COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
Inquiry into the Prevention of Suicide and Self-Harm
29 November 2007
Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Rev Dr Robert Coulter
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mrs Carmel Hanna
Mr John McCallister
Ms Carál Ní Chuilín
Ms Sue Ramsey
Mr James McBennett ) Niamh Louise Foundation
Ms Catherine McBennett )
Ms Michele Baird ) South Antrim Rural Support Network
Mr Raymond Craig ) Oakleaf Rural Support Network
Mr Colm Donaghy ) Southern Health and Social Care Trust
Mr Francis Rice )
The Chairperson (Mrs I Robinson):
This is a joint evidence session with representatives of the Rural Community Network and the Niamh Louise Foundation. Members have been provided with the witnesses’ written submissions.
I welcome Raymond Craig from Oakleaf Rural Support Network, Michele Baird from the South Antrim Rural Support Network, and Catherine McBennett and James McBennett from the Niamh Louise Foundation.
I do not know whether you are aware of the procedure for a Committee meeting, but you are most welcome, and we look forward to hearing your presentations. You have 10 minutes to make your presentation, and then we shall open the meeting for discussion.
Mr Raymond Craig (Oakleaf Rural Support Network):
Thank you for the opportunity to contribute to the discussion on suicide prevention.
We, of course, have a particular interest in the issues of rural communities — although that does not mean we are in any way at odds with urban communities. Some 40% of the population of the Province live in rural areas, so we are concerned with a significant number of people.
As members know, there is a distinction between rural and urban settlement patterns; their way of life; the way in which people do things; and the concerns that they have. One of our main concerns is how we can ensure that the rural population has access to services that are comparable with those for people who live in cities. I am sure that members will take up that point later, and develop it through questions.
What makes living in a rural area different? There is a problem with the perception of confidential material in rural areas, because there are generations of people who know one another in those neighbourhoods, and people are inclined to keep their business to themselves. There is also a crisis in the farming and agriculture industry in respect of debt management. The rural way of life can result in particular pressures, and there may be a stigma attached to accessing help and support, particularly when one does not know how to go about doing that, because access to such support is not as well signposted as it could be.
I do not intend to hog the floor — my colleagues have plenty to say as well.
I shall finish on a statistical point: the rural population has experienced suicide rates of up to 12 per 100,000 people. The urban rate is around 8·6 per 100,000 people and, unfortunately, Banbridge has the highest rate of suicide, at 14·5 per 100,000 people. I say that to illustrate the point that suicide affects the entire Province.
I know for a fact that many of our incidents may be confused with, or concealed as, accidents. Often, when we hear stories about young people alone in their cars hitting trees on a straight piece of road at 3.00 am in the morning, we question what really happened. The statistics may not reflect the true depth of the problem.
Ms Catherine McBennett (Niamh Louise Foundation):
I am wearing two hats today: I am representing the Niamh Louise Foundation, but I am also speaking from personal experience as a bereaved mother. I lost my 15-year-old daughter to suicide, and the idea of setting up the foundation was a reaction to the lack of services that I encountered after the death of my child. There were plenty of such services in urban areas, but nothing to meet our needs at that time.
Since then, with old traditional standards still being very prevalent in rural areas, and even though we are campaigning locally every day, the stigma is still very strong. The foundation and local groups need more help to destigmatise the issues of suicide and self-harm. The foundation is not only concerned with prevention — it is also trying to help families in the aftermath of suicide and to encourage them to come forward.
There is a suicide and self-harm strategy in place, and I welcome that, but, in rural areas, a more softly-softly approach is required, owing to the stigma and the old traditional values.
The key is the allocation of resources and the use of prevention, rather than intervention, which reduces stigma through education.
Ms Michele Baird ( South Antrim Rural Support Network):
Towards the end of last year, the Northern Health and Social Services Board commissioned us to carry out a mapping and scoping exercise into the provision of services for mental health and suicide prevention in the Northern Health and Social Services Board area. From that exercise, we found that there was no evidence of postvention work or of self-help groups operating in the northern board area. That was particularly evident in Ballymena, which had just witnessed a spate of suicides by young people when we visited.
We also found that there were over 102 community and voluntary-sector organisations in the northern board area that had registered that mental-health care was either their primary or secondary objective.
The board provides a wide range of services in respect of mental ill health and suicide prevention. However, we contend that the problem is not a lack of available support services — except in postvention work — but a lack of co-ordination among those services. In partnership with the board, the Investing in Health strategy, and other networks in the area, we are examining specific ways to overcome that. One is a co-ordinated approach at local level — through voluntary and community-sector provision — and through the board, which is examining how it can co-ordinate with Departments and sectors.
The need to access services was identified as a key priority and, with that in mind, we examined the idea of establishing a physical hub in two or three locations within the northern board area that people could identify as a point of access to the available services. We recognise that access to a physical hub may not always be appropriate in rural areas because — as Catherine has highlighted — there is a stigma attached to mental-health problems, and a feeling of isolation. We want to start a series of training exercises and identify key community leaders — from Churches or the community — who can be trained to support people with mental-health problems or those who are suicidal.
The provision of a range of co-ordinated services at various levels will provide a more effective response than the one that is currently in existence.
The increased numbers of foreign nationals who live in rural areas, particularly in the northern board area, bring specific and separate issues. In the first instance, many are not registered with GPs, so the first point of contact is not available. Furthermore, when foreign nationals are placed under emotional or financial stress, the pressure is greater for them than for indigenous people because there is no family structure available as a support mechanism.
Ms C McBennett:
Michele has talked in depth about the rural issues in the northern board area. I want to highlight those issues that overlap the northern and southern board areas. Everyone seems to have their own remit. That is why we are representing both the southern and northern board areas. The issues overlap from one area into another, and we feel strongly that that must be addressed. We have taken the initiative to come to this meeting together, even though we are from different board areas. Rural issues cannot simply be put into boxes.
Mr R Craig:
To extend that point, there are 12 rural support networks that cover all of Northern Ireland, two of which are represented here today. They offer a clear delivery mechanism for support for local people. We cover a range of topics that affect rural communities, including issues facing new citizens and migrant workers. Within our delivery mechanism, there is an opportunity to provide co-ordinated support to rural communities.
However, each network receives a different level of funding from its respective health board. An audit of the 12 networks showed that they all work actively with the health boards, but that does not mean that their actions are co-ordinated. Community groups may be able to access money to deliver programmes aimed at the prevention of suicide, but their product is not being harmonised, and, to extend the analogy, there are 12 different shops. Although each health board is proactive in using the mechanism of the rural support networks, those networks do not deliver a harmonised product, and it may be useful to consider that.
I am delighted to welcome you to our meeting. On behalf of the Committee, I extend our sympathy to you, Catherine and James, on the loss of Niamh Louise in 2005. It is said that time is a great healer, but it is hard to accept that any amount of time is enough for a parent to get over the loss of a child. O ur condolences are with you.
The broad theme of your presentation is that there should be a holistic, seamless approach to the services that are available throughout Northern Ireland, and that the back-up support should be the same wherever one goes, rather than being provided in isolated boxes. I take the point that Churches and others, such as educational groups, must be involved, and the Committee has taken steps to engage with such groups.
The Committee has targeted this particularly traumatic area of provision because of the rise in completed suicides throughout the population. There is no pattern, nor does suicide affect any particular age group. It affects people right across the board and of every social status. That is why we embarked on tackling what we consider an extremely important issue and why we invited you here today. We will hear from further witnesses before preparing a report for the Minister.
I invite members of the Committee to ask questions or comment on what they have heard.
You are all very welcome; thanks for coming along today. Catherine, in your written submission, you highlighted the poor communication between public bodies and organisations such as yours. Has the Protect Life strategy improved the level of communication? Is the Southern Health and Social Care Trust of great support to your foundation?
Ms C McBennett:
The strategy is only a starting point. There is always a need for more communication, but groups such as ours are not sufficiently referred to in research and information. The many leaflets that are handed out rarely refer to bereaved families or to how organisations such as ours manage to intervene and enable people to access the appropriate resources.
The Protect Life strategy is a start, but it is not enough, and, without meaning to sound derogatory, there must be improvement and a more direct link with community organisations such as ours.
Your submission also mentioned how you would like to open a centre where people can call in and get information. Is that being progressed with the help of the trust?
Ms C McBennett:
I put my views strongly to the trust, which is aware of our plan. However, since the introduction of the Protect Life strategy, the trust has also started work on suicide prevention, and I respect it for doing so.
We take a ground-level view: meeting people who are self-harming and who are suicidal, and the bereaved families, and what we have learned is that they do not want to walk into a centre that is labelled “suicide awareness” or “mental health”. They would rather go to a place where there is access to information or help, within a resource centre where there is perhaps a coffee shop, a library, and a drop-in centre, but, bearing in mind the rural stigma, where no one will notice them walking in — which might prevent them from seeking help. The idea of such a resource centre is to take away the whole problem of stigma, so that people can access help through correct information and available counsellors, and to give it a friendlier, open-door atmosphere.
I represent Mid Ulster, and I entirely understand where you are coming from. I am very aware of the situation in rural areas, where everyone knows everyone else’s business. Your idea is fantastic, and I will support you as much as I can in moving it forward.
Ms C McBennett:
You mentioned the stigma that is attached to suicide in rural communities. In what way will you try to address that?
Mr R Craig:
The stigma stems from the culture, and the approach needs to be based on education and information. Suicide will not be understood as a journey, and not just a final act, until there is greater awareness of the suffering that anxiety causes — mild and serious anxiety can lead to depression. There is an entire journey before the final act of suicide.
Through education, information and raising the topic in a public setting, we can increase awareness, because a stigma goes on existing when an issue is kept in the closet.
Ms C McBennett:
I agree with Raymond. We have actually been told not to speak in public about our daughter’s suicide in case it would ideas into someone else’s mind. However, as research has shown, when someone is thinking of suicide, it is already on their mind. Talking about it can only destigmatise it and open the door for therapeutic intervention. Therefore, the more we talk about it in a natural way, the better.
There is no stigma attached to going to hospital for a physical complaint, such as a heart attack, and yet there is when it comes to mental health. We in the foundation want to see people getting help without feeling guilty about being on antidepressants, which carries a stigma of its own. We must try to get rid of that and encourage people to seek help, because there is nothing to be ashamed of. Depression is an illness like any other, and, as Raymond said, getting help can prevent that final act of suicide, which is the final straw when someone has not had the appropriate intervention.
We have all seen television reports of how whole communities feel they have been affected when suicide happens in an urban area — everyone feels the impact, and so the family feels the support of everyone around them. In a rural area, however, the family is more isolated, because the wider impact does not seem to be felt by the wider community.
We need to take a step back and examine the issues that affect the entire rural community, such as the changes in agriculture, the impact of recent diseases in animals, and other external pressures, and use them to create a sense that suicide affects the wider community, and not just an individual.
Mr R Craig:
There is also an opportunity to address the issue in a positive way, because people find it very difficult to talk about suicide. Positive mental-health attitudes need to be encouraged, such as involvement in sport, daily activities, and awareness of the impact of alcohol and drug abuse on the body. We need to educate young people, and everyone else, to understand the risks that they engage in due to the lifestyle that they adopt. Talking up the positive will help to prevent suicide.
Thank you. You are more than welcome, and I am sorry that I missed the first few minutes of your presentation.
I have worked as a GP for 21 years in a rural area, and I take on board what you have said. The aim should be to prevent all illnesses, and particularly to prevent suicide. Catherine and James, all members of the Committee feel for you.
I have encountered cases of suicide as a GP, and I could not agree more that a stigma is attached, even after the event, because people do not want to talk about it. I remember one family who did not even want suicide to appear on the death certificate. That stigma must be challenged.
The Committee is determined to address mental-health issues, and suicide is the first area that we are examining to try to evolve a strategy. I spent some time in America, and I know that people in the US may go overboard a bit, and talk too much, but at least they talk about mental-health issues. You are quite right to say that there is a culture in Northern Ireland of not talking about mental health. That culture is perhaps even stronger in rural areas, where sometimes what the neighbours think is considered to be more important than how people feel. We must overcome that culture. In rural communities, everyone knows what everyone else is doing, and people dare not let others find out certain things about them. I could not agree more with everything that you said.
At a recent Committee meeting, I mentioned — and I think that I am correct — that my large rural practice, with more than 8,000 patients, is the only one in Northern Ireland to have patients from three different health board areas. Down the years, I have seen the problems that that can cause, owing to the lack of harmonisation. We must encourage young people to talk and to focus on positive mental health and self-esteem.
Many GPs are being encouraged to avail of GP awareness training, although I have not yet done so. A couple of times, the first I heard of a young person’s mental-health problem was after the individual had taken his or her life, and it was too late. I felt so helpless; if only I had known those young men, or they had spoken to someone.
The Committee’s examination of this matter is at an early stage. However, we have made it an extremely high priority, and rightly so. The Committee must develop a strategy that considers the needs of urban areas, represented my some members here, where suicide is a major problem. However, a strategy must also recognise the unique needs and differences of rural communities. The development of a strategy must be complemented by the harmonisation of services, and everyone on the Committee is on board, if you will excuse the pun. In my years of experience of the four health boards, one did not know what the other was doing, probably due to lack of collaboration or joined-up thinking.
Approaches to health issues must be consistent throughout Northern Ireland. There is an opportunity to try to improve all areas of health, particularly mental health. Is there anything else that you can suggest that rural GPs could, or should, be doing? I have found it particularly frustrating to be made aware of a mental-health problem only when I have been called out to attend to someone who has already taken his or her own life.
One of the main points to emerge from our focus-group consultation was that an individual sees the GP as the first port of call. However, the difficulty is that the GP can respond only if the individual visits the surgery and tells the GP about the problem. We came across several families who had not gone to their GP or sought help after the suicide of a child. Their attitude was that there was nothing wrong with them, and that the GP could not bring their child back.
However, all evidence shows that there is a tendency for one suicide to be followed by another, and that is probably partly due to the lack of support after the first suicide in the family. You mentioned depression-awareness training, but GPs are under great stress.
Perhaps there is another form of resource that could be made available through the surgery to support people in that situation.
Mr R Craig:
There was an interesting pilot scheme in Eglinton, outside Limavady, where, in co-operation with an organisation known as Northwest Counselling, patients who were on repeat antidepressants were targeted and offered the opportunity to have counselling to examine what was going on in their lives that might have caused depression in the first place. There is a lot of merit in counselling and support, rather than solely depending on prescription drugs — perhaps the two should run in parallel.
It is very distressing that only one-in-10 suicides engage with the Health Service. Most suicides are not known to the Health Service before that point. That is why Oakleaf Rural Support Network plays a major role in engaging with communities and the public as a point of contact, rather than the Health Service being the first point of contact, although, obviously, that is where people will end up. Suicides will generally not see the Health Service as being the place where they would first go.
Ms C McBennett:
Speaking from the point of view of a bereaved family, the PSNI and the GP are the first to arrive on the scene, and afterwards you look to your GP for help. Our GP was very good in the knowledge that she had, and it would be good if all GPs had such knowledge. We were given a book that we did not look at, instead of having a community organisation, such as the Niamh Louise Foundation, to go to.
I would like GPs to be aware of a bereaved person’s need to talk, although I know that their time is in great demand, but listening for five or 10 minutes may be all that is needed, if they are aware of what help is available, for them to refer someone on. In rural communities, people tend to go with who they know, and will not invite strangers into their homes. We were the same — we would not have sought help from someone we did not know, and we did get help by being referred by someone we knew. It would be very helpful if GPs could refer people to where they can get help.
We all agree that talking therapies are an essential part of either preventing suicide, or helping the family come through the other side. There is a very staunch view in Northern Ireland that men and boys, in particular, should not cry, or talk about their problems.
The Committee went to Scotland to gather evidence, and found that they have a very innovative way of reaching men there, by targeting football stadiums, and issuing cards with the message that it is all right to talk. Women talk in hairdressers, shopping centres and over coffee about not feeling up to the mark, which is a natural ability that we have — I am sometimes told that we talk too much — but we have that resource. In the rural community, talking is more difficult because of the isolation of homes, and neighbours being a long way away.
It would be good to see a programme of information cards rolled out in all our sporting facilities. It would be excellent if we could get the proper structures in place for a one-stop centre for therapy, a coffee shop, aromatherapy, etc, under one roof, so that no one would know why people were entering the building.
Over the past few years, three families in Drumquin have suffered bereavement as a result of suicide. The families said that there were no telltale signs of any problems. The young people had no financial problems, they were happy and content, and there was no breakdown in family communications. The fact that the families were unaware of any problems adds to their sense of loss and makes it more difficult to overcome. It is difficult to know what to do to tackle the problem. A one-stop shop has been suggested where people can go if they have something on their mind. That could be a step forward in addressing the issue.
Is there any follow-up action to help families that have been bereaved as a result of suicide? There needs to be work to ensure that any follow-up action is adequate.
Ms C McBennett:
I agree. We were in that position; Niamh’s suicide came as a bolt out of the blue; it seemed that there were no warning signs. However, in hindsight, as a mother I could see that there were warning signs.
Michael McGimpsey should provide people with more education. When Niamh was two or three years old I took her to get her injections; she got all the vaccinations that I was aware of for illnesses such as tonsillitis and chicken pox. However, I never once thought of suicide; not once did I think that my child would ever have a mental-health problem. There was no family history of mental-health problems; I knew nothing about it, and it was not brought to my attention. Therefore why would I look out for it?
In the run-up to Niamh’s death, I did start to question myself and felt that something was not right. However, I come from a rural background with traditional values, and I chastised myself for thinking that about my own child. I now wish that I had acted on my instincts.
Parents are made aware when their children are very young of problems to look out for such as chickenpox, cancer and so on. They should also be made aware that their children could have mental-health issues in their teenage years. It is not scaremongering; it would simply be to advise them what to look out for, what to do about it, where to go for help and not to neglect the issue.
The issue could be addressed by early education; schools need to be more open about possible problems. We are able and willing to go to schools to give presentations; however, people in rural schools are reluctant to talk to us. There is a fear that when one suicide takes place it could happen to others. That fear needs to be eliminated.
As Raymond said, the information needs to be given out in a positive way to let people know that if the problem is acknowledged their child can be saved and be happy. People need to be made aware that it is no different from going to a doctor about a physical illness; there is no shame in it. They need to be told to get their child sorted out to enable them to lead a normal, healthy life.
That will not always be the case. Education as early as possible is required to make it worthwhile. It is a mother’s job to watch out for all those illnesses, and we watch out for everything from when the child is born until they die.
Mr J McBennett:
I would like to say something about postvention services. From the perspective of a bereaved family, there was no one to help us when Niamh died. Our GP did her best, but our families simply did not know what to say, which further isolated us. Even now, some 18 months later, that sense of isolation continues.
We try to be active in postvention services in the greater Tyrone and Armagh areas that we represent. We set up a support-group mechanism called ALO, which is Latin for support; it meets every second Thursday in a specific area. At the first meeting, 10 families who had been bereaved by suicide joined the group; some had never spoken about the suicide before, even those who had suffered bereavement some 10 or 15 years previously.
The group is beginning to go out into rural areas, but the stigma —even of coming to the group — is so great that it prevents some people from attending. We have tried to create a comfortable environment in an area, and at a time of night, that means that people who attend will not be as visible. We try to accommodate the wishes of the families.
We have been proactive in addressing the needs of young people by establishing a presence on the Bebo website, which is extremely popular with young people. The charity incorporates a youth group that regulates a Bebo-linked site with almost 100 members, and it is run for the youth by the youth. We moderate the site, which is totally dedicated to suicide awareness and prevention. Mr Buchanan mentioned that people do not realise that such things happen, but young people usually talk to one another.
Niamh had spoken to someone about how she was feeling, but this person, perhaps out of loyalty to her friend or peer pressure, did not act. It is vital that we have created a forum for young people through the Bebo site, and anyone who links into it will see that the discussions between kids are unreal.
Although we have been proactive on postvention through setting up the support group and providing a link from the Bebo site, much more must be done in rural areas. More support mechanisms must be made available, because it not good enough that we have to travel to cities to access services. The journey from a rural area to a city can last longer than the counselling session. Support must be hands-on, and it must be available when we need it.
May I ask a very personal question? If you prefer not to answer, that is fine. You said that your instincts told you that something was wrong but that you felt guilty about thinking that. What did you think was going on? I suppose that you did not want to be having such thoughts and told yourself to move on.
Ms C McBennett:
I am happy to answer the question. Niamh had mood swings. As a teenager, she was facing —
I imagine that you put it down to hormones.
Ms C McBennett:
When she reacted to me, sometimes it was Niamh; at other times it was as though she were a completely different person. She had an air of royalty about her, and we would laugh about that because she was a bit of joker. It was hard to distinguish between reality and her messing about.
Parents sitting at the dinner table, watching the children banter with another notice any slight change in their personalities. All I noticed was a slight change in Niamh’s personality. She could be extremely high one minute, and the next minute change completely. Her mood was extremely high or extremely low.
When she was on an extreme high, she could do no wrong, but that was followed by an extreme low, which I did not recognise and which is very hard to diagnose. A mother’s instinct told me that something was wrong. I asked her what was wrong and told her that I knew that something was not right with her, but she refused to speak.
When we ask young people why Niamh did not talk to me, they say that children to not want to worry their parents, and that goes back to culture and traditional values. The youth do not want to speak out primarily because they do not want to worry their parents and because they are anxious about how their parents will react.
Knowing what I know now, I would have reacted wrongly, because I did not know how to react. The issue is how parents react when their child approaches them and says that he or she has been self-harming. Would parents be so horrified that the children would keep anything else to themselves? There must be an educational process in which parents teach each other how to react. That does not apply only to parents: everyone in the community needs to know how to sit, listen and react accordingly when a young person tells them that he or she has been self-harming or is thinking of suicide, rather than becoming defensive and making the young person retreat.
I do not want to focus totally on parenting because my reaction would have been the same as that of any parent. Niamh spoke to her friends, but misguided loyalty prevented them from telling anyone; had there been an educational programme in schools, they might have spoken out. They knew about drugs, alcohol and sex, but no one knew how to respond if one of their friends started talking about suicide websites, as Niamh did. We are only scratching the surface here today; a much broader education package is required.
Unfortunately, parents lump problems together as symptoms of children going through their teenage years, but that is not the case. There are so many pressures on young people, such as bullying, peer pressure, and whatever messages are being sent to their mobile phones, that it is almost incomprehensible.
There is a need for greater peer support. My daughter self-harmed and made a suicide attempt that, fortunately, was unsuccessful. However, even when the signs are recognised and help is sought, the problem is that the stigma is transferred to the parents: they feel that they must be failing and that it is their fault. When everything around the child appears to be normal, the implication is that the parent must be doing something wrong. The child reacts against the parent and those who want to provide support; it would be better to have support from peers, GPs and psychiatric services.
Ms S Ramsey:
Thank you for your presentation. I commend you, because it is very hard to deal with bereavement and to cope with what you are going through as well as trying to help others. You will probably be glad to know that the next person to give a presentation is the chairperson of the suicide strategy implementation body.
As the Chairperson said, we are taking this inquiry seriously. Although she and I represent city constituencies, all members have probably been directly or indirectly affected by suicide, and, therefore, it is problem of which we are aware. We do not have all the answers, and therefore it is useful to talk to people who have been directly affected or who deliver support services.
It is a pity that most groups that support others are set up by grieving families, and society must examine that. I am conscious that sometimes we indirectly create a rural versus urban divide, but suicide and self-harm know no boundaries. Have you established links with other groups? I know that most of them are probably based in cities, but it is important to learn the positives and negatives from one another, because you suffer as much as those families.
The Bamford Review was seen as the be all and end all of dealing with mental health, and it highlighted many issues. However, none of us is an expert in identifying mental-health problems. Nevertheless, Bamford was seen as a start, and with the fanfare that introduced it there seemed to be a possibility that it would make changes when it was implemented. However, going by the information that we have received, there is a strong possibility that that will not happen.
Ms C McBennett:
The Niamh Louise Foundation works very closely with the West Belfast Support Group, the Public Initiative for the Prevention of Suicide and Self-Harm (PIPS) in Belfast and Newry, and with all the Derry groups, but it takes all an organisation’s energy to cover its own area. We meet them regularly, and if I need anything I can lift the phone to any one of those groups; but they are consumed, as we are, with the needs of their own communities. I cannot say whether they have considered rural issues — I can only go by what we are doing — but there is a network and we are all part of Family Voices, which was set up to bring us all together.
We communicate and talk together, but the differences between rural and urban areas are so immense that it is very hard to explain them to a group that may think that one shoe should fit all. Unless you have lived in a rural area, it is very hard to understand; I have not lived in Belfast or Newry so I cannot speak for people who live there. Working as I do at ground level, I have not seen any evidence of effective co-operation. We are not against the idea of working with urban groups — far from it: we encourage joined-up working and have learned from the organisations that went before us; we hope that there will be more co-operation in future. However, because of boards’ restrictions, the suicide prevention strategy, money and the fact that everyone is fighting for their own area, groups often feel isolated, and that is not how it should be. The aim is to reduce suicide. We should forget about what each area needs and remember the overall objective — bringing rural and urban together.
Ms S Ramsey:
I do not deny that there are issues specific to rural areas, but there should be joined-up thinking; we should not create a gap between urban and rural, because lessons can be learned from both.
Mr R Craig:
I come from a further education background; I was the project manager of Limavady Learning Partnership, the aim of which was to raise attainment rates. Each of the schools involved was preoccupied with its own agenda, but after three years we managed to raise the attainment rates in Key Stages 1, 2 and 3 in all schools. Culturally, we are not comfortable with collaborating — and the Committee’s experience with the health boards will tell it that. Professionals tend to regard the community and voluntary sector as poor cousins, and that has to be addressed. If we are to co-operate in partnership, we need to be trained in that culture. We come to the table wondering what we will get out of it, when the challenge is what solutions we can bring to it.
The Committee has a great opportunity to advance joined-up thinking, although I do not like the term, because much more is involved — we must have a passion for what we do. We must consider our resources in a different, corporate way beyond the geography of our own townland and council area because, as Sue said, there is no curtain dividing rural and urban. This is about saving lives and improving the quality of life, which should be lived to the full, whatever your disposition or religion.
There are already hotspots. There is a seriously high suicide rate in the gay and lesbian community — it is in crisis. People end up in hospital through self-harm and are given the Samaritans’ number. That is wholly inadequate. They need on-site counsellors who can be available within 24 hours. All the groups attended a conference in Kilkenny, where we were presented with research that showed that certain actions have very good outcomes, such as a councillor being available within 24 hours of an attempted suicide. At that point the person is much more receptive to help and support, but leave it 48 hours and they go into denial. They will say that they are OK and that they will not do it again; they will simply want to get away. However, that is e when they are at risk.
We know that there are actions that have positive outcomes. We also know that the problem will not necessarily be solved through more money: collaboration between all the different tiers is the key. Some people are involved at the point of contact, and we have considered the issue on a sub-regional basis. Those areas need to be brought together so that the issue can be addressed comprehensively.
I work in the Northern Health and Social Services Board, covering the whole of Newtownabbey Borough Council area, Carrickfergus Borough Council area and Antrim Borough Council area; I work with groups including PIPS, Cruse and the Samaritans. There are lessons to be learned and we are taking on board their experiences, knowledge and training that we can transpose.
It is important to emphasise that although there are elements of their work that are good and that we can apply, work is also required that is specific to rural areas so that local people can identify with it.
Ms S Ramsey:
Do you have any views on the Bamford Review into mental health and the possibility of not getting funding to address the issues that were highlighted?
Mr R Craig:
I am not familiar with it.
You are all very welcome. The Committee does not have the answers either; however, it can bring the statutory agencies and the Department of Health together with groups such as yours and the wider community. I know that it is difficult for the families. It is through your sad loss that you can help to inform future services. It is important for you to have the courage be involved.
Raymond made some important points about co-operation. Colm and his colleagues will give evidence next and perhaps they will give us a more holistic view. This issue has to be dealt with comprehensively; it has to be inclusive, and it has to be so many different things to different people.
Your work will not bring Niamh back, but it might save other young lives. A young lad called Francis who lived next door to me took his own life; his family felt hurt because people did not want to talk about it. The stigma attached to suicide has to be dealt with. As Catherine said, people do not mind saying that they have had a heart attack or have cancer, but they do not like to admit that they cannot cope.
Some of us were at the presentation given by the Northern Ireland Association for Mental Health, which outlined the economic case. It is terrible to have to talk about making an economic case; but that is what we have to do.
Early intervention, prevention, good health promotion and raising awareness with parents are all important. As Catherine said, parents take their children to the doctors for vaccinations, but they are not trained to look out for their children’s mental health. There should be awareness training for parents, teachers and in the schools. The association spoke about encouraging positive thinking and self-esteem and the importance of simply talking; and we have heard about the talking therapies. All those areas must be brought together in a comprehensive service. There is now a great opportunity to do that because of increased awareness.
We are trying to do something similar to address the needs of victims and bereaved people. We need the best service available and we need to ensure that it reaches rural areas. People in rural areas feel isolated, as perhaps they do not have a next door neighbour that they can talk to.
This Committee does not have the answers, but we are determined to play our part in getting them and creating a far more comprehensive service.
Part of the Committee’s deliberations will cover the fact that accident and emergency units should contain dedicated rooms with volunteers who can talk to people and calm them down until the professionals can do their work. I take the point that as time moves on people with problems get annoyed and embarrassed and that they will want to get out as quickly as possible, but, as Raymond said, the first 24 hours are vital.
How do we overcome the stigma attached to suicide? I mentioned two individuals for whose families it came as a bolt out of the blue because the individuals concerned had not seen a health professional. I also felt helpless. Although, looking back, it did seem that one fellow had had problems.
I am also thinking about the stigma that attaches to mental ill health. I have looked at the results achieved by Alcoholics Anonymous and Narcotics Anonymous whereby people can go to meetings and help one another. By talking to one another their lives can be saved and transformed.
I do not know whether you are aware of a group in Northern Ireland called Emotions Anonymous. It deals with people who have problems with emotions and feelings. Should we provide such facilities for young people? Indeed, for all people, because suicide affects people of all ages. There should be places where people can meet to talk through their problems without fear of being identified. Such a facility would allow young people’s peers to say in confidence that they have concerns about their friends. I am trying to think of ways in which the current situation could be prevented.
Ms C McBennett:
That is a great idea. It is something that we have tried with our youth group, all of whom have had some experience of suicide and self-harm through knowing Niamh or someone like her. We gave them a platform on which to speak. It is not a counselling session: we are not counsellors. They talk among themselves, and they are very passionate about creating awareness about self-harm and suicide. It was they who created the website on Bebo. That healing method works; I have seen it work with the youth group. I have seen individuals being healed through taking ownership and saying that either they or their friends are battling with problems and that they are going to help one another. However, such a scheme needs to be operated anonymously. We tell newcomers that they are helpers and that no one need know why they have come. If they need to see a counsellor, we can direct them.
I agree that if such a scheme were rolled out it would be of benefit.
We have been rolling out a small grants scheme in partnership with the Northern Health and Social Services Board targeting specific mental-health and suicide-prevention initiatives. One scheme that we recently funded is in a primary school in Antrim and it is similar to the one that has just been described. It targets children in P1 to P4 and is about allowing them to talk about their emotions and deal with emotional situations such as bullying and how they feel about other people and themselves. Although it is a pilot scheme at the moment, it will be interesting to see how it turns out.
There is great value in having a counselling facility in schools in addition to the other kinds of support that we talked about. To call a spade a spade, there is a problem with attitudes and it comes from our Churches.
Throughout history, Churches have not always adopted a positive, caring role. They sometimes have had closed minds about completed suicides, and Churches have a big part to play in transforming mindsets so that everyone can rally round and support families that are left blaming themselves or wondering what they did wrong. Churches have a key role in helping our society to move on from strict interpretations in respect of such traumatic experiences, which are on the increase in Northern Ireland.
We have come to the end of the question-and-answer session. I thank all of you sincerely for coming along, particularly Catherine, James and Michele, for allowing us insight into a sensitive and personal part of your lives.
Mr R Craig:
Thank you very much, Chairperson. I hope that our contribution was useful.
It was very helpful, believe me.
We shall now move to the second evidence session, with the Southern Health and Social Care Trust. I welcome Mr Colm Donaghy, chief executive of the Southern Health and Social Care Trust, and Mr Francis Rice, the trust’s director of mental health and disability services. Ten minutes have been allocated for your presentation, and then we will open the session for questions and answers.
Mr Colm Donaghy (Southern Health and Social Care Trust):
Thank you, Chairperson. I am wearing two hats today.
I should have said that you are also the chairperson of the Suicide Strategy Implementation Body. I apologise.
The trust has provided a written submission to the Committee. As director of mental health and disability services, Francis will take the Committee through the key action points of that written response. I will begin by giving the Committee an insight into the work of the Suicide Strategy Implementation Body, before Francis makes his presentation.
That would be very helpful.
My formal involvement in suicide prevention goes back to 2005, when the then Minister with responsibility for health, social services and public safety, Shaun Woodward, asked me to chair a suicide task force to develop a suicide prevention strategy.
The engagement process that was used to develop the suicide prevention strategy was unique. We engaged with statutory bodies, families who had been bereaved through suicide, the Churches, the PSNI and all the relevant professionals. The task force was composed of those groups, as well as representatives of the relevant Departments.
Following the development of the strategy, at its launch, the then Minister with responsibility for health, social services and public safety, Shaun Woodward, announced that I would chair a suicide prevention strategy implementation body — hence the establishment of that body.
The title of the body is a misnomer, because the Suicide Strategy Implementation Body does not have any executive powers or the authority to implement recommendations, nor, I believe, should it. The authority and the executive powers should remain with those statutory and community organisations that are tasked with implementing the strategy. Instead, the Suicide Strategy Implementation Body’s role should be that of a scrutineer or, when required, an adviser to the Department.
An indication of that oversight and collaborative role is that six of the seats on the Suicide Strategy Implementation Body are reserved for members of families that have been bereaved through suicide. For example, Catherine McBennett, who gave evidence to the Committee earlier, sits on the body, as do several other people who have been bereaved through suicide.
I had the heroic intention of establishing a membership comprising 12 to 14 people. In fact, there are 38 members, and counting. That is not to say that the body is any less effective. In fact, I believe that it is more effective and that that level of membership indicates people’s interest and commitment to be involved in suicide prevention. Therefore, the body is composed of representatives of the relevant statutory Departments, the boards and community and voluntary organisations that play a part, including, for example, the rural support networks. The body’s composition is therefore unique, and no similar body exists in other jurisdictions. Thus, it has a high level of expertise on which to draw, and advice can be sought on specific areas, some of which has been acted on by the Department.
Bearing in mind that the suicide prevention strategy is a long-term one, it will take time to ascertain whether it has directly impacted on suicide statistics. On a positive note, although the figures may not be linked to the strategy, and one should not assume a direct correlation, compared to the first six months of last year, the Registrar General’s statistics for this year show a 25% reduction in suicides. At this stage, those figures are encouraging and offer a positive message for Northern Ireland, and we hope that that trend continues.
The Suicide Strategy Implementation Body believes that, in order to implement the strategy, several areas require strengthening, one of which is in the co-ordination of performance management of the implementation of the strategy. I am aware that the Committee has visited Scotland, and I have also been there to visit Choose Life, Breathing Space and See Me. I was struck by infrastructure — which does not exist in Northern Ireland — that is in place to implement the Scottish suicide prevention strategy. My role, as chair of the Suicide Strategy Implementation Body, is not just to criticise the statutory organisations involved in the implementation of the strategy — including my own — but also to criticise the Department and other organisations that are not playing the part that they should.
A firm of management consultants gave us the opportunity to review the community-support model, and to consider the co-ordination of performance management of the implementation of the strategy. I discussed that matter with departmental officials and the Minister, who were supportive. As chair of the Suicide Strategy Implementation Body, I asked the consultancy firm to review the co-ordination and implementation of the strategy and to consider a community model and principles that might be adopted in order to deliver such a model in the future.
The Bamford Review was mentioned earlier, and it is a key element in the prevention of suicides. We have drawn a distinction between prevention and treatment in the strategy. However, we have called on Government to implement the recommendations of the Bamford Review, which deals with the service and treatment of mental-health services.
Several other areas have been mentioned, including cross-departmental working. I am delighted that we now have an inter-ministerial group examining suicide prevention, and I have attended those meetings on several occasions. Government are very open to ideas and suggestions on how we can improve the strategy’s implementation.
I want to mention two specific areas. We commissioned work on the evidence of what would help to prevent suicide, and it became apparent that, globally, there is not a lot of evidence of what works in suicide prevention, although there is some — hence the GP training awareness programme. One of the stark statistics in the strategy, which is not a criticism of GPs but gives us a potential, is that 80% of people who have taken their own lives had been to see their GP in the previous six months. That gives us an indication of some of the potential. That is not to say that they went to see their GP with a mental-health or emotional problem, but it gives us an incentive for the GP training. More research must be done — and that is another serious recommendation.
My final point — and I am conscious of time — concerns the media. A lot of work is ongoing with the media. The media and the Internet have a big impact on our young people. Some 6% to 7% of suicides are copycat suicides, and that is primarily due to the impact of the media on young people. In Northern Ireland terms, that equates to 20 young people. Those would be imminently preventable suicides if we could ensure that our media reported responsibly on suicide.
I have several other points that I would like to make, but I will raise them during the course of the discussion.
Mr Francis Rice (Southern Health and Social Care Trust):
I will take the Committee through the action plan that the Southern Health and Social Care Trust has established to take forward the Protect Life strategy. I will also address some of the issues that face the trust. I have copies of the action plan and the trust’s engagement paper, which deals with the issue of how communities and agencies can be engaged. I shall circulate those papers to the Committee.
Thank you. That would be helpful.
I will refer first to the inter-agency action plan, and then the engagement paper.
The trust’s approach follows the approach of the suicide prevention strategy. There is a correlation between the two, but we have built and customised our approach to suit the needs of the southern trust. The action plan is divided into two different approaches. The first is a population-based approach under which we have specific objectives and targets that deal with communities; families, children and young people; health and personal social services; workplaces; emergency services; Churches; and the media.
We then move on to more specific, targeted approaches that have objectives with specific outcomes and deal with areas such as self-harm and mental illness; drug and alcohol misuse; young males; those bereaved by suicide; survivors of sexual, physical and emotional abuse; marginalised and disadvantaged groups; high-risk occupations; and prisoners.
It is important to point out that the process is evolutionary. It has been agreed in the terms of reference that, as we work through the process, we will modify it to suit the needs that have been identified in our communities.
Approaches are targeted from the point of view of prevention, intervention and postvention. The trust has initiated a collaborative approach that is populated by people from statutory services, communities and voluntary groups. The action plan reflects the shape of the regional strategy and, under the population approaches, I will explain the specifics. The action plan focuses on the key population groups that are identified in the suicide prevention strategy and includes action such as awareness raising, education and training. That refers not only to training inside statutory services, but across all communities, and involves voluntary groups.
The specific objectives of the population approach are: to develop peer education and mentoring support; the development of action to support families; to try to identify and address the broader needs of communities; to build capacity within communities; to develop the resource and support that is available within communities; to work with schools to promote positive mental health; and to ensure that there is easy access to support for children and young people.
Our targeted action is focused on developing mechanisms to improve joined-up working across sectors, and improving communication and information. As part of the action plan, we will develop an information and communication strategy. Other targeted action includes improving our research base and sharing best practice, and I will explain more about the regional research that the trust is currently involved with.
The trust aims to improve co-ordination and links among services to reduce duplication and improve client and patient flow, and to address the gap areas. Further objectives are: to reduce the stigma of suicide; to improve access and signposting to specialist intervention services, such as child and adolescent mental-health services, and the transition between services; to improve support for families and people who care for someone with a mental illness, where suicide has been experienced; to ensure that responsive self-harm services are in place; to develop agreed protocols for those who may be at risk as a result of drug and alcohol influences; and to target the particular needs of looked-after children, black and ethnic groups, and high-risk occupational groups. Under each of those areas, we have specific objectives, actions and outcomes.
I currently chair the trust’s Protect Life implementation group, and we have built in monitoring and review mechanisms. That will be reflected in how we choose to develop new objectives with new outcomes and police the progress made against those objectives.
Since we last addressed the Committee, the southern trust has become involved with the Belfast Health and Social Care Trust, the University of Ulster and Queens University Belfast in a suicide-research project, which has national and international links. We are pleased to be involved in that significant project. It has just received ethical approval, and it will start at the beginning of December.
I am happy to apprise the Committee of the developments since we last spoke. Some of the areas that we have progressed are mentioned in our submission. The trust has now developed a number of community-development workers that are provided by community and voluntary groups. We have contracts with those groups, with specific service-level agreements so that we can ensure that they provide a range of services to meet the wide and varied needs of our population. The service-level agreement ensures that we can measure outcomes, but also that we monitor the identified needs to ensure that they are being met.
There are also now six pilot resource centres across the southern trust area. Those have been developed primarily with community and voluntary groups, with input from statutory services. Those services are mainly drawn from mental-health services, child and adolescent mental-health services, and children’s services where specific intervention is required. Those resource centres focus on specific needs of their localities. The trust did a lot of consultation as to where those centres should be sited because of the size of the southern trust and the locality-versus-urban argument.
We are monitoring the progress of those initiatives, and regard the resource centres as a one-stop shop, in which people can access a range of services, even if it is just talking therapy — someone to have a cup of tea with — or specific counselling. Access to statutory virtual team services is also available, where appropriate. We have also developed locality-based counselling services, because, as the Committee is aware, that was a particular issue of concern across the region. People felt that they were not always able to access local counselling services. We have worked hard to put that in place.
We now have a portfolio of training, and a training co-ordinator, who is employed by the trust. It is important to note that that training is provided to statutory services, voluntary agencies, community organisations, the education sector and the police. We analyse what training and education is available. Our aim is to determine whether or not that is effective, and, if it is not, to stop it and develop new needs-based programmes through the resource centres, which are becoming more sophisticated in relation to the needs of the localities and their populations.
The trust has attached such significance to the action plan that it has appointed a trust co-ordinator to implement it. The co-ordinator comes from a community-development background; has significant links with the southern trust area and is well known in the area; and has the ability to work across the trust area with community and voluntary organisations. The co-ordinator’s credibility in the area is very important, because of the work that we need to do.
Having listened to the earlier evidence, it is clear that there is an issue about people working collaboratively. To be frank, some people tend to deliberate on their own organisation’s needs. We want to create a mechanism that allows people to get together in a consortia arrangement. We want to cultivate a culture whereby specific communities or voluntary groups specialise in certain aspects of service provision, rather than all of them doing the same thing, leaving us unable to offer the full range of services.
We are examining mentoring programmes and new models of service delivery. The southern trust is reviewing all of its mental-health services, which is opportune, because we can build all of this work into that review and involve all the appropriate people, such as crisis-response and home-treatment services. We will examine primary-care and secondary-care services, and acute-care services, because they are significant, particularly in relation to accident and emergency services.
As members can see from the engagement paper, the action plan implementation group comprises 42 people. It is quite a task to manage that, so, with their agreement, we have developed a strategy to better engage people. We have proposed the development of a management group and a stakeholder network that will take forward the issues raised in the action plan and others which arise in the southern trust area. People feel that they can sign up to that arrangement.
The implementation group will meet next Monday to discuss the engagement paper. As members can see, the main purpose of the paper is to engage and represent everyone’s views, not just in relation to the implementation of the action plan, but in respect of the suicide strategy and all of the issues that arise in the southern trust area, and all of the needs that we are charged with meeting. A situation will be created in which we can adopt a collaborative approach to the representation of views and the provision of services to meet identified needs.
I am happy to take questions.
Those are useful documents. I congratulate you both on the way in which you are moving forward in trying to address a difficult issue.
Colm, you talked earlier about ideas for strengthening the strategy and about co-ordination. Will you outline more of your views on that? Obviously, that is something that the Committee will want to include in our report to the Minister when our inquiry is complete.
The clinical-excellence guidelines state that suicide rates can be reduced by targeting specific groups. One of those groups is people who self-harm. How effective has that strategy been? Does everyone who is treated for self-harm in the southern trust area quickly receive a follow-up appointment?
In respect of co-ordination, I am not necessarily referring to how the strategy is implemented locally by people such as Catherine McBennett, local community groups, and others from whom the Committee has heard today. Better co-ordination of the implementation of the strategy is about holding people to account. Therefore, it is important to ensure that the performance-management element is strengthened.
Scotland has a programme named Choose Life, which is a national strategy and action plan to tackle suicide, and which consists of up to 11 staff. I am not proposing anything such as that for Northern Ireland. However, as I have said, that programme has up to 11 staff helping to co-ordinate the implementation of that strategy and holding people to account.
There is a National Office for Suicide Prevention in the Republic of Ireland. Five or six members of staff are involved in ensuring that that strategy is being implemented across the country. Nothing of that nature exists in Northern Ireland.
This year in Northern Ireland, £3 million has been specifically earmarked for suicide prevention. Although £3 million is not a great deal of money, £1·8 million of that is earmarked for the development of local community plans. It is important to have in place an accountability arrangement that ensures that those plans are developed in a way that is consistent with the strategy, and that will actually make a difference.
Therefore, the co-ordination that I am referring to is about holding people to account in respect of the implementation of the strategy.
A good point was made earlier on the self-harm issue. During the development of the strategy, we heard many stories about people who had seriously self-harmed — either self-cutting or self-poisoning — being discharged from hospital after one night and not getting an appointment with mainstream services for two or three months. Invariably, the person does not keep the appointment, and there was no follow-up action.
In the north-west region, the Department has put in place a pilot scheme as a result of the strategy that utilises Zest — a community and voluntary organisation — and Altnagelvin Area Hospital, which refers people to that organisation. Zest has properly trained mentors who are prepared, when someone self-harms and is being discharged into the community, to provide six sessions with that individual.
That tends to begin to build a symbiotic relationship between the statutory and voluntary sectors. When people who have self-harmed are discharged, the statutory sector refers them to Zest, which then provides that mentoring service, providing the individual agrees. That is designed to bridge the gap between the discharging of people who have self-harmed and the time when they can access mainstream services.
There is other work that we are taking forward locally in respect of people who self-harm. I shall hand over to Francis to talk about those.
Since many people turn up in accident and emergency units, we are trying to develop psychiatric liaison services so that they have access to appropriate medical and nursing services. That was not available previously. We have just appointed a second psychiatric liaison nurse so that we can look at the matter from a statutory perspective.
I referred to the mentoring systems that we are examining. We have looked at Zest, which operates in the Western Health and Social Services Board area, and with the additional moneys we propose to augment the statutory services with access to an appropriate service, such as that provided by Zest.
In addition, we are working on an information leaflet, part of which deals with suicide prevention, self-harm and self-help. It lists all the organisations that people can be referred to while they wait for or are receiving psychiatric or statutory services. To be honest, we are still developing it because we realise that there is an issue. I was asked recently to join a departmental group to examine the interface between psychiatric liaison and accident and emergency services with specific reference to that issue.
Should there be a suicide prevention strategy for the whole of Northern Ireland or should it be the responsibility of specific trusts?
It is better to have one prevention strategy for a population of 1·7 million; however, different areas might have different implementation structures and plans. There was discussion earlier about the different needs of urban and rural areas, and sometimes a different response is required in a rural area. Suicide is no respecter of urban or rural demarcations, although the response to a suicide prevention strategy might differ from one area to another, as might its implementation. Nevertheless, the strategy must straddle the entire population.
My first question has just been answered. I commend Mr Donaghy and Mr Rice for taking on such a serious issue. It is very important that they do and it is good to hear about it. First, Colm mentioned a 25% reduction in six months. What do you attribute that to, primarily?
Secondly, suicide cannot be treated; it can only be prevented. Treatment is reserved for the families. I would like to think that the work that you are doing with conviction and determination will be rolled out and will be taken up by other trusts, for example the Western Heath and Social Care Trust, according to a strategy for the whole of Northern Ireland. Francis, you talked about a one-stop shop and pilot resource services, and that is a wonderful idea. I have often thought that there should be a half-way house that people could go to. Did you mention six or eight centres?
Can you tell us about the one-stop shop? Colm and I mentioned that some people see their GPs before committing suicide, but it can be impossible to detect suicidal tendencies in some people. At times of trouble, adolescents and young people need places where they can seek help. How long would the one-stop shops be open and how would they be staffed?
I wish I knew how the 25% reduction was achieved, but I do not. However, I hope that it has something to do with our work over the past two years and the work of our local communities before that, because our communities are the reason that we have a suicide prevention strategy. The commitment and resilience of our communities have meant that we have begun, I hope, to turn the tide. That said, I might be proved wrong; it depends on the statistics that appear in six months’ time.
I can give a positive example of prevention that will have long-term effects. As a part of the strategy development, we lobbied the Department of Education hard to introduce into the school curriculum a compulsory element of coping and life skills for children. I am encouraged to find that, from 1 September 2007, that has been an essential part of pastoral care responsibilities. It may not prevent every suicide, but it will give young people something else in their armoury when they encounter problems in later life and it may stop them taking their own life. That is part of the preventative strategy. It is a long-term measure, but it is important that we do not lose sight of the preventative element.
That is wonderful news; I am glad to hear it.
Resource centres are primarily operated by community and voluntary groups; however, we have service-level agreements on how we want them to operate. It is important that the resource centres have access to statutory services where appropriate so that when someone is in crisis they can access those services.
The resource centres fulfil a useful purpose, as people told us that not everyone who was in difficulty wanted to go to a GP or felt that they could go. Therefore this is an interim arrangement: if they are getting into difficulties, they can go to a resource centre anonymously — if that is what they want — to access services. In that way, they can begin to tease out their issues, address some of the coping mechanisms, and staff can work with them to enable them to deal with their problems.
There is also a recognition that staff should also have access to specialist statutory services where appropriate: childcare services, child/adolescent services or mental-health services. That is because it is not just young people who access the centres. Over the summer, we had an issue with some young children in the Southern Health and Social Care Trust area; however, we also have a problem with men aged 40 upwards. We are trying to address those issues and make the resource centres attractive so that people feel they can pop in to discuss their problems.
What are the centres’ opening hours?
The resource centres do not open 9.00 am to 5.00 pm; much depends on volunteering, week in, week out. We cannot afford to keep them open 24 hours day, but they open out of hours. Furthermore, if they are open out of hours, they can contact statutory services. An on-call arrangement operates there. We will continue to review the service to see what we can add to it.
That was an interesting presentation. I was encouraged to hear the witnesses’ answer to Michelle’s question.
What is the best way of ensuring that people do not fall through the cracks between different board areas?
I am pleased that groups follow up after instances of self-harm or attempted suicide; that is vital. Earlier evidence told us how important it is that it is done as quickly as possible.
In the ‘Protect Life: Northern Ireland Suicide Prevention Strategy’ document, I was encouraged to find that people are expected to take a lead, that there are expected outcomes and that individuals are held to account.
Where are we with that? It is easy, with something on this scale, to produce only warm chat with no real substance without any follow-up.
It is about co-ordinating all the various groups. The Chairperson spoke earlier about getting the message out to football clubs. Some of the groups that I have been involved with look at every area of life. In rural areas that means communicating with farmers and their families at livestock marts and in youth clubs, schools and churches.
I would also value your comments on the media. Colm said that 6% to 7% of suicides were copycat incidents and that they claimed some 20 lives. It is important to educate the media. I know that the Minister has visited his Home Office colleagues to discuss the role of the Internet. What has been the general response of media outlets to your submission to the Department — which, hopefully, has been sent to the Home Office — on control of the Internet?
I will answer your question about the media first and then talk about mentoring and people who fall between stools. The media are important and will become more important as the Internet becomes more widely available and becomes young people’s chosen source of information and news, as some of our regional newspapers will testify.
The Irish Association of Suicidology and the Samaritans have produced very good guidelines. We were involved in their preparation and have recommended them to our local media. We have on occasions sent them to the local media about their reporting of specific incidents of suicide.
Have you monitored its use?
The suicide strategy implementation body and the Department are examining a facility called Media Watch, which we will pay to monitor how the print, television and radio media deal with incidents of suicide. If they deal with it improperly we will raise the matter and make complaints. We have identified volunteers and others in Northern Ireland who will take part in the Media Watch campaign to ensure that the media report suicide responsibly. Unfortunately, we have found that the media respond but fall into old ways when getting a story; the difficulty for us is to ensure that we sustain media interest in suicide prevention and how they report suicide. Research shows that if the media report responsibly, we will prevent some suicides. It is worth concentrating on that 6% to 7% of young people.
The Internet is not controllable. The Minister has met Internet providers, and one concession has been given that has proved effective to some extent. When the word “suicide” is typed into Google, the first sites that appear will be suicide prevention sites such as those provided by PIPS, which encourage people to prevent suicide. It ensures that the first site to appear is not one that tells people how to take their own lives. That was not the case before, but it is happening now. The number of hits on suicide prevention sites in Northern Ireland has gone up as a result. The traffic is going first to sites that advise on suicide prevention.
The issue of people falling between stools is difficult. The mentoring scheme that I mentioned is a pilot scheme. It is running only in the north-west but not in other parts of Northern Ireland. However, a similar, although not identical, pilot is running in the Mater Infirmorum Hospital. The hospital provides a discussion forum for young people in north Belfast who have presented at accident and emergency having self-harmed. The suicide strategy implementation body advises the Department to take seriously the evaluation and outcomes of those pilots; if they show benefits, the body will urge the Department to roll them out at some stage.
How long has the pilot been running?
It has been running since September 2007. Given the nature of the scheme, it has taken a long time to train mentors, to get ethical approval and to get over hurdles of data confidentiality.
When the Committee visited Scotland, it discovered that a key aim was to get good evaluations of such schemes.
Indeed. The Health Promotion Agency has been tasked with ensuring proper and robust evaluation of the pilots so that any lessons that can be learnt will be learnt. If the pilot proves beneficial, I hope that further schemes will be rolled out.
In the north-west, 40 people have been trained in mentoring, so the evaluation should yield good information.
Mentoring makes sense. Often, all that someone needs is a listening ear and some sound advice. Although that is not always the answer, in most cases when someone is going through an extremely anxious period in his or her life, it is certainly helpful to be able to turn to someone who has been in the same situation or someone who has taken a course in how to generate discussion and offer sound advice. A price cannot be put on that.
I thank the Southern Health and Social Care Trust for its enlightening submission. I want to ask a question that is particularly relevant to my own constituency and probably to others in the Committee. How does the strategy relate to health authorities across the border? It was mentioned that when someone is taken into casualty, there is a mechanism by which a trained person will follow up the case. However, a young person from a border area might be in Bundoran and could be admitted to Sligo General Hospital; if someone was in Monaghan, he or she could be admitted to Cavan General Hospital, Louth County Hospital or Dundalk. Is work being done with counterparts across the border?
Recently, the Committee received a submission that promoted the benefits of workforce training. What is the trust’s experience of that?
I will deal with cross-border co-operation first. There is an all-island action plan for suicide prevention, so we work closely with our counterparts in the Republic of Ireland. It makes sense that programmes on research, training, and development are not carried out in isolation.
However, there is not only a cross-border aspect to that work but a five-nations aspect as well. We meet our counterparts from Scotland, England, Wales and the Republic of Ireland in a five-nations working group that examines how our resources can be brought together to ensure that, for example, future research is not duplicated. There is a great deal of co-operation on suicide prevention.
The Committee may already be aware of two recent television awareness campaigns, one of which was known as ‘It’s me’ and featured Lynda Bryans. The other was known as ‘Share it’ and featured a young man who carries a large box around with him. The box gets smaller and smaller the more he talks to people until eventually he can put the box in his pocket and walk alongside his friends without the box being an obtrusion.
Both those campaigns were funded through the suicide prevention funding. It was to promote awareness that people should talk and that the stigma should be removed from mental ill health.
The ‘It’s me’ campaign was taken by our colleagues in the Republic of Ireland. They ran the same advertisement but without Lynda Bryans, as they did not think that she would be recognisable in the Republic. We did the work and they lifted it. Subsequently, they developed another phase of the awareness campaign, which some of you may have seen. People’s faces show the effect that isolation and marital breakdown can have on mental health; it promotes the idea of talking and getting help for problems. It was developed by our colleagues in the Republic of Ireland and we ran it on television in the North.
I wear another hat as director general of an organisation called Cooperation and Working Together, which looks at where it makes sense to co-operate across the border on community, social, secondary or primary care services. A substantial amount of work is being done to examine how we ensure that services are delivered as seamlessly as possible as well as aspects of cross-border mobility. Recently, you may have seen in the media the announcement that people in south Armagh can now access the out-of-hours GP service in Castleblaney. That is to encourage people to access the out-of-hours service closest to them, irrespective of the jurisdiction.
Much is being done on self-harm; we are learning from our colleagues in the Republic of Ireland about the self-harm registry, which is to improve the recording of and the follow-up care for people who self-harm. We are repeating a self-harm registry in the north-west that we hope will roll out across Northern Ireland. It deals with how we register people who have self-harmed in hospital and accident and emergency departments.
Ms S Ramsey:
The information from the Department says that from 2002 to date, more than 22,000 people have been admitted to hospital as a result of self-harm. That is a sizeable number.
It is merely the tip of the iceberg because not all people who self-harm present to accident and emergency.
Ms S Ramsey:
You are carrying out positive work, even at the trust level. The ‘Protect Life’ paper from the implementation group says that its aims are to ensure the implementation of the recommendations in the Southern Health and Social Care Trust area between 2006 and 2011. You say that you will ensure that the recommendations are implemented; however, we are in the midst of a debate on the Budget and the Programme for Government.
We plan to ensure it with the resources that we have to the greatest extent that we can. We will ensure that the roll-out of the Protect Life strategy is funded as best we can. In the Southern Health and Social Services Care Trust our share is just over £400,000 of the £1·8 million community total. A sizeable percentage of that is non-recurring; however, if what we put in place proves beneficial, the funding should be made recurring. We plan to use the funding to deliver on those outcomes and objectives.
In the Protect Life strategy the funding is run out over three years. Is that more beneficial?
That is where we have a big opportunity in Northern Ireland compared to Scotland.
When I was in Scotland, about a year and a half ago, a debate was triggered because the funding for the Choose Life strategy was running out and some of the co-ordinators were thinking about applying for other posts.
The positive aspect of funding here, which the suicide strategy implementation body has welcomed, is that the Department said that the £3 million earmarked for suicide prevention in Northern Ireland is recurring: it is not three-year funding, nor is it time-limited.
Colm and Francis, thank you for coming today. It was most informative, and I congratulate you on your project. I hope that somewhere down the line it can be rolled out as a model of excellence that everyone in Northern Ireland can tap into.