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Seanad Éireann - Volume 141 - 15 February, 1995

Adjournment Matters. - Suicide Prevention.

An Cathaoirleach: I welcome the Minister.

Mr. Neville: I welcome the Minister and thank him for taking this Adjournment debate. I wish to share my time with Senator Henry.

An Cathaoirleach: Is that agreed? Agreed.

Mr. Neville: The suicide rate has increased dramatically in Ireland since the early 1960s, particularly among the young. 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. Those most at risk are young men aged between 15 and 34 years, in particular young farmers and people living in rural areas. The distressed young person today is more likely to consider suicide as a solution than a similar young person was 30 years ago. The purpose of raising the [1993] matter on the Adjournment is to ask the Minister for Health to identify suicide as a public health issue and introduce measures to assist in the prevention and reduction of suicides in Ireland.

The British Government in its Health of the Nation paper has set two targets for 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 a target of reversing by the same year the current rising trends in suicide and attempted suicide. It has called on all member States to take steps to develop national programmes for the prevention of suicide, to establish national co-ordinating committees, to promote the co-ordination of current research and to stimulate further research.

Two approaches to preventative programmes are suggested by international experts. The first of these is the population approach where an attempt is made to reduce the prevalence of suicide risk factors for the whole population. The second approach is to concentrate primarily on high risk individuals, but the difficulty is in identifying them. In addition, the factors present in high risk individuals must be understood before they can be used to combat such risk.

Suicide preventative programmes should be directed at the general population and at individuals thought to be at risk of suicide. The most strongly associated risk factor in suicide is the diagnosis of psychiatric illness as more than 90 per cent of suicides have suffered at some time from mental illness, the most common of which appear to be depression, alcoholism and schizophrenia. Since depression is the most common psychiatric disorder, an important aspect of any suicide prevention programme would involve its recognition, prevention and treatment.

It is well know that suicide rates are influenced by socio-demographic factors such as age, sex, marital status, employment status, social and cultural attitudes, and whether people are living [1994] alone. Employment opportunity also has a considerable effect because those most at risk are people whose employment has become insecure and where there is a real threat of redundancy, or they have recently become unemployed.

Access to the means of suicide is also regarded as a risk factor. Between the late 1950s and early 1970s the incidence of suicide by domestic gas poisoning in the UK 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, and some studies have found that a reduction in their availability has reduced the incidence of suicide.

It has been pointed out that the prescription of drugs such as tricyclic anti-depressants, which are toxic in overdose, may have possibly increased the incidence of suicide by being readily available to potentially suicidal patients. Since tricyclic anti-depressants are regularly prescribed to depressed or potential suicide patients, this is an area of 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 non-toxic in overdose and can be equally as effective.

It is well recognised that following para-suicide there is a significant risk of eventual suicide. Some 1 per cent of adults who commit suicide do so within one year of a suicide attempt, thus the para-suicidal group are at high risk. Despite these theories there is, as yet, no clear evidence of the best way of preventing suicide, or a repetition of suicide attempts, among this group.

The Minister should look at the establishment of suicide prevention programmes, but prior to doing so, if targets or objectives must be clearly stated they should be formulated by a multi-disciplinary working party and must be realistic. A second prerequisite is adequate funding to establish and maintain [1995] such a programme. Education has a vital role in suicide prevention, and educational programmes must be directed both at the general public and at professionals.

In Ireland particularly a stigma remains associated with suicide which can only be reduced by freely providing information and discussing the topic. The decriminalising of suicide in 1993 has contributed greatly to reducing this stigma. AWARE, the voluntary organisation operating since the mid-1980s, has made a major contribution towards educating the general public about suicide.

If a national suicide prevention programme is to be established, and we suggest that it should be, contributions will be required from a wide range of disciplines including the medical, social, legal and political ones. Good communications in pooling 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 it is necessary to 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 risk signs to look out for which could help to save lives. Those most at risk are people who have been recently bereaved or who are experiencing the trauma of a break up or violence in the home. Also at risk are those who are suffering from a downturn in health, employment or finances, those who have a painful or disabling illness, dependency on drugs or alcohol, and those who experience suicide in their family or the suicide of a friend.

The signs which can identify a person as suicidal include being withdrawn and finding it difficult to relate to others, talking about suicide or death, putting their affairs in order or giving away valued possessions, experiencing a feeling of failure or lack of self-esteem, dwelling on problems which may have [1996] no solution or attempting suicide or self injury.

Suicide programmes are available in the United States, in the UK and other countries. The simple solution of transporting these into Ireland has often been suggested but I disagree with that because our culture, background and problems are totally different. While we can learn from what is happening in other countries we cannot transport their solutions to our situation. We need intensive research to identify what the Irish solution should be as well as preparing our own suicide prevention programmes. While we may take the headlines from other countries, we need a lot of domestic research. This is a new issue for the Department of Health because two years ago, when it was considered a crime, suicide was dealt with by the Department of Justice. Nonetheless it is a vital and important one and for that reason I urge the Department, the Minister and the Minister of State to take on board what we have said.

Dr. Henry: I thank Senator Neville for sharing his time with me, and I welcome the Minister to the House. I wonder where we would stand as regards suicide if it had not been for Senator Neville's tenacity in pursuing it. I want to address the area of suicide in prisons. I am sure the Minister is aware that in some countries it is the Department of Health and not the Department of Justice which runs prisons. The incidence of suicide in our prisons is very serious. When we put people into prison they are, at least, supposed to be safe, but if they come out dead having committed suicide — or injured having attempted suicide — it is a tremendous indictment on society.

The Department of Health needs to take a far more active interest in the health of prisoners. This matter ties in well with some serious deficiencies in the Department of Health at the moment. For example, what happened to the White Paper on mental health legislation about which I have been hearing for a long time? People are [1997] being discharged from psychiatric hospitals where they may have been voluntary patients, into inadequate community psychiatric care. They become homeless, get involved in crime and are committed to prison, without adequate psychiatric assessment, where they commit, or attempt to commit, suicide. This is a terrible indictment not just of the Department of Justice but also of the Department of Health. We have no knowledge from the Department of Justice concerning the level of psychotropic drugs, sedative drugs and sleeping tablets which are being given to prisoners who may be suicidal.

The Samaritans have some, but not total, access to prisoners. The supply of cordless phones in prisons is important in that those prisoners who feel suicidal will now be able to phone the Samaritans who are more than willing to back up the splendid service they already do by trying to help those in prison.

I urge the Minister to ask the Department to take far more interest in the health of prisoners who, after all, are members of the community even though they may be confined for a period laid down by the courts.

Minister of State at the Department of Health (Mr. O'Shea): I thank Senator Neville and Senator Henry for their very informed and constructive contributions on this very serious issue.

Around the world many thousands of people end their lives through suicide and thousands more make non-fatal suicide attempts, that is, perform para-suicidal acts. Suicide is probably the most personal act anyone can perform. In the past the rate of suicide in Ireland was genuinely low but over the past 20 years there has been a continued increase. In 1974 there were 118 deaths attributed to suicide; in 1992 the number of reported deaths from suicide was 354 and in 1993 it was 357. This increase in the numbers of suicides has not been accompanied by a fall in other causes of unnatural death, such as accidental poisoning, accidental drowning and open verdicts in coroners' courts. For this [1998] reason, it is accepted that there has been a genuine rise in the number of suicides.

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. Few acts have such deep roots in social and human conditions or have such farreaching 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. It outlines the role mental health personnel can play in the prevention of suicide and emphasises the important contribution of voluntary bodies, such as the Samaritans.

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 even discuss the issue and this made the compilation of accurate data on the frequency and pattern of suicide more difficult. 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 further research on the factors which lead people to take their own lives and the most effective way of intervening to prevent premature loss, the Department of Health is contributing towards the cost of a pilot project on attempted suicide in Cork carried out by the staff of the Southern Health Board under the direction of Dr. Michael Kelleher, consultant psychiatrist. The aim of this project is to reduce the occurrence of para-suicide and to develop intervention skills which may be applied in this area.

[1999] The Department of Health also provided financial support towards the cost of the Fifth European Symposium on Suicide and Self-poisoning which took place in University College Cork from 31 August to 3 September 1994. This symposium was attended by researchers from diverse backgrounds from all over Europe. It enabled medical and nursing personnel, social workers, voluntary groups and others to exchange experience leading towards a better understanding of suicide and suicidal behaviour. The proceedings of this symposium “Divergent Perspectives on Suicidal Behaviour” are of interest and would inform any discussion on the issue of suicide.

I am pleased that my colleague the Minister for Health recently gave his support to the participation of the Cork study to which I have referred in the WHO-EURO Multi-Centre Study on Para-Suicide. This was started in 1988 and covers two broad areas of research. These are the monitoring of recent trends in the epidemiology of para-suicide, including the identification of risk factors and follow up studies of para-suicide populations as a special high risk group for further suicidal behaviour, with a view to identifying the social and personal characteristics predictive of future suicidal behaviour.

With research into the factors that influence an individual to undertake a suicidal act, it is also important to look at the services which are already in place and to look 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 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 in its “Targets for Health for All” has recommended action to reverse the rising [2000] trend in suicide by the year 2000. It highlights the importance of early detection and treatment for depression, alcoholism and schizophrenia. These are all being addressed in the context of reorganisation of our mental health service.

The World Health Organisation also suggests the need for improvements in the underlying societal factors that 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.

My colleague, the Minister for Health, and I are open to other suggestions from this House as to how, as a society, we can reduce the incidence of suicide in this country. In this context I have noted the recent proposal of Dr. Kelleher that a review group be established which would examine the annual statistics on suicide and make recommendations which might help to prevent some suicides. I would like to discuss the role such a review group could play with my colleagues, the Minister for Health and the Minister for Justice. I will keep Senators informed of any developments in this regard.

Mr. Neville: It is important that we distinguish between para-suicide and suicide. The research in Cork is into [2001] para-suicide not suicide. Para-suicide is a cry for help; suicide is a wilful attempt to take life. I thank the Minister for his openness in asking for further contributions. Would he be agreeable to our working with some of his officials and talking to them in an informal way rather than just bringing up the subject in the House?

Mr. O'Shea: I would have no difficulty with making officials available in a constructive way to develop this issue.

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