I welcome this opportunity to make a statement concerning the level of suicide in Irish society. As we are all aware, suicide is a serious social problem. The number of deaths in Ireland attributed to suicide in 2001 was 448. This represents an increase of 35 on the 2000 figure of 413. However, the high incidence of suicide in the general population is not confined to Ireland; it is a growing global problem. A disturbing feature is the male suicide rate, which accounted for 79% of deaths from suicide in 2001. In particular, young males and older males aged 65 years and over have shown an increase in the rate of suicide. These are trends which require further research so that strategies can be developed to help people who are particularly at risk.
When the incidence of suicide began to increase in the early 1990s, my Department became aware of the need for reliable and concrete information on which to build a national strategy to address the growing problem of suicide in Ireland. The national task force on suicide was established in 1995 to address the growing prevalence of suicide in Irish society. The task force comprised 15 individuals from a range of backgrounds, including the coroner services, the Garda Síochána, nursing, psychiatry, psychology, public health and voluntary organisations.
In September 1996, the task force published its interim report, which contained a detailed analysis of statistics related to suicide and attempted suicide in Ireland and a preliminary analysis into the factors that could be associated with suicidal behaviour. The final report of the task force was published in January 1998 and marked the completion of a detailed examination of the incidence of suicide and attempted suicide and outlined a comprehensive strategy to reduce their incidence in Ireland. The report outlined 79 areas where interventions should be targeted to reduce suicide levels. This highlights the complexity of the issue of suicide prevention – there are no simple solutions. The report also identified the various authorities with jurisdiction in suicide prevention strategies and their respective responsibilities.
One of the key components of the overall strategy aimed at reducing the number of suicides includes the implementation of measures aimed at high-risk groups, provision of information and training in suicide prevention for relevant professionals and organisations and the improvement of services which would benefit those at risk of suicide and those who attempt suicide. Health boards in particular have a major role to play in co-ordinating efforts to help reduce the level of suicide and attempted suicide. Resource officers have been appointed in all health boards with specific responsibility for implementing the task force's recommendations. Their responsibilities include the recruitment of additional staff, the provision of staff training in risk assessment, production of information literature and events aimed at raising public awareness of suicide and parasuicide.
Within the mental health services provided by the health boards, support on an out-patient and, if appropriate, in-patient basis is provided for patients with suicidal tendencies. The mental health multidisciplinary team in liaison with the person's general practitioner closely monitors those who are chronically suicidal. Active intervention takes place when crises occur.
Preventing suicide means influencing, in a corrective and constructive way, a person's development and his or her own resources at different phases of life. Adolescence is traditionally viewed as a time of profound change when young people make the transition to adulthood. This transition is not easy and for many young people is accompanied by levels of self-doubt, fear and stress. An important aspect of suicide prevention for young people will be the promotion of self-esteem and self-confidence and ensuring they develop personal and social skills. Children and young people often need support in gaining control over their lives and coping with their problems.
An important aspect of suicide prevention has been the establishment by the chief executive officers of the health boards of a national suicide review group, membership of which includes experts in mental health, public health and research. Its main responsibilities are to review ongoing trends in suicide and parasuicide, co-ordinate research into suicide and make appropriate recommendations to the health boards. A researcher has been appointed to the group to collate existing research materials, both national and international, examine the effectiveness of intervention programmes and liaise with local co-ordinators in each of the health boards.
A proposal to develop and implement a national policy framework for suicide prevention has been developed by the national suicide review group and submitted to the health boards executive for review. It is important to stress that this proposed strategy will be action based from the outset as it will build on existing policy vis-à-vis the final report of the national task force on suicide published in 1998. Furthermore, ongoing strategies and prevention programmes across the health boards are continuously reviewed by the national suicide review group and routinely reported in its annual reports. This report meets the requirement of the Health (Miscellaneous Provisions) Act 2001, which provides that the Minister for Health and Children will make a report each year to each House of the Oireachtas on the measures taken by health boards in the preceding year to address the problem of suicide.
The Department also allocates funding, through the national suicide review group, for voluntary and statutory groups engaged in prevention initiatives, many of which are aimed at improving the mental health of the younger age groups. These projects include life skills courses for high-risk youths, school-based personal development modules and mental health promotion campaigns. A number of these projects have been positively evaluated and proven to enhance the coping skills of the participants. It is anticipated that such campaigns will lead to a reduction in youth suicidal behaviour over time.
In order to reduce the number of suicides it is essential that those undergoing life crises should get appropriate support. Expenditure on suicide prevention programmes has increased significantly in recent years. The Department has given special attention to the resourcing of suicide prevention initiatives in recent years and the level of funding being provided by it for suicide prevention is now more than 20 times what it was in 1999. It is important to bear in mind that additional funding allocated to a service in one year becomes part of the baseline funding for the service in subsequent years. Since the publication of the report of the task force on suicide in 1998, a cumulative total of over €13 million has been provided towards suicide prevention and research aimed at improving understanding of the issue.
These figures do not include funding provided by other Departments such as the Departments of Education and Science, the Environment and Local Government and Justice, Equality and Law Reform which were identified in the report of the national task force on suicide as having a role to play in suicide prevention. The health strategy, Quality and Fairness – A Health System for You, includes a commitment to intensify the existing suicide prevention programmes in the coming years. The Government is fully committed to ensuring further investment takes place in this area. Additional funding has been allocated this year to the Irish Association of Suicidology, an organisation concerned with raising public awareness of suicide prevention issues.
Additional funding has also been allocated to the National Suicide Research Foundation, a multidisciplinary research centre which informs health service developments and policy formulation. The late Dr. Michael J. Kelleher founded the foundation in January 1995. It consists of a multidisciplinary research team with contributions from a broad range of disciplines, including psychology, psychiatry and sociology. Its primary aims are to define the true extent of the problem of suicidal behaviour in Ireland; identify and measure the factors that induce and protect against suicidal behaviour; and develop strategies aimed at preventing suicidal behaviour.
The bulk of the foundation's work to date has involved the monitoring of parasuicide. On a yearly basis data relating to every suicide and undetermined death registered in Ireland are sent to the foundation by the Central Statistics Office which are analysed so as to produce up-to-date age-specific and age-standardised rates with respect to demographic variables. These statistics are also provided in response to the numerous requests the foundation receives from professional bodies, students and the public for information relating to suicide.
I am aware that due to the foundation's reputation for high quality research, it has been invited to participate in several important international studies, among them the WHO-Euro multicentre study of parasuicide. International studies have found parasuicide to be one of the most significant risk factors associated with suicide. Those who engage in parasuicide are 20 times more likely to eventually kill themselves. Studies have shown that at least one third of all suicides have a history of parasuicide.
The association has launched the national parasuicide registry. This important project is being undertaken by the foundation with funding from the Department. The national parasuicide registry provides information on the general characteristics of those who attempt suicide. It will provide better knowledge of suicidal behaviour and specify trends in parasuicide over time and in the different regions of the country. The analysis of this general information will be useful in the development of policies and the implementation of measures aimed at preventing suicide. The registry will also be useful in the allocation of resources. It will help identify groups which are particularly vulnerable and assist health boards to evaluate the impact of the preventive and clinical services being provided.
The task force report recommended that steps be taken to make the mental health services more accessible to the public, particularly young people. Concern was also expressed at the risk of suicide in older people. In this regard, significant additional funding has been made available to further develop consultant-led child and adolescent psychiatry and psychiatry of later life services to assist in the early identification of suicidal behaviour and provide the necessary support and treatment for individuals at risk. The level of capital funding made available for the development of community based mental health facilities has increased significantly in recent years and community services such as home nursing, day centres, family support, hostels and day hospitals will continue to be developed in order to make services more accessible to people who may be at risk.
A suicide is a tragic and shattering occurrence that not only brings a life to an untimely end but also has a devastating impact on family and friends. We need to do all we can to make it as easy as possible for those bereaved by suicide to confront and deal with the situation in order that they can learn to get on with their lives. The national suicide bereavement support network, established in 1998, supports those bereaved by suicide by providing them with information on the availability of support groups and counselling services in their local area. This information is essential for those in need of support to enable them to cope with this tragic situation. It will help those finding it difficult to grieve. The people concerned are particularly vulnerable as it is impossible to move on without grieving.
Priority is being given to education awareness and promoting a better understanding among the public towards mental health. We are all aware of the pressures on young people such as bullying, emotional distress, addictions, peer pressure and examination pressure. We tend to think that people are weak if they suffer from anxiety, depression inability to cope or have suicidal tendencies but it is widely acknowledged that one in four women and one in ten men will experience depression during their lifetime. Many are successful people, role models and celebrities.
There is a growing awareness and concern among the community about mental health matters. The national health promotion strategy 2000-05, in conjunction with the new health strategy, Quality and Fairness, sees mental health as being equally as important as physical health in the overall wellbeing of a person. Increasingly, mental health is being recognised as a major challenge facing health services in the 21st century. My Department recognises the need for positive mental health promotion. Mental health promotion is a broad concept as it emphasises the promotion of the psychological health and wellbeing of individuals, families and communities. It is a key task of the health services, not just to treat mental illness but, more importantly and using the principles of health promotion, also to try to improve the mental health of the population.
I emphasise the importance of voluntary organisations in supporting and promoting positive mental health among the population. My Department is fully committed to working with voluntary groups to promote positive mental health among third level students. Close links between the mental health services and voluntary organisations are of the utmost importance and every health board has a development officer who liases between the statutory health services and the local mental health associations to provide an integrated and comprehensive service. Also, the health promotion unit of my Department funds and supports in a variety of ways the efforts of mental health organisations such as Mental Health Ireland, AWARE, Schizophrenia Ireland and GROW. We recently supported the production of "a resource manual for mental health promotion and suicide prevention in third level institutions" jointly produced by Trinity College Dublin and the Northern Area Health Board which will be available to all third level institutions.
There are also numerous regional initiatives being run by the health boards in conjunction with non-statutory organisations which focus on mental health issues such as stress management, depression, stigma reduction and suicide related matters. These are issues of paramount importance which require further attention to ensure positive mental health and the well-being of people is promoted.
The Government shares the public concern about the level of suicide. It is a worrying trend. We are fully committed to the further implementation of suicide prevention initiatives and the further development of mental health services in order to prevent any further premature loss of life.