I thank all contributors to this debate. Suicide is an issue about which we can never speak enough given the low base from which we come in terms of public understanding and our ability as a people to speak about issues of emotional distress. Our belief that emotional distress and mental well-being are not part of the entire person or human condition is unique. They are clearly part of the human condition. We have no difficulty in acknowledging our ability to solve unique problems in the world — we shine at that — but we have huge difficulty talking about the distress we sometimes experience. I am conscious of John's recent demise and the importance of the language used around this issue. We have an inability to define what causes us mental and emotional distress. We find defining ourselves difficult.
Many issues have been highlighted during this debate, including that there is no one cause or trigger of suicide. However, we must remain conscious that, as sensitive human beings, anything can trigger or cause a person to commit suicide. We must be prepared to be the nosy neighbour and to step in and ask people if everything is alright, when we perceive them to be in distress or experiencing difficulty. I agree with the comment that governments alone cannot solve this problem. It is a societal issue. We must be conscious that people sometimes find themselves in distress and we must be able to step up and ask them if there is anything we can do to relieve that distress. When one finds people respond in a way that confirms one's suspicions, one must then be able to point them in the direction in which a service is available. The additional €35 million that has been ring-fenced in this respect will flesh out the community psychiatric teams and put in place the psychological and straightforward counselling services to which a GP will be able to refer. In this regard, GPs will be key as they are the medical professionals within the community who everyone first approaches. A total of 90% of all those with mental illnesses approach their GP in the first instance. Heretofore, GPs have had two options, namely, to prescribe or to send someone to the acute unit, but this is not the point at which we should be. While psychiatrists may not like it if I suggest the last person in front of whom one should find oneself is a psychiatrist, that is the case. There should be many steps in between because not everyone needs such intensive treatment. Some simply wish to talk to someone and although others will need a little more, that is what this is about.
The Government is putting in place nurses within the community. There will be two in each of the 17 health board areas who will have specific responsibility for dealing with those who present with suicidal tendencies or self-harm. They will act as roving nurses who will travel to particular GP practices, as well as dealing with accident and emergency departments. It should be noted that each year 12,000 people present themselves at accident and emergency units having self-harmed. Moreover, this is the tip of the iceberg as I am informed that at least a further 60,000 do not present at all despite having self-harmed. We must move away from current perceptions on what constitutes self-harm. When I first thought about the issue, I thought of overdosing and a person cutting himelf or herself. Are people who drink to excess not self-harming? This possibility should be considered.
I recently visited an incredible service in Wexford where the big old psychiatric hospital is being closed down and the very few who still remain are determined to get out of it, even though there was resistance to this at the outset. Familiarity is comforting for all of us. There is a familiarity about working in an environment for 28 or 30 years and one is reluctant to move on. However, those who remain now wish and need to move on.
This process is about day hospitals and people's ability to walk in. It is about being able to pick up the telephone to contact a GP in the middle of the night when something serious happens and about that GP referring someone to the 24 hour service. In this context, the Government in still in consultations with the mobile providers. Heretofore, providers of listening services such as Samaritans, Console and similar organisations operated a landline-based service for which Eircom used to pick up the tab. Most distress calls are now made with mobile phones, for which there are five service providers in the State. The Government is engaged in negotiations to ensure this service also will be free. The negotiations are almost complete and dedicated numbers such as the 112 and 123 numbers which will have a specific purpose will be made available.
Above all else, we must begin to examine seriously what children are being taught about emotional health. I have four grandchildren, two of whom are grandsons who are at an age at which one can communicate with them. One could joke that as they are boys, it is uncertain whether one will ever be able to communicate with them properly. To be serious, however, from a very young age, they said things like, "You have hurt my heart," or, "You have hurt my feelings." Consequently, it is not as though one cannot communicate what feelings are with very young children as one can; it simply needs to be appropriate. In this context, we must begin to consider how we can begin this process. It should take place in primary school. Why should we wait until young people are 12 or 13 years old, even though they all develop at a different pace, to begin to talk to them about feelings, emotions and bullying? If we are to introduce such education, we must start very early and ensure it continues right into third level and beyond. The Government is working on these matters and a working group is giving them serious consideration. I hope to have such an education programme developed because people do not live in separate boxes and suddenly develop emotional distress. Although I am told that adolescence is usually the time when psychosis begins to develop, this is only because it is the time when it is visible and becomes evident. People are emotional beings and we need to begin looking at life in the round. We must consider the whole and how well we keep ourselves from a young age to when we become older.
As for the 400 posts the Government has managed to secure, I note that for the two previous years 100 posts were allocated in each. Some of them were filled in the first year, but thereafter there was a pause by the HSE. I do not blame the HSE for this as it simply reflected the times and apportioning blame is a futile exercise in such matters. We now have 400 posts that will not be subjected to a pause in respect of community teams, counselling, psychology services and so on. Moreover, the Government will put in place a director, or a directorate, of mental health. I am a great believer in ensuring that when one does something, one should not be obliged to do it twice. When that person is put in place, he or she will have control of the figure of €35 million and, I hope, in the future complete and total control of the entire budget for mental health services.
I am conscious that not everyone who dies by suicide has mental health issues. I am conscious that there are other issues and that this is a multifaceted problem. However, while meeting people as I travel around the country, one aspect I have noticed is the isolation felt in respect of mental health. Institutions are located on the outskirts of towns and usually isolated. While they are usually beautiful buildings, they are isolated. The director must bring mental health issues into the mainstream. Dealing with mental health issues must be as commonplace as dealing with kidney stones and should become part and parcel of what we are. That is what must happen and what I hope the aforementioned director will do.
Within the strategy set out in A Vision for Change there is an entire programme on suicide entitled, Reach Out, which is under constant evaluation. A working group of individuals who engage in research in, and have expertise of, this area are constantly engaged in updating and upskilling. Moreover, they make constant contributions in considering what must be done next in terms of what did not work and what will. We must be more focused because a message that will work for those aged between 15 and 19 years will not work for those aged between 35 and 45. Consequently, concentration on the focus of the message is required.
I take great heart from the fact that we have in a very short period become far more open on this subject. The only thing that really matters in the context of an issue which needs to be aired is ensuring the light is allowed to shine on it. Senators have my commitment that this will be the case.
