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JOINT COMMITTEE ON HEALTH AND CHILDREN díospóireacht -
Thursday, 21 Feb 2008

Incidence of Suicide: Discussion with Delegation from Northern Ireland Assembly.

I welcome everyone to the meeting. I have received apologies from Deputies Bernard Allen and James Reilly. The joint committee expresses its condolences to Deputy Reilly on the death of his brother, Dr. William Reilly.

The purpose of today's meeting is to meet members of the Committee for Health, Social Services and Public Safety from the Northern Ireland Assembly. It gives us great pleasure to welcome the Chairperson, Vice Chairperson and members of the committee to Dublin. We have with us Ms Iris Robinson, MLA, Chairperson; Ms Michelle O'Neill, MLA, Deputy Chairperson; Mr. Alex Easton, MLA; Dr. Kieran Deeny, MLA; Ms Carál Ní Chuilín, MLA; Mr. Tommy Gallagher, MLA; Ms Carmel Hanna, MLA; and the Rev. Dr. Robert Coulter, MLA. I ask members of the joint committee to introduce themselves.

I am a representative of Fine Gael and the party's leader and spokesperson on health in the Seanad.

I am Vice Chairperson of the joint committee and Labour Party spokesperson on health.

I am not a member of the joint committee and I am deputising for Deputy James Reilly who cannot attend due to the death of his brother.

I am a member of the joint committee and Fine Gael spokesperson on mental health.

I am a member of the Labour Party.

I am the Labour Party spokesperson on equality and disability.

I am the Sinn Féin spokesperson on health. While I am not a full member of the joint committee, I regularly attend its meetings.

I am a member of the committee and represent the Cavan-Monaghan constituency.

I am a Fianna Fáil member of the joint committee.

I am an ordinary Fianna Fáil member with no additional titles.

I am the Fianna Fáil spokesperson on children, older people and mental health in the Seanad. I have taken up the issue of a positive action programme against suicide.

We will have a short meeting as the delegation has a long agenda. I compliment officials from the Assembly on the tight schedule and work programme they have drawn up for the delegation. We intend to conclude the meeting by 1 p.m. for lunch and I understand the delegation will meet the Minister of State at the Department of Health and Children, Deputy Jimmy Devins, at 2 p.m. The joint committee looks forward to many further such meetings.

This is the first time the health committee from the South has met its counterpart from the North. This is a small island and we have many issues in common. From speaking to members of the delegation last night, I noted we share similar difficulties. I hope we can pool our resources and expertise to promote good health on the island.

The Committee for Health, Social Services and Public Safety has prioritised suicide prevention. The joint committee made suicide prevention a priority in 2005. I recognise the major contribution of Deputy Dan Neville who has been to the fore on this issue for many years. In more recent times, Senator Mary White has taken a major interest in this area. In prioritising suicide prevention in 2005, the joint committee produced 33 recommendations. I understand the delegation has had a brief period to read the report in question.

While I do not intend to discuss all aspects of the report, several points were highlighted by members. They include the close connection between suicide and mental illness; the need to ring-fence in the health budget funding for treatment and the upgrading of mental health services; the issue of adolescent difficulties and the need to target specific funding at this area; and the role of alcohol in the high incidence of suicide.

I invite the party spokespersons from the joint committee to contribute, after which I will ask Ms Iris Robinson, MLA, and her colleagues to respond.

I congratulate the Chairman on organising this meeting. It gives me great pleasure to extend a warm welcome to the Committee for Health, Social Services and Public Safety of the Northern Ireland Assembly. I hope today marks the beginning of what should be a productive and mutually beneficial relationship in which we can exchange ideas and learn from our experiences. As the Chair noted, this is the first official meeting between committees of the Northern Ireland Assembly and Oireachtas and, as such, it is of historic importance.

It is appropriate that we should at the outset discuss the area of suicide and mental illness because mental illness recognises no boundaries, borders, emblems or creeds. It is a difficulty and challenge which all societies are facing and a particular difficulty for us in Ireland. I have no doubt we can exchange much useful information and learn from each other.

The Chairman has pointed out that funding remains a huge concern for us. All member of the committee are concerned to ensure that the issue of mental health, mental illnesses and facilities are accorded the priority they deserve. This is especially the case given that one in four people will experience a mental health difficulty in the course of their lifetime. Every family is affected by mental health issues and it is therefore appropriate this is the topic we have chosen as the key topic to discuss at our first meeting.

The committee has issued a comprehensive report on this area. Much of the work to be done is concerned with implementing its recommendations. To highlight a few key points, the study shows that alcohol plays a major part in the majority of suicides and attempted suicides amount young adults. In this regard I am sure there is scope for cross-Border co-operation to reduce the prevalence of drug and alcohol abuse. This would reduce suicide in both societies. Aspects for consideration include common policies towards alcohol sponsorship of sports. Banning the association of alcohol brands with sporting activities would help reduce the use of alcohol among young people. Studies have shown a correlation between suicide and the extent of young people's exposure to alcohol advertising. That is a key area for us to examine.

The breakdown of community is a factor we also need to consider, as less support is available to people. In many ways economic progress has put more pressure on individuals and families. This is another area of mutual concern. Perhaps we can examine the community organisations that operate all over the island and investigate how their resources can be brought together to help young people.

I understand that in Northern Ireland there are approximately 150 suicides every year and that many of them are of young men. The average number of suicide deaths each year is approximately 500. That is the official figure. The real figure is probably higher. This is a significant issue for us. We also have a high number of people who deliberately self-harm.

As the Chair stated, my colleague, Deputy Dan Neville, has played a key role in increasing awareness and helped to alert individuals, families and communities to the cries for help that exist. It is very important that we are all alerted to the signs in a timely way.

I thank the group for its attendance. I wish its members a very productive and enjoyable visit and l hope for a long and productive relationship of co-operation between us. I look forward very much to hear the points of view and experiences of the group and what it is doing to tackle the problem of suicide.

I welcome the delegation also. This is an historic occasion. I hope we will be able to learn from each other and work together for the benefit of people on this island. I acknowledge the work of the previous committee, of which I was not a member, on suicide and suicide prevention. The report it produced is a fine one. I believe the Chairman will distribute copies to everyone.

It is most important to ensure funding is ring-fenced for suicide prevention and mental health generally. The Chairman referred to this area. We have already seen examples where money was set aside for mental health purposes by the Health Service Executive but which has not been spent on mental health. That is a cause of concern for all of us. Some members attended a meeting this morning on eating disorders, which is a separate issue to suicide but there are connections, where we were told that money which was specifically allocated for that purpose was not spent on it. A nice phrase was used to indicate that, effectively, the money was spent on something else. The provision of the service was "put on hold". We must ensure that money allocated for purposes about which we feel strongly is not diverted elsewhere.

I believe a rationalisation of health services in Northern Ireland is ongoing. Similar to what happened here, the intention is reduce a large number of bodies to a smaller number. We now have one body, namely, the Health Service Executive. Members of all political parties have difficulties in ensuring that plans are delivered on and that the money allocated is spent. We have a mental health programme called A Vision for Change, where there is already slippage in terms of providing funding for services for people with mental health issues.

We can achieve a great deal in co-operation with each other. As the Chairman indicated, we share a lot of common ground and the reasons why people are suicidal are similar, irrespective of the Border. We can learn a lot from each other, especially in terms of research, which is emphasised in the recommendations of the report. There is no reason to separately research the same issue when we can co-operate in this area.

A number of support groups work in this area. People who deal with the issue all say that we need accessible services where young people feel they can go to talk to someone who will listen and understand if they have a problem. The last thing people need is to be told they must go on a waiting list when it is clear they have an acute issue that needs to be addressed. This is an area where we have something in common.

I do not wish to speak at length, as there are many others who wish to contribute, and it is important to exchange views and hear from each other. We must ensure that this area of our health budget is not treated as a Cinderella, which has been the case very often in the past. On this side of the Border there are indications, unless we are very determined, that this will happen under the large bureaucracy of the Health Service Executive, which much of the time seems to focus more on meeting budgetary requirements than providing care. There is a danger, especially in this area, that it will be swamped by other demands and pressing needs.

Deputy Rory O'Hanlon is our spokesperson but he has deferred to Senator Mary White who has expressed a special interest in this area.

I thank Deputy O'Hanlon. The delegation is very welcome. I know many of its members from my past involvement in the peace process in the North.

I compliment this committee on the ground-breaking work it did in 2006 in producing its report on suicide. It was an innovative project. I also compliment Deputy Dan Neville of Fine Gael who has singularly spearheaded this issue, which is a very difficult and dark one.

I am a spokesperson on children and older people. When I was involved in my Seanad campaign this year a number of county councillors asked me to take up the issue of suicide which they felt, from their experience on the ground, had reached epidemic proportions.

In 2006 we had 409 registered deaths from suicide. They are the declared ones; we cannot say how many people actually died as a result of suicide as families do not want to admit to it. We had 366 deaths as a result of road traffic accidents yet all the focus and money to date has been on the prevention of road traffic accidents. The budget for the National Office of Suicide Prevention is very small. It is only €4.5 million. We need to get more funding for this office.

From my research to date, I concluded it is not just a question of funding for this organisation, but it is about what local communities can do. I came to this issue cold last September. There are so many opportunities for community groups, residents' associations, clergymen and clergywomen, voluntary groups and active retirement groups to do something to reach out to people in their communities.

The rate of suicide in Ireland is the fifth highest in the EU. It reached a plateau in the past year but there is anecdotal evidence of an increase in suicide among older men, especially as a result of the decline of the traditional way of life in the agricultural community. Creameries, and in many cases cattle marts, are gone, as is the rural pub. From studying this matter in depth in recent months I concluded that there is a need to change the way older people live. Older people cannot just say they will go out a couple of times a week or that their social recreation is to go to the pub. We have stringent drink-driving laws now which we all support. However, the local groups I mentioned must put pressure on older people to engage in a different manner socially. I meet many active retirement groups nationally and tell them to keep going to meetings, on the grounds that they will live longer if they do so. It is all about social intercourse.

I could keep elaborating on this. In 1993 we decriminalised suicide in Ireland and it is only since then that the issue has been on the radar. My bottom line is that there should be a 24-hour emergency helpline service with psychiatrists, nurses and social workers at the other end who will listen and offer advice. They will determine whether the caller is experiencing a short-term social crisis or needs to be hospitalised. In the Republic, the only 24-7 helpline we have is provided by the Samaritans. They listen but do not refer to the medical or other relevant services. It has been proven in the United Kingdom that where the emergency service exists, there has been a decline in suicide. I would like the delegates' opinions on this because I know they have a service in the North similar to that for which I am calling.

Sadly I have learned that many suicides are preventable. The word "suicide" is treated like the word "sex" was 20 years ago in that people are afraid to say it. Depression and mental illness are stigmatised and we must address this. Perceptions are out of date and we must talk about suicide. The bottom line is that many people would not have died had they had somebody to listen to them and offer help. It is not just a question of money but of people in one's community reaching out in new ways to get people out of their homes to meet people.

It gives me great pleasure to invite Ms Iris Robinson to speak to the committee.

Ms Iris Robinson, MLA

On behalf of the members of the Heath, Social Services and Public Safety Committee of the Northern Ireland Assembly, I thank the committee for inviting us today. The meeting has been interesting thus far and I am sure it will remain so.

Our committee has been in existence since last May, at which time devolved government returned to Stormont. This was a very positive step and I supported it wholeheartedly despite some of the negative remarks from some of the media. I am conscious that the Oireachtas Joint Committee on Health and Children has been in existence for an even shorter period, that is, from November. Although both committees are in existence for a relatively short period, ours is already starting to have an impact. Ours, like this one, has identified a number of priorities.

The first priority concerns mental health and learning disability. This area has been described as the Cinderella of the health service and has been neglected badly over many years. The spotlight has been focused on the issue by the publication of the Bamford Review of Mental Health and Learning Disability in Northern Ireland. It is a comprehensive and wide-ranging review that produced ten separate reports on different aspects. The committee is taking a keen interest in how its recommendations will be implemented. I refer not only to securing the necessary resources but also to how the numerous recommendations will be prioritised and put into operation.

The committee considers it can make the greatest impact through committee inquiries. By undertaking an inquiry, the committee can set its own agenda and select an area or issue for detailed examination, and then make strong recommendations to our Minister for Health, Social Services and Public Safety.

The first inquiry focused on health care-associated infections, mainly MRSA. This has caused grave concern among many, particularly those who have gone into hospital, even for minor operations. In September, the committee decided it should put that inquiry on hold for a time while carrying out an urgent inquiry into the growing scourge of suicide, particularly among younger people.

The issue of hospital infections has returned to the glare of publicity in Northern Ireland following an outbreak of clostridium dificile in Antrim Area Hospital. Just last week the committee called in the chief executives of the health trusts to question them on the extent of the outbreak and the actions being taken to tackle it.

On the 24-hour helpline referred to by Senator Mary White, this morning we visited Pieta House, a charitable organisation. This State already has something on its doorstep that should be funded as a mainstream project because it is doing excellent work. In the two years since its establishment, 1,100 people have passed through the doors and not one of those who wanted to engage in self-harm or was contemplating suicide followed through in this regard. This figure alone demonstrates how well the project is doing. The chief executive, Joan Freeman, stated suicide is not just a health issue or political problem but that it is also a community problem. The project needs to be considered with a view to being supported by the Government. I pay tribute to those involved in the Pieta House project.

The committee inquiry into the prevention of suicide and self-harm is the main reason for our visit to Dublin today but I am sure there are many other issues of concern to our two communities. I hope we will have an opportunity to explore some of them today. On our suicide inquiry, we are nearing the end of our evidence-gathering phase and hope to produce a report shortly after Easter. We have received approximately 65 written submissions and have taken oral evidence from a range of organisations, not just those in the field of health. For example, the leaders of the four main churches were before our committee to discuss the role the churches can play in preventing suicide and dealing with bereaved families. Interesting issues arising from that meeting revolved around the training of the clergy and clerical students and how the stigma associated with suicide and mental illness must be tackled. Churches can also play an important role through their work with youth groups, scouts and guides.

Last November we visited Scotland to see what suicide strategy was in place. It was called "Choose Life" and has been in place for a few years, and it is therefore well ahead of that in Northern Ireland. We learned a number of valuable lessons from the Scottish experience. Our visit to Dublin presents an opportunity to hear from the Minister and departmental officials about the Reach Out strategy and its impact to date with a view to comparing it with the action being taken in Northern Ireland. We are aware of the considerable co-operation that exists through the joint cross-Border action plan, which exists at both ministerial and strategic levels to tackle the issues of suicide and self-harm.

One of the main issues for our committee has been examining the level of stakeholder involvement in drawing up and implementing the strategy. There are many family and community groups throughout Northern Ireland working to support vulnerable people and provide support to bereaved families. Our visit to Pieta House in Lucan was very interesting and informative and demonstrated how stakeholders are involved in the Reach Out strategy. Our committee is called the Committee for Health, Social Services and Public Safety, which covers a wide range of issues. I look forward to a fruitful discussion on some of our common issues and hope we can draw on each other's experiences to act in areas of mutual interest, to help those who suffer and need compassion and tender loving care.

I also welcome a fellow Ulster representative, Deputy Dinny McGinley. I will ask one member from each party to speak and will then invite members from Ms Robinson's committee to speak.

I welcome the delegation. Our previous committee visited Scotland and was impressed by the work there, where suicide rates are dropping significantly as they are in other countries. We must quash the notion that there is nothing to be done about it. That is not so. We have seen very effective suicide prevention programmes in Australia, Canada, Scotland and Finland, although the rate remains high there. From 1997 to 2002 suicide in Australia dropped by 27%.

Community involvement is significant in this area but it requires leadership because those who wish to do something do not know how to act. They fear it but could get involved if there was investment and commitment. I am sure if we asked them, the GAA, the FAI and the IRFU would embrace an invitation to help us identify issues surrounding suicide among young people and train some of their leaders, as would other groups and organisations. It is not easy to identify someone who is suicidal. While 500 suicides is too many, a GP might encounter only one every five years on average. There are 30,000 deaths a year in Ireland, of which 500 are caused by suicide. To have the fifth highest rate of youth suicide after countries from the eastern bloc, and Finland, is highly significant and serious. Will the rate drop or will it continue at that level? As the 20 and 30 year olds age, will the rate remain the same? The rate is lower in older groups.

This is not a political issue. I said at a Sinn Féin conference in September that the State has a duty to, and does, respond to the express needs of our people at election time but political parties do not respond to the unexpressed need because they see no return on that. Mental health problems and suicide are an unexpressed need but will hopefully be expressed some day. We see the outcome now of burying unexpressed needs in the 1940s and 1950s. We have a duty to respond to unexpressed needs. The Northern Ireland suicide prevention office has a budget of £3 million. Our service receives €4.5 million, whereas an equivalent fund in terms of population and the exchange rate would be €20 million.

We need to do more to respond to psychiatric illness by ensuring services are available because it is contradictory to alert people to use services that do not exist but we must alert people in order to de-stigmatise the problem. Only then will people feel free to ask me to help their son or daughter who has been waiting four years for psychiatric intervention. We do not hear that at election time or any other time because of the stigma surrounding the problem.

We must also, however, be careful about how the media handle the issue. There are common media guidelines here and in Northern Ireland. I am involved with the Irish Association of Suicidology which is a 32-county organisation. We and the Samaritans have strict media guidelines but the press often does not adhere to these and sensationalises suicide. In Wexford, for example, there was a serious problem and the media showed coffins, families, grief, etc. Several suicides followed and we are always concerned about the copycat issue. The media must discuss suicide. Without its intervention we will not be able to communicate the difficulties or the need, or to tell young people that it is alright not to be alright and to seek help. Many young people suffer minor depression without recognising it. They go on a drinking binge and the problem becomes chronic for a time. That is a serious situation. Education and investment are needed.

The current service in this area is inadequate. Most of the recommendations made in July 2006 were ignored. A total of 96 minor recommendations of Reach Out have been introduced. The first report was published in 1999 containing 82 recommendations, of which only 10% were introduced before there was another Reach Out, which contained most of the recommendations of the 1999 report. Failure to get a political response or of the will to do something is frustrating.

Even today, on the Order of Business in the Dáil, the Tánaiste referred to massive advancements in mental health care in the past 20 years. They did not happen. Patients are still being treated in a hospital built in the 1840s. According to the 1984 report, they should have been gone by 1990. Perhaps these meetings and reports help, but one must invest in resources to change things and put in community-based multidisciplinary teams, as recommended in the 1984 report, that do not exist anywhere in Ireland. Child and adolescent psychiatry is in its infancy here, with only 20 beds. I know a woman who has a 13 year old child who has been in a hospital ward for nine months with patients aged between 50 and 80. We have a great deal of work to do.

My association has significant co-operation with people in Northern Ireland. Roy McClelland, professor of mental health at Queen's University, Belfast, was chairman of the Irish Association of Suicidology. We look forward to working with the delegation over the years.

Ms Michelle O’Neill, MLA

As many members said, we are a small island and we have much to learn from each other. Health inequality knows no boundaries. It is an issue that needs to be tackled on an all-Ireland basis. This morning, we visited Pieta House, a shining example of good community and voluntary work on the ground. If any strategy is going to be successful, it is vital it has community grassroots involvement. Do members believe there is enough tie-in with voluntary community groups on this issue? Do families fit into the whole analysis of the strategy?

On behalf of the Sinn Féin Members, both in the Dáil and the Seanad, I warmly welcome Ms Robinson and the full team from the Assembly. This meeting of the two committees is an important and historic opportunity. It is appropriate to address an issue that knows no political boundaries which we all recognise as an urgent and pressing matter for collective address. Only collectively can we hope to impact on it in any appreciable way.

The report of the former committee entitled, The High Level of Suicide in Irish Society, was referred to by other speakers. It contained one damning statement on the reality of how suicide is addressed in this State. It stated, "The provision of mental health services for adolescents is high on aspiration but low on action".

I was the Deputy referred to by Deputy Neville who raised this matter with the Tánaiste and Minister for Finance on today's the Order of Business. It was against the backdrop of this week's announcement by child and adolescent psychiatric services in counties Cavan and Monaghan advising GPs that, because of the under-resourcing of the service, they will only be able to take emergency referrals for at least the next four months, when it will be reviewed.

Given the population base of the area we need a multidisciplinary team of 22, with three secretaries. Instead, we have 6.5 whole time equivalent posts in place. They cannot cope.

The delegation will later meet with the Minister of State at the Department of Health and Children, Deputy Devins. As an Opposition voice on health and children, I recognise that the Government's stated policy, and one which we have all signed up for, A Vision for Change, is a worthy document. However, the important issue is the manner in which it is worked out in the delivery and resourcing of services. Implementation of the policy is where the real failures are occurring.

This morning we attended a briefing by Bodywhys on the area of child and adolescent eating disorders. If young people are going to have important interventions, then it is hugely important they begin at the earliest opportunity. Self help starts with the GP and the psychiatric services. We have a situation in Cavan-Monaghan where the GPs cannot refer cases except in the most serious situations. Early intervention is suspended.

We need to be honest with each other about the realities with which we are contending. The last health committee spelt it out in clear terms. Deputy Neville referred to attending the conference hosted by my colleague, Gerry Adams, in Stormont last year which he addressed. People of all opinions attended it. I commend Deputy Neville for his role as president of the Irish Association of Suicidology. Michael McGimpsey, the Minister for Health, Social Services and Public Safety, addressed it too and his contribution was equally welcome and important. Out of the meeting came a shared hope and intent to move forward. We need to find the mechanism by which we can do this in a practical way. I hope today's engagement will offer such a vehicle.

I was a member of the now defunct North Eastern Health Board for several years. It was one of those health authorities involved in North-South co-operation on a mental health project — CAWT — for 12 years. One of the areas addressed in common with North-South co-operation was information on suicide prevention. It did not present itself in any great in-depth way but it was the publication of an information brochure for distribution North and South that had a common message clearly understood and appropriate. We need to build on that in real and practical areas of co-operation in order to get the statistics down.

Regarding Deputy Neville's point about the numbers of people who have died from suicide — or as Senator Mary White said, from known suicides — it raises the question as to what is the real figure. On the point about the number in proportion to the overall death rate, I do not believe that is the ratio we need. All suicides must be viewed at least as potentially avoidable deaths. That is the big distinction.

We need to act urgently. This problem is not confined to our island. We need to know it is contagious and epidemic. We do not want to see a scenario occur similar to the recent tragic situation that has arisen in Bridgend on the neighbouring island.

I do not wish to curtail debate but I remind members we have only ten minutes remaining.

Reverend Dr. Robert Coulter, MLA

I thank the committee for hosting us. I believe this is the beginning of something which will be of benefit to all of us. So far as I am concerned, suicide prevention is above all politics of whatever shade. This is something that is vital for our communities. If we have any love for our communities at all, we must make every effort to join together in producing a system that will be of benefit and reduce the number of suicides in our land.

While I endorse and support all that has been said this morning, there is one aspect which has not been touched on. Going back to my earlier life in the church, it is the aspect of families in which there has been a suicide. I have found there is a lingering sense of guilt. While we are putting all our effort into preventing suicide, I feel we must take on board that siblings, the wider family and in particular mothers, suffer. I urge the committee to examine that aspect of the situation and in the round we can achieve something that is worthwhile for our communities.

Like everyone else, I welcome our parliamentary colleagues from Northern Ireland. It is a subject important to all of us on the island.

When Reverend Coulter referred to the church, I was reminded of when I was young that people were afraid of what happened after life which was enough to ensure many people never contemplated suicide. It was rare when I was young. Of those who commit suicide 55% die at the first attempt. I believe that if those who survive that first attempt received help the majority of them would not make another attempt. I have spoken to people who have attempted suicide. One medical colleague in the west of Ireland actually bought a rope. He heard one of his children cry, went into the room to attend to the child and thereafter never attempted it.

I do not want to go over everything that was said because I can identify with the views expressed by all the speakers. However, I want to touch on something Deputy Dan Neville said concerning the question of community and what can be done in that regard. One of the difficulties is that regardless of how good the statutory services are, it is very hard to make contact with them 24 hours a day — and that applies to any statutory service. The fact that defibrillators are being dispersed throughout the country and that community groups are learning to use them is a recognition that no matter how good the State services are, they cannot be everywhere when they are needed. The question of communication within families is very important, where young people with problems can speak to a parent. Teachers, the primary care services, the medical profession, nurses, anyone in the community, can have a role to play in this regard, including the Garda and prison officers because, unfortunately some of these people find themselves in trouble with the law. It is a question of ensuring all have sufficient training in identifying those at risk.

Health promotion should be part of every activity in the community because 50% of illness is self-induced, one way or another. I always recommend to youth groups that they should spend five minutes a month at their meetings discussing some aspect of health promotion. I believe positive mental health is something that is very important and should be part of the school curriculum. It should be pursued by all voluntary sporting and community groups, including the GAA, FAI and IRFU. They should all involve themselves so that communities are better aware of the people who are likely to commit suicide. Again, the people likely to commit suicide will not seek the help of services. They need to talk to somebody who will advise and encourage them to go. I believe this is an area to be explored, apart from the psychiatric and support services at statutory level.

With regard to my colleagues in the north east to whom Deputy Ó Caoláin referred, I have no doubt that if somebody needs a service, irrespective of what level, he or she will find a way of circumventing whatever new rules are brought in by the psychiatric service, and that people will not be left to suffer.

Ms Carmel Hanna, MLA

I take this opportunity to say how pleased I am to be here today. It is very important that we share knowledge and learn from each other, particularly in the area of mental health and suicide. I want to say a few words about the Bamford Review of Mental Health and Learning Disability in Northern Ireland, RMHLDNI. Some of the committee will know Professor Roy McClelland who took over the chairmanship of the review. Our committee has spent much time considering the review. We now have the resources, at least to get us up and running and hopefully implement the review's recommendations. Even with so much fair wind behind us it is an enormous challenge because we are coming from so far behind, in terms of getting things up and running, figuring out the building blocks and working from small pieces.

It should be borne in mind that the whole mental health area is like looking at a map and it is difficult to know where to start. It is important to start on the ground, however, and listen to people. We know this from going out and about in the community and meeting people who have been bereaved. We must first listen to them and realise how important it is for them to talk.

Many of the professionals refer to the importance of the talking therapies. That area is not very developed with us. Deputy Dan Neville mentioned Australia and the need to learn from other places. Sweden is another country where the suicide rate is very low, and one must wonder why.

The changing community values and family structures must also be considered. These questions are part of the wider issue for all of us. Even when Professor McClelland talks about Bamford, he emphasises the importance of the reskilling in team working, a totally different approach in terms of working with the community. The big issue for us is co-ordinating and integrating the statutory, voluntary and community resources, so that they all work together. That seems to be the key.

We are working on some aspects of this problem but it is very difficult to link up all the effort involved, particularly community support. There are so many areas at the community level where people so want to get involved, but leadership is needed to ensure that the resources are complementary, achieving positive outcomes and that there is good value for money as well. Much of this will depend on training and there is much talk about assistance training at different levels. A great deal of work needs to be done towards ensuring that where communities are involved, their efforts are linked into the voluntary and statutory agencies, if positive outcomes are to be achieved and to make a difference. It will make a difference when we see the suicide and self-harm numbers going down.

The statistics for suicide are very high among older people. I am talking about people my own age, say, the over 60s, and those living in rural areas.

I, too, welcome the delegation from the Northern Ireland Assembly. As somebody who was involved in education, I believe this has a significant role to play, particularly in the whole area of health promotion. I would be interested in getting details from the delegation, not necessarily today, about the programmes that are being used in Northern schools from which we might be able to learn. In the north east many of the second level schools are involved in the "Mind yourself" programme, which is very worthwhile for transition year students. It is a ten-week programme, where students look at health promotion and developing strategies towards positive mental health, which is enormously important. It is an unfortunate but sad fact of life that because of altered family structures and the major changes in society, young people often find themselves stressed out and under pressure and believe they have nobody to turn to.

Another initiative in which we were involved was a mentoring system, where senior students counselled their junior colleagues, particularly in first year, where many children who formerly attended, say, a two teacher primary school, would now find themselves at second level and in a year group of 100 or 120. From an educational viewpoint, it is very important that this good work continues, but we need to expand it. In our situation here the social, personal and health education, SPHE, programme is only in place up to junior certificate. We need to look at something for senior students, because they equally face pressures, if not added ones, and they need to be able to deal with them and cope with entry into the world of work and a changing world, where life is not as structured as it is at school and where the difficulties and challenges are increasing with every passing day.

As all members have said, the challenge facing us knows no boundaries. All of us have much to learn and I should be interested in any documentation members of the delegation might have or can forward to me with regard to the educational programmes they are using.

Dr. Kieran Deeny, MLA

Thank you, Chairman. I am delighted to be here. I am in politics because I am a doctor and it is like coming back to where it all started, because I qualified up the road in UCD in 1980. I am still a practising GP and am learning about this issue in my professional job, and not just as a member of a health committee that is very committed to mental health. I was delighted to hear Deputy Neville speak about community and about how we need leadership. In our own committee, we discussed how this is a societal problem. In recent years there were two very tragic suicides in our own practice, involving young people who were not clinically depressed. We were often asked why the depression was not picked up, but both events came from a relationship breakdown.

For a long time suicide has been seen primarily as a mental health issue, to be picked up and dealt with by medical professionals. However, we have seen that is not the case. There is a very dangerous period following a relationship breakdown or a bout of alcoholic excess, when the health services will not get to these people in time. Deputy O'Sullivan correctly pointed out that the old-fashioned method of seeing a GP and being referred to a waiting list is just not acceptable.

I was very impressed with this morning's visit to Pieta House. The witnesses talked about how they deal with each of the patients on the physical, emotional and spiritual levels. The setting was not in the old style psychiatric hospital outpatient department, which is a very threatening and unwelcome situation. Patients have told me in the past that they were often worse coming out of such a setting than they were going in. In this case, we had a very welcoming setting.

References were also made to problems being solution centred, which is important. Rather than just listening to people, we need to be able to find solutions to their problems. Some of these problems have been mentioned already, such as the life events that occurred to people who were not clinically depressed but who could not cope. The question is about how to get to them during this very dangerous period. Talking therapy is very important and we need to have a system in both our countries where we can pick these vulnerable people up at that particular time.

I worked in an out-of-hours centre in my own area for a while, and we involved a community psychiatric nurse with us, so we could have psychiatric backup 24 hours a day. The issue is about getting to those people. If they need further psychotherapy or any other help with their health, then that can be arranged. However, it is about carrying them through a dangerous period after a certain life event with which they cannot cope. The first thing we often hear is that they have ended their life. I have certainly learned a lot from today and I hope to learn more.

I think the Reverend put his finger on the button when he said it was about family, community and church. It is not about the colour of our party or the colour of our skin, but about human beings. Prior to being elected to the Dáil last year, I was involved in youth work for a long time. We could actually pinpoint some young children as being those who were never going to reach their 20th birthday. Unfortunately, many of them passed on, often through suicide and drug addiction.

Ms Robinson correctly pointed out that it is about small projects in communities that are accessible on the ground. This is particularly the case with voluntary youth work in situations where a young person might be on the edge on any given evening, but there is nothing out there. That was certainly the case 30 years ago, but it has improved a little since. There is a project in England called YAP, or Young Action Project. There is one similar project in Ireland, but there are quite a few of them in England. These projects bring in the most vulnerable people in the community. They have a beginning, middle and end and when they leave after a couple of weeks they are different people. I have met some of them who participated in the project we have in Ireland. It is a very positive way to change young people's lives and it gives them a new identification with who they are and where they are going.

I welcome this morning's meeting. As someone who is still involved in the local community, I feel that suicide must be tackled at grassroots level. Much suicide is due to people living in very deprived areas with very poor social housing and a lack of early intervention in education. I am here in place of Deputy James Reilly, whose answers may have been more eloquent than mine.

Not at all. We all welcome Deputy Byrne's contribution. Before we finish, I would also like to say a word of thanks. The last committee published its report only two or three years ago. The 33 recommendations within that report should be borne in mind, because it is clearly nonsense for people to talk about an old report when it is far from that. I was delighted to chair that committee and was ably assisted by my colleagues from this committee.

One very important aspect was touched upon by Ms O'Neill, namely, the involvement of the community. Every group that comes before our committee wants to do something about the problem, but they always feel that it is not targeted properly and that is where our problems begin. Of all the issues that came out of the report, one simple target is that we should be able to reduce the incidence of suicide in this State by 20%. That is the most important target. It might be unrealistic but I am delighted to see that Deputy Neville is saying that is not the case. However, the report stated that we could achieve that figure if we adopted a targeted approach, as has been done in Scotland and has been the root cause of success there.

I noted from Ms Robinson's contribution that her committee's report will be ready by Easter. I am delighted to hear that her committee has had 65 submissions. We had a similar number of submissions from professionals and families involved. I do not know the protocol for my suggestion, but I would like to see a situation arise where three members of this committee could sit with three members of Ms Robinson's committee after her report is published. We could see whether our recommendations are similar to the recommendations in her report. If they are similar, then what we are about on this island would be all the one. It is important to see if that is the case.

I thank the committee members from Northern Ireland for attending. We have all made our contributions and we recognise that there are other issues as well, such as waiting lists, accident and emergency departments, MRSA and so on. These issues have clearly affected both sides of the island. We would like to meet with Ms Robinson's committee on a more regular basis. I will not even say that we are postponing our next meeting, but rather that we are adjourning until the next meeting.

Senator Frances Fitzgerald thanked me for organising this meeting, but as we know Ms Áine Breathnach and her staff are the people who do all of the work. We feel that we can learn a lot from our counterparts on the Northern Ireland committee and I am sure they can learn from us as well. We hope that we can get together informally to work out how we get together more often, how we organise specific agendas and hopefully each year report back to this committee on what we have achieved and the targets we are setting.

It is important to believe that we can reduce the incidence of suicide. It is up to us to put the methods in place. If we are seen to work together on this specific issue, I am certain it will give hope to many on the island that people are getting together to recognise the great difficulties that exist. I will allow Senator Mary White to speak before we finish. I will then call on the chairperson to wind up the meeting.

The National Office for Suicide Prevention has set a of target of a 10% reduction by 2010, so it will be interesting to see what happens. It is a short time away but it is important it has agreed to set that target.

I have organised a conference on suicide prevention for Friday and Saturday of this week. Among the speakers will be Deputy Dan Neville. As noted by Reverend Coulter, this issue is beyond party affiliation. The National Office for Suicide Prevention and the North Clondalkin Action Group Against Suicide, a local community group in west Dublin which came together because of the suicides in its area, will speak tomorrow night. I will provide the witnesses with a programme.

It is my pleasure to invite the chairperson, Ms Robinson, to wrap up the meeting.

Ms Iris Robinson, MLA

I thank everyone who has contributed. As the Chairman says, this is only the beginning and we will learn much from one another. We must always bear in mind that life is precious and we must value it. The targets are aimed at turning people away from death. We must remember that targets are human beings. It is about turning them around from thinking that life is not worth living to valuing life. The three areas pinpointed by the Pieta organisation, the physical, the emotional and the spiritual, are what we need to examine, along with community involvement.

I thank the committee for the opportunity to meet with it and look forward to a more informal gathering at lunch. I would be very disappointed if, having produced this document, little of it is run with. I hope that when we get to the point of preparing our report to give to our health Minister, we will not be sitting back — I do not mean this committee is doing so — or accepting a small percentage of rollout of any suggestions we will make. We will certainly sit on our Minister's case and watch vigilantly to ensure whatever recommendations we make will be enacted for the good of all the people of Northern Ireland. That is the approach we would all take.

There is goodwill out there to make progress on mental health and all the related issues around it, such as anorexia and bullying, which can trigger so many people into thinking the only way out is to take their lives. I hope we can all make a difference in the end in terms of the proposals we will bring forward after Easter.

I thank the Chairman. Before I finish, I wish to make a small presentation on behalf of the Northern Ireland Assembly. It is a beautiful print of our Assembly. It gives me great pleasure on behalf of the committee to present it to the Chairman.

I thank Ms Robinson. It is much appreciated.

The joint committee adjourned at 1.15 p.m. until 3 p.m. on Tuesday, 26 February 2008.
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