"Reach Out" — A National Strategy on Suicide Prevention — was launched in September 2005 and one of the key priorities of the Strategy is the development of an effective service response for people who have engaged in deliberate self harm. The Strategy acknowledged that a history of one or more acts of deliberate self harm is the strongest predictor of future suicidal behaviour, both non-fatal and fatal. It recognised that there was a need to develop support services in the hospital setting and also to develop active outreach for those who do not currently access services.
Following the launch of the Strategy, the Health Service Executive established the National Office for Suicide Prevention (NOSP) to oversee the implementation of the Strategy. This Office coordinates suicide prevention activities across the State and will consult widely in relation to the planning of future initiatives and will work to ensure best practice in suicide prevention.
At the end of 2004, 24 A&E Departments had a crisis nurse response to incidents of deliberate self harm (DSH). In recognition that the speedy follow-up at home or in a day/out patient setting can reduce the rate of DSH, there has been further investment in this service through the NOSP in 2005 and 2006 and it is now expected that the service will be extended to all A&E Departments by the end of this year. Most DSH staff work in A&E Departments but receive professional support from the local mental health services. As liaison mental health services develop DSH staff will become part of the multidisciplinary liaison mental health teams.
Liaison services intervene in A&E departments where the presentation of suicidal behaviour and substance abuse requires expert assessment and management. The main benefits of liaison mental health services are the identification and treatment of mental health problems in the general medical and A&E settings. "A Vision for Change" acknowledges gaps in the current provision of liaison mental health services and makes several recommendations for the further improvement of these services.
The Report states that every acute admitting hospital in Ireland should have access to liaison mental health services. The number of teams required will depend on the volume and type of workload. In addition to the existing nine teams operating in general hospitals, the Report recommends that a further four mental health liaison teams be established nationally, to result in a complement of one liaison mental health team per regional hospital.
In relation to child and adolescents liaison mental health services, the Report recommends that complete multidisciplinary liaison mental health teams should be established in the three national children's hospitals. It also recommends that liaison child and adolescent mental health services should be provided by a designated child and adolescent Community Mental Health Team, one per 300,000 population.
The Government has accepted the Expert's Group report as the basis for the future development of our mental health services. In this connection, an additional €25m was made available this year to the Health Service Executive for the further enhancement of our mental health services. A further €1.2m was provided for suicide and DSH prevention.
