COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
OFFICIAL REPORT

(Hansard)

Suicide Inquiry

31 January 2008

Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mrs Carmel Hanna
Ms Carál Ní Chuilín

Witnesses:
Mr Colin Loughran ) Action Mental Health
Ms Sharon Sinclair ) Aware Defeat Depression
Ms Suzanne Costello ) Samaritans
Mr Anthony Langan )

The Chairperson (Mrs I Robinson):
I welcome Mr Anthony Langan, the public affairs manager of Samaritans; Ms Suzanne Costello, director of Samaritans Ireland; Mr Colin Loughran of Action Mental Health; and Ms Sharon Sinclair of Aware Defeat Depression.

Ms Sharon Sinclair (Aware Defeat Depression):
I thank the Committee for giving Aware Defeat Depression this opportunity. I know that other Aware representatives have met several members individually, but we provide a range of support and information services for adults across Northern Ireland who are affected by depressive illness and bipolar disorder, and we run a number of mental-health promotion programmes in schools and in the wider community. Our work is very much grounded in self-help principles, and the bulk of it is carried out by volunteers, the majority of whom have had personal experience of depression.

Suicide is a recurring theme in our support-group meetings and in a proportion of the calls to our helpline. One of our local facilitators described suicide as “the unseen guest at the table”. Volunteer staff and service users across the organisation have welcomed the Protect Life strategy, not least because it acknowledges and highlights the very strong link between depression and suicide. Those are both complex issues and are, therefore, unlikely to have simple solutions. For us, the vital element in the strategy will be a commitment to long-term, wide-ranging and sustained action on the issues, building on emerging evidence and promoting cross-departmental and cross-sectoral work.

The level of stakeholder engagement to date has been very impressive, and my experience has been largely positive, but there is clearly room for improvement in communication and networking and so on, but some of my colleagues will address that matter.

I am mindful of the Committee’s wide knowledge of the subject matter and the amount of evidence that it has already taken, as well as the time constraints today. We have already provided the Committee with a written submission, so I will restrict myself to a few key remarks on where we believe the potential for development lies.

It has been estimated that only about half of people with depression seek help for their condition. The other half do not even attempt to access services or support. Our service users tell us that the main barrier to seeking help is the stigma attached to mental-health issues, and the consequent fear that they will lose the esteem of family members, friends, colleagues, employers and so on.

As a starting point, Aware Defeat Depression believes that a successful suicide-prevention programme will not be possible without significant change in public and professional attitudes to suicide and mental-health problems in general. As we know from the Health Promotion Agency’s public attitude survey, there is still a way to go in that regard. The attitudinal shift that we believe society must undergo needs to begin to be addressed in, or before, the teenage years. Therefore, continued public-information campaigns of the type that have been launched over the last year must be evaluated regularly and remain a core element of the strategy.

The potential for the development of public attitudes also needs to be coupled with action to equip people with the skills in problem-solving, conflict resolution and building self-esteem. Those skills can effect a significant change in help-seeking behaviour by those in psychological distress and can help to avoid the kind of progression into hopelessness that will often prompt suicidal behaviour. Again, we feel that such work must begin at school age and on a widespread basis.

To appropriately support people at risk, targeted efforts are needed to enhance depression and suicide awareness among professional groups in health, education, human resources, the criminal justice system and so on. In the voluntary and community sectors, those initiatives need to be continued. A commitment to skills development of the kind that we have seen over recent years is equally important so that people can access appropriate training, including depression awareness, mental-health first aid, and ASIST (applied suicide intervention skills training) programmes. In our view, they must remain as part of the long-term strategy.

I know that colleagues will touch on service provision, so I will not do so now other than to point out that we see the implementation of the Bamford Review as a fundamental aspiration in this regard.

On a broader level, we need to continue to address the wider determinants of mental and physical ill health, which include poverty, low educational attainment and social isolation. We also need to reduce the negative impact on individuals of life crises, such as loss in childhood, family breakdown, abuse and chronic physical ill health,which are factors in suicide. There is a need to increase public awareness and recognition of drug and alcohol problems and their link to depression and suicide. Action is required to seek to reduce alcohol consumption. It is important that everyone’s behaviour — in public life and in the media — emphasises the individual value of all citizens and the importance of strong family and community bonds, which are key protective factors against suicide.

The high level of interest in and commitment to mental-health and suicide-prevention issues that has been shown by this Committee and other public representatives is regarded as very positive by our members and service users. After so many years of neglect, people find that affirmative and they feel that it is making a positive contribution to keeping hope alive for people in their struggle against depression.

Mr Colin Loughran (Action Mental Health):
I concur with a lot of that. On behalf of Action Mental Health, I thank the Committee for the invitation to attend here today and for its involvement in the Protect Life efforts at regional, board, trust, community, and voluntary levels.

My organisation has over 40 years of experience in providing services for people with severe and enduring mental-health problems and people with learning disabilities. The neglect of investment in this sector, particularly at community level, has been a big problem in properly addressing the needs of those with severe and enduring mental-health problems. The ‘Protect Life’ document describes such people as being one of the groups at the highest risk of suicide. As an organisation, we applaud Government on their recent investment in mental-health services and we advocate the continuation of that. The Bamford Review should be committed to on a long-term basis and its recommendations should come to fruition.

Continuing support for mental health and learning disabilities, particularly at community level, is important. Furthermore, cross-departmental support is necessary to tackle suicide rates and promote suicide prevention. It is not simply a health issue; it spans the spectrum of Government, and it is important that it is not only the Health Committee that shows an interest in that work. Issues such as poverty, housing problems and so on need to be addressed; they are key factors in the full recovery of the people that we serve.

Better communication and clarity is necessary in relation to Protect Life, particularly if it is to reach the cutting edge at grass-roots level where people are self-harming or contemplating suicide. It is vitally important that structures are clear and that there is a clear awareness about where the sources of support are. I am aware of models of good practice, which may get mentioned during the discussion. However, even where those models exist, it is still difficult for them to reach everyone. Therefore, a continuous effort is vitally important in order to reach people who feel alone, isolated and unsupported.

My organisation supports a focus on preventative approaches. We have seen, and are glad of, crisis response and response to particular events. However, I would like to see a longer-term vision of a healthier community. We must start to build resilience in children — and those who are vulnerable — at an earlier age and end the stigma of taking the pathway to support, which often prevents people from accessing the support that they require at times of distress.

Ms Suzanne Costello (Samaritans):
I echo my colleagues in thanking the Committee for giving us the opportunity to give evidence. Samaritans is an international charity which has been at the forefront of suicide reduction since 1953. I slightly differ from my colleagues because my position, as director of Samaritans Ireland, is a new one, which was created to help volunteers across Ireland fully implement our projects and initiatives on a local basis. I have been in that role since March 2007 and can offer my impressions as someone relatively new to the area.

Samaritans Ireland has 21 branches, eight of which are in the North of Ireland. We have approximately 600 volunteers in Northern Ireland and we deal with 73,500 dialogue contacts, which are occasions of emotional support offered by a volunteer and accepted by a caller.

I have paid a lot of attention to suicide in Northern Ireland — when I started last summer, the deaths in Laurelvale and Craigavon focused everyone’s minds intensely. It is heartening that suicide prevention is so high on the agenda of politicians and wider society in Northern Ireland. I have received a very warm welcome for the work that Samaritans does from everyone working in the sector, but in particular from the community groups — there has been a historical difficulty in connecting and establishing where the synergies could exist between community groups and a large voluntary organisation like Samaritans. I particularly acknowledge the help of Mary Creaney and Philip McEntaggart in that.

Based on my experiences so far, I am concerned about the duplication and replication of services, the lack of evaluation of initiatives that are started in the community, and the complexity of accessing funding. My point is not about the funding itself, but rather the accessibility of that funding to volunteer-led organisations. They are often faced with 50- or 60-page applications for relatively small sums. That can be daunting for people who volunteers who have signed up to help people experiencing despair and isolation, not to carry out administration.

The biggest challenge that Samaritans faces in the community is anonymity, which is a big part of being a Samaritans volunteer — especially in Ireland, as I am sure you will appreciate. In small and rural communities it is vital that Samaritans do not speak about being volunteers in case it prevents someone from seeking help. That presents us with a challenge, because our work is not always acknowledged. Although we are best known for our telephone service, we are accessible by email, and live emotional support will soon be available by text. We work in prisons and have extensive school and workplace programmes. Volunteers are sometimes frustrated that their work is not widely acknowledged. However, we appreciate that it is the nature of our organisation that we do not seek that type of recognition, and we try to balance that.

Samaritans can bring two benefits to Northern Ireland. The first is partnership; we use an extensive range of technology and are at the cutting edge of innovation — for example, the text-messaging live support pilot scheme has been very successful. We want to deliver that service as widely as possible in partnership with other organisations.

My colleague Anthony Langan has done some work on the other thing that we can bring to the table. As an international charity, we are able to access key groups that are not necessarily available to people working only in Ireland. For instance, on the issue of suicide and the Internet we have been able to facilitate Department of Health officials to directly meet key people in the large Internet service providers to tackle the specific difficulties that have been so prominent recently, and we would very much like to continue that.

The Chairperson:
I am delighted to meet you, Ms Costello. I have been using your good services for one of my constituents. I cannot praise enough the efforts that your organisation has put in to that constituent, who has a problem with alcohol abuse.

The key to this issue is stigma, and, having had depression at one time in my life, I take it all very seriously. Two psychiatrists are working with me on a part-time basis to see the workings of the Bamford Review roll out.

Mrs O’Neill:
Thank you for coming to talk to us; it helps us as we go through the inquiry. Ms Costello, you spoke of duplication, and we have also heard that from other groups. We have heard concerns about the establishment of the Department’s phone line, and in your submission you said that the Samaritans is progressive and have had a phone line for a number of years. Do you feel that the Protect Life strategy creates unnecessary duplication, especially with the phone line?

Ms Costello:
There is duplication in certain areas. The phone line that is to be rolled out in the next couple of months has aspects that our service does not provide, but there are significant areas of overlap and there could be better synergy if we were able to work more closely with the Department. There would also be a cost saving. Although cost is not the principal factor — that is the delivery of a valuable service at the right time — the costs must be borne in mind if we are to achieve long-term sustainability, which is absolutely vital. It is important that the services are still in operation in 10-15 years’ time. As we are working all the time on public awareness and removing the stigma from depression and suicide, it is important that people know where to seek help.

Mrs O’Neill:
As an all-island charity, do you feel that you are more involved with the strategy in the South than you are here? Can lessons be learned from your involvement there?

Ms Costello:
I am loath to make comparisons. The South has a different structure in that it has a National Office for Suicide Prevention. Therefore, there are three or four individuals who form the point of contact for every aspect of suicide prevention, making the process swift, flexible and clear. Everyone has access to those key individuals, whether a small charity in a rural part of the country or the larger charities. From that point of view, it is a fair and transparent process.

Dr Deeny:
You are all very welcome, and I applaud the work that you do. I like being on this Committee, because it impacts on the work I do — I have been a GP for over 20 years. I am sure that you know that, of our consultations, around 30% are [Inaudible].

I divide health into three areas. I notice that your document refers to emotional health, and that is very important. To me, the concept of emotional health means happiness, contentment and peace of mind. If a person’s emotional health is good, their mental health and physical health tend to follow. As a GP, I find that people who are emotionally unwell sometimes end up with full-blown clinical depression.

Some years ago, I used to have leaflets from Aware Defeat Depression — which was then called Aware — in my surgery, and I directed people to that organisation. I work close to Omagh in County Tyrone, and it would be a good to idea to keep GPs such as me in tune with your organisation. Does Aware Defeat Depression still hold local meetings?

All the charities that are represented here are involved in the talking therapies, which is important. Conventional medicine is deficient and is failing the public in that respect. I have seen many people who I know, if they could talk about it, would — particularly young men. I have seen suicide before in my patients and their families. It is devastating; I know of one family that has gone to pieces. That might have been avoided if he had been able to speak to someone. In my opinion, the National Health Service is failing with regard to the talking therapies.

Openness about mental health is important and must be encouraged. In Northern Ireland, more people are talking openly about mental-health problems on television and radio programmes, and it is good for people to understand that talking is better than worrying. I have told many people who are depressed about their lives that they can recover.

Ms Costello, you mentioned bureaucracy, which sends a shiver up my spine because GPs are inundated with forms for this, that and the other, and it drives us round the bend. Surely to God, there must be some way that the Committee can help to ease the bureaucracy that holds back people who are trying to help those with mental- and emotional-health problems. It is ridiculous that time that would be better spent attending to people’s lives is taken up by filling in 60-page forms. Do you feel that there are any bureaucratic areas that we can help you with?

Ms Costello:
We raised that issue at the last suicide strategy implementation body meeting and got a positive response. Structures are in place for us to apply for funds regionally. My role is to take the pressure off volunteers, allowing them to concentrate on providing the helpline service. If we can access that regional funding mechanism, the volunteers can be relieved from administrative fund-raising duties, which they find daunting and which, in many cases, is not very fruitful.

Dr Deeny:
And the leaflets?

Ms Sinclair:
Aware Defeat Depression was involved with the Health Promotion Agency in the design and delivery of the depression-awareness training programme for primary-care providers. As a consequence of that programme, each GP practice in Northern Ireland should have received a stock of our ‘Depression: The Facts’ publication and a general leaflet about our services. If they have not arrived at your practice, I will follow up on that. Hopefully, those leaflets will be supplied annually.

The evaluation from the GP training programme showed that GPs want access to good, straightforward, user-friendly information about depression that they can give to their patients and information about services for their own benefit, and we are committed to providing such information. In our organisation, we often say that people with mild or moderate depression are either at their GP surgery or at home, and those are the places in which we must connect with them. I will check up on those leaflets.

Dr Deeny:
Are Aware Defeat Depression’s clinics convenient to most areas?

Ms Sinclair:
At any time, we have about 20 support groups in Northern Ireland. Currently, there are 23, and there are active groups in the Omagh, Cookstown and Magherafelt areas. I will supply you with specific information about that.

Concerning talking therapies, it is one of our policy aspirations for people with mild to moderate depression to have better access to cognitive behavioural therapy, because evidence-based research shows that that helps in the recovery process.

In addition, we have developed, and are in the process of piloting, a six-week, structured-workshop, group-education programme with the Northern Ireland Centre for Trauma and Transformation — based in your hometown of Omagh. That programme imports the best cognitive behavioural therapy principles into group support sessions. [Inaudible.]

The Chairperson:
On the heels of that, Sharon, it is worth remembering that there are 108 MLAs, and each party has two or three offices in each constituency. Our offices have a high footfall of people with big problems. It might be helpful if packages of leaflets were to be sent to all our advice centres, which are listed in the telephone directory. In my office, there is a display of all types of information, but, sadly, I have nothing that gives direction to people who need that sort of help. That is one area that you could consider.

Ms Sinclair:
I am aware of the funding difficulties, because I have had some experience of having to submit many funding applications for fairly modest amounts of money. One of my staff refers to that as “dear money”, because the effort required to access it costs more to the organisation than the sum received. Therefore, we are very pleased that the implementation body has agreed to examine regional organisations that deliver a comprehensive service throughout their region and that the key people will facilitate the progression of a regional strategy that will allow people to put more of the scarce resources into front-line services.

Mr Easton:
My first questions are directed at Sharon. Correct me if I am wrong, but I think that you said that a suicide strategy will not be successful unless we change public attitudes. You went on to talk about society letting its children down. Why do you feel that there were fewer suicides 10 years ago, and what is causing the current trend? Why does it seem that people coped better years ago? You also mentioned alcohol and drugs, both of which can contribute to depression and suicide. We hear about stand-alone units, and the Committee visited the small one at Antrim Area Hospital, which seems to be successful. What more would you like to see being done in that area? Perhaps we have not explored that as much as other areas.

My final questions are directed at Suzanne, because the Samaritans runs a depression helpline. Do you think that the proposed 24-hour helpline should deal with issues other than suicide? For example, should it extend to depression and other mental-health issues, or should there be two separate helplines?

Ms Costello:
I can respond to that question straight away. It is a massive undertaking for the group that will run the new Province-wide helpline. What it is trying to achieve should not be underestimated. Running a 24-hour helpline of any sort is extremely difficult. The majority of calls to the Samaritans come between 10.00 pm and 2.00 am. As you know, the Samaritans is staffed by volunteers — people who feel very passionately that they want to help and that they are making a difference. That is what spurs them on to sit there at 2.00 am, 4.00 am and 5.00 am, which is not easy. They genuinely believe that they are having an impact, and that is why they do it.

I am not desperately familiar with the new helpline, but, as I understand it, it will have many facets. I understand that counselling will be suggested to people, calls will be followed up — perhaps the staff will ring a person back, having made a call or a counselling appointment — and callers will be taken right through the process and put into counselling, if that is appropriate and if that is what they want. In that sense, it will be directional. That is somewhat different to the service that the Samaritans offers.

The Samaritans is best known for suicide reduction. If you were to ask people in the street about us, they would say that people who are suicidal phone the Samaritans. In fact, people call us for a range of reasons across the emotional-health spectrum. About 20% of the callers to our helpline are actively suicidal. We would place the remainder of people somewhere between good mental health and serious despair, but we actively encourage those calls, because we consider that as early intervention.

Ms Sinclair:
The attitude of the public is crucial in creating the context that enables people to seek help, because one can develop gold-standard services and support, but if people feel that they will lose esteem by being seen to use them then you are putting the cart before the horse. Statistics from the Health Promotion Agency’s public-attitude survey showed that 54% of people in Northern Ireland said that if they were experiencing a mental-health problem, they would not tell anyone about it, which is the reverse of what we are trying to achieve [Inaudible].

I am loath to proffer an explanation on suicide trends, because there are differing views on the causes, ranging from geography, age, gender, and so forth. One theory is that the pace of change in human development is so rapid that psychologically, and often physically, we have to run much faster to keep up, and when people have difficulty adjusting to that speed, it can have a negative impact on their emotional well-being. However, with any depression or suicidal tendencies, there is a complex series of factors at play, including low self-esteem, early-life events in childhood and social determinants such as poverty, ill health and educational attainment, which have impacts on communities and individuals.

Mr Anthony Langan (Samaritans):
There is a key role for coroners and the Coroners Service for Northern Ireland in the strategy, both in the recording of deaths in a standard way and also in identifying trends by passing information on.

The Chairperson:
Representatives from the Churches will be giving evidence to the Committee next week. They have a major role to play, and I am looking forward to hearing from them.

Mr Loughran:
Those involved in investing in health in the Southern Health and Social Services Board area commission small grants to local organisations. Work was done with the Churches in Dungannon to raise the profile and need for support, because when suicide occurred and people turned to a Church for support, it was not there. Church representatives are involved in some of the work that I undertake in the voluntary and community sector, and they need help to understand what support they can give when presented with mental-health needs and also what support is available to them. A wide range of organisations and religious bodies can offer support, which is encouraging, but it is at an embryonic stage.

The Chairperson:
Some Churches have their own Christian counselling services, which is tremendous. We must welcome everyone working together.

Ms Ní Chuilín:
Anthony, you mentioned the Coroners Service and the reporting of statistics, and NISRA has been mentioned in connection with deaths through MRSA and C difficile. Years ago, people ended their lives, but suicide was not recorded on their death certificates if the family did not want it to be. I know that there have been different ways of reporting deaths over the years, but there is still anecdotal evidence that suicide is not reported as much as it is happening. What are your thoughts on that?

The Samaritans produced good guidelines on reporting suicide through the media, which I meant to bring to the Committee. Can the Committee have a copy of those guidelines? In north Belfast, where I live, a couple of people ended their lives a few years ago, and some of the media coverage bordered on being grotesque. Those families lived just round the corner from me, and, as an elected representative, I felt that it was almost as though the media were trying to sensationalise the grief that those families were experiencing.

When I saw the guidelines, I quite happily went to almost all the editors involved, although that had already been done by the Samaritans. Since then, there has been a difference, even in the way that questions are asked. However, that may all depend on whether the papers are local, because they would report local issues more sensitively. A national paper with a wider circulation may have some sensitivity but not to the same extent. We all have a job of work to do in that area.

I would like your thoughts on coroners and how the Committee should approach that issue. Are there any updates or ongoing work with media outlets, because the media affect the way in which families are allowed to grieve?

Mr Langan:
The Samaritans had hoped that there would have been a coroners Bill in the Queen’s Speech. Unfortunately, that did not happen, but we are pushing for such a Bill in the next parliamentary term, if possible. We are working with the Ministry of Justice and the Department of Health in England to change the rules for coroners so that they have a remit to identify trends in deaths, and we want to carry that work over into Northern Ireland.

We want standardisation of reporting. There must be training for coroners and the Coroners Service, so that they understand the implications and how to work with families in the recording of deaths. There should be some balance and sensitivity about how families feel. However, we will never learn from those situations unless we begin to record those deaths properly.

I sent copies of the media guidelines to the Committee Clerk, and I hope that members may have seen them. We will continue to work on improving those guidelines. We have been successful in working with the Press Complaints Commission in England to improve the code for editors on reporting of suicides, and we hope to extend the voluntary uptake of that code. We will be examining new media guidelines some time this year, and we will also consider the issue of new media and the Internet to explore how we can build in some guidance for people making use of those services.

Ms Ní Chuilín:
We have received the guidelines.

Mr Langan:
We can make the guidelines available to MLAs through our branches.

The Chairperson:
That would be very helpful, because we all face that dreadful situation.

Ms Costello:
I do not know whether the Committee is aware of Headline, which was formed recently. It monitors the media for irresponsible reporting of suicides and mental-health issues. There are moves to have Headline operational in Northern Ireland. There were some horrendous breaches of the guidelines after the suicides of two young men in Omagh last year. The difficulty for charities taking up those breaches individually is that they are subsequently penalised by the papers, and it becomes very difficult for an individual charity to take that on. Headline comprises a group of charities and people working in the mental-health and suicide-prevention field who feel that when problems are tackled as a group, its voice is much stronger.

Ms Ní Chuilín:
I had occasion to complain about an editor when the media were saying that it was not good enough that the person ended his or her life. The media were asking the entire community a list of horrendous questions, particularly when a cluster of young people had ended their lives — copycat suicides. Committee members are subject to reporters asking really bad questions that they do not expect. It is hard enough for us to field off those questions, but it must be much harder for people without such experience.

The establishment of Headline is a good move, because it means that no one person or group will be left vulnerable, and there will be confidence in being part of a collective.

Ms Costello:
We have run some awareness-raising workshops. The media and people who are involved in the charity are aware of copycat suicides, but the wider public are not. If they were aware of that factor, they would possibly shun the type of coverage that they see. Therefore, it is important to get that message across.

Mr Loughran:
We developed working relationships with eight editors in the Southern Health and Social Services Board area, because the mental-health promotional material that we sent out under our youth programme — AMH MensSana — was not being reported at all. The articles were well written, and they provided good information and sources of support that we thought would be useful. However, they were not effective, so we decided that the only way to get the message across was to go out and nurture relationships with editors. That has been a long, sustained piece of work, which must continue, or it will fall. Unfortunately, however, when those editors move to new posts, we must start the whole process again

Ms Ní Chuilín:
The situation is different in cities.

Mr Loughran:
There must be a strategically sustained focus on the media. Last week, the ‘Belfast Telegraph’ inaccurately reported a recent suicide, according to guidelines.

The Chairperson:
We need to keep on top of that issue.

Mrs Hanna:
The Mind your Head television advertisement was good in addressing the stigma attached to mental health, which is a huge issue. The advertisement showed a high-profile woman admitting that she had a mental-health problem. People will admit to many things, but they will not admit to being unable to cope.

I agree with you on the bigger societal issues — talking about the wider determinants and the risk factors. Sharon and Colin mentioned the importance of models of good practice. In our anti-poverty strategy, we must get into the details and consider narrowing the gap that is widening all the time. We must also start to measure where we are making a difference in our strategies, such as the drug and alcohol abuse strategy, rather than simply producing glossy brochures.

It is important to address the issue of duplication, because we want the best service and the best cover, with models of good practice to ensure that things are being done correctly. When people contact the helpline, volunteers must be trained to address issues such as talking them through the problem or signposting them on. If someone needs help there and then, volunteers need to know whether they could be referred until the following day or whether they should be kept on the line. There are many issues to be addressed so that the best care can be provided for those people. People must work together. There is no point in phoning one helpline and getting one piece of advice, and phoning another helpline and listening to an answering machine message telling them that someone will talk to them tomorrow. The issue must be addressed by professionals.

Sharon mentioned the level of training. We have heard about the ASIST programme, but psychiatrists need to have an input to ensure that the training is appropriate. It is great that much work is going on in the voluntary and community sector, but that must be measured to ensure that there are models of good practice and that services are not being duplicated. If someone is really desperate and phones a helpline, best practice is essential. I agree with the societal issues involving families, Churches, better parenting programmes and early-years programmes, and I understand the economic argument. There should be upfront measures to prevent those problems rather than picking up the pieces when the problems arise.

Mr Loughran:
There is great determination in the voluntary sector for much of that work to be done. Action Mental Health certainly advocates the need for resources. We are in a position where we can signpost people on. However, I would urge caution that organisations are not overstretched before additional resources are available. Organisations such as Action Mental Health work to capacity, whether through direct contact with our client group or through AMH MensSana service in mental-health promotion. It is important that resources are available.

Ms Costello:
Everyone is in a similar situation. All Samaritans volunteers undergo a rigorous training programme. The charity has psychiatrists and psychologists involved at every level: in trusteeship, policy, training, research and best practice. There is a rigorous system of training and checking. For example, in individual branches, when a caller needs help, a psychiatrist is involved in taking the decision about how best to react.

Mrs Hanna:
It is important to evaluate that training and to ensure that everyone is trained to the same standards.

Mr Loughran:
An evaluation has been completed for the Southern Health and Social Services Board area. ASIST was evaluated as a part of that. The indications are that ASIST is appropriate and helpful to front-line practitioners, but, for the general population, it may not be the most effective source of training. Something pitched at a lower level, aimed at a general understanding of mental and emotional health, would be more effective for the wider public.

Mr Buchanan:
Sharon spoke earlier about her work with schools. How are you received by the pupils? Are they prepared to admit that suicide is a problem? Will they talk about it? Do you work with social workers? Social workers deal with families at early stages, perhaps in cases of child abuse. When a child becomes a teenager, that earlier abuse can lead to depression and suicidal tendencies. Do social workers who work with children who may have been abused follow up their work to check whether the abuse has led to suicidal problems?

Ms Sinclair:
In schools, Aware Defeat Depression runs a depression-awareness programme for young people between the ages of 14 and 16. It aims to alert them to the signs and symptoms of depressive illness, to highlight the importance of help-seeking behaviour and to indicate the ways in which they can improve their emotional health. The programme is generally well received by young people. It is delivered by young facilitators; 14- to 16-year-olds think that anyone aged over 25 is ancient. We use facilitators who are in their mid-20s so that there is a higher degree of empathy.

The programme has been externally evaluated a number of times, and we now have longitudinal evidence about how well the pupils take the learning on board. That yields interesting information on the need to build skills, and so on. We find that, after 12 to 18 months, a high percentage of young people — more than 50% — remember the key signs and symptoms of depression. They remember what should be done to try to improve mental health and the importance of seeking help. However, a substantial number say that they would not necessarily take the step of asking for help. Therefore, pupils take the information in, intellectually, but they do not necessarily translate that into behavioural change. Much work needs to be done in developing skills; but the programme is generally well received by young people and schools.

It is not marketed as a suicide-prevention programme; it focuses on the development of positive mental health and recognises that depression is the main source of mental ill health. We advise young people that depression is the most likely form of mental ill health that they are likely to experience in adulthood, whether it affects a family member or someone in the wider community, and so on.

Mr Loughran:
It is more important that schools address the issue rather than simply children recognising it. I am involved with AMH MensSana, which, like Aware Defeat Depression, has a programme for post-primary young people up to the age of 25.

It used to be difficult to get into schools because teachers were afraid of the consequences of recognising the issue. However, there has been a significant increase in the number of schools that are prepared to allow organisations with expertise to conduct sessions and support their pupils. That is what I was referring to earlier when I mentioned cross-departmental support. Such issues need to be embodied in the Department of Education, and schemes need to be progressed and embraced.

My son is in the process of choosing his secondary school, and we have been visiting the various schools. I have been encouraged by posters, and so on, around the schools that identify sources of stress for young people, which may lead on to more prolonged and enduring mental-health problems. That was not the case when I was at school; those types of issues were not discussed. The existence of pupil support workers is an excellent development.

The Chairperson:
Our time is almost up. I will refer briefly to the judicial system, which is an issue that we have not yet discussed. A number of my constituents have looked to the judicial system for help after suffering as a result of incest. Often, as people get older, such issues come to light, and they discover that their siblings have also been interfered with. If the judicial system lets them down, they feel that there is no hope and that they are not going to get justice.

In a recent court case, an offender received a sentence of two years and nine months for interfering with two young girls aged five and six. The judge made a comment that he did not think that the children would be adversely affected. I went on ‘The Stephen Nolan Show’ — although I sometimes question whether I should — and absolutely berated that judge for his attitude. I pointed out that the lives of those five- and six-year-olds could be destroyed: they may be unable to have relationships later on; they could become suicidal, alcoholics or drug addicts; and they may flit from relationship to relationship because they cannot settle down.

I threatened to go to the Lord Chief Justice to raise the issue of sentencing; he later phoned me and invited me to visit him at the Crown Court. He said that the judge’s comments were regrettable. He explained that judges have to tick boxes and that if offenders meet certain criteria, they receive a shorter sentence. He also pointed out that 50% remission is still granted. Therefore, the legislation that governs the judicial system restricts the sentences that judges can give.

However, victims often find it difficult to face the fact that the offender will be released in a short time. Victims simply have to get on with their lives, even though they are left scarred — mentally, physically, and so on. They often feel that they have been let down and that their only recourse is suicide, which is a dreadful situation.

Therefore, the judicial system and the issue of 50% remission in Northern Ireland also have to be considered in order to address the issues of suicide and mental-health problems.

The Committee Clerk:
Recently, I was the Committee Clerk for the Ad Hoc Committee on the Draft Criminal Justice ( Northern Ireland) Order 2007. As soon as that Order is introduced, there will no longer be automatic 50% remission. It will no longer be unconditional, but it does not apply retrospectively.

The Chairperson:
That is right. That is the problem. I just wanted to highlight that issue, because I am very concerned about it.

Thank you all for making the time to come along; it has been really worthwhile and very interesting to hear your views. I wish you all well in the difficult work that you have to do. No doubt we will see you all again.