NORTHERN IRELAND
ASSEMBLY
COMMITTEE FOR
HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
OFFICIAL REPORT
(Hansard)
Families Bereaved by Suicide
5 July 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
Mr Tommy Gallagher
Mrs Carmel Hanna
Mr John McCallister
Ms Carál Ní Chuilín
Ms Sue Ramsey
Witnesses:
Mrs Jean Carson
Ms Mary Creaney
Ms Rhonda Hill
Mr Séamus McCabe
Mr Gerard McCartan
Ms Ann McGarrigle
Ms Maureen Young
The Chairperson of the Committee for Health, Social Services and Public Safety (Mrs I Robinson):
I welcome representatives from families bereaved by suicide to the Assembly. This is a difficult subject with which to deal, and I can appreciate how much it has cost you all to come here and open up on the delicate and sensitive matter of bereavement.
I welcome Mary Creaney from north-west Belfast; Maureen Young from mid-Ulster, Séamus McCabe from Newry; Rhonda Hill from south Belfast; Gerard McCartan from north Belfast; Ann McGarrigle from the north-west; and Jean Carson from west Belfast. You are all very welcome. You will have 10 minutes to make a presentation, although I am sure that that could be extended a little due to the number of witnesses. Members of the Committee will then ask questions. Who will start?
Ms Mary Creaney:
We are a group of parents and families who have been bereaved through the tragedy of suicide, and I have been nominated as spokesperson for today’s session. I welcome the opportunity to speak to the Committee for Health, Social Services and Public Safety.
Our group’s first concern relates to depression-awareness training for general practitioners (GPs). The GP is likely to be the first person in the primary care setting to whom individuals go to report depressive symptoms. That first contact can be particularly difficult for the individual who presents with depression, and the initial support and treatment from the GP are critical for the person involved. As families, we continually hear horror stories about how families are treated with condescension or perhaps even ignorance by some GPs. Some GPs treat individuals with the greatest respect and provide adequate care, but there are those who do not.
One action point from the Northern Ireland suicide prevention strategy ‘Protect Life — A Shared Vision’ was the development and delivery of a depression-awareness training programme for GPs. To date, 161 GPs from the four health board areas have attended a total of 10 courses. There is obviously an inability to engage successfully with GPs to avail of training. GPs were offered locum support for their surgeries while they undertook the training, which is delivered in a three-hour period. Plans are being developed for the second phase of training for GPs, but that is questionable, given the Health Promotion Agency’s inability to attract more GPs and surgeries to undertake such vital training for depression awareness.
We believe that the depression-awareness training programme should be made compulsory for all GPs, particularly at the contract stage between them and the Department of Health, Social Services and Public safety. The Committee should investigate the nature of GP training in the South of Ireland — where depression-awareness training is compulsory — and examine policies there in the hope of adopting best practice and bringing it to the North of Ireland.
The Belfast Health and Social Care Trust is commissioned by the four health boards to provide adolescent psychiatric inpatient services at a regional inpatient unit. At present, sadly, there are five adolescent beds to cover four health board areas, with a pending increase to eight beds by the end of July and a purpose-built bed unit by 2009. Meanwhile, adolescent and young people are exported to various parts of England to receive the treatment that they require.
The Bamford Review of Mental Health and Learning Disability (Northern Ireland) ‘A Vision of a Comprehensive Child and Adolescent Mental Health Service’ states in its introduction:
"At present the workforce profile of Child and Adolescent Mental Health services clearly shows them to be wholly inadequate. Despite many examples of good practice the overall quality, consistency and accessibility of services is so inadequate that urgent strategic action is needed to tackle these shortages."
One year into the implementation of the Protect Life strategy, the dearth of adequate services for children and adolescents still prevails. This week, the office of the Northern Ireland Commissioner for Children and Young People published a report that stated that Northern Ireland’s Department of Health, Social Services and Public Safety’s spending on healthcare provision for children and adolescents is half that of Scotland and one third of the spending budget for such services in England.
The fact that resources are inadequate and that services are underfunded was reinforced by the Bamford Review of Mental Health and Learning Disability (Northern Ireland), which, in 2005, put in place a strategic framework for mental health services. Families are concerned and need more information on the 24/7 regional response teams, as well as information relating to child and adolescent mental-health services (CAMHS), particularly when working with those in crisis. Families need access to pathways to those services; information is often fragmented and referral pathways to services are sometimes confusing. Clarity is, therefore, required, and we would like the Committee for Health, Social Services and Public Safety to help us to obtain it.
Individuals present themselves at accident and emergency departments because of self-harm or following a suicide attempt. If individuals present having consumed drugs or alcohol, they will not receive any kind of psychiatric assessment and could be sent home to injure themselves further or to attempt suicide.
Lost opportunities at accident and emergency departments can be fatal, especially for those with alcohol or drug problems, as they are six times more likely to die as a result of suicide. Lost opportunities cost lives, and accident and emergency service provision at primary care level needs policy development and delivery of adequate services in order to provide a place of safety until a proper assessment can be conducted on those who present themselves because of self-harm or suicidal tendencies. There are best practice models in parts of England, Scotland and Wales.
One concern raised by families is unique to Northern Ireland: in the past, families have highlighted the problem of bullying by paramilitaries in loyalist communities. Such bullying has a detrimental impact, particularly on young men, who may go on to self-harm or to develop suicidal tendencies. Families feel that that issue needs to be raised because it is detrimental to the well-being of those young people.
The urban/rural divide is represented today, and that brings a particular set of problems.
We ask the Committee for a follow-up meeting to discuss our concerns in more detail and to form a working relationship with Committee members. The overarching aim of the suicide strategy is to reduce the suicide rate in Northern Ireland, and we hope that the members of the Committee for Health, Social Services and Public Safety will feel that they have a vested interest in that.
Each of today’s witnesses has the same aims, which we hope Committee members share. Our aims are not only, eventually, to save lives, but to help bereaved families. Until recently, there was no service provision for those who had been bereaved, and there were gaps and deficiencies in the services. Often, people do not realise that when a loved one dies due to suicide, close relatives automatically go into a high-risk suicide category. It is, therefore, imperative that adequate services be put in place for bereaved families.
I thank the Committee for listening to us today. We have a host of other concerns, such as education, training, and interdepartmental relationships. However, we have brought to the table the concerns that we felt needed to be highlighted today.
The Chairperson:
Does anyone want to comment before the discussion is opened up?
Ms Rhonda Hill:
Mary made the point that we represent the rural/urban divide, which is important. I come from mid-Ulster, and the needs of the people in the Sperrins and the outlying farming communities are different from those of people in intercity areas.
The Chairperson:
That brings us to a new area, which includes the suicides following the BSE outbreak.
Ms Hill:
Age is not a limiting factor: my husband was 50 when he died, so suicide does not happen just among young people.
The Chairperson:
We realise that although the media concentrate on suicide among young adults, a wide age spectrum is involved.
Ms Creaney:
Last week, in a programme on suicide among the elderly, Dot Kirby, the health correspondent for BBC Northern Ireland, reported that one in eight suicides in Northern Ireland is in the over-60 age group.
The Chairperson:
We were not aware of that.
Mr Séamus McCabe:
I represent the Newry and Mourne branch of the Public Initiative for the Prevention of Suicide and Self Harm (PIPS). In rural, areas resources are scarce. There has been a spate of suicides in Kilkeel and Tandragee. The media coverage of those incidents amounted to frenzy, and there was no evidence for, or truth in, much of what was published. We are greatly concerned about the news media’s coverage of suicides, especially when two or three suicides occur in a short time, as happened in Tandragee.
The Chairperson:
Did the media sensationalise those events or was its coverage over the top?
Mr McCabe:
The entire community in the surrounding area of Tandragee was affected — and is still greatly affected — by the way in which the media reported those suicides.
The Chairperson:
Do you have difficulty with the media highlighting the issue? Good can come out of that.
Mr McCabe:
Suicide is contagious: a person who has been exposed to suicide becomes at risk of suicide. That community was exposed to suicide and consequently became at risk. When the news media sensationalise a suicide, it heightens the risk and extends it to a wider population.
The Chairperson:
I concur with you.
Ms Ann McGarrigle:
That is similar to experience in the north-west. I represent families in Limavady and Derry/ Londonderry. As Rhonda said, suicide does not just affect young people. Four people, two of whom were over 30 years of age, took their lives last weekend, yet their ages were not mentioned in the news media. Suicide among younger people is highlighted rather than cases involving older people.
I also work in education, and I am keen to ensure that efforts in that sector are co-ordinated. The health of young people must be examined from primary school onwards. As regards the problem of suicide, Northern Ireland is different from the rest of the United Kingdom.
The Chairperson:
Another tragedy occurred in Armagh today: a 16-year-old boy took his life. We all feel for the families affected by that dreadful event.
Ms Ní Chuilín:
I welcome the delegation. Most Committee members are also the health spokespersons for their respective parties, and we are all very keen that the issues of suicide and suicide prevention are kept to the fore. I am anxious that that be put on record.
As my colleagues from the UUP can testify, the Minister of Health, Social Services and Public Safety, Michael McGimpsey, has appeared in the Chamber almost every week since devolution. The issue of mental health is raised almost weekly during Oral Answers to Questions and in various debates. The issue is very much to the fore.
However, debating the issue and raising awareness is only one part of the solution; finding the necessary resources is a separate task. I see the members of the delegation nodding their heads in agreement. The suicide prevention strategy and the initiatives associated with it must be accompanied by adequate resources.
I have no wish to put members of the delegation under further pressure; however, at some stage, voluntary groups must quantify the hours spent working on this cause in their communities. The Committee has stressed that point to other delegations. Those hours need to be totted up and costed. Protect Life is a three-year strategy. When voluntary groups seek funding from the Department or other bodies, the financial cost of volunteering should be identified. The financial cost of suicide must also be calculated, and that issue has also come to the fore. The caring work of voluntary groups must also be costed.
I ask voluntary groups to do that, even though they are already under pressure and helping people. Sometimes, however, talking about financial costs or money that has been saved as a result of saving lives receives attention. That is what people will listen to. Committee members are all sympathetic to your cause, and I urge the delegation to consider quantifying its work in that way.
The Committee has considered the use of the terms "suicide", "taking one’s life" and "ending one’s life", and Sue may wish to comment on that. Families’ groups have lobbied against the use of the term "commit suicide" in the news media, and Sinn Féin has instructed its party spokespersons to avoid using such terms. Other Committee members may have done the same with their parties; I cannot speak for them.
The Committee is very keen to help bereaved families, so if there is anything else that the Committee can do, please let us know. I am aware that I have asked the volunteer groups to do much more work, but the Committee is here to support bereaved families in any way that it can. However, as regards resources, groups need to start totting up the exact cost of volunteering and the cost of caring.
Mrs Jean Carson:
It is very difficult to put a cost on that work. Like Mary, I have been a member of the suicide awareness and support group based in west Belfast for the past seven years. People think that support for families bereaved through suicide is new — seven years is not what I would call new. We have provided support for the past seven years, but we secured funding only last October. We are grateful for the funding that we have received.
I hit John McGeown with figures from the documentation. A life lost to suicide costs the Government £1·9 million. In the past two weeks, the suicide awareness support group based in west Belfast completed 11 interventions — 11 lives have been saved that would have been lost to suicide. The most recent case was this morning, when we handed a man over to accident and emergency at 2.15 am. Three members of our support and awareness group were volunteering in the middle of the night. We had to work with the person at risk and get his permission to involve the emergency services.
A price cannot be put on the work that we do. People are getting paid to man phone lines, but our support group owns only two mobile phones, which we pay for and run ourselves. Our support group has one worker, Mary, and the rest are volunteers. If our funding were snatched back tomorrow, west Belfast would still have a suicide awareness and support programme. Money is not our main issue — although it makes it much easier for us to deal with matters.
The Chairperson:
You say that you have prevented the deaths of 11 people. As those young people are alive and can talk about their experience, have you established a pattern as to why they felt that their lives were not worth living?
Mrs Carson:
The man from last night was 45 years old. Suicide knows no age barriers.
The Chairperson:
Were most of those 11 people young or were they from different age groups?
Mrs Carson:
Many of them were young.
The Chairperson:
Have you established a pattern or contributing factors, such as bullying?
Mrs Carson:
Nothing that we could identify, only that they were desperate, sad, isolated and, at the time, felt that suicide was their only option. As a result of the interventions, we have opened up other ways for them. They all now receive counselling, and they have opened up to their families — initially, no one but themselves knew how desperate they were. Thank God that 11 people are still alive because of those interventions.
The Chairperson:
Why do you think that they do not talk to their families?
Mrs Carson:
I have learnt that they do not want to burden their families. It is easier for people to shut down and keep their feelings to themselves rather than feel that they are a burden to their family. However, the devastation to families in the event of a suicide is much worse than a family member being burdensome in life. We could all cope with burdens in life, but it is very hard to cope with the loss of a loved one to death by suicide.
Mr Gerard McCartan:
At the start of the year, we were involved in an intervention with a young man. No drugs or drink were involved, but he had attempted suicide a couple of times before. We kept a close watch on him and did what we could. His GP gave me his private mobile number in case anything should happen, which is rare for a GP to do. We got to the root of the situation. The process is exactly as Jean described it: we talked to him, and he told us that he just did not want to live life. He thought that he was a burden and a waster — those are his words. He did not want to tell his mother because he did not want her to be worried, but deep down he did want to tell her.
We took a chance and got him into a house. We brought him into the kitchen and made him a cup of tea to settle him down, and we sent for his mother. We brought them both into the front room and the two of them burst out crying. That was a relief for him. He is now working in the town and has just come back from a holiday in Turkey. He opened up. He really wanted his mother to know, but he did not want to be a burden to her. That is what working on the ground is about — taking that chance. It took a few weeks to get to that point, but we took a chance, and it worked out for the best.
Mr McCabe:
We held workshops in Kilkeel following the suicides there. A couple of workshops involved youths from youth clubs, gyms and the Kingdom GAA club. We asked them to write down, anonymously, their thoughts, concerns and suggestions and post them into a pillar box. Most of the comments expressed concerns about who they were going to hear had died the following weekend. They were also very concerned for their own safety, because they did not know themselves how much at risk they were, and they were afraid that it might impact heavily on them. The young people involved in those workshops were aged between 13 and 18.
Despite their ages, it was very mature of those young people to do and say what they did. Their major concerns were: about whose death would they hear next; how that would affect them, and whether it would have such an impact on them that they would consider doing the same.
Ms McGarrigle:
I have visited five different homes in the north-west in the past fortnight. Three were the homes of young people, and alcohol had been the underlying issue. The other two were: a nurse in her fifties and a man in his forties both of whom had been afraid of losing their jobs. Change at that stage of life, and the sense of hopelessness that it brought, made them depressed. However, they were reluctant to go to their GPs because they thought that they would lose face.
Therefore, there is a need to heighten awareness. As Carál said, everybody needs to be aware of suicide. We have reached the stage where it is everybody’s business — everybody in this room, every member of the press, everyone. If we ask a person how they are feeling, we must take the time to listen. It could be you, or me, or any of us: it is happening now.
I do not know how to answer Carál’s question in the time available. When people ring us, it is because they have obtained our numbers, and they know that we have experience of death by suicide. We cannot turn them away. At the same time, we cannot say to counsellors that they owe us travel expenses. I do not know how to answer the question.
Ms Ní Chuilín:
I would like to clarify my point, because I have been misunderstood. I am not saying that you should not do what you do; I want to make that clear. When the Department of Health, Social Services and Public Safety and other Departments set budgets — which they will not do for a while — someone needs to demonstrate, even on your behalf, that your voluntary work is valued by costing the number of voluntary hours that you do regardless of the time, day, or season.
Mrs Carson:
Our work is 24/7, Carál.
Ms Ní Chuilín:
Absolutely. However, your work needs to be factored in.
Mr McCabe:
Given that we were told that an application for funds for a full time co-ordinator, an administrator and premises had to be submitted for April, we applied to the Suicide Strategy Implementation Body (SSIB) in March. The premises are in Newry and Omagh and they are still awaiting the funding. It is now the middle of July, and still no money is available. Last year we were told that £1·1 million was available. The southern area that covers Armagh to Kilkeel and Crossmaglen to Banbridge received 18% of that. Despite submitting our proposal, we are now being told that there might not be enough money to appoint a co-ordinator.
The Chairperson:
I understood what you were trying to get at, Carál.
Ms S Ramsey:
I want to put on record that I thank you for the work that you are doing, because I know that, directly or indirectly, you are suffering yourselves. You need to be commended for the fact that you are doing positive work in the communities. You have given the Committee an idea of how many people’s lives you have had an impact on and possibly saved. On behalf of my party, and my colleagues, I commend you for all that work.
The Committee received a briefing paper from the Assembly’s Research and Library Service. I commend the team for putting a great deal of work into that paper. What strikes me about it reflects a point that Carál also made. The papers states:
"for 2004, the total estimated cost of suicide…was in the region of £202 million, which equates to £1·4 million per suicide."
Therefore information is available and can be used, and the knock-on effect that suicide has on individuals, families and young people must be taken into account. I am not unique — suicide has touched my family also. The research paper also states:
"Suicide is a permanent solution to a temporary problem."
That point struck me, and it is something to consider, especially where young people are concerned. I represent West Belfast, which has been dealing with suicide for a long time.
I do not want to come across as someone who just talks about the issue. Some of you know me and know that I like to get things done. You are not just here to make a presentation and listen to us telling you how good we are. Ms Creaney said that, to date, 161 doctors have taken depression awareness training. I want to hear more about that, because if there are obstacles preventing other doctors taking that training, I want to do something about it. Whether as individuals, family members or community or political representatives, we are trying to focus on suicide prevention. If there is a blockage in the system, we must unblock it.
Ms Creaney:
I can provide an evaluation of the training that has taken place to date. There are more than 1,000 GP surgeries in the north of Ireland and it is deplorable that only 161 doctors have taken up the training. In the north of Ireland, 25% of GPs run surgeries on their own and do not avail of any type of training. However, the majority have not signed up for depression awareness training. A GP is normally the first port of call for a person facing a crisis, so it is imperative that they take up the; lives could be saved. It is only three hours long; surely they could spare that amount of time.
Further to the depression awareness training, GPs can avail of Applied Suicide Skills Intervention Training (ASIST), which is a two-day workshop providing skills in suicide first-aid and intervention. If 10 GPs and their staff in west Belfast gave up one weekend, that programme could be delivered to them at very little cost. Surgery managers do not always have hands-on relationships with patients therefore all the receptionists and GPs could have the ASIST training in their own surgeries over one weekend.
Ms S Ramsey:
Please leave the details with the Chairperson, and members will receive a copy. As individuals or Committee members, we can do something about that.
I have a couple of other points. Ms Creaney mentioned a 24-hour response team; we need to know more about that. The Committee can do several things; it can write to the Minister to get the clarification needed. However, all of the information must be put together.
According to the Bamford Review, bereaved families should have a major influence on the introduction of a suicide prevention strategy. What I am hearing is that this is not happening. Would Ms Creaney make some brief comments about that?
Ms Creaney:
Ms McGarrigle was the chairperson of the recently established Families Forum, and I was its secretary. The NIO Minister Paul Goggins had the idea of bringing families on board, because it was they who were pushing to establish the campaign and without them, the strategy would never have been implemented.
Mr Goggins valued our contribution and wanted to do something about the problem. He said that a forum would give us a powerful voice, but that did not materialise. We knew that we would never have a veto, but our voice was never as powerful as we had envisaged. Sadly, the Families Forum was dissolved two weeks ago. However, the network of connections established via the forum will be kept going, and we will meet at least four times a year, so that the issues that we have talked about today can be raised with local and regional health and personal social services boards.
We were really enthusiastic about the concept of a families’ forum, its establishment and its ethos, because it was new and was evolving. Indeed, a group of families in New York had developed something similar. However, while we were enthusiastic, we had to be aware of the issue of accountability, and we had to be accountable to ourselves, especially when we realised that the forum was not doing what had been intended.
Ms McGarrigle:
There was a very well publicised mental-health programme rolled out in February. We are not against it, nor would we say anything about it. However, approximately £380,000 was spent on that campaign yet not one member of our forum was involved in the programme. The forum was set up in September 2006, and it was well known that we were representing people across the Province as best we could. Therefore, it was embarrassing not to have had more involvement in the campaign.
Ms S Ramsey:
I am trying to tease out how the issues can be tackled. I hope that you picked up my point earlier about your not just coming to give a presentation and then leaving. Earlier, Carál Ní Chuilín mentioned the terminology that is used when discussing suicide. What is the proper terminology so that we can educate people? Education is crucial, and attitudes must change. Without going into detail, I am dealing with a case in which a professional who works for an out-of-hours-service told someone flippantly: "Go on to a railway track and take your own life." It is important that we change attitudes.
Ms Creaney:
As bereaved families, we hear stories like that all the time. The word "committed" has legal, ethical and moral connotations — suicide was once a crime. It was decriminalised here in the 1960s and in the South of Ireland in the 1990s. Therefore, it is hurtful for families to hear it being said or reported that someone has "committed suicide" because that phrase slices through those who have recently been bereaved. If the words used were changed to "died by suicide" or "died through suicide" it would help reduce the unbelievable stigma that is attached to the word "committed".
Rev Dr Robert Coulter:
I admire immensely the work of the bereaved families. As someone with experience of counselling people who have gone through such trauma, I have found that Churches get involved only after an event. Could more be achieved through Churches becoming involved at an earlier stage?
Ms Creaney:
Last year, we gave a presentation to the Knights of Colombanus, a lay organisation in the Catholic Church that is similar to the Freemasons. After the presentation, the Knights of Colombanus started to take the ASIST workshop as they visit the homes of people in their parishes who are in suicidal crises.
My experience from attending funeral masses in Catholic churches is that the comments made by older priests with an old-fashioned mentality can often be hurtful. All the Churches must be educated about suicide, because, although it is no longer considered a sin, many older priests and ministers believe it to be sinful. That attitude must change, and it must start in the seminaries where priests are being taught. The theology around suicide must be reconsidered.
Rev Dr Robert Coulter:
In my experience, Churches might be able to do more in the period after funerals. Could they do more to help those with guilt complexes and who wonder whether they could have done more to prevent the suicide?
Mr McCabe:
We have had the same experience. The public initiative for the prevention of suicide and self-harm (PIPS) project has support groups that facilitate both sides of the community. The concern is that Churches perform no follow-up action in the aftermath of suicides. That has created a great deal of resentment, because it is felt that Churches should act as a support mechanism for the community. Although Churches on both sides of the community provide support in other circumstances, they seem to withdraw when it comes to suicide. They especially withdraw in its aftermath. I am talking about both sides of the community because, although I am a Catholic, our support group facilitates both sides of the community.
Ms McGarrigle:
I am a Presbyterian, and I have noticed some change in the Presbyterian Church’s attitude. When my son took his life 12 years ago, we were fortunate to have a good minister. I told him that he had to come to me. My 20-year-old son, in common with the behaviour displayed by most young people, had not gone to him.
I lobbied the Presbyterian clergy in my area, and, subsequently, Church House has produced a good leaflet about suicide. However, there is still much to do. Barry McGale, the suicide co-ordinator for the north-west, ran workshops that have been attended by clergy from all sides. They learned a lot, particularly about good practice, and we hope that there are more such initiatives.
Rev Dr Robert Coulter:
When I attended college, the subject was never mentioned.
Mr McCabe:
Eighteen months ago in Dublin, the Catholic bishop’s conference addressed the issue of suicide by sending a letter to each church to be read during the homily at morning Masses. The letter spoke of openness and suggested that congregations should be more sympathetic towards families that have been bereaved through suicide. However, that was all that was heard, and there has been no follow up.
Ms Maureen Young:
It is the luck of the draw. I was lucky to have had good support. However, I appreciate that the experiences of many people have been as negative as mine was positive. We must also appreciate that church attendance among young people has fallen. Other areas that could be used to reach young people are through organisations such as the GAA in which a lot of interaction is structured around playing sport and training.
Ms Creaney:
Sometimes, in the aftermath of a suicide, families are stigmatised by their community, including the clergy, which reaffirms the general lack of understanding. People cross the street before stopping to talk to a bereaved person.
Ms McGarrigle:
They do not know what to say.
Ms Creaney:
Therefore, the bereaved person must also contend with the stigma that arises after a death.
Ms Young:
It is a matter of education. Public-awareness must be increased, and there must be a drive to address that perceived stigma. Suicide echoes mental health in that, as Ann McGarrigle said, people are afraid to go to their GPs. There is a huge problem with how people perceive mental illness.
The Chairperson:
Many people just do not know what to say.
Ms McGarrigle:
There was a cluster of suicides in Ballymagroarty or Ballymac. On Sunday week ago, despite its being a miserably grey and wet summer evening, a fabulous and most moving homily was held to attract young people. Initially, I was sad that more people such as us attended rather than young people. Later, I thought more positively. About 200 young people were changing the 16 Stations of the Cross and there was music. In that church setting, with Fr Chris, it was a positive, forward-looking event for people in the north-west. I am sure that similar events take place in north and west Belfast. There are changes afoot among the clergy, and we must encourage more of that.
The Chairperson:
They are supposed to look after us from the cradle to the grave, and in between.
Mr Gallagher:
Thank you all for coming along. Most of you have been through difficult and challenging experiences and are taking a positive approach to suicide.
Policies and resources have been mentioned. It was suggested that not everything is being done as regards primary care and accident and emergency (A&E) provision that could be done. What is best practice elsewhere?
Resources are scarce. However, if resources could be made available, for what purpose should they be used? Should they be used to make counselling more accessible and readily available, or should they be used for 24/7 response teams?
Ms Creaney:
As regards best practice in A&E — in America, if people present themselves at a hospital’s A&E department and are suicidal and have taken alcohol or drugs, they are kept in a secure place until a psychiatric assessment has been done.
The abuse of staff and the damage that is done to A&E departments due to people’s consumption of alcohol is well known. We have always said that if a room were made available for individuals who present at an A&E department as being suicidal through self-harm, nursing staff would not necessarily have to baby-sit them. Volunteers could sit with them until they were well enough to have a psychiatric assessment. That is one solution to the problem at A&E departments.
Sometimes, it is at the discretion of a psychiatrist as to whether or not a person who has taken alcohol or drugs would be given a psychiatric assessment. Sometimes, psychiatric assessments are given, but those are usually the exceptions to the rule. We want individuals to be kept in a secure place until a psychiatric assessment can be done.
If the recommendations of the Bamford Review were implemented adequately, it would make such a difference to mental-health services. In 2005, in north and west Belfast alone, there was an estimated underspend of £2·5 million on mental-health provision. I do not know what the current figure is as I have been unable to obtain that information. More resources would be welcome.
I agree with Ann’s comments about the Health Promotion Agency’s Minding Your Head public information campaign and the amount of money that was spent on it. Sometimes people think that by throwing money at a problem, it will be solved. However, it is how and where the money is spent that is important. Creating safe environments in A&E departments would be a good place in which to put resources.
Ms Young:
I have talked to people on the Northern Health and Social Services Board, and its primary care team would like more training equivalent to that, which was given to GPs. Also, the board feels that its rapid response team is far too small for the geographical area that has to be covered.
Mr McCabe:
It might be worthwhile incorporating some mental-health training into the medical curriculum. As things stand, the curriculum does not include that.
Mr McCartan:
The Minister of Health, Social Services and Public Safety has said that 33 beds will be available in 2009. On three separate occasions a consultant told my son that he should be in hospital — but hospital was not the place for him. So, where did he go? He went back home. I would like to see a halfway house where patients could be away from their daily environment and getting a wee bit of respite. As parents, we would know that our sons or daughters were in a safe environment for a couple of days.
Mr McCabe:
I had a different experience. My son had no mental-health problems of which I was aware. He did not exhibit any signs. He was a bright lad at university and he was outgoing. Caroline Farquhar is head of implementation for the Choose Life anti-suicide strategy in Scotland and her research has shown that 7% of those who take their lives are not in the mental-health system.
Of the 30% who are in the mental system, 1% receives the largest amount of funding — that is for those who are in-patients. The problem is community based, and we who are working at community level need to get the resources to do our work. At present, the SSIB funding is going out to everybody and their granny while many people who are doing the heavy groundwork with the communities are not accessing those funds.
Mr Gallagher:
Are you talking about a kind of counselling services?
Mr McCabe:
We buy in counselling services. Contact Youth provides the biggest counselling service. They got a lot of funding for north and west Belfast.
Mr McGarrigle:
That was part of the Minister’s strategy.
Mr McCabe:
It was launched on 30 October 2006.
Mrs Carson:
We want emotional literacy to be included in children’s early education — not starting in post-sixth- and seventh-year education.
Let us start to educate young people early that it is OK for them to say that they feel sad. They should be comfortable with such language, be able to say that they do not feel right, and be able to ask whom to talk to about it. With the stiff upper lip attitude, no one dares mention sadness in case people will think that they are not right in the head. It must be OK for people to say that they do not feel well.
In the Linda Bryans’ campaign — and people in this room know how much money was put into that campaign — the word "suicide" was not mentioned once. Another campaign slogan was, "If your head’s away just say", and rightly so, but who can you say it to? The resources are not there for people to say that their "heads are away".
The 24/7 youthline is going to be extended. It will be inundated with calls, as are we in the West Belfast Suicide Awareness and Support Group, but the resources are not available to deal adequately with the calls. The Government is throwing good money after bad. They need to listen to the people who are working from the bottom up — we definitely do not work from the top down. We deal with the issue 24/7; we cannot walk away from it, but we are not paid to do it.
The 24/7 help line does not answer the calls on a 24/7 basis. I tried it; I targeted that help line over the Christmas period. I called it six times during the three-day period, Christmas Eve, Christmas Day and Boxing Day, and I got the "engaged" tone. I have taken up the issue with Opportunity Youth and Contact Youth because it is not providing the service it claims to provide. Opportunity Youth is having massive amounts of money thrown at it to provide that service.
Mr McCabe:
I would like to pass a card around that will show the Committee what PIPS has done. We distributed 40,000 such cards in the Kilkeel area to address the issue of suicide. It is a help card that offers advice to young people who feel suicidal. It simply refers to us as PIPS Newry and Mourne. It gives a number for the 24/7 free-phone Youth Line, as well as the numbers for the Samaritans, the out-of-hours GP service and Childline. It also has spaces in which to add the numbers of three friends, which they are advised to enter into their mobile phones. It also mentions the T.A.L.K. model, which breaks down advice to the following:
"Tell someone
Ask for help
Listen to advice
Keep safe".
I will pass the card around so Committee members can look at it.
The cards have been well accepted in the community, and the Probation Board in Belfast contacted us to get some of them. That is the sort of work that is happening on the ground.
Ms McGarrigle:
I work in education, and information sources such as that card are very useful. I use materials from the north and west Belfast groups, and the PIPS Newry and Mourne card, which I leave in foyers for people to pick up. It is wonderful to see how many are lifted. Young people want advice and help.
The Chairperson:
That is an excellent card. It is lovely that it says:
"MY PROMISE FOR TOMORROW: If I feel helpless, hopeless or confused. I promise to talk to someone."
It is all about talking, and young kids should be encouraged to start talking when they recognise that they do not feel the same as their friends and siblings.
Mrs Hanna:
You are all very welcome. As you said, suicide is difficult to talk about, and it is difficult for the Committee too, because nobody has the answers. It is a complex issue, which, as you know, is different for everybody. I have four children, three of whom are open and outgoing and one who is quite introverted. He would not talk about his feelings at all. Some people find it easier to talk than others.
You talked a lot about training. People such as yourselves, who have the experience, must be listened to. Training programmes should be rolled out for peers and relatives first and then for the professionals, such as GPs, teachers and nursery schools, so that they will be more aware of the issues.
There are some good schemes. I have worked with PIPS in north Belfast and with some of the schools. There is a very good programme in the Holy Family Primary School in north Belfast. All the teachers there have been trained to be aware of the problems. If they feel that children need to open up, they try to encourage them to talk about their feelings, and they try to work with the parents. The message must be spread. There are no easy answers.
Suicide is no respecter of age or class. I represent South Belfast. In the space of two weeks, three young people, one of whom was my next-door neighbour, took their own lives. Another good friend of mine, a man of my age, who was very outgoing, was a teacher and was involved in many charities, took his own life. He was the last person that anybody, including his family, would have thought might do such a thing. His suicide appeared to be out of the blue. Mental health is not always about obvious problems, but sometimes it is.
As has been mentioned, some stigma is still attached to admitting that we need help with mental-health issues. If people suffer a broken bone or even if they have cancer, it is easy for them to go to hospital to ask a doctor for help. However, admitting that one cannot cope is the hardest thing in the world. I suppose that all of us — starting with very young children — need to be encouraged to speak about our feelings and to recognise when we have a problem.
As a midwife for many years, I never heard the term "early intervention", but I knew very quickly that some babies and parents needed help —better parenting skills, for example — to cope better. The sooner that we all give that help, the better.
The problem is a societal one. We no longer have the values and support systems of family and the Churches; we are too materialistic and do not appreciate the simple things any more because we live in a society in which we throw everything away. We will never get back to quite where we were, but we need to get back to stronger family values and support systems; we need to start with the family and then consider the wider community.
We can do that through the Bamford Review, which talked about the need to look at the big picture while making small incremental steps. Those small building blocks need to start with the likes of our witnesses today and other health professionals and educators who can provide training and raise awareness to get things started. Sometimes the issues are so complex that it is difficult to know where to start. We should look at the big picture, listen to the people who have experience and then take the first small steps. However, that is not easy for any of us. There are no easy answers, but everyone wants to help. It is not just a question of resources — although they are part of it — but of knowing exactly what is required and having a plan. It is about how we start to put things together.
The Chairperson:
Thank you, Carmel. That was not so much a question as an observation —
Mrs Hanna:
The issue is really about values.
The Chairperson:
Yes; if only we could get back to the tradition of family.
Mrs O’Neill:
I thank all the witnesses for sharing with us today. Who better to hear from than people who have been bereaved by suicide and are aware of what is happening?
A nurse told me that there are great concerns about local accident and emergency services: if someone presents with self-harm at, say, 12 o’clock at night, there is no one to whom the person can be referred until the next morning. Is that the case? If the patient chose to leave before then, that would create a massive problem.
Mr McCabe:
It is very hard to keep people over the age of 18 on board because so much red tape is involved. We have that problem with our services in Kilkeel. The referral system for people up to the age of 16 is easily accessible because services are available 24/7 and there are many resources that people can access. After the age of 18, people need to go through the adult system, which can take three or even four days.
Mrs O’Neill:
The rural/urban divide has been mentioned. Has the Department taken a blanket, one-size-fits-all approach? Should more be done on a rural-specific and urban-specific basis?
Ms Young:
It is for people like us to — for want of a better term — fight our corner. It is important that the powers that be are aware of the different needs; we must emphasise those needs as well as addressing the issue of stigma.
Mr McCabe:
Cities get more attention than rural communities. For example, there are three co-ordinators in the Belfast area — and rightly so, as they are needed — but there is nothing for the Southern Health and Social Services Board area, which I represent. We have put in a proposal, but we have no co-ordinators for suicide prevention and intervention in the whole southern board area.
Ms Young:
We deal with a different type of people. In the rural farming communities that I mentioned earlier, people have more resilience so, as Carmel said, the last thing that they want is to tell someone that they cannot cope and to admit that they are helpless. That is not part of their mentality.
We must break that down and get across the message that it is OK to feel that way, and that everybody is the same.
Mrs Carson:
Everyone has a role to play in addressing suicide, whether in rural or in urban areas. Rhonda lost a 13-year-old daughter; my son was 21; Maureen has told you that her husband was 50; Gerard and Séamus lost young sons; Ann’s son was 20; and I think that Mary’s brother was 47. Gender and age are not relevant.
Everyone hears about young people who have committed suicide because such stories make for good media, but we have not heard in the media about Carmel Hanna’s neighbour. During our car journey here, Séamus said that a 70-year-old in his area had committed suicide. Local people hear about such incidents, but they will not be covered in the papers because they do not make for sensational journalism. We need to have journalists on our side. I speak to journalists regularly, and they have a role to play.
Our loved ones died through suicide — I am not ashamed of that. I have to get on with life, do the best I can, and walk this walk. Sadly, the people alongside me are walking the same walk. We have all had the same experiences of suicide. Media hype must be addressed. Where suicides occur, whether in rural or in urban areas, does not matter.
Members of the Committee will be aware that I am from west Belfast, which has been socially and economically deprived for many years. Suicide is expected there. My child died as a direct result of sexual abuse, as has been well documented. Knowing the reason for my son’s suicide does not change the fact that we lost our child. The person who abused my child might as well have murdered him because my son was left with his own life sentence — he could not live in darkness any longer.
Which professions does the Committee think have the highest rates of suicide? It is not the working class of west Belfast; it is our dentists, anaesthetists and farmers. Because they have means, the other needs of those people are not met. We will lobby wherever is necessary because we have a voice and we will be heard; in contrast, the higher echelons of society often hide the stigma of suicide. They fear that because their relative was an anaesthetist or ran their own business, they dare not reveal that they committed suicide; instead, they say that their loved ones died of massive heart attacks or strokes. We deal with the reality, and I am not ashamed to say that my child died through suicide.
The Chairperson:
I take your point. A psychiatrist will give evidence to the Committee later, and I hope that you can stay to hear what he has to say. The Committee would be delighted to meet you again if there are any updates or other problems that you wish to highlight. The Committee holds working lunches every Thursday before it meets, and it also visits outside venues and can address specific issues, the Bamford Review and its consequences for example. The Committee is happy to meet you again either here or in your areas so that we can observe a session with those who have come to you for help — if they do not mind our being there.
There will be a Hansard report of today’s meeting, which we will send to the Minister immediately so that he can read of your concerns and outline how he will implement appropriate back-up services.
The suggestion to set aside a room in the accident and emergency departments of hospitals to deal with those who present with suicidal tendencies was extremely good and should be highlighted. It is sad that so few GPs attended the three-hour training programme, given what is happening in our society — that should be highlighted.
I thank all the witnesses. It was very brave — I mean that in no patronising way — to express what you feel should be done to help those in the same situation as yourselves and others who will, sadly, experience such dreadful trauma in the future.