I welcome Professor Eadbhard O'Callaghan of the DETECT programme. I invite him to begin his presentation, after which members will ask their questions.
High Levels of Suicide: Presentations.
Professor Eadbhard O’Callaghan
I thank the committee for affording me this opportunity to discuss suicide and how it relates to the DETECT programme in Ireland. I have a series of slides which I will discuss. They will help me both with my anxiety about making this presentation and also in highlighting certain points. My title could be "a stitch in time saves nine" because everything comes from there. One of the key messages I wish to discuss is early intervention. Intervening early in people's lives makes a difference. In fact, early intervention is our best bet when dealing with mental health. It saves lives and money and gives youngsters a chance to develop and have good opportunities in their lives.
Ireland is only now playing catch up to international best practice in mental health, through programmes such as DELTA and DETECT, which I will discuss in more detail later. There is a strong evidence base to demonstrate that early intervention should be a core part of any effective suicide prevention strategy. There are numerous examples from around the world to show that this is the case.
I have been a psychiatrist for the past 18 years, working with people with mental illness and suicidal ideation and intent. My research interest is in serious mental illness and I and my colleagues have published extensively in international journals on this topic. I hold the chair of mental health research at UCD and I work with Professor Malone, who came before the committee previously to discuss the suicide component of psychosis.
To give the committee some background information, psychosis is an umbrella term. The word is used to describe conditions that affect our mind and feelings and where we lose contact with reality. Psychosis is characterised by hallucinations, where one might hear voices when there is nobody else in the room, or delusions, for example, fixed false beliefs. There many different types of psychosis. Drug induced psychosis is probably familiar because it is receiving much attention at present. We can get psychoses from general physical conditions such as tumours, AIDS or dementia. It can also be a component of severe depression. Members of the committee are probably aware of manic depression or bipolar disorder.
Psychosis is the umbrella term for these conditions. It affects much of our population. Essentially, the number of people in Ireland today who have a psychotic disorder could almost fill Croke Park, that is, approximately 75,000 people. The most common form of psychosis is schizophrenia. It affects approximately 34,000 of the 75,000 I mentioned. In other words, the number would fill Lansdowne Road. That is a great deal of people. Each year approximately 1,200 young people in this country are affected by psychosis. It is predominantly young people who are affected. The suicide rate for these individuals is 20 times the rate in the general population. Data from the United States in 1998 suggest that of the 29,000 suicides in the US, between 17% and 19% had a serious mental illness. This group of people is at ultra high risk. However, we can identify these people fairly reliably and most of the conditions can be effectively treated, if reached in time. If we reduce the mental illness, we will reduce suicide. I would argue that these are a suitable group of people who we should target to help most to reduce suicide in Ireland.
Health care is like every aspect of our lives in that if we delay doing something about a problem, there is a penalty for it. As with managing a bank overdraft or the development of a cancer, the longer we delay the bigger the problem. The same is true in mental health care. If one leaves issues for long periods, secondary deficits accrue and it is much harder to redress the balance.
The slide in the presentation shows a group of young people, with an arrow leading to a picture, which appeared in an American daily newspaper, showing a boy crouching at the gates of his house. It was taken by the boy's father, who was unable to access mental health care for his son. I acknowledge that this occurred in southern California and that it is not necessarily appropriate here but it shows the transition from the slide on the left to a normal healthy adolescent. Adolescents are at a critical time of development in life. Members need only think back to their own social, educational and career development in adolescence. All of these aspects of development are delicate during one's late teens and early 20s and this is the time of highest risk of psychosis.
We found that there is a period in which people are untreated, that is, the period between the time they first develop a symptom of mental illness and the time they get first effective treatment. That period is called the duration of untreated psychosis. This, in a young person's life, is a long period. We have studied this in Dublin. In fact, Ireland, in comparison to many other countries, has good research on this topic. The average length of time these youngsters are untreated is two years, with a considerable range between one month to 20 years. The average period is ten months. I would argue that ten months in a young person's life spent out of touch with reality presents a serious problem. It gets worse. According to our own data, some 22% of the people living in a certain part of Dublin who we have studied over a decade have considered taking their own lives during the period in which they were untreated. Some 10% made a serious attempt, by which I mean attempting to drown, hang or electrocute themselves.
The slide in our presentation on the breakdown of that data shows that as time passes, shown in the right-hand column, at 13 months — the average length of untreated psychosis — there were not that many who were suicidal, the average period for those who contemplated suicide was 22 months and for those who made serious attempts, the period approached 3.3 years. The longer one leaves it, as with everything else in life, the worse the problem becomes. Not only is there a problem in that period of untreated illness but our studies and those from Australia and the UK have shown that how long a person is left untreated predicts how he or she will do four years later. In fact, it was the predictor in that regard. If a person was to recover, he or she had a short duration of untreated illness. Those left untreated for long periods were much less likely to recover, needed more medication and drugs, spent more time in hospital, etc.
It costs, not only lives but also money. An Australian study shows that people who have long periods of untreated illness cost approximately two and a half times as much to treat over the first three years of their illness than if they are treated early. People might say that this is not rocket science and we were aware of that. In fact, not many people knew all of this and the research is only emerging to show the importance of treating illness, particularly in vulnerable youngsters, early.
Action can be taken. In Australia, Norway, Denmark, Holland, Canada and the UK, there are developed early intervention programmes to specifically address this problem. These programmes work. The Norwegian programme, which is perhaps the most rigorously and scientifically studied, used evidence from Irish research in its application for government funding. It has shown that untreated psychosis can be reduced from almost two years to 26 weeks. If people receive care earlier, the results are that fewer individuals need hospitalisation, they function better, there is less involvement of police and fewer compulsory admissions — this is a topical issue in Ireland — there is a reduction in suicidality and their outcomes are improved. This is factual evidence rather than hearsay.
A group of people in Ireland got together to form a broad alliance composed of service users; families and the organisations representing them — namely, Schizophrenia Ireland and the Mental Health Association; mental health professionals, adult and child and adolescent; administrators from the Eastern Regional Health Authority and the St. John of God Order; and general practitioners, both public and private and, strangely for this country, across catchment areas. We asked if we could do something similar in this country. We decided that we would emulate the Australian, which is the best studied, and Norwegian models. We put together a proposal called DETECT, Dublin East Treatment and Early Care Team. Acronyms are vital in this business.
We have a public education programme so that people in need of care would know where to go and what to do. We target key referrers, such as general practitioners, accident and emergency departments, school counsellors, university counsellors, the Garda and the probation and welfare service, to inform them of what psychosis is and help the general community to be more aware and better at picking up this group at high risk of suicide. We also want to break down barriers to care because there are barriers to accessing mental health services in this country. We proposed a specialised team that would provide continuity of care for young people and their families over three years.
We submitted this proposal in 2003 and 2004. In 2003 we were unsuccessful. In 2004 the St. John of God Order gave us some seed funding. For 2005, the HSE has given us approximately 14% of the costing of the original proposal. It is a start and we are grateful for that. That proposal is currently under way.
We had to modify our proposal. What will be developed for a population of 371,000 in Dublin does not allow the comprehensive package of individualised care proposed but allows for assessment within 48 hours. This is holistic assessment, based not only on medication but also on psychological, vocational, family involvement and feedback to clinicians and general practitioners and modules of psychological, family and vocational support.
I will end with my original key message. Early intervention in mental health, particularly in psychosis, is the best bet for Ireland at present. It saves lives, saves money and gives youngsters a chance. It has been shown to do so. Ireland is playing catch-up and there is strong evidence to demonstrate that early intervention should be a part of any effective national suicide prevention strategy.
I thank Professor O'Callaghan for his interesting presentation. He outlined a pilot form of what is required here, that is, a multidisciplinary psychiatric teams, perhaps community based, dealing with 371,000 people.
Professor O’Callaghan
It is dealing with 371,000 people. It incorporates the former East Coast Area Health Board. It was a pilot for the country.
What was the total cost for the 13%?
Professor O’Callaghan
We included the inpatient care. It was of the order of €3.5 million.
Is Professor O'Callaghan saying that €3.5 million will cover that? If that amount covers 371,000 then, if my mathematics are correct, ten times that amount, €35 million, would cover the country.
Professor O’Callaghan
Broadly speaking, yes.
Is Professor O'Callaghan saying that it would take €35 million to cover the country and deal with the issue in the manner suggested?
Professor O’Callaghan
Yes.
We accept that this does not deal with the entire range of psychiatric illness.
Professor O’Callaghan
Absolutely not.
However, would it make a significant difference to suicide levels to have this funding of €35 million per annum?
Professor O’Callaghan
I believe so.
In the context of the money that has been spent over a number of years, this is a small sum.
We saw the report of the Irish College of Psychiatry on child and adolescent psychiatric services recently and what Professor O'Callaghan said confirms the needs suggested in that report. What he said speaks for itself and it is interesting to see it operating. We have known for some time that we need to follow international practice of multidisciplinary psychiatric services. When we see the percentage decrease in investment in mental health services here, we wonder whether we will ever see this in Ireland.
I wish to ask a question I have put to other witnesses who came before the sub-committee. What three steps would Professor O'Callaghan like to see the sub-committee take to address or reduce levels of suicide?
Professor O’Callaghan
Early intervention is common sense. It has not been part of thinking on mental health because people have been so busy trying to stop the floodgates. However, international best practice suggests this is the best way to go because it has been proven to work elsewhere. Early detection programmes in psychosis are required. If this is shown to be efficacious, it will extend outward.
Early detection should surely also be the direction to take with depression.
Professor O’Callaghan
Yes. Tackling substance misuse should be the second step. For example, although the group of people with psychosis, whom I mentioned earlier, have a twentyfold increase in suicide risk compared to the general population, which makes them a good group to target, we have studied people who also have a substance misuse problem. Approximately 40% to 60% of the people we see have both problems. Many of the services here are set up in a manner where a person with both mental health and substance misuse problems will be sent from one service to the other and will vacillate between the two. People in this group are eight times more likely than those in the high risk group to harm themselves. Tackling substance misuse, in particular cannabis and alcohol misuse, would be the second and third steps I recommend.
What is the professor's opinion on the treatment of adolescents, in particular, those for whom we do not have dedicated services such as 16 and 17 year olds? What services are available for those under ten years of age? The profession concentrates on dealing with 13 to 15 year olds but younger people are ignored. Early intervention would probably work best with those if we accept the professor's approach.
Professor O’Callaghan
It would if we could identify people at that age. However, the symptoms of psychosis do not usually develop until people are in their late teens. I am not sure there is a way to do what the Deputy suggests.
The Deputy is correct when he asks what happens to adolescents in the middle. They are in some sense neither fish nor fowl for the health services. The child and adolescent category leans towards children and the law has changed somewhat with regard to where adult services start dealing with adolescents — now at 16 years of age. Putting adolescents of 16 years and 17 years in settings with older people in their 20s, 30s and 40s is not necessarily appropriate. Their is an argument for specific adolescent services.
I found the professor's presentation interesting and was surprised by some of statistics I had not come across previously. He recommends early intervention, which makes sense. In general, if one intervenes in an illness, one is already aware there is an illness. In most cases the reason there is no early intervention is that the illness is not diagnosed. How can one intervene in an illness of which one is not fully aware?
Despite the fact that budgets in the area of psychiatry have fallen from 11% to 7%, it is good to see that initiatives are being taken. In my area an AOT, assertive outreach team, won the national innovation award. I was disappointed that when the DETECT programme was put forward in the former Eastern Health Board area, it was not funded. It was rejected in 2003 but did eventually receive some seed funding. Is that correct?
Professor O’Callaghan
Yes.
Did the moneys come from within the mental health budget?
Professor O’Callaghan
I am not sure. It was, I think, additional money. It was not money taken away from people with pre-existing illnesses. We got service users, administrators, mental health professionals to agree that services were already compromised and that the money should be new. It was new.
The Deputy's first question touches an important point. He is probably inferring that to some extent these conditions cannot be diagnosed or recognised at that stage. There is much research going on about the phase of the illness before people have symptoms. However, I referred earlier to two years of untreated illness. The latter could be diagnosed by any clinician.
Is nothing done about it?
Professor O’Callaghan
These cases do not reach clinicians because general knowledge about them among the population is low. That is why public education programmes to teach school counsellors and the public how to recognise the symptoms are good and will encourage individuals to seek help.
We should be concerned that the duration of undiagnosed psychosis ranges from ten months to two years. We must have awareness programmes for general practitioners and parents. Parents, siblings and schools would be the first in contact with these people and I would welcome moves to provide awareness programmes for them.
As a person who wants something done about substance abuse, whether drugs or alcohol related, what are the professor's views on the provision of in-house detoxification programmes? Should we concentrate on in-house detoxification or is there something that can be done in the community?
Professor O’Callaghan
I am not an expert on the issue of alcohol treatment. As a practising clinician, however, my sense of it is that we have moved from the sort of situation where everybody was admitted to psychiatric hospitals to detoxify. There were no ifs or buts about it and people would walk in and walk out. The hospitals provided that kind of service many years ago. The pendulum has swung strongly to community-based services. There is no evidence that people do better in inpatient care than in the outpatient care provided by many day hospitals and treatment programmes throughout the country. There are instances where inpatient care is very beneficial for people with alcohol problems. Many people who repeatedly try but fail to overcome their problems as outpatients can succeed if they get that additional support. There are many very good residential alcohol treatment centres around the country which are not strictly part of psychiatric services.
We had these facilities in the north east at one stage but they were withdrawn. People are now voting with their feet and travelling around the country to ensure they get some kind of service, which is regrettable. People have travelled to places such as Newry, Galway, Limerick and Dublin for treatment. Early interventions work and money should be directed towards them.
What are Professor O'Callaghan's views on the number of patients who spend some time in care and then go on to commit suicide? He spoke about early intervention but patients might have been incorrectly diagnosed and people might have considered these patients were medically fit to go out into society when they were not. The suicide rate among former patients of psychiatric hospitals is quite high.
Professor O'Callaghan
There is an association between being admitted to a psychiatric hospital and suicide. However, I imagine there is the same kind of correlation between going to a general hospital and death. It is not necessarily causal. Is Senator Browne implying that being admitted to a psychiatric hospital causes people to commit suicide?
Professor O'Callaghan is putting heavy emphasis on early intervention. Something has broken down in between in the case of patients who attended a psychiatric hospital or received medical care and took their own lives afterwards. Does Professor Callaghan believe this to be true, based on his experience?
Professor O’Callaghan
Senator Browne's comments are correct. Communication can break down, particularly in the absence of assertive community outreach teams. It is possible to lose contact with a discharged patient if there are insufficient community-based services to follow him or her. Communication can also break down when assertive outreach teams are in place, but early intervention teams are geared towards connecting with the person and his or her family, irrespective of whether it is inpatient or outpatient care. They stick with former patients for three years, which leads to the development of a relationship. It was demonstrated in Canada that if people had relationships and somewhere they knew they could turn to such as a 24-hour telephone number or somebody who knew their problems, it reduced suicidality during the period when people were in that programme compared to those in a conventional mental health service.
This outreach service is present here and in countries like the UK and Canada. We are not in the Dark Ages in Ireland but this innovation has been introduced in countries such as Australia, New Zealand, the UK and Canada and we are one step behind in our approach to mental health and the need to intervene earlier. It is common sense, a case of "a stitch in time saves nine". The data I have shown the committee reveal that people are less suicidal if they are reached earlier. The evidence from Canada or Australia shows that if people attend these kinds of programmes, they are less likely to feel like harming themselves and to make attempts at deliberate self harm.
The data for completed suicide is not as compelling because suicide is a relatively rare event. One would need thousands of people in studies to examine whether it is effective in this way. It certainly reduces the number of attempts people make to harm themselves, which can only be a good thing.
Many of these people tend to present at accident and emergency departments. What are Professor O'Callaghan's views on having follow-up measures for all attempted and possible attempted suicides in accident and emergency departments in general hospitals? We must target this area. I did not notice any reference to accident and emergency counsellors or to follow-up measures in Professor O'Callaghan's presentation. What are his views regarding one counsellor providing a service for two to four hospitals?
Professor O’Callaghan
I wholeheartedly agree with Deputy Connolly's call for follow-up measures. One of my slides refers to general practitioners and accident and emergency departments as being target key referrers. All the early intervention programmes across the world that I am aware of target accident and emergency departments in order that doctors, nurses and the specific counsellors attached to accident and emergency departments in many countries are trained to recognise psychosis and seamlessly take over the care of these people.
Do all accident and emergency departments in this country have counsellors?
Professor O’Callaghan
No, but it proposed that they do.
What are ProfessorO'Callaghan's views regarding the carrying out of an audit following each case of suicide in order that we can establish the circumstances surrounding it? These circumstances would include the person's age, whether he or she tried to contact the relevant services, whether the services failed him or her, whether he or she had been to see a GP and whether he or she told a friend about their suicidal thoughts? People claim after many suicides that they did not know what the person in question was thinking. Not every suicide is unexpected. A small percentage of suicides are unexpected but I am fairly sure that the people in question must have confided in someone.
Professor O’Callaghan
In my profession, I have met many families who have lost a loved one through suicide and have known people who have taken their lives. Suicide affects everyone, particularly family and friends. The question of whether we choose to confide in others is very complex. People confide their distress if they can but others do not wish to burden family members with their problems and hold them in. The issue is as complex as human personalities. Many people do not come to care or go to their GP and do not specifically state their suicidal thoughts or deny them. There is no reliable predictor of suicide.
Do we ever try to find out whether these people have spoken or expressed a concern to anyone? Parents will always tell their children not to do something silly. Do parents know how to pick up signals of suicide? People will sometimes say that they should have listened more attentively to the person who committed suicide. Suicidal intentions are indicated in many cases but the clues are not picked up and acted upon.
Professor O’Callaghan
Deputy Connolly is correct, but equally there are many families and friends of people who have committed suicide who are beating themselves over the head and telling themselves they should have picked up the signals. Hindsight is all very well but one in four people suffers from some form of mental distress.
Nobody wants to be in a situation where a person indicates to them that he or she believes life is not worth living. What do we say to these people? Should we talk to them, ring a GP or pass it on to a professional? We may be recipients of information we are unable to handle.
Professor O’Callaghan
We can teach people through education programmes what to do in these circumstances. There are mental health aid books that are used in schools in some countries to teach people how to react if a friend is acting in a particular way and how to reassure that friend. It is a form of mental health first aid that is being used in several countries.
Is this book widely available in Ireland?
Professor O’Callaghan
It is not widely available at the moment but it is available. There are strategies to help people. This is early intervention in a different form.
We need to get this information out to schools and students and ensure it is readily available to parents.
I would like to conclude by asking Professor O'Callaghan, who is an eminent psychiatrist, a question I have asked several psychiatrists. In my opinion, psychiatrists too often fail to discuss problems with families because they are concerned about confidentiality. There are two views on this issue in psychiatric circles. The first is that there should be an inclusive and holistic approach to dealing with problems. This approach is favoured in the US, where families are often brought to meetings together. The second view, which is more common in this country, is that the problems of people over the age of 18 should not be discussed with their families. Many psychiatrists who hold this second position are informed by their belief that their dealings with patients are confidential. If a patient who has been treated by such a psychiatrist latercommits suicide, his or her family will be very frustrated and angry. What are ProfessorO'Callaghan's views on the matter?
Professor O’Callaghan
My views are as disparate as those described by the Deputy. I decide on such matters on an individual-by-individual basis. I do not think a policy can be set in stone. If I talk to the Deputy, I might tell him some things about which I might not want my family to know. I might be right not to talk to my family about such matters. The Deputy would have to decide what to do in such circumstances — it would be his judgment call. If the Deputy were to feel that I have a serious illness or that my judgment is impaired, his duty of care would have to override his concerns about confidentiality. It sometimes happens that a psychiatrist does not suspect that a patient plans to hurt himself or herself but he or she goes on to do so. The psychiatrist has to reflect on the decision he or she made in the case. Psychiatrists make such judgment calls every day. I do not think there is an easy solution to this problem. My personal preference is to be inclusive.
Not all psychiatrists make judgment calls. Some of them have decided that they will not discuss the issues affecting their patients under any circumstances.
Professor O’Callaghan
Yes, I accept that such people exist.
There are too many of them.
Deputy Connolly spoke about helping people to open up. A witness told the sub-committee last week that people who ring him up on their own behalf often speak in the third person. Is that a common phenomenon?
Professor O’Callaghan
It is extremely common. This country is saddled with the burden of the stigma of mental illness. People are ashamed to admit they have a problem in a part of their body that is half an inch above their eye. If we get something in our eyes, we do not hesitate to telephone eye and ear clinics or accident and emergency departments. For some reason, however, we are carrying a stigma in respect of mental illness that is destroying us in many ways.
Does Professor O'Callaghan intend to extend his programme to all parts of the country?
Professor O’Callaghan
It was originally proposed to provide a specialised programme as a pilot study. I believe it should be extended throughout the country. That should have been done from the outset but it did not happen because it was felt that a full study needed to be piloted in a region to reflect the different patterns throughout our health care system. The regional study allowed us to undertake economic costings to ascertain whether the programme is cost effective and to determine whether it achieves substantial benefits in terms of reducing suicide levels and the length of time it takes people to get care. If we can prove that such benefits can accrue from the system, we will present our findings to officials in the Department of Health and Children and the Health Service Executive who will decide whether the programme should be rolled out throughout the country. We are trying to fiddle around with the restricted funding we have acquired, to try to make it fit the original proposal as best we can. We have made a start. It is the first foray Ireland has made in this field. We are trying to catch up with the rest of the world.
I thank Professor O'Callaghan for his presentation. As he is aware, the sub-committee will take the various submissions it has received into account when it prepares its report, to be published in November, on how it can help to reduce this country's incidence of suicide.
Professor O’Callaghan
I thank the Chairman and the sub-committee for listening to me.
Sitting suspended at 2.44 p.m. and resumed at 2.46 p.m.
I welcome the representatives of Console. I am sure they are familiar with the members of the sub-committee who are present — Deputies Neville and Connolly and Senator Browne. We will be joined later by Deputy O'Connor and Senator Glynn. This sub-committee of the Joint Committee on Health and Children is dealing with the high incidence of suicide in this country. It hopes to present a report on foot of its deliberations and hearings by the end of November. The sub-committee has made it clear to everybody who has attended these hearings that it does not mind being told that it has chosen the wrong target or is off the mark in some way. I ask the members of the delegation to feel free to advise the sub-committee, which wants to hear the comments of professionals and to make some impact. I ask our guests to commence their presentation, which will be followed by a discussion and some questions.
Professor O'Callaghan told the sub-committee earlier that significant numbers of people are affected by psychosis. I was present when Mr. Gareth O'Callaghan spoke in County Leitrim about the number of people who do and do not present with depression. I was staggered when Mr. O'Callaghan said that over 100,000 people are in the latter category. It was mentioned at the meeting in County Leitrim that 50 people are directly affected by every case of suicide. If there are 400 suicides every year, some 20,000 people are affected. The figures seem to be stacking up. I agree with Deputy Neville, who said that the level of funding being allocated to the psychiatric service is insufficient. That was underlined by Professor O'Callaghan during the previous presentation. I would like Mr. O'Callaghan to address issues of that nature.
Mr. Gareth O’Callaghan
It is a great honour for the representatives of Console to attend this meeting. While I have not been involved with the organisation as long as some of its other members, I can say that today is a significant point in its history. We are delighted, four and a half years after the establishment of Console, that its members have been invited to discuss this matter with some distinguished Members of the Oireachtas. We intend to give the members of the sub-committee some information on mental health problems. Console is probably the organisation that is closest to the suffering being endured by many Irish people. The endurance of most such people takes the form of an isolated and lonely race against time. I would like to introduce Console's administrator, Ms Josephine Quinlan, who is also one of Console's senior counsellors. She will give the sub-committee some information on the organisation's background.
Ms Josephine Quinlan
Console is a registered charity that supports and helps people who have been affected by suicide. It promotes positive mental health, with the aim of reducing the high number of attempted suicides and deaths through suicide in Irish society. It was established in 2002 by families that had experienced the immense grief of losing a loved one through suicide. It has subsequently developed into a professional organisation that responds to those affected by suicide. It offers a range of services throughout the country, through its offices in Dublin and Galway.
Console embraces the model of postvention. The eminent suicidologist, Dr. Edwin Schneidman, suggested the concept of "postvention as prevention for the next generation". He has argued that a postvention model is an integral part of any comprehensive suicide prevention strategy, preventing further deaths by interrupting the multi-generational impact that those bereaved are often reported to have as a legacy of suicide. The aims of postvention are threefold: first, it aims to minimise the distress of those bereaved through suicide; second, it helps people bereaved to adapt to life without their loved one; and, third, it reduces the likelihood of imitation, such as clusters within the community. Clusters represent a dramatic increase in observed suicides in a community.
Console intends to highlight the immediate impact of the high levels of suicide within Irish society. Since 2000, there has been an average of 494 deaths through suicide annually. Men under the age of 35 years account for approximately 40% of people who die annually through suicide. This contrasts with traditional patterns and with most other countries, where suicide is most frequently observed in older men. It is estimated by Dr. Schneidman that for every death through suicide, six people would suffer intense grief reactions. Dr. Campbell believes this underestimates the number of people directly affected by suicide. Dr. Byrne has suggested that a minimum of 50 people suffer from loss, grief, blame or shame as a result of a single suicide. We can conclude, therefore, that an average number of 10,860 people are affected annually by the high levels of suicide in Ireland.
Four longitudinal studies have shown an increased risk of suicidal behaviour among bereaved people. Those bereaved through suicide report more frequent feelings of responsibility for the death, rejection and abandonment than those who have lost someone from natural causes. Feelings of stigmatisation, shame and embarrassment set them apart from those who grieve a non-suicidal death. Research indicates that some of the factors which may increase the risk of suicidal behaviour among those who have been bereaved are a desire to be reunited with their loved one who has died, reactive depression following the death and intense feelings of guilt and self-blame. A recent study states that suicidal feelings may be inherited. In addition, there may be a sense that those left in the aftermath are also destined to die by suicide. Losing someone close through suicide can make a previously impossible idea suddenly possible; the unthinkable can become thinkable. Researchers have suggested that suicide rates among those bereaved through suicide is between 80% and 300% higher than the general population.
Console responds to the needs that arise following the trauma and devastation of suicide for an average of almost 11,000 people each year by providing relevant services. Console provides a national freephone helpline, which is a confidential listening service for people bereaved through suicide. This service provides callers with the opportunity to speak about their loss without fear of judgement. We offer callers contact details from our database of counselling services and support groups that may be in the proximity of the caller throughout the counties of Ireland.
Console provides individual and family counselling. The journey of the bereaved after the loss of a significant loved one can be excruciatingly painful, devastating and traumatic. When someone dies through suicide, feelings may emerge such as guilt, anger, sadness, despair or fear. The intensity of these feelings can leave people confused and unable to manage everyday life. The bereaved may begin to question the meaning of their own life following their tragic loss. This search for meaning can leave a person feeling isolated from others who do not seem to understand or are unable to help. Counselling can offer a safe place where the unspeakable may be spoken and the unthinkable thought about with the support and confidentiality of a counsellor. Console recognises that there is no standard timeframe or way of grieving. Each individual experiences his or her personal loss in his or her unique way. People are, therefore, welcome to attend counselling at any time. However, early intervention is encouraged to avoid maladaptive coping mechanisms following bereavement such as chronic, delayed, exaggerated and masked grief reactions.
Console provides therapy and support groups. It facilitates two types of support groups for those bereaved through suicide, namely, a monthly open support group and an eight-week therapeutic support group which runs twice a year. Support and therapy groups for people bereaved through suicide provide an opportunity to meet others who have experienced a similar loss and to gain support in their bereavement.
Console provides a series of community outreach programmes supporting local and community initiatives. Our most recent venture is with the newly established Finglas Suicide Network, which developed as a direct response to the high levels of suicide in the area in recent times. Console, working in partnership with the Finglas Suicide Network, has made a counsellor available in the Finglas area to work with people affected by suicide. The Finglas Suicide Network committee comprises of concerned residents living in the area — many of whom have been intimately affected by suicide — social workers, youth workers, a Health Service Executive suicide resource officer, community liaison gardaí, parish pastoral workers, community development officers and members of Console. Console has been invited to implement a similar programme by Clondalkin Community Action on Suicide committee. It is committed to supporting the people of Clondalkin to tackle the high incidence of suicide by providing a counsellor to work with people in the area who have been affected by suicide.
Console, in partnership with the Daughters of Charity, intends to provide a counselling service specifically responding to the needs of children and young people bereaved through suicide. This will include supportive resources for teachers and pupils following the death of a pupil or peer through suicide. This can be a very traumatic and difficult time for teachers, who may need guidance to sensitively respond to the needs of pupils following the death of a friend or family member of a peer.
With regard to educational programmes, Console provides the Seasons for Growth programme, which is a successful education programme for schools and colleges. The Seasons for Growth programme was developed in Australia and explores the effects of change, loss and grief in a person's life. This programme will help young people to understand and manage the changes and experiences as a result of death through suicide in their families.
With regard to information provision and public awareness, Console is frequently asked for information on suicide and suicide prevention strategies in Ireland for a variety of individuals and agencies. We provide resources and assist research students, voluntary agencies, statutory service providers and the media. A number of radio and television interview requests are made annually. Furthermore, Console strives to enhance public awareness of suicide, suicide prevention and mental health issues through public lectures, accessible print materials, conferences and publicising suicide prevention initiatives.
Console's national conference, entitled "Suicide Bereavement — Responding in the Aftermath", was held in September last. There was unprecedented attendance of 300 professionals and volunteers who work throughout Ireland and are concerned about the high rates of suicide. This conference, while being informative, provided an informal supportive structure for those working, often in isolation, to respond to suicide in their own town or rural setting throughout Ireland.
Console's Christmas service of light will take place on 18 December to commemorate the many lives lost through suicide this year and in the past. The service will provide those bereaved with an atmosphere to express their grief, while simultaneously destigmatising suicide, a taboo subject in Ireland which often causes further isolation for those bereaved.
The President, Mrs. Mary McAleese, recently launched Console's suicide prevention DVD, A Life to Live For, which is intended for use where the issues of suicide and suicide bereavement are addressed. The thrust of the programme demonstrates help is available and offers hope to anyone who may now or at any time in the future find himself or herself feeling down, depressed, suicidal or grieving the loss of a loved one through suicide. The educational booklet accompanying the DVD contains guidelines for teachers and facilitators and includes exercises to help young people and group members to reflect on the material contained in the DVD. It also contains work sheets exploring coping skills, healthy living and supportive action, designed to raise awareness of positive options regarding mental health and well-being.
Console has also published a booklet entitled, Living With Suicide, which sensitively explores the complex issue of suicide. It aims to be an information resource, while acknowledging the personal devastation that is the reality for those living in the aftermath of suicide. In a review of the booklet The Irish Times described it as valuable for anyone whose friend or family member had died by suicide.
Console's development strategies will provide for greater availability of the national helpline with opening hours extended to evenings and weekends. This is a time when people have a greater need for support and often have privacy to use the telephone outside daily working hours. The expansion of Console's Dublin service to a central location will increase public accessibility to services such as counselling and support groups, already provided in All Hallows College in Drumcondra. Suicide prevention initiatives are developing through the provision of educational programmes such as the Seasons for Growth programme and the adaptation of models such as the Wellness programme to schools, colleges and workplaces. These programmes promote positive mental health, increasing personal coping skills and general well-being.
In response to over 11,000 cases of self-harm, some of which were the result of serious suicide attempts, Console believes it is of grave importance to actively engage and support family members to cope with and support their loved ones engaged in self-harm. This will lead to a reduction in repeated deliberate self-harm and suicide attempts.
Through consultation with Dr. Frank Campbell of the Baton Rouge Crisis Intervention Centre, Console intends to expand its community response programme by adapting successful models such as the Baton Rouge loss programme. This highly effective model of post-intervention will comprise a first response, highly trained team which would liaise with gardaí, health professionals and coroners immediately following a suicide. This first response team will be an effective resource and support for the Garda and health professionals, as it will be for the immediate needs of families, following the trauma of discovering that a loved has died one through suicide.
Console is a voluntary, non-profit making organisation, dependent on the support and generosity of its benefactors. It urgently requires core funding to sustain and maintain its wide range of services and to continue developing the strategy needed by those who experience the traumatic impact of the high levels of suicide.
Professor O’Callaghan
What we have heard is an accurate representation of the position in Ireland in 2005. The problem is that the issue of suicide is largely ignored. A young man, aged 22 years, telephoned me at 11.30 p.m. on Saturday. I spent an hour on the telephone with him. The thrust of the conversation was that he wanted me to give him one good reason he should not hang himself there and then. His best friend had died by suicide several months before and his girlfriend had decided to call it a day with their relationship. He was the most isolated young man in Ireland that night and he was not thinking about anyone else, let alone himself. He is typical of callers to Console. We do not have the money to have our confidential helpline open all the time. That was the reason he could not call that night. However, he happened to get hold of my mobile telephone number. We must look at the humanistic reasons that led an individual such as this young man, Pat, to reach a point where he felt life was pointless.
The word "psychosis" was frequently mentioned. It concerns me when words such as this are used because we are only increasing the stigma attached to suicide. Once stigma takes a firm hold, if I feel I will be stigmatised in a small community, I will not go public in declaring a mental health problem. However, I will go to an organisation if I know I can speak with it confidentially and it will give the advice and support I need.
We are too focussed on the 431 young Irish men who died by suicide last year. This morning I read that 5,000 Irish people could die if there was a pandemic of avian bird flu. In excess of 5,000 young men and women attempted suicide last year, many of which are statistically noted because they presented at accident and emergency departments. However, a much larger number woke up after a drugs overdose, for example, but did not appear at hospital. Having spoken to so many survivors of suicide over a period of several years, they are very relieved they are still alive. Many have gone on to lead very happy lives and will not report to the local accident and emergency department or their GP to discuss an attempted overdose because they do not want anyone to know they tried to take their own lives. One positive benefit of an organisation such as Console is that many of the individuals concerned will ring because no statistics are kept and they are just given professional help at the end of the telephone line.
Ms Quinlan's presentation encapsulates all that has taken place in the past four years. However, this organisation is expanding at such a rate that, as a small voluntary group, it cannot cope. It needs money. We were lucky to get the support of Boston Scientific, based in Galway, with 2,000 employees, the majority of whom took Console on as their charity of the year. They have raised €140,000 in the past nine months, mainly outside working hours. As a result of their generosity, we have been able to open a new call-in centre in Galway offering confidential advice, one-to-one meetings and telephone conversations for people, not just in Galway but also in counties Mayo, Sligo and Roscommon. There are two full-time counsellors, yet there is already a waiting list. Two more counsellors need to be brought on stream. Thanks to local entrepreneurs in the Limerick area, we are on course to open a brand new centre there in January. In the long term Console wants to reach into the grassroots such as villages and communities where suicide has taken a terrible hold. It affects an entire community, be it a school, workplace or factory.
When national newspapers report national statistics, they are above the heads of the bereaved because they do not address the pain they experience. Often people take comfort if the figures are lower but, tragically, they may be higher. I am reminded of the humanistic work this agency is striving to do. It exists to help as many as 40,000 or 50,000 every year. That might sound an exaggerated figure but I do not believe it is. We do not have official statistics because the majority of such cases do not come forward and admit to trying to take their own life. Having spoken in schools and colleges and given more public talks than I can keep count of, that is my gut feeling. People will tell me confidentially that, although they have not told anybody else, they attempted to take their life last year. Alternatively, they come to me to discover what drove them to it and what pulled them back from the brink.
It is a great honour to be here. I emphasise that we need to know at national and local level that we have the sub-committee's support. In turn, we offer it our support in any way we can in compiling its report.
I welcome the representatives of Console and thank them for their presentation. I commend their work, of which I have been aware for some time.
One of the key issues surrounding suicide, psychiatric illness and other emotional difficulties experienced by young people in particular is that of stigma. It is impossible to deal with. On the one hand, it prevents people seeking help and, on the other, inhibits the system from giving help because if help is not sought, facilities will not be put in place.
There are two barriers to be broken down. There is a responsibility on those who should be destigmatising psychiatric illness. We must destigmatise everything from depression to psychosis and bipolar depression. There is a move to separate certain problems when it comes to psychiatric illness. It has been said depression should not be counted as a psychiatric illness. If we were to follow this road, we would never destigmatise psychiatric illness. We must place it on a par with physical illness because only then will we achieve success.
Professor O'Callaghan has much experience in dealing with depression. I have heard him speak impressively many times on the subject. I also meet young people who say they have had difficulty in seeking counselling, not because of stigma as somebody from Limerick could always travel to Dublin to be seen privately, but because they fear labelling themselves. Self-labelling is the second barrier to seeking help. There must be programmes to break down the stigma. In this respect the State has a key role to play. While there is a stigma, the system is prevented from providing resources for organisations such as Console, Living Links or the many others involved, including the psychiatric services. Does Professor O'Callaghan have any views on how the stigma can be broken down?
Professor O’Callaghan
I have been impressed by the fact that everybody present is in agreement on the need for early intervention. I have seen children as young as eight years of age showing clear symptoms of depression.
Even infants.
Professor O’Callaghan
Yes.
Is there no infant psychiatric service available?
Professor O’Callaghan
No. Usually it is left to schoolteachers to identify problems. We need to identify the emotional crises that cause depression. Even for teenagers the word "depression" is too big and unwholesome to take on board. We should tell 14 and 15 year olds that emotions hurt when a relationship breaks up, when we are bullied or abused, or where somebody comes from a dysfunctional family. In my experience young people are not as prepared to come forward to talk about the reasons for their crisis if there is a possibility they may be told they are suffering from depression. The diagnosis of depression often takes away from the original reason for the crisis. In my experience young people identify more with what they see on MTV or Nickelodeon about a situation in their own lives than they would with an article in a newspaper giving the latest depression statistics but the tide is turning because more and more professionals understand we need to simplify the issues. Depression is not a simplistic issue. As Deputy Neville knows, it involves a myriad of major psychological and psychiatric problems. The way to tackle it is to identify from a young age the crisis which is increasingly disabling an individual.
Professor O'Callaghan will be aware that children as young as seven years discuss the issue of suicide.
Professor O’Callaghan
Yes. I am glad they discuss it. It is an issue we need to bring out of the woods more and more.
If adults only realised what was going on in young people's minds. Only when those concerns are understood will the system deal with the problem.
Professor O’Callaghan
Ultimately, it would be great to see mental health as a curriculum subject in the leaving certificate. It could be introduced at a later stage in primary schools. It is not beyond the realms of possibility. We do not need a three year course at St. Patrick's College in Drumcondra. Teachers can be trained as counsellors and implement a mental health strategy and programme. Another subject could be removed the curriculum in place of one as important as mental health.
The Brent report suggests suicidal feelings may be inherited and reopens the nature versus nurture debate. I have some experience of the issue in the Carlow area where extended families have been devastated by two or three members taking their own lives. Professor O'Callaghan might expand on this, although I imagine there are some who would completely disagree.
In the course of my work as a member of the sub-committee I have been struck by the range of groups which are doing great work. We heard from Living Links which does fantastic work, as well as Aware, in which I believe Professor O'Callaghan is also involved.
Professor O’Callaghan
More recently with Console.
Should we recommend that services be amalgamated and co-ordinated centrally? There are many agencies involved. Is the work Console does very different or more specific or could different groups be amalgamated? Would there be a better nationwide service if that was done or would there be drawbacks?
I wish to ask about life assurance. I recently acquired a second mortgage for an office and made the mistake of putting on the form that I suffered from asthma during the summer for the first time in my life. I was soon quite sorry as it complicated the mortgage procedure. People treated for mental illnesses may have similar stories. Should we make recommendations that issues of mental health should be exempt with regard to people taking out life assurance for mortgages? If people are forced to state that they have received counselling, it could act as a deterrent to such people seeking treatment. It adds to the stigmatisation.
I am aware of a new course and new practices in secondary schools. Churches are finding it difficult with the current numbers of priests. Instead of having chaplains in schools, the job is being delegated to teachers. A new role similar to that of a chaplain is being created to facilitate a counselling service. I am not sure if the witnesses are aware of the course being offered in secondary schools, but it would be sensible to integrate this course with counselling and the issue of suicide.
Mr. O’Callaghan
Perhaps Ms Quinlan will deal with issues relating to the Brent report and different styles of work that involve Console in comparison to other voluntary organisations.
Ms Quinlan
There are research studies more recent than the Brent report, and it was just one taken from a reputable book. Each research piece would have to be examined for quality. People are continually exploring the mystery behind suicide and the possible existence of a genetic factor. Scientists work in this area but nothing has conclusively emerged since the report in question. This is common in many research areas, and I am sure research is taking place all the time in America on different studies. However, no theory based on factors such as the number of people in a family has become dominant on why a person commits suicide. The cause may be genetic but may also be emotional. Other aspects on the list may be relevant also.
We attempt to liaise with other organisations in Ireland, as we must do so to provide a valuable end service. People contact us on our helpline with questions on all aspects of suicide, such as prevention, intervention and bereavement. We liaise with Living Links, the Samaritans and other organisations, for example.
I am making the point that every group coming before the sub-committee is seeking further funding and complaining that it is not spread across the country to the extent it would like. If this sub-commitee made a recommendation that all the services should be amalgamated or co-ordinated, what would the reaction of Console be?
Ms Quinlan
That process has begun through the national strategy launched in September. President McAleese examined the issue, and a forum took place in Áras an Uachtaráin where all voluntary and professional bodies came together to discuss the direction Ireland must take on the issue of suicide.
The Minister of State at the Department of Health and Children, Deputy O'Malley, launched the Reach Out strategy last month, which follows the strategy from 1998. That gives details on implementing action for bodies to work together. The National Office for Suicide Prevention is being formed and Mr. Geoff Day will be the prevention officer there. He will be responsible for co-ordinating the strategy.
I assume that Console would not be in favour of amalgamating or co-existing with other groups.
Ms Quinlan
Autonomy is good, but a body should also work with other groups. Each group has a different perspective to offer on the issue of suicide prevention and bereavement.
Mr. O’Callaghan
Console has a specific outline of what the organisation will become and where it will go. We are looking for funding for this. Professor Eadbhard O'Callaghan earlier mentioned implementing a programme with consultants in accident and emergency departments. We have examined this issue closely for a long period, as many specialists, doctors, surgeons and triage nurses from these departments have called the Console helpline stating that they cannot cope with attempted suicides.
In these cases people who have attempted suicides may, for example, be lying on trollies on their own with nobody to sit with them, counsel them or chat or listen to them. A young person may have been treated but is in an emotionally, physically and psychologically distressed state. This person would be left to contemplate that the life that he or she tried to finish is still going on. Such a moment would equate to being as low as the moment prior to the attempted suicide. Some young people may argue that they feel lower at this stage, as they did not want to come back. If a person made a final decision to get help by ringing a neighbour or an ambulance, they are left in confusion as to what happened.
This is a big project which Console wishes to undertake on a serious basis. It would be piloted in Dublin as soon as possible by making a number of trained Console counsellors available by mobile phone to accident and emergency department staff. This would facilitate an around the clock back-up operation for doctors and nurses. A counsellor can be sent to the department in 20 minutes, and a young person who has attempted suicide can receive assistance and support during the stay in the accident and emergency department and as a long-term follow-up when he or she leaves hospital. It would be one of our big projects.
What Console and other groups do is to the forefront. Rather than such groups supporting what the health service should be doing, they are in front and the health service is in the background. Groups struggling for money and working in this area are the ones really dealing with the issue. The Health Service Executive should be doing most of the work done by the likes of Console but it is not. It will probably not do it in the near future with the speed at which events are moving.
Mr. O’Callaghan
We have a great relationship with the HSE. I agree with the Deputy's point, and some success stories have emerged from the hard work by Console that goes into helping people. The HSE has acknowledged this. However, in what is typical of the budgetary state at the moment, the HSE is telling us that money which we require is not available.
Some €500,000 has been given to Geoff Day and his organisation. In comparison, over €6 million has been given to the National Safety Council for road safety.
I welcome the witnesses, whose presentation was very interesting. It is always good when people are prepared to come forward and admit that they suffered from depression. A number of other people may see this as an example of a person letting others know that he or she did suffer but can analyse the experience.
The representatives mentioned support for Console's project, and I will encourage whatever support possible. Awareness is a big issue with regard to suicide, and many people should be made aware that it does occur and is not uncommon. The witnesses referred to stigma, and I would like to think that the issue is not as big as it once was. Around 25 years ago, people would whisper about the state of a person's mental health. If a person went in for alcohol treatment, it may not have been stigmatised as much. People will now recognise alcoholism, or other illnesses, as a fact of life. Depression would be seen in the same light.
Many people know that suicide is a big issue. They are not pointing a finger but recognise that it could have been a personal experience under other circumstances. It could be on their doorstep tomorrow. Many people suffer from depression due to various factors such as pregnancy, marital breakdown or whatever. It is a major public health issue. I understand there were 440 deaths last year.
I recently heard a figure from Northern Ireland to the effect that each suicide cost £1.2 million. I was astonished. Given the number of suicides we have per year, if a fraction of their cost to the economy was allocated to help Console and similar groups, many families might be saved much heartbreak.
The conference held in Drumshanbo earlier this year has been remarked upon. A similar meeting held in the Hillgrove Hotel in Monaghan was packed, as was another in the south of the county. It is clear that people want knowledge. Perhaps it is a question of funding, but people read different information and are scared. Society as a whole is scared, not only parents and people who have had relatives commit suicide. They want information on suicide.
The witnesses commented that President McAleese has recently launched a DVD, A Life to Live For. I do not know how widely available it is, possibly because I have not looked for it in the right places. While good information is being collated, it does not necessarily get into the right hands. People might not always know where to get it.
I want to comment on the issue of duplication, although I do not believe it to be an insurmountable problem. Various organisations are all trying to achieve the same goal. The people in these organisations have the right motives and are all there for the right reasons. Hence, I believe we will be able to overcome this issue at some stage.
I will take up some points made by the committee members. While Deputy Neville was present at the meeting in Leitrim, I am uncertain about the other members. I wish to take up the point made by Deputy Connolly to the effect that people are eager to get as much information as they possibly can. I ask the witnesses for their response and assure them the committee members will be able to handle it.
That evening in Leitrim, in a room with perhaps 400 or 500 people, all of whom had been affected in some way by the issue of suicide, I felt a sense of rage against the political system. People felt that little was happening, or that attempts were being made but were perceived to go nowhere. I felt that impression strongly and such sentiments were voiced that evening. While it is possible that the level of stigma associated with this issue has been reduced in recent years, it is still there.
What would it cost to roll out throughout the country the programme to which the witnesses refer? I know that other groups perform similar roles.
The national suicide group that came before the committee suggested that the first stage of Reach Out, the national strategy for action on suicide, would cost €3 million.
I heard that as well. I wonder if that could be a reasonable figure. Deputy Connolly referred to this point. Mr. O'Callaghan has made his own circumstances quite public and I respect that. It has done wonders for people who have suffered from depression.
On that note, I heard for years that people were reluctant to present themselves at psychiatric hospitals for the treatment of alcoholism. It took years to make progress in this regard, which was ultimately facilitated by the introduction of the concept of having acute psychiatric units attached to regional hospitals. My father also suffered from alcoholism. He was dry for 20 years before he died and was a member of a health board. He consistently made the point that people did not want to present themselves to units where it was stigmatised. While we have moved on as far as alcohol treatment is concerned, we have not even started with respect to depression and, ultimately, suicide.
While I am an amateur who is trying to grasp at straws to see where to go from here, I continually hear of one stumbling block. Many friends of mine have taken their lives by suicide. In my business, I have encountered many families who felt that services were inadequate when family members presented themselves to hospital authorities and that matters were not taken as seriously as the situation warranted. Too often, I have heard the nonsensical quotation that someone was only looking for notice. Subsequently, one finds that perhaps they were, but by then it is too late to redress the issue.
Do the witnesses feel that the associated stigma has been reduced somewhat? If so, how can we work towards its further reduction? What are their recommendations? The committee's purpose is to make recommendations.
I am interested in the witnesses' recent remarks about trying to go into the schools and making people aware that this is a common everyday illness. Perhaps the pace of life is responsible. It important people should realise that the illness is not unusual, given the pressures and demands of everyday living.
I will return to my original question regarding the Leitrim conference and the fact that people there felt that the political and governmental process had not taken their concerns into account. Deputy Neville twice made a point concerning funding, which I believe all committee members support. A comparison could be drawn with the funding devoted to the road safety campaign. We will not get anywhere until funding is secured that is more or less on a par with that provided to the road safety campaign. While the establishment of a specific traffic corps is frequently discussed, has the time not come to set up a specific corps dealing with the issue of depression, based on the emerging figures?
I want to hear the witnesses' thoughts on the question as to why so many people under 35 take their lives by suicide. I hear various viewpoints of professional people on this issue, but it will not be addressed publicly. Why can we not discuss this issue?
Mr. O’Callaghan
I shall share the response with my colleagues. My own view is that six or seven years ago, when I started talking publically about my own experiences, one would be lucky if one got 20 or 30 people in the audience. I am sure Deputy Neville will echo that opinion. As the Chair saw for himself, more than 450 attended the meeting in Leitrim. The organisers were obliged to look in different rooms for chairs. That has become increasingly common. People want answers and want to voice their opinion. They are fed up with hearing it time and again. They want to know what can be done that is different. They question why they are obliged to accept the situation and to be made feel that it is the hand they have been dealt in life.
We must begin to tell people that depression is as treatable as diabetes. It is as treatable as a bad chest infection and it can be overcome. There is still stigma because many people believe that depression is a life sentence, which it is not. I heard Deputy Neville speaking on Vincent Browne's radio show a few weeks ago, as I returned from a talk in Adare, where 450 people turned out in a small rural area to listen to a variety of speakers. One point made was that mental health is not an electoral issue and does not garner votes. It will in 18 month's time. However, Deputy Neville does not believe so.
No.
Mr. O’Callaghan
I believe, from what I am hearing, that there is a shift and the tide is turning.
I do not agree with Mr. O'Callaghan.
There is now great awareness due to these new talks. There are talks in hotels in all parts of the country.
I must agree. Recalling that Friday meeting in Leitrim, by 9 p.m. or 10 p.m. the room was absolutely electrified with vexation and annoyance that this was such a major issue. Families and relatives felt they had brought it as far as they could and that as far as the political process was concerned, regardless of all the information presented to them, nothing was moving.
This matter does not show up in any opinion poll in respect of the issues for the next general election. It is not on the map. It does not appear on the lists of issues identified by either Fianna Fáil or Fine Gael.
When one thinks about this, I agree with the Deputy. It does not appear on such lists. However, if we could give it the same prominence as road traffic deaths, it could start moving up the agenda.
It would be great if it could be given the level of prominence of even diabetes or any of the physical illnesses.
The point made was that it can be treated.
Diabetes is a modest example but even that level would be a large step.
The point made by Mr. O'Callaghan is that people do not believe it is the same as diabetes. They have a view that if someone gets depression, it is one's hand and one should forget about anything else.
The Chairman knows that our colleagues here, when they are canvassing at doors, are not asked about mental health, suicide or psychiatric illness for two reasons, namely, it is not seen as a political issue and the stigma prevents people from doing so. Those who suffer do not have the motivation to raise the issue and say they are not getting proper treatment.
Mr. O’Callaghan
As to why men are increasingly depressed and more men die by suicide than women, while the statistics show more women suffer depression, the reason is that women are more prepared to admit it is the case.
They talk.
Mr. O’Callaghan
Women are great talkers. A group of women will have no problem sitting down and talking about breast cancer but I have never heard a group of men sit down in a pub to talk about testicular cancer. It is the same story with depression. Men really need to change their outlook on what is relevant to their contentment and peace of mind. Manchester United might give one peace of mind if it wins its next three games or one might have peace of mind if one does well golfing this weekend. Women are stronger because they take health far more seriously than men do and are not afraid to look out for each other if they feel there is a problem in a close-knit group of friends. Their friendships are based on far more emotional strengths and bonds than men's.
We must increase men's awareness, particularly among younger men, who will talk to one another. However, men unfortunately become more blinkered and isolated as they go on in life, which is why more men now in their early 40s are beginning to ask themselves "Is this it?" and "Is this all I have to look forward to for 20 years?" Many women will have found hobbies and sidelines. Many have decided that, as their children have reached certain stages in life, they can return to full-time employment. If we are to be progressive in the whole area of mental health, men must be taught that it is good to talk. If there were ever a catchphrase that really appeals to where we are today, it is that one.
The word "talk" is written on my charity wristband and is the name of the Young Fine Gael campaign.
Ms Quinlan
I would like to address a point made concerning the anger present in County Leitrim based on my experience in talking to people. We received a call three months ago from a parish priest in Clondalkin who experienced a bereavement in the community, a death through suicide. We got together over several weeks and held a seminar in Clondalkin last Saturday, which was attended by Professor Patricia Casey and approximately 150 people from the area. Community initiatives such as this are very positive.
There was much anger towards the psychiatric system because there is a lack of awareness. The reality is that the psychiatric system is all that has ever been present. It is under-resourced and underfunded but many good psychiatrists are trying to do as much as they can. However, there is no bed anywhere in the country for a whole weekend for people who are suicidal, as Professor Casey said. Three people in Dublin needed beds but stayed in a general hospital when they could not get any. The Clondalkin audience was probably similar to that in Leitrim. Persons were very angry because some of them had lost people through going into the psychiatric system, which is underfunded.
Console's emphasis is on health promotion and early intervention, promoting positive health through education by initiatives such as the Seasons of Growth programme, which examines details of loss and change encountered in every aspect of life, and gaining awareness through seminars and public initiatives. This depends on examining each individual's capacity to cope because we do not know why suicide occurs. Researchers all over the world are trying to find out whether it is genetic, emotional, learned or so on but there is no definitive answer yet.
I believe intervention and positive mental health are key. Community initiatives coinciding with the psychiatric system, which is trying to do as much as it can, are composed of the people on the ground. They are supporting one another, which was very evident in Clondalkin, as there were many positive responses at the end of the seminar.
As to whether this is an issue for voters, I was struck by the reaction I received when I commented to a newspaper that I was a member of the sub-committee examining it. I received telephone calls and people met me on streets to discuss the matter. There was a more significant reaction to this than to other issues in which one could become involved. It is there under the surface.
Following Mr. O'Callaghan's valid point that depression is only a small and short-term illness that can be treated like many other illnesses, is it right that, on life assurance forms, one is asked whether one has attempted to commit suicide and other issues of mental health come into play? Should these questions be removed from questionnaires? It is a significant issue for people taking out mortgages or loans from banks. I see it as an invasion of privacy and it stigmatises mental illness even further. It prevents people from seeking help.
Mr. O’Callaghan
I wholeheartedly agree with the Senator. It is not an economic issue and should not be treated as such. It is an emotional and highly complex issue. Going to a life assurance or motor insurance company, the former being a key element, only serves to compromise the self-worth of individuals. It also goes much further than this as it becomes a work issue. The majority of people in workplaces all over Ireland do not want their bosses to know they have had mental health problems because they feel that it would jeopardise their positions, undermine themselves, leave them in very vulnerable positions and could result in their being overstepped for valuable promotions.
The prospect of promotions is reduced.
Mr. O’Callaghan
Beyond a general practitioner's office or a psychiatric unit, it is no one else's business whatsoever.
I thank the delegation for its excellent presentation. We will arrange to have details of the previous presentation sent out to the delegates and ask that they keep track of what we are doing until the end. We would welcome any recommendation or pursue or investigate any matter or any area asked of us. We will do everything we possibly can to make some significant change.
The joint committee went into private session at 3.50 p.m. and adjourned at 3.55 p.m. until 2 p.m. on Tuesday, 1 November 2005.