HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
Inquiry into the Prevention of Suicide and Self Harm
3 April 2008
Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mr Thomas Buchanan
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mrs Carmel Hanna
Mr John McCallister
Ms Carál Ní Chuilín
Mr Sean McPeake ) Northern Ireland Local Government Association
Ms Heather Moorhead )
Ms Anne Donaghy Antrim Borough Council
Today, there will be two evidence sessions as part of the Committee’s inquiry into suicide and self-harm, which will conclude the oral evidence for that inquiry. Representatives from the Northern Ireland Local Government Association (NILGA) will give evidence first. Their presentation is at tab 3 of the Members’ pack.
On behalf of the Committee, I welcome the witnesses from NILGA and apologise that a previous evidence session, which was arranged for 14 February, had to be cancelled because the Committee had to consider the important matter of clostridium difficile. I welcome the chief executive of NILGA, Heather Moorhead, my dear friend and colleague whom I have known for many years; Sean McPeake, who is the vice president of NILGA, and Anne Donaghy, who is director of environmental services at Antrim Borough Council. I invite all of you to make comments for five or 10 minutes, after which members will ask questions.
Mr Sean Mc Peake (Northern Ireland Local Government Association):
Thank you very much, Madam Chairperson and members of the Committee, for allowing us the opportunity to speak to you this afternoon on how local government envisages a better joined-up approach being taken on the important issue of suicide prevention. There are many good examples of that in the local government sector. However, in view of Minister Foster’s RPA statement to the Assembly on 31 March, it is an opportune time to get some clarity on the matter. Perhaps the community-planning remit will be the vehicle with which to take that forward. That is primarily what I will discuss today; the greater roles that we envisage in health provision in light of the Minister’s recent announcement. In fact, we are lucky to have the Minister attend our full NILGA meeting tomorrow to explain the matter further.
I will hand over to Anne Donaghy who is an officer at Antrim Borough Council. Anne wears two hats — she does much work in suicide prevention for the council and similar work throughout the region for the community and voluntary sector, which she shall explain.
Ms Anne Donaghy (Antrim Borough Council):
Thank you, Madam Chairperson and members. After I have made my comments, I will ask Heather to expand on other activities in different local authorities across Northern Ireland. I will concentrate on the contribution of local government from a political and leadership perspective.
Local government takes a keen interest in the Protect Life strategy. We believe that we have an important role to play in that. We can help to target resources and to ensure that those that are set aside for suicide prevention can be used more effectively. We have local knowledge and can use it to help to target resources on the ground.
From a community point of view, when a suicide happens, the bereaved are very often left to pick up the pieces. Those are the people who will establish community groups to try to co-ordinate services. The councils can help them to do that. My involvement is through a local community group, which asked me, because of my local government skills, to help it to find funding, to influence the right people and to get a joined-up approach in order to streamline the partnership.
We have come a long way, but when local communities come up with those types of initiatives, they put in a lot of their own time and resources. Local government can help those groups by providing its available skills and capacity to achieve funding and to form projects that address real issues. Young people — young men in particular — the elderly and farmers have been driven to the extreme of committing suicide. There is a key role for local government. I have seen instances in which local government has helped to save lives by talking to community groups. The networks already exist, and I urge local government to take a stronger role.
Local government is involved in several strategies, such as Investing for Health, the health action zones and Healthy Cities. However, there could be a stronger role for the Protect Life strategy, to make it more effective where it is needed. Strategies come and go, but Protect Life must be introduced to local communities. Our elected members and officers know the local communities. When someone commits suicide, the bereaved relatives will often turn to the officer or elected member whom they know. Sometimes, they cannot go back to work. We can be used as a signposting service, for example, to help those people to get some money to sustain them until they can go back to work.
I know that local government has the ability to co-ordinate a streamlined partnership approach, in which we can connect organisations and individuals, such as the Churches and health professionals, who have an important role to play. Some of the "softer" roles can be taken on by local government officials and elected members, who can take a synergistic approach. Those of us who are involved in local government really want to see this strategy put in practice. We would like to put into practice some of the projects that have been suggested by local communities.
Rather than allowing piecemeal projects to use up funding, we want to be involved in making a co-ordinated strategy work. There is so much emphasis on road traffic accidents, but there are far more deaths by suicide in Northern Ireland than there are on the roads. We must make people aware of those facts. Local government has a strong voice in the community, and with MLAs. We can use that strong connection to promote the issue. As members will be aware, suicide has a stigma, and local government can help to remove it.
We have a central role to play. We have rural connections; rural suicide is as big an issue as it is anywhere else, and it affects young and old. We can use some of the existing local government services to help to eradicate suicide. We can channel our sports and leisure and community development resources. There is a real need for an evidence-based evaluation of suicide. I know that some work has been undertaken, but we must be more involved in that. There must be clear communication between all the players.
It is not only an issue for the health profession; it is an issue for the Churches and local government. Clarity is needed between those areas, and it must be ensured that the precious resources that have been set aside are used to make a change on the ground. As I said earlier, local government has the capacity to address suicide. We have an opportunity to work in a co-ordinated fashion with all the other professionals, the Churches, and the community, which is crying out for help to make that happen on the ground and to share best practice.
I propose the creation of a task and finish working group to consider the issues and to decide how the recommendations can be taken forward practically. The key is that local government wants to be involved in the implementation and evaluation of the Protect Life suicide strategy. We want to channel the capacity that exists — and the resource that is paid for — to the community and address the issue. We want to connect and co-ordinate the key players to have a streamlined approach. We want to help the communities to achieve funding, set up systems, make connections and have influence so that they can focus on the real issues in their communities — young people and the people who are under threat from suicide.
Ms Heather Moorhead (Northern Ireland Local Government Association):
I want to highlight what councils are doing. There is a massive role for local authorities, but their work is piecemeal. Many things are happening on the ground and we want to pick a few of those that highlight and explore, with our other partners, how we can step up to the plate and have a much more strategic role so that we are adding value. Clarity is needed because everyone who works at local government level is stepping over each other and no one knows what is happening.
We have listed seven or eight excellent examples that are making a real difference at local level in different areas. The Lord Mayor of Belfast has set out suicide prevention as a priority, and Belfast City Council has been working for a long time in north and west Belfast through the health action zone. In the southern region, local government has worked through the Investing for Health partnerships. Five councils have worked together, employing three officers. They are carrying out training and raising awareness on the ground, which is another initiative. Strabane District Council and Omagh District Council have decided to work together; Strabane District Council’s chief executive is leading a convening partnership to consider delivery of the strategy. Derry City Council has been working on the issue for a long time, and it convenes a local partnership through its Healthy Cities work. Newry and Mourne District Council has community safety officers, who are supporting a community initiative. The community started those initiatives and the council is supporting them.
Some other councils are not doing anything at all because suicide is not seen as a problem in their areas; either no one person has been interested in an initiative or the council has seen suicide prevention as a health issue. NILGA should be able to provide a lot of support to the Health Service to make a real difference in communities. As 26 disparate councils, we need to find a more strategic approach to working with the Health Service, in particular, and the other organisations in that area. Therefore, we have made a practical proposal to set up a task and finish working group to define the role of considering strategic issues so that NILGA and, particularly, the environmental health and community development professions provide a way to promote that in the councils.
I will open up the discussion for questions. From what I gather, the work of the councils is piecemeal and not all the 26 councils are engaged. That answers a question that I was going to ask about the level of engagement between district councils and trusts in local implementation. If all the councils are not involved, that falls short in every sense.
Ms Ní Chuilín:
The review of public administration puts an emphasis on coterminosity. That means working together better in a more joined-up way. What opportunities are there for that under RPA? What community planning will take place?
As you say, people in rural and urban areas will have different experiences of this. It is important to respond to the needs of people, instead of presenting services and hoping that people will respond to them. How will you go about using the reorganisation of local authorities, community planning and RPA as an opportunity to get a better response to suicides?
We see great opportunities here. We have an issue with coterminosity, and we welcome the opportunity of exploring that with the Minister and the commissioning groups. It is very important for us.
Community planning in other regions yields much fruit on what are known as "wicked" issues, those on which it is nearly impossible to make a difference. Here is an example: in Nottingham, 36 budgets were operating for youth and antisocial behaviour, but they were making no difference. In the community-planning process, all the agencies clubbed together their budgets and set new stretch targets. Those agencies were able, within a two-year period, to transform the situation, as everyone worked to the agreed strategy.
We hope that community planning will not wait until 2011: we are starting to form transition committees. We welcome the opportunity to have a community-planning pilot scheme at an early stage. Some of the issues are more pressing than others, and it depends on the area concerned, as everything is not appropriate in every area. However, it is important to take a lead and pilot measures that make a difference locally. That is our main priority, and it is something that we will explore with the Minister. It is important for this issue.
It is vital that all the community groups that deal with suicides get together and adopt a joint approach with councils and the Health Service. Otherwise, everyone will go his or her own way, and that will not help to tackle the problem.
Does NILGA feel that that is the way forward? In every council area, or Westminster constituency, should there not be a body at which all the community groups, together with the council and the Health Service, get together once a month to co-ordinate an approach on suicide, decide on programmes and work together?
That is the current concept. The Department for Social Development (DSD) has a community development budget, which will be devolved entirely to councils, so that, at local level, there will be a community forum and a community support plan. Each forum will decide upon priorities. During the community-planning process, that forum will be able to contribute to environment, health and other aspects. However, there will also be thematic groups in the community-planning process: one for health, another for environment, another for the economy, and so on, meaning that there will be a proper interface.
To be honest, in our experience, the lack of co-ordination at local level is a major block to getting collective action on the ground. So much time is spent negotiating, arguing, checking, and passing things from one group to another, that those transactions are all very wasteful. A local authority, however, can work magic in a local area to join up efforts. We hope that community planning will make a big difference, but we should not underestimate the difficulty of that.
That is our vision; that is how it should work. There is everything to play for, if we get support at local level.
Thank you, Heather, Sean and Anne for attending. The Committee has been looking into this for some time now.
Anne mentioned the need for a synergistic approach, the united approach that society must take. She talked of strategies and practical solutions. I have worked as a doctor for 27 years, and I have heard repeatedly about strategies. What is needed is progress on the ground.
I am thinking of structures, and Heather mentioned that local commissioning groups will have council input. That decision was made — correctly — by the Minister. The Committee visited Pieta House in Dublin, which provides a facility, which seemed to me — as a doctor who has dealt with suicides and the family devastation left in the aftermath — to be the answer. The building provides support for the whole Dublin area and has a lot to do, but, still, it achieves fantastic results. It is non-threatening, which is important because, as a doctor, I see that when young people leave the old-style psychiatric hospitals, they feel almost more suicidal than they did when they went were admitted.
We must find a practical solution: for example, a building in each of the five trusts where councils have an input, and where young people can gain immediate access through accident and emergency departments, the police, GPs, themselves, families and girlfriends or boyfriends. That is what happens in Pieta House — the staff get to patients in their vulnerable first few days when they are most likely to commit suicide and before they have been near a health professional. Do the witnesses agree that a facility such as that is required?
I am on the local commissioning group, although I am not sure if I will be on the next one. There may be three different councils. Local government will have an influence on the commissioning of healthcare. We should not just look at the strategies, which can overwhelm people and — as Alex said — leave people not knowing what they are doing. We should also look at building a non-threatening structure, which may not even be medical, that young people can access immediately. As I have mentioned in other Committee meetings, I know two young men who took their lives before anyone knew that they were depressed. Does NILGA see a practical way forward rather than just strategies?
The only way to advance suicide prevention is on a practical basis. I have worked in the community on the front line with young people who have been suicidal, and the bereaved families of those who have committed suicide. Those people do not want to know what the strategy is — they just want the problem to be resolved.
On average, one person commits suicide each day in Northern Ireland, which demonstrates the enormity of the problem. When someone commits suicide, it is often the local MLA or the council officer to whom those people turn. I am an example of that. The group that I have worked with spans the Armagh and Tyrone areas, and its members did not know what to do. The people who try to address the problem of suicide are often bereaved themselves — either through a loss in the local community or their own sons or daughters — and are trying to help those who are about to be bereaved or who have a child or adult whom they do not know what to do with. Sometimes, the health profession or the Churches fail those people. Often, the problem is that no one in the local community knows where to get help. Even when they do find out where to get help, the professional often acts on a piece of medical information or assesses the situation from a religious or local government viewpoint. The process is not joined up enough for people to know that they have covered all angles. As a result, people sometimes slip through the net.
Therefore, there must be a joined-up approach, which can only be achieved on a practical project-approach basis, with everyone around the table. Otherwise, we will continue to lose people, young and old, and particularly men, to this terrible disease.
I agree with Kieran — everyone who was at Pieta House left wishing that we had community houses dotted around each trust area. The level and depth of creating the right ambiance and the work that went into creating the beautiful facility, down to the colours, the paintwork and the candles, resulted in a beautiful setting. All the various groups were at hand, including psychiatry and the Churches. Everyone was involved, but the community was driving it. Nobody was turned away. If someone presented at accident and emergency, he or she did not fall out at the bottom; people were taken by taxi to Pieta House, where they immediately received a cup of tea and were able to relax. Everything was well thought out, even down to the seating, where the psychiatrists were sitting lower than those who were traumatised or distressed, and they were followed through the system. Around 1,100 people were catered for in two years, and not one was lost because of the community-based house approach. It was a tremendous inspiration to us all, and we were very envious.
Much of the ground has been covered. I agree with Kieran, in that practical solutions are needed. Obviously, there should be non-threatening areas, with no stigma attached, where those people can go.
The work that bereaved people are doing to help others in a similar situations was mentioned. In some instances, a person who has been bereaved and has gone through that experience can offer help that no one else can provide. Only someone in that position knows exactly what has happened and can remember the signs. It is important that someone who has been bereaved is part of the group, so that he or she can give assistance and guidance on the way forward.
The work of some of the councils was mentioned. Has NILGA made contact with all the 26 councils on the issue and, if so, have any of those councils refused to take up and work on those issues?
NILGA has not done a lot of work on that, because of the capacity issue more than anything else, and so much is happening in RPA. It could do some work to encourage councils to get involved. However, support is needed to have a strategic approach and to define a role and a partnership for local authorities. That would all help to step up the matter.
The 26 councils and NILGA made practical solutions and a joint response through Heather’s offices. We tried to say that local government needs an input at the early stage. Bereaved people have an understanding of the situation, which is essential, and the skills to listen and guide others. However, they should not be spending their time setting up meetings and applying for funding, which they seem to be doing. That diverts them from the help that they are prepared to give, and into a more bureaucratic role. Local government has the skills to help them with that.
Do you feel that you did not get enough involvement and input into the strategy?
Certainly, we could have added more. We submitted a paper, but we would have welcomed more open discussion. However, we still want to do that, and to add further to our comments and give practical examples and solutions to the issues in the communities.
Is NILGA proposing to contact local councils again about that issue, because it seems that many of the councils are doing absolutely nothing? As you say, they have the skills and the expertise. Is NILGA thinking about making contact again with councils to try to get the necessary input?
We were thinking that a more proactive approach would be a task and finish working group with some of the other key providers so that we could go back and add something productive instead of just saying please get involved. The question is: get involved in what, or do what? We want to define the type of role that we believe that local authorities could be playing and the things that we could be doing.
The important aspect about community planning is that many issues are dealt with at only the coalface instead of there being a long-term public health prevention role. Suicides happen in a society in which things are going wrong. If councils are to have a power of well-being, the question is what role do they need to provide in order to create a sense of well-being, safety and community support in a more fragmented society over the long term rather than dealing with this issue at the sharp end only? Community planning provides for that approach. However, as Anne would say, local government covers a range of services and does not look at the issue in silos.
This is not just a health issue: it is a societal public-health issue, and a solution cannot be arrived at with only a health mindset; a broader mindset is required. As a result, when we become involved in dialogue, we can add value and provide more creative and powerful solutions with a broader approach. Those are some of the solutions that we would like to see coming out of this meeting. Perhaps there are a few of your colleagues in the Health Service at ministerial level with whom we could explore some of those issues and then return with recommendations that councils could be invited to consider. This is just a snapshot: I did not carry out a full survey of all local authorities. However, my point is that some local authorities are doing a lot; others are doing something, while some are not doing anything.
Thank you for that. It is important that there are good links with other agencies, particularly with the Health Service. In the new structures, the Minister of Health, Social Services and Public Safety announced greater opportunity for representation from elected representatives on those structures. Perhaps NILGA is not entirely happy with that arrangement and would like a greater proportion of elected representatives. In addition, has the Department consulted NILGA on the new health structures, and is NILGA one of the consultation team?
We are really pleased that the Minister has singled out NILGA for a proper dialogue with our elected members, and that issue is coming before a full NILGA meeting tomorrow. We are also pleased that the Minister has responded to our request for greater public representation in the new health structures. We want to discuss with the Minister how to get best use from those structures, because we want elected members on the new structures but we also want them to have an institutional relationship with the councils and through community planning. Therefore, we welcome the opportunity; we think that it is a positive move; and we will be looking to see how we can best do that. We find that policy is better when we are engaged at the front end instead of policy being produced and then us being consulted because, by that stage, policy is almost set.
I thank Anne, Sean and Heather for coming today. That concludes almost everything in our consultation process. We take on board all your views, and we thank you for your paper, which is very helpful. We believe that this is too important an issue to let go; and the Minister, in all fairness, recognises that the way to proceed is to involve as many community groups and elected representatives as possible in drawing up plans to try to alleviate this dreadful curse on the communities that we represent. Thank you for your attendance.