Adjournment Matters. - Suicide Preventive Programme.

I welcome the Minister but am disappointed the Minister for Health did not see fit to take this matter because it is a very important issue of health. During the many years of debates in this House on the decriminalising of suicide, I constantly laboured the point that suicide is a public health issue and not a crime. In most European countries it ranks among the ten most frequent causes of death. In 1992 there were 354 official deaths from suicide in Ireland, the highest ever recorded. The suicide rate has increased dramatically since the early 1960s, particularly among the young. The purpose of raising this matter on the Adjournment is to call on the Minister for Health and the Government to identify suicide as a public health issue and to introduce suicide preventive programmes.

The British Government in its Health of the Nation paper has set two targets on suicide prevention — to reduce the suicide rate by 15 per cent among the general population and by 33 per cent among severely mentally ill people by the year 2000. The World Health Organisation has set the target of reversing by the year 2000 the current rising trend in suicide and attempted suicide in Europe. The WHO has called on all member states to take steps to develop national programmes for the prevention of suicide, establish national co-ordinating committees, promote the co-ordination of current research and stimulate further research. I call on the Government to respond to the WHO request.

Two approaches to preventive programmes are suggested by international experts. The first of these is the population approach whereby an attempt is made to reduce the prevalence of a risk factor for suicide for the whole population. The second approach is to concentrate primarily on high risk individuals. The difficulty with the second approach is the identification of such individuals. Also, the factors which prevent suicide in high risk individuals must be understood before they can be used to combat such risk. Suicide preventive programmes should be directed at the general population and individuals thought to be at high risk of suicide.

The most strongly associated risk factor for suicide is a diagnosis of psychiatric illness, as more than 90 per cent of suicides have suffered from mental illness at some time. The most common illnesses appear to be depression, alcoholism and schizophrenia. Depression is the most common psychiatric disorder. Thus, an important aspect of a suicide prevention programme is the recognition, prevention and treatment of depression.

It is well known that socio-demographic factors such as age, sex, marital status, employment status, living alone and social and cultural attitudes influence suicide rates. Employment opportunity has a considerable effect. Those most at risk are those whose employment has become insecure, with a real threat of redundancy, and those recently experiencing unemployment.

Access to means of suicide is regarded as a risk factor. In the UK, between the late 1950s and early 1970s, the incidence of suicide by domestic gas poisoning declined rapidly following the reduction in the carbon monoxide content of domestic gas. The availability of firearms is another factor which may influence suicide levels. Some studies have found that a reduction in availability has reduced the incidence of suicide.

I would say to the Minister that I have ten minutes in which to make my contribution.

We can discontinue it now if the Minister so wishes.

I have to be in the Dáil for a vote at 8.30 p.m. Does the Senator wish to speak for ten minutes? I am just asking, because my reply will take about four minutes.

My understanding is that I have ten minutes in which to speak on this matter.

An Leas-Chathaoirleach

The Senator must conclude by 8.27 p.m.

It has been pointed out that the prescription of drugs such as tricyclic anti-depressants, which are toxic in overdose, may possibly increase the incidence of suicide by being readily available to potentially suicidal patients. Tricyclic anti-depressants are regularly prescribed to depressed and potentially suicidal patients, which is an area of great concern. There is an onus on doctors to exercise caution in the prescription of those potentially toxic drugs to potentially suicidal patients and consideration should be given to the newer generation of anti-depressants, such as SSRIs, which are thought to be not toxic in overdose and can be equally effective.

It is well recognised that following parasuicide there is a significant risk of eventual suicide, with 1 per cent of adults who die by suicide doing so within a year of a suicide attempt. Thus the parasuicide group is a high risk group for suicide. Despite these theories, as yet there is no clear evidence of the best way of preventing repetition of the parasuicidal act or suicide among this group.

Prior to the establishment of a suicide prevention programme, its targets or objectives must be formulated and clearly stated. These should be formulated by a multi-disciplinary working party and must be realistic. A second prerequisite is funding. Adequate funding should be provided to establish and maintain a programme.

Education has a vital role in suicide prevention and educational programmes must be directed at both the general public and health professionals. In Ireland particularly there remains a stigma associated with suicide which can only be reduced by freely providing information and discussing the topic. The recent decriminalising of suicide will contribute greatly to reducing the stigma. AWARE, the voluntary organisation operating in Ireland since the mid 1980s, has made a major contribution in educating the general public in the area.

If a national suicide prevention programme is to be established, contributions will be required from a wide range of disciplines, including the medical, social, legal and political ones. Good communications and pooling of information and resources will be vital. The collection of accurate suicide mortality statistics and ongoing research into suicide will provide the way forward in suicide prevention.

To deal with the problem of suicide the Government must acknowledge that a major problem exists which requires urgent attention. We must identify those at risk. The Samaritans have provided a valuable list of suicide risks, signs to look out for and action which could help to save lives. Those most at risk are those recently bereaved or experiencing the trauma of the break-up of a relationship or violence in the home. At risk are those who are suffering from a downturn in health, employment or finances; those who have a painful or disabling illness or dependency on drugs or alcohol and also those who have experienced a suicide in their family or by a friend.

The signs which can identify that a person is suicidal include being withdrawn and finding it difficult to relate to others, talking about suicide or death, putting affairs in order or giving away valued possessions, experiencing feelings of failure or lack of self-esteem, dwelling on problems which may have no solution and attempting suicide or self injury, however tentatively.

My objective is to initiate and call on the Government to commence a suicide prevention programme and I hope that I have made my case. I am disappointed that the Minister for Health is not here to reply.

I appreciate the Senator's contribution to this matter. Around the world many thousands of people end their lives through suicide and thousands more make nonfatal suicide attempts, that is, perform parasuicidal acts. Suicide is probably the most personal act anyone can perform. Few acts have such deep roots in social and human conditions or such far reaching consequences. Suicide not only affects the person's immediate social circle but also the local and wider community in which the individual lives. The Green Paper on Mental Health, which was launched in June 1992, discussed the challenge of promoting mental health and the prevention of suicide. The Green Paper outlines the role which mental health personnel can play in the prevention of suicide and emphasises the important contribution of voluntary bodies.

The number of reported suicides and parasuicides in Ireland has increased over the past 20 years and the number of reported deaths for 1992 was 354. The factors giving rise to suicide in society have been the subject of debate for many years. Changes in the fabric of society, depression and social isolation are factors which can contribute to individual distress.

Investigation and detailed research into the causes of suicide has not been easy at national and international level. In the past there has been an understandable reluctance to complete accurate data on the frequency and pattern of suicide. It is clear, however, that reliable information on the occurrence of suicidal behaviour is essential if help is to be made available to those considered to be at risk of suicide.

I believe that the traditional public custom of regarding suicide as a taboo subject can be altered. In recognition of the need for future research and development on the factors which lead people to take their own lives and into the most effective way of intervening to prevent premature loss of life, the Department of Health is contributing towards the costs of a pilot project on attempted suicide in Cork to be carried out by the staff of the Southern Health Board. The aim of this project is to reduce the occurrence of parasuicide and to develop intervention skills which may be applied in this area.

The Department of Health is also providing financial support towards the cost of the Fifth European Symposium on Suicide and Self-poisoning which will take place in University College, Cork, from 31 August to 3 September of this year. This symposium will involve the attendance of between 200 and 300 researchers from all over Europe — people working towards a better understanding of and the prevention of suicide and suicidal behaviour.

Along with research and development, it is also important to look at the services which are already in place and at ways of improving and making services more accessible and user friendly. I am glad to say that the development of psychiatric services in line with the aims of Planning for the Future— a service which is comprehensive, community oriented, sector based and integrated with other health services — has led in a short time span to a position where there is a greater level of understanding and public tolerance of psychiatric illness.

The World Health Organisation has recommended action to reverse the rising trend in suicide by the year 2000. It highlights the importance of early detection and treatment of depression, alcoholism and schizophrenia. It suggests the need for improvements in the underlying societal factors which put a strain on the individual, such as family stress, social isolation of elderly people living alone and failure at school. It emphasises the need to develop the individual's ability to cope with events of life and provide a better network of social support.

The ability of people to cope with life is a crucial factor in preventing and managing mental illness. Health boards are already involved in a number of ways in promoting better coping skills through parenting programmes, pre-school play-groups, life skills education in schools, alcohol and drug awareness programmes and social support for elderly people living alone. The health strategy, Shaping a Healthier Future, recognises the importance of health promotion, including the promotion of mental health. Over the next four years the health services will continue to support and provide programmes to promote mental health and prevent suicide.

The Seanad adjourned at 8.30 p.m. until 2.30 p.m. on Wednesday, 1 June 1994.