of 18. Unfortunately, services differ, and it is a pity about the lack of uniformity across the country. I commend Senator MacSharry and wish him well. I had not thought about whether I would support the Bill or not, but looking at what the Senator is trying to achieve, I will support it.
I commend Senator MacSharry on his hard work and the commitment to this issue that he has shown over the past few years. I welcome the discussion as I believe we need to spend more time in this House focusing on mental health strategies. To be fair to the Government, it has shown its commitment to providing mental health services in a number of ways such as through the National Office for Suicide Prevention, the increased funding for suicide prevention in 2012 and 2013 and the increased funding for mental health services over the past three budgets. If we take some time to focus on each of these, it is clear that it is a Government priority. The National Office for Suicide Prevention has carried out substantial work on almost every recommendation of the national strategy for action on suicide prevention and funds more than 30 non-governmental organisations through agreed grant aid agreements. The programme for Government has committed to ensuring that part of the ring-fenced funding provided for mental health will be used to implement Reach Out, which is the national strategy for action on suicide prevention. This commitment is of great importance and one we need to ensure we adhere to. The priorities of the Government are further demonstrated through the increased funding for suicide prevention, with the HSE allocating funding to the National Office for Suicide Prevention from its overall budget for mental health. The budget has increased significantly from €4 million in 2011 to €8.8 million in 2014.
I agree with the point made by Senator Mary Ann O'Brien about Arthur's day. It is unfortunate that this has turned into a discussion on alcohol, but there are obviously significant links. I do not always agree with Senator Healy Eames and I normally agree with Senator Barrett but I find myself agreeing with her and disagreeing with him for the most part on this issue. Arthur's day was just another excuse for young people and indeed adults to drink. There is much debate about how young people are doing this, that and the other when it comes to the misuse of alcohol but they do not learn their behaviours from the sky. In the vast majority of cases, it is learned behaviour - granted, from their peers, but also from adults in their immediate families in many instances and in society.
Senator Healy Eames said that the link between alcohol and suicide could not be underestimated. My mother is a psychiatrist and she would definitely say there was a significant link. This is not to say that alcohol is not a drug that is fine to use once consumption levels are reasonable. I would disagree with Senator Barrett. That is not what I see. I do not know what those statistics are based on. When I am out and about, I see young and older people behaving in a way that is off the charts. It happens in other countries such as the US, the UK and Australia, particularly where Irish and English people congregate. We have a dangerous relationship with alcohol and I do not believe the statistics. If the statistics show anything, they show that people are not drinking in pubs, if one pub per week is closing. That is unfortunate for business but it means that people are drinking at home. I would disagree fundamentally with Senator Barrett on this point. If people are drinking at home, it is totally uncontrolled. There was a time in Ireland where the publican took an interest in the clients in the pub and would make sure they could not fall. As Senator Gilroy said, at least if they are in a pub they are not in a forest drinking. The availability of cheap alcohol is fuelling drinking in all sorts of environments and the pubs are the least of our worries when it comes to drinking. I regret that I am speaking about alcohol all the time in a debate about suicide, but the link between the two cannot be overemphasised. I raised the issue of water safety recently. One in three deaths by drowning involved people who had been drinking alcohol. We have a really serious problem across the board in Ireland that we need to face up to.
The new strategic framework for suicide prevention will seek to build on the comprehensive work delivered under the current Reach Out strategy, which was devised in 2005. The aim of the new strategy is to support population health approaches and interventions that will assist in reducing the loss of life through suicide. It is expected that this will come into place by the end of this year. I hope the Government follows through on this. Through these initiatives, it is clear that the Government is making consistent efforts and some progress, although I completely agree that more work needs to be done.
The Bill is commendable for attempting to continue and sustain this work. I agree with the revenue-raising side of the Bill, which would seek to tax off-licence trade. This is something that the Government effectively intends to do via the introduction of minimum pricing of alcohol. I have consistently called for this. The intent of the Bill in seeking to bring about awareness and to ring-fence funding for mental health services is admirable. I believe minimum unit pricing will go a long way to achieving the goals of Senator MacSharry's Bill. Government progress on rolling out a holistic mental health strategy with increased funding that is not tethered to any particular revenue-raising initiative but is instead embedded as one of the core fundamentals of our budgetary strategy is the way to continue to pursue this. I thank the Minister of State and commend Senator MacSharry on his work on this.
I thank Senators MacSharry, Leyden and Mary Ann O'Brien for bringing forward this Bill. I welcome the opportunity to participate in this debate. The Minister of State with responsibility for disability, equality and mental health is unable to be here and sends her apologies to the House. Like physical health, mental health and well-being are relevant to everyone. I know that Members are well acquainted with the complex and sensitive issues that arise when this subject is under discussion. Senators and the Government share the same objective, which is to reduce the number of deaths by suicide. We are fully committed to this aim but, of course, there are different ways of achieving and funding it.
The Bill proposes the introduction of a levy on all alcoholic beverages sold from but not intended for consumption on licensed premises to be paid into a specific fund for supporting suicide prevention. While I appreciate the motivation behind this Bill, it is important to point out that issues around the misuse of alcohol are much broader than just suicide and that, therefore, any measures taken by Government must have regard to the many social and health harms caused by alcohol. It is important to state that the Minister for Finance has responsibility for levying and collecting taxes and excise duties and that the Government has no plans to alter this arrangement. The collection of an excise duty on alcohol which would be placed in a tightly defined fund would restrict the Government's ability to prioritise expenditure. This would not be in keeping with the Government's approach to revenue collection and the process by which decisions are made as to the most appropriate use of the revenues raised.
This Bill seeks to limit the levy to alcohol products sold for consumption off premises. As has already been mentioned, Directive 93/92/EEC, which governs the structure of alcohol taxation, requires taxes on alcohol products be applied by reference to the nature and strength of the product. It does not allow for differentiation of rates according to where the product is sold or the type of packaging involved. Accordingly, the introduction of a levy on take-away products only would not be possible, and we must recognise that fact here.
This debate is very welcome in that it brings a focus on the damaging impact alcohol abuse has on mental health and the role alcohol plays in suicide and self-harm. In 2012 the National Substance Misuse Strategy Steering Group reported that alcohol was responsible for at least 88 deaths every month in 2008; is associated with 2,000 beds being occupied every night in Irish acute hospitals; is a contributory factor in half of all suicides and in deliberate self-harm; and was a trigger in one third of domestic abuse cases and cost the health care system €1.2 billion in 2007. The devastating consequences that alcohol specifically has on mental health are startling. Alcohol was a factor in 40% of all cases of self-harm in 2010. Alcohol-related disorders accounted for one in ten first admissions to Irish psychiatric hospitals in 2011. The WHO has estimated that the risk of suicide is eight times greater when a person is abusing alcohol and half of all those who took their own lives in Ireland had abused alcohol in the previous 12 months.
The Government is committed to tackling alcohol misuse and the widespread harm and pain it obviously causes. Last year following a full consultation involving Ministers and Departments, a comprehensive and detailed package of measures was approved to address this problem. It is the first time the misuse of alcohol has been addressed as a public health issue. We understand that we need decisive and innovative actions. The overall objective is to reduce the consumption of alcohol from 12 l of pure alcohol per person per year to 9.2 l, which is the OECD average, by 2020. That is what these measures have been framed to address.
The key measure is the drafting of a health orientated legislation on alcohol, the public health (alcohol) Bill. This Bill will be drafted taken into account the recommendations of the national substance misuse group's report. The Bill will provide for minimum unit pricing for retailing of alcohol products, regulation of marketing and advertising of alcohol, regulation of sports sponsorship specifically to place on a statutory footing an existing voluntary code that governs sports sponsorship, separation of alcohol from other products in retail settings, enforcement powers for environmental health officers in relation to alcohol and health labelling of alcohol products. The nature of the challenge we are addressing requires a significant public health response. This public health (alcohol) Bill and the measures for which it will provide are proportionate to the scale of the problems we face as a society.
I would like to inform the House of the work to date in regard to suicide prevention and mental health and outline the Government's approach to the development of an updated framework for suicide prevention over the coming years. Our mental health and well-being is something we all have to nourish and cherish and in these very difficult economic times it is even more important than ever to do so. Since Deputy Kathleen Lynch was appointed as Minister of State with responsibility for this area her priority has been to ensure that our mental health services are developed in such a way that we provide the best quality of care in whatever setting is needed whether that is in an inpatient setting in the community or in a person's own home. We are fortunate in the mental health area that we have our strategy document, A Vision for Change, guiding us in the way we deliver our services. This strategy is well recognised as being in line with best practice internationally. It is evidence-based and realistic and it proposes a new model of service delivery which will be patient-centred, flexible and community-based.
The House will appreciate that the current economic environment presents a significant challenge for the health system generally in delivering and furthering services, however, it is being treated as a priority by this Government. In line with our programme for Government commitments, €90 million and some 1,100 additional posts have been provided since 2012 to develop community mental health teams and suicide prevention resources. The budget for the National Office for Suicide Prevention, NOSP, has also more than doubled from €4 million in 2011 to €8.8 million in 2014. Dealing with the current high levels of suicide and deliberate self-harm is obviously our key priority as well. Policy is guided by the national strategy for the period 2005 to 2014, Reach Out, which has made a number of recommendations in relation to fast-track referrals to community-based mental health services, an effective response to deliberate self-harm, training, reducing stigma, promoting positive mental health and research. The NOSP has primary responsibility for the implementation, monitoring and evaluation of Reach Out and has been tasked with co-ordinating suicide prevention efforts around the country as well as supporting agencies and individuals interested and active in suicide prevention. It funds more than 30 non-governmental organisations to carry out an array of work in communities that promote positive mental health and work to reduce the incidence of suicide and self-harm. This work is supported at a regional level by HSE resource officers for suicide prevention. In 2014 the number of officers will increase from ten to 16. The office has also developed a range of initiatives not just to support people who are suicidal but also their families, friends and peers in recognising and responding appropriately to signs of emotional distress and suicidal thoughts.
Work is also continuing to build the capacity of front-line service providers and communities to respond to suicide through the delivery of a wide-range of awareness and training programmes which are available in the area of mental health promotion and suicide prevention. These include safeTALK which trains participants to become more alert to the possibility of suicide in their community and other training programmes such as Reaching Out, ASIST, Taking Control, Mind Out and STOP. A number of media awareness campaigns have also been run in recent years, including the Let Someone Know campaign, which focused specifically on young people and delivered a message that it is important to reach out and seek the support of others. Other awareness programmes including the Please Talk initiative running in third level colleges since 2007 encourage young people experiencing problems to talk to others and identifies the supports available to those in need.
Mindful that schools are one of the key settings for the promotion of mental health and well-being of young people and that they are all also in the position to identify young people experiencing emotional difficulties, the NOSP has worked closely with the Department of Education and Skills to develop guidelines for mental health promotion and suicide prevention in post-primary schools.
Reach Out comes to the end of its ten-year term this year and, consequently, the Minister of State, Deputy Lynch, has begun development of a new national strategic framework for suicide prevention, building on the comprehensive work delivered under the existing strategy. The objective is to have the framework completed by the end of 2014. This new framework will support other relevant Government policies, including A Vision for Change, Healthy Ireland and the National Substance Misuse Strategy. The aim of the framework will be to support population health approaches and interventions that will assist in reducing the loss of life through suicide while aiming for improved co-ordination, integration of services and responses in this area. The process of developing the framework includes consideration of national and international evidence and existing good practice, addressing areas such as policy, practice improvement, engagement, research, communications and media. The process also includes a review of Reach Out, a public consultation process and a review of the evidence base for suicide prevention initiatives. This strategy will be focused on a whole of government approach and will include engagement with other Departments, including the Departments of Children and Youth Affairs, Education and Skills and the Environment, Community and Local Government. A number of new suicide prevention measures have also commenced or will commence shortly. These include increased training for GPs and practice staff, the development of the suicide crisis assessment nurse model which allows for crisis intervention at primary care level. Eight new services will commence before the year end. This service provides active liaison between primary care and mental health services; the role out of dialectical behaviour therapy, specialist therapeutic services for people who have a history of deliberate self-harm and who have certain personality profiles; a community resilience fund has been established to support local HSE suicide prevention initiatives; and the launch earlier this year of the Samaritans national free to call 24-7 number for people in emotional distress. Another worthwhile initiative is the new counselling in primary care initiative. Funding of €7.5 million has been provided from the ring-fenced moneys for mental health for the development of psychological and counselling support services in primary care.
This service is specifically for persons with mild to moderate psychological difficulties who are eligible under the GMS scheme. This initiative, together with the continued development of adult, child and adolescent community mental health teams, will help to provide services in the community where they are most needed.
I welcome the opportunity afforded by the House to debate these critical matters, in which we are all engaged, in order to address the complex societal issues associated with suicide. I reiterate the Government's commitment to the mental health service and the continued development of modern and responsive person-centered services in line with the plans set out in A Vision for Change. I acknowledge the contributions made by all Senators involved in the debate which will certainly inform Government policy. I also acknowledge the commitment, thought and effort that has gone into presenting the issue in the House. The contributions from all sides have increased our knowledge of how best to deal with it.
The policy document entitled, Actions Speak Louder Than Words, was welcomed by the Minister of State, Deputy Kathleen Lynch, last year. However, very little has happened since, largely because she has no money. I can understand why the Minister of State, Deputy Fergus O'Dowd's officials did not bring copies of his speech because, with respect, it was not worth distributing to us. I am not talking about its delivery.
That is a little pejorative and I reject it.
That is fine. I would expect the Minister of State to reject it, but we know what the reality is in terms of actions on the ground.
In my view, it takes from the debate.
In truth, if everything the Minister of State described was happening on the ground, I would not need to bring forward these proposals. I want to briefly run through some of the initiatives this plan would have financed. They include reform and restructuring of the National Office for Suicide Prevention as an independent office with special status; a ring-fenced budget; performance targets; and an independent employment system in order that it would be free to obtain the required expertise. There would also be a clear interdepartmental input at Government and Secretary General level but not within the bowels of the HSE. It would enhance the size of the office in order that it would have the appropriate staff, as well as a 24 hour helpline. In addition, the number of resource officers would be increased from ten to 60, which is what is required.
All GPs would be adequately resourced. Our survey showed that an incredible number of GPs felt ill-equipped to deal with the suicide crisis. A system of GP practices would be put in place, whereby the prescription of anti-depressant drugs would be checked on a monthly basis, rather than every three to six months.
An out-of-hours social worker emergency service would be established across the country. Such services are not currently available.
The plan would reverse the Government's decision to abolish dedicated guidance counsellors' time allocations in secondary schools, while introducing guidance counsellors in primary schools. That is not about careers but about the availability of counselling and pastoral services, whereby somebody could tap into these teachers as a pastoral resource under the cover of seeking career advice. Mr. Brian Mooney, a commentator and career guidance professional, has said expecting teachers to deal with children's mental health issues daily was akin to expecting passing motorists, instead of paramedics, to deal with road casualties.
The plan would regulate the professions of counsellor and psychotherapist by mandatory registration, as well as phasing out advertising and sponsorship of events by alcohol brands. It would consider alcohol and substance abuse a form of self-harm to be treated accordingly. Funding would be increased dramatically for projects aimed at preventing suicide rates from increasing in all sections of society but particularly in high risk groups. Banks would be compelled to provide professional counselling for those at risk of foreclosure or who have already been subject to foreclosure.
All forms of media should be requested to embrace a new approach to the coverage of mental health issues. In fairness, some of this has been happening in terms of the commentary on this difficult issue. This document contains a lot more detail and is available to anybody at any stage.
Our legal advice leads us to believe the EU directive on the structure of alcohol taxation can be tested. In my introductory remarks I said some people would raise this issue and they have. There is a precedent in the case of betting tax. How did we manage to facilitate gamblers on a racecourse but not in a betting shop? As we managed to do this in the past, why can we not do it to save lives? If the Bill were to be accepted on Second Stage, on Committee Stage we could examine the potential of an amendment to the Rates Bill or amend existing excise duties. In that way we could ring-fence moneys within the licensed sector, including pubs, and put it directly into the fund. That would create equality.
We have heard much rhetoric about the Public Health (Alcohol) Bill. I would like to provide a few facts. It refers to minimum unit pricing, which the authorities in Scotland tried to introduce. The Scottish Whisky Association appealed the deicison to the Scottish Supreme Court which, in turn, referred it to the European Court of Justice, where nothing will happen for two years. God knows who will be in government when we get to bring forward that Bill, if we have to wait for that decision.
Structured separation will not happen, although we are waiting for the Minister for Justice and Equality to bring forward her proposed consultation paper. It is a proposal to bury alcohol at the back of a shop instead of stuffing it at the front beside the sweets where at present one can buy a case of premium larger for €10.
I do not want to focus too much on the alcohol abuse issue in this debate which is about providing for measures to deal with a difficult societal issue. It is not to beat those who sell alcohol over the head necessarily, although the link with mental health issues is widely accepted. That is a fact. Nothing will happen on minimum unit pricing and nothing will be done to increase funds for the Minister of State. I have mentioned some of the things that can and need to be done. We have learned from our Scottish cousins that if we were to implement some of the measures I have outlined and finance them appropriately, the professionals would be able to begin to peel back the blindfold on the loss of life through suicide. If so, we can win this battle. We could reduce suicide levels by 30% in ten years, but we will not do so. I do not want the Minister of State to be personally upset, but I have heard this speech for 12 years on how well the Government is doing. According to it, we are all brilliant at writing down what needs to be done but not in doing it. I sat on the Government benches and cringed as Government amendments were tabled commending our brilliance in spin and incoherence, instead of highlighting our neglect and inability to show the leadership and political will to do what was necessary. There are challenges within the Bill, but it offers an innovative solution at a time when there is no money available. The EU directive is a red herring. It can and ought to be tested in the interests of saving lives. As we have done it before for others, why can we not do it when it is to save lives? Sadly, in the coming week ten more lives will be lost through suicide, eight of them men. I am bound to say our ambivalence is damning.
Is the question agreed to?
No, it is not agreed. As I understand it, we have a problem with the EU directive on the matter.
- Barrett, Sean D.
- Byrne, Thomas.
- Crown, John.
- Daly, Mark.
- Healy Eames, Fidelma.
- Heffernan, James.
- Leyden, Terry.
- MacSharry, Marc.
- Mooney, Paschal.
- Mullen, Rónán.
- O'Brien, Darragh.
- O'Brien, Mary Ann.
- Ó Domhnaill, Brian.
- Ó Murchú, Labhrás.
- van Turnhout, Jillian.
- Zappone, Katherine.
- Bacik, Ivana.
- Brennan, Terry.
- Burke, Colm.
- Coghlan, Eamonn.
- Coghlan, Paul.
- Comiskey, Michael.
- Conway, Martin.
- D'Arcy, Jim.
- D'Arcy, Michael.
- Gilroy, John.
- Henry, Imelda.
- Higgins, Lorraine.
- Keane, Cáit.
- Landy, Denis.
- Moloney, Marie.
- Moran, Mary.
- Mulcahy, Tony.
- Naughton, Hildegarde.
- Noone, Catherine.
- O'Donnell, Marie-Louise.
- O'Keeffe, Susan.
- O'Neill, Pat.
- Ó Clochartaigh, Trevor.
- Reilly, Kathryn.
When is it proposed to sit again?
Tomorrow at 10.30 a.m.