COMMITTEE FOR
HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

OFFICIAL REPORT
(Hansard)

Inquiry into the Prevention of Suicide and Self Harm

7 February 2008

Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mrs Carmel Hanna
Mr John McCallister
Ms Carál Ní Chuilín
Ms Sue Ramsey

Witnesses:
The Most Rev Patrick Walsh ) The Roman Catholic Church
Dr Oliver Woods

Rev Roy Cooper ) The Methodist Church in Ireland

The Right Rev Dr John Finlay ) The Presbyterian Church in Ireland
Mr Lindsay Conway

The Most Rev Alan Harper, OBE ) The Church of Ireland
Rev John McClure

The Chairperson (Mrs I Robinson):
I extend a warm welcome to Rev Roy Cooper, President of the Methodist Church in Ireland; Rev Dr John Finlay, Moderator of the General Assembly of the Presbyterian Church in Ireland, accompanied by Mr Lindsay Conway, the Presbyterian Church’s director of social services; and the Most Rev Alan Harper OBE, Church of Ireland Archbishop of Armagh and Primate of all Ireland, accompanied by Rev John McClure. We have received an apology from his Eminence Cardinal Sean Brady, the Roman Catholic Archbishop of Armagh and Primate of All Ireland. However, he is ably represented by the Most Rev Patrick Walsh, Roman Catholic Bishop of Down and Connor, who is accompanied by Dr Oliver Woods. You are all very welcome.

I invite each of the Church leaders to make a short presentation of about five minutes, then we will open up the Floor for questions. I cannot reiterate enough that you are all very welcome.

The Most Rev Patrick Walsh (Roman Catholic Bishop of Down and Connor):
It is good to come off the substitutes’ bench and score the first goal. We are grateful for the opportunity to address the Committee today. The fact that the four Churches are represented at this high level shows that we regard this topic as an important one in our pastoral ministry. We support the fact that the issue of suicide and self harm received prominence in the draft Programme for Government. It is clear from that, and from the minutes of your last meeting, that the Minister and the Committee are very much involved in the issue.

All of the Church leaders will say pretty much the same thing today. We have met regularly to discuss various social issues, and each Church has given a great deal of thought to the problem, but we have not met to prepare for this meeting; therefore, we will probably repeat each other. However, from a Christian point of view, we speak with one voice on this important issue, as we do on many social issues.

In the Catholic Church there is a group of people called the Northern Ireland Catholic Commission on Social Affairs, and Dr Oliver Woods is a member of that group. When it was preparing its submission to the draft Programme for Government, the commission received a full briefing paper from the Royal College of Psychiatrists. I understand that the Committee has met members from the Royal College, so we do not need to repeat what was in that paper. I found that a most interesting and enlightening document.

I would like to talk about the emphasis put on the group that is attached to the Mater Hospital: the Self Harm Service for North and West Belfast. Currently, there seems to be a preponderance of suicide incidents in those parts of Belfast. Self harm is obviously an important issue, and the report says that is the one issue that really must be tackled in the prevention of suicide.

As a trustee of the Mater Hospital, I take a certain pride in the group, and the Mater Hospital is the first general hospital to have a dedicated psychiatric service. I understand that the group is funded by Department of Social Development, not by the Department of Health, Social Services and Public Safety, and the funding will be there until April 2008.

Psychiatrists have stressed the importance of having such groups based in general hospitals. Is there any indication that they will be replicated throughout the Province? Can the Committee give some guidance?

The Chairperson:
The Committee is concerned that there is only one pilot scheme in north and west Belfast, and it is incumbent upon us to see that rolled out right across the Province. A gentleman who gave evidence to the Committee last week told us that suicide is not determined by location or areas of social deprivation, and I am gravely concerned about people in rural constituencies who are isolated, who have many problems and who do not have direct access to doctors, psychiatrists and accident and emergency units.

I hope that we, as a Committee, to a man and a woman, will ask the Minister to look at rolling that programme out in all areas, with the trusts providing a back-up service for those who self- harm or contemplate suicide.

Bishop Walsh:
I am very glad to hear that, and thank you. It is being funded by DSD rather than by Health?

The Chairperson:
Yes, but it should be funded by the Health Department.

Bishop Walsh:
I will not enter into that. [Laughter.]

The Chairperson:
We will chase the Minister about that.

Bishop Walsh:
Everyone will want to talk about involvement of the clergy, therefore I will not take up time. They are involved in three areas of suicide. The first is that, from time-to-time, they are among the first to be called out to a suicide incident, which is a very harrowing experience.

Secondly, they are then involved with the care of the families, and that is a most important part of pastoral ministry for all our churches.

Thirdly, they are, very often, the first port of call for someone who is contemplating suicide, or who has indulged in some sort of self-harm.

Those are the three main areas that the clergy are involved in, and we are all very conscious of the need for them to be trained. I am sure that those points will be taken up by my colleagues.

Rev Roy Cooper (President of the Methodist Church in Ireland):
The Methodist Church is, along with other churches, concerned about suicide and that is evident from the following statement found in our publication ‘Methodist Beliefs’:

“We recognise that suicide is a complex issue, which presents many challenges in developing appropriate responses. We believe that the Church’s role is to show, in speech and action, the compassion of God for those who are suffering. We seek to promote deeper understanding of the many causal factors that lead to suicide. We work for the development of sensitive, pastoral responses for all affected by suicide.”

As a Church we recognise that suicide affects all age groups. Economic difficulties, health concerns and that difficulties in relationships can become exacerbated when people are isolated or involved in occupations, such as farming, where they are on their own for considerable periods of time. Psychologists like Rory O’Connor of the University of Stirling have underlined the link between rumination, that is the continued dwelling on a problem, and the ideation of suicide, which allows for the possibility of suicide as a way out of a problem, where one otherwise feels trapped.

I served in the Irish Republic for 18 years. My last parish was in County Wexford and shortly before I left in 1996 there were six suicides, four of which were among the farming community. Part of the problem was that lending agencies and banks had thrown lots of money at those people and, when things did not work out, the lending agencies and banks put the squeeze on them. Many young men resorted to suicide to solve their problems.

The Church’s role in suicide prevention may include as many efforts as possible to develop experiences of community. Indeed, for many in town and country, the Church is their basic community. There may be other initiatives, including co-operative working and being prepared to talk openly about suicide, thereby giving opportunity to challenge its perceived role as a solution to problems.

We have an annual conference — “Autumn Soul” — for young people aged between 12 and 18, which is the largest gathering of young people in our Church. One of my colleagues, John Alderdice, carried out a major survey among those attending the 2004 conference, and found that depression headed the list of most important issues that the Church had to deal with. About 9% acknowledged that they did not enjoy life and that they felt inadequate and of less worth. As a result, a programme was set up through our youth department, which organises groups in churches and among young people, such as youth fellowships, etc.

There is isolation for the young and old alike in rural areas. We have produced a book through our council on social responsibility, and many topics are germane: for example, understanding suicide; personal stories; responding as individuals; and responding as churches. The book was produced and printed by Veritas, and has been used by many churches. Veritas has said that it has finished its final publication and that the book is sold out. I am cheeky enough to wonder whether there is any finance available in the Department and whether it might be able to effect the publication of that book. Lindsay Conway tells me that he uses the book regularly. That is my pitch for some finance.

In relation to clergy training, courses are provided for those studying at our theological colleges, while further study days on the topic have been organised by our director of ministry for those in parish work who await ordination. Moreover, our laity has been offered seminars on the topic at our theological colleges. We want to try to do that as Churches. Hopefully, today will show not just the Committee, but those watching or listening, that the Churches do speak with one voice on the matter; we are not simply trying to pick up on each other, we move together. Our presence here today shows just that.

The Right Rev Dr John Finlay (Moderator of the General Assembly of the Presbyterian Church in Ireland):
I reiterate the appreciation that we all have as Churches for the opportunity of sharing with you this afternoon. We are always willing and desirous to be a comfort and counsel to those who have suffered, especially the families. Perhaps our concern and our frustration is that, more often than not, people who take their own lives are very peripheral to our membership and association with the Church. We are frequently unaware of the need, and sometimes the families involved are unaware of the particular problems or circumstances that may create a suicide situation.

As you might expect, we have absolute confidence in the hope and the purpose of the message that we bring, and in the support and the helpfulness that the Church can be, given the opportunity. However, we accept that the challenge — especially for us — is the provision of some sort of preventative measures.

Our Church, like most denominations, has first-hand experience in dealing with a wide range of mental-health issues. Our ministers deal with members who are depressed and who are suffering from alcohol or drug addiction. Sadly, ministers increasingly have to deal with members who have taken their own lives. I have had to deal with a couple of such incidents in the recent past, and I know one minister, in a rural setting, who has had to deal with four instances in one year. Therefore, pastoral-care situations clearly indicate that people are not coping in the same way as past generations may have done.

Furthermore, we are concerned that the prevalence of suicide in an area — especially among teenagers — can, sadly, create a copycat culture. We fear that the situation is exacerbated by the media and by the influence of soaps.

Our board of social witness has produced a suicide awareness leaflet, which has been reprinted three times. We also offer a Christian-based counselling service to the whole community, and this year, our chaplains’ conference is considering the subject of suicide and church. Therefore, we accept that we have a clear role in what is a major social problem.

We are committed to reducing the risk of suicide by offering a listening ear and a safe place to address problems. During lunchtime, I spent an hour at a cross-community and inter-denominational project in Ballynahinch. Its main focus is mainly, though not entirely, on youth work, and it has made a significant difference on the streets of that town. It has created a sense of a safe place to which those who are potentially suicidal can come. That project has been effective and encouraging, and it is something that we would like to see repeated in other areas of the Province, especially through our own Church.

One request that we might make is for encouragement and possibly help with the provision of training, not only for clergy but for others who are involved in this field.

The Most Rev Alan Harper (The Church of Ireland Lord Archbishop of Armagh and Primate of All Ireland):
Thank you for giving me the opportunity to address the Committee. This is the fourth time that you will have been thanked.

The Chairperson:
It is lovely.

Archbishop Harper:
It is a privilege to be here. The Committee will be aware that essentially similar issues and similar levels of suicide exist in both political jurisdictions of this island. I say that because I am responsible for a cross-border diocese, and suicide is not merely confined to the part of that diocese that is in Northern Ireland. That, perhaps, provides a small corrective to the too simplistic analysis that suicide is some sort of direct outcome of 30 years of community discord.

I included that information in a paper to the Irish Association of Suicidology a couple of years ago. In that paper I suggested that high levels of suicide could be associated with rapid societal change — the kind of rapidity with which people find it difficult to grapple — and community change.

The parallel example that I used referred to studies of the Inuit, which is a highly traditional society in the north of Canada. Everything in their lives is changing — not just climatic change but everything relating to family and social structures. Their levels of suicide are higher than ours.

Obviously, among other things, societal change includes the role of religion in society. I do not think that any of us would be foolish enough to suppose that that is not a major concern for all of the Churches. We see a significant decline both in religious affiliation and in religious practice. However, there is a significant amount of research to demonstrate that having some definite philosophical and religious commitment provides people with satisfaction, happiness and well-being. Therefore, that is a serious challenge to all of the Churches, and I suspect that it is an issue that we need to correlate in some way with the increasing tide of secularisation.

Societal change includes issues such as family stability and the collapse of family structures, which deeply concern the Churches. Other concerns include small issues such as deference, which is an indicator of how people relate to one another and the way in which they acquire some sort of validation from other people in their social network.

The last matter that I want to draw attention to is one of concern for all of us. Societal change also includes problematic substance and alcohol abuse. There is significant evidence that that may be directly correlated with mental-health issues.

When I speak of mental health, I do not want to suggest that suicide is merely a matter of mental ill health. It is not. To deal with it simply as a mental-health matter will address some, but by no means all, of the issues.

What are the Churches responses and opportunities? First of all, information and communication are key. The Churches that we all represent are social networks with significant social capital, but significantly dependent upon volunteers, and volunteerism is not necessarily on the increase at present. Before we came in, we reflected that there is a helpline, but no one knew the number. There is an issue about disseminating information. There is no reason at all why Churches at parochial level — let alone, at diocesan level — could not be significant players in disseminating the kind of information that might enable people to access the help they want when they want it. That would not necessarily require people to disclose that they have a problem to a group that they might not want to expose that problem to.

That is one issue; a second is the training of clergy and church workers, which has been mentioned by several of my colleagues. In the Church of Ireland, we conducted a survey amongst clergy on the issue a couple of years ago. The overwhelming number of clergy said that it was a major issue for them; however, they felt that they were seriously under-resourced in dealing with it. They said that that they needed to know how to recognise the signs of self-harming or suicidal behaviour, and to help subsequently in dealing with the outcomes, whether that involved dealing with survivors or bereaved families. Clergy need to be able to address questions such as: “Why?”, “How?” and “What was my responsibility?”

Training is a very significant issue for us. We are reconstructing our clergy training programme: a radical overhaul is being conducted at the moment. Suicide awareness will be a significant component in that. However, that is only a forward projection. We have some structures in place, but they are insufficient for upskilling the clergy to deal with an issue that many of them will not have encountered face to face.

In my diocese last summer, in one small area bridging two parishes, four young people, three of them in the same class at school and belonging to the Church of Ireland community, took their own lives — two of the four in an identical fashion. The impact of that on the whole community was incalculable on that class and school, and the response that the Church had to make was demanding on the clergy in the area. We are deeply aware of the problems.

If there is even a scintilla of truth in the notion that there is a societal rather than a mental-health issue involved, then we certainly need joined-up thinking and acting. I welcome very much the suicide strategy implementation task force. I have stressed that all suicide is not connected with mental-health issues, although there may be a connection between those and problematic substance abuse. I would love to see the Bamford Review revisited, to see the proposals brought forward and implemented and to have it extended to include consideration of personality disorders as a category. That is not dealt with at all in the Bamford Review, and there is no strategy provision of any sort to deal with that, admittedly, very difficult area. However, it needs to be addressed.

Finally, I publicly welcome the support that many bereaved families and survivors of suicide attempts get from community groups such as the Public Initiative for the Prevention of Suicide & Self-Harm (PIPS) and Rural Support. I echo earlier comments about the issue not being confined merely to deprived inner city areas: it is also a rural issue. Although suicide is portrayed largely as an issue for young males, which statistically it may be, I am concerned that the number of suicides among elderly people has been under-recorded due to their deaths, for one reason or another, being put down to different causes.

Thank you for giving me the opportunity to address the Committee today.

The Chairperson:
Thank you very much for your input, gentlemen. The Committee takes the issue of suicide and self-harm very seriously, which is why we immediately launched an inquiry into it. We have received more than 65 submissions, and we hope to examine those at Easter. We will collate all that information and produce a report that we can look at after Easter, DV. We can tweak that report and, hopefully, have something to present to the Minister.

It would be helpful if we could have copies of the papers and pamphlets that you all mentioned, as they would be useful to have as evidence. Rev Cooper, you mentioned a book that was available.

Rev Roy Cooper:
I have brought a copy of the book for the Committee.

The Chairperson:
Thank you. We can collate that information and study the advice that you give to your parishioners. We could lose sight of the fact that it is not just young men who commit suicide, although it is predominantly young men. Some women suffer from post-natal depression; some suffer depression as a result of sexual abuse, and so on. The law may never have protected them, as their problem may have been brushed under the carpet. There are many types of depression and many types of mental illness, and, as you said, they should not simply be lumped together.

I welcome this opportunity to hear your views, and I will now open up the meeting for questions from members.

Mr Easton:
I better behave myself, because my brother is a Church of Ireland minister. Would it be helpful if the Department of Health, Social Services and Public Safety provided training for clergy of all denominations? How do you envisage building up a good working relationship with the Department of Health to work on those issues? The Church does not represent the whole community, but it represents a huge and very important part of it. It is essential for us to tap into it and to assist it.

During the Troubles, there did not seem to be as many cases of suicide as there are now. I am not trying to connect the two issues, but attendances have dropped off across all the Churches. I was wondering whether some people cannot cope with the pressures of life, because they are no longer getting that pastoral care and that input from the Church in their lives. How do you feel about that?

Rev Roy Cooper:
Our Church, through our council on social responsibility, would be happy to engage with Government and to get involved.

The decline in church attendances is not only among young people. Even grandparents now are non-churchgoers. When I was growing up, I remember that if someone’s mum and dad did not go to church, their auntie would have. There was always some connection, but now it is so tenuous.

Churches need to say that they were perhaps too judgemental in the past. Maybe they were not prepared to accept certain situations that people were going through. I knew someone who took his own life. He took the courageous step of coming out and saying that he was living as a homosexual. He thought that that was the way in which his life was going. However, he felt that he could not say that to his minister or to the youth club leader, because, at that stage, people would have been judgemental. Maybe the Churches pushed people away by adopting that attitude. However, as we have said in the book, we are now taking a different attitude; we are not condoning or condemning things, but we are making ourselves more user-friendly, from that point of view. That is my answer to your question.

Rev Dr John Finlay:
As I implied earlier, statistically, it is less likely that someone will commit suicide if he or she has a close church connection. I am not sure whether that was the case in the past; it would be presumptuous of us to say, “Oh, yes”, just because that situation has arisen.

The challenge that faces us, and which we take very seriously, is to find a relevant and helpful way in which to connect with a community that is distanced from us, and which may be, largely, disinterested in what we are trying to do and in the message that we are trying to bring. We are all challenged to do that effectively. We take that challenge seriously, and we are seeking to address it. It is a question of building a bridge. As I implied earlier, the problem is finding the people who are in that sort of need. Often, they may not be the people whom we would target.

The Chairperson:
Will someone deal with the issues of training the clergy?

Rev John McClure (The Church of Ireland):
I have been speaking to an official in the suicide strategy implementation body, and there is funding for the Churches to train new and existing clergy. The four Churches must put together a finance plan to show what it will cost, but I have been informed that the money is available.

To go back to the points made by Bishop Walsh, I have been involved with the Mater Hospital’s programme for people who self-harm. At the last meeting, I was told that another six hospitals are to get involved in it. The Mater Hospital has been running a pilot programme, and it has been so successful that another six hospitals will take it up.

The Chairperson:
That information has not yet reached the Committee, but the Minister will be coming to brief us.

Rev John McClure:
The programme has been successful. About 7,000 people self-harm each year in Northern Ireland.

The Chairperson:
The statistics are horrendous.

Rev John McClure:
For some people, the programme is a way of staying alive.

Mr Lindsay Conway (The Presbyterian Church in Ireland):
Finally, from the point of view of theological training, we are more and more conscious that candidates for the ministry, licentiates and those already in ministry must be trained. They must be aware of what to look out for at a pastoral level. Although church attendance may be falling, there is clear evidence that some of the counselling services and some of the other supports — whether through playgroups or some recreational element of church life — provide the safe place that the moderator mentioned. People need somebody who will listen, and listening posts and counselling services will do that. The number-one issue is that people, from a younger age, suffer from what we used to call “feeling down”. In their language it is depression, and they say that they can take no more, that life is not worth living. It comes back to the lack of a coping mechanism. Yet the Churches of all denominations still provide, at a conservative estimate, 60% of the youth and children’s work in Northern Ireland.

Archbishop Harper:
Seventy-eight per cent of the registered youth work in Northern Ireland is carried out by the Churches.

To follow on from what Lindsay said, one of the things that we are in the process of providing for — and in which we would be very pleased to receive assistance — is the training of those people who are not necessarily clergy but are youth workers in the Church. Currently, in the Church of Ireland, we employ approximately 80 paid youth leaders. Last March, we had a joint conference — with the Methodist Church — of 50 youth leaders that dealt to some degree with that matter. They are probably in a more accessible position than the clergy to deal with, or at least to begin to recognise, issues that might lead to suicide among young people. It is a bigger issue among them than it is among the clergy.

There is a phrase, in another document that I am almost too familiar with, that clergy are the “gatekeepers of change” in the Churches, which is true. Therefore, it is important to have the clergy better informed and more open about those issues.

Mr Conway:
Given that we are an all-male team, which is just a fluke —

The Chairperson:
I was not going to comment on that. [Laughter.]

Mr Conway:
There is an argument that, because, statistically, males are more at risk than females, we avoid and neglect women’s issues. We cannot do that, because when you consider the matter of self-injury, the opposite prevails. We must take that on board, and with that mass of youth work and children’s work, we are well-placed to do so. It is the self-esteem factor and the self-image that we have to impact on.

Bishop Walsh:
Reading about the subject during the past few days, in our personal preparation for today’s meeting, has helped us — it has certainly trained me, somewhat. We would be happy to agree to a joint programme of training for clergy and youth workers such as that mentioned by Archbishop Harper. The issue of suicide is taken seriously in our seminaries. In the year before ordination at Maynooth College, there is quite an emphasis on training in the various aspects of pastoral ministry, including the issue of suicide. However, it is the ongoing information that tends simply to drift away, and much of it is provided on an ad hoc basis.

We should all fully support, and get together on, a more formal programme of training for clergy and youth workers. This morning, I spoke to the director of our youth commission. He told me that a lot of people in the youth clubs are undertaking training. I think that he said that it is funded by the Department and that training was available for youth workers.

Mr Easton asked about the link between suicide and the Troubles. Again, I spoke to one of my priests who served for many years in a parish that was at the centre of conflict. He told me that there was a dramatic rise in the number of suicides after the ceasefire. He was able to provide me with figures. I was surprised by what he said, but it is a definite fact.

Mr Easton’s other question was about communication with the Health Committee. I know that, from my own experience, we have good links with the Department of Education, for obvious reasons. However, this is the first time that I have attended a meeting of the Health Committee. We were not really aware of the channels of communication that could be built up in the Department. I have met the Minister of Education and the permanent secretary about various issues. However, it has been useful to have the opportunity to come to Committee and meet a wider cross-section of MLAs. Is this channel open to us at any time?

The Chairperson:
Yes, at any time.

Bishop Walsh:
I know that, as you mentioned, our family ministry commission attended an earlier meeting of the Committee. It was the commission’s idea to ask for that meeting. It would be helpful if it were known that people could ask for meetings of that kind.

The Chairperson:
This Committee is one of the busiest, with regard to lobbying and hearing presentations. We could, literally, spend all week hearing presentations on all aspects of health provision and delivery. We brought in 20 different groups, on one day, because we had such a backlog.

Indeed, we are contemplating bringing in another large group of people who want to lobby us on specific issues, although they are not the top priority. They are important matters, but issues such as cancer are seen as being more important. However, we want to hear from everyone, and our door is always open. That is why we decided to keep the good wine to the last, and invite you folk to give your views on this very difficult matter.

Ms S Ramsey:
I welcome the fact that the Churches are here as a collective voice, and I think that that is useful. It strikes me that Bishop Walsh has said that there is a lack of sharing of information and resources. No matter what is said about attendances, the four main Churches are seen as the heart of the community in the majority of areas, and they do have an input. A sharing of resources and information between the Churches would be useful.

This is not a criticism, but it strikes me that none of the Church leaders know the number of the 24-hour helpline. I do not know the number either, so there is a lack of information across the board. If the helpline is to be extended, we must consider how to get that information out to the communities.

Mention was made of GPs and medical professionals taking up the assist training. Although the Department has provided funding for new clergy to be trained, I am concerned that the old timers should also get that training. Furthermore, laypeople who are involved in youth work must be considered. A number of people are involved, not only the clergy.

When considering school involvement, we must talk about prevention as well as dealing with people who self-harm or take their own lives. Schools and youth clubs have a solid foundation to get involved in prevention.

I agree with Rev Roy Cooper that, for a long time the Churches have been too judgemental. Families have told the Committee about the impact that language can have when people take their own lives. I have attended a number of funerals of people who have taken their own lives, and the language that some of the clergy used during the funeral services was, although not deliberate, quite hurtful to the families. They told us that they wanted to get away from people saying that someone “committed” suicide. To the families, that makes it seem as if the person has committed a crime.

Today has been helpful, and I would like to know if information could be shared formally, or if a formal gathering could take place so that the Churches could discuss about how they might strategically impact on the communities that they represent. Can the Churches come together with a collective strategy, rather than working piecemeal all over the place? I think that today’s meeting has been positive.

Bishop Walsh:
Sue’s point about funerals is interesting, because my priests say how difficult they find those. It is often a question of language, and you said the word “committing” suicide is language that should not be used. The priests say that they are hesitant about preaching about the subject in their ordinary Sunday Masses, when the opportunity might arise. They feel that someone in the congregation might have been through that and that they might be hurt by what is being said. You raise a very important issue, and how to cope in those situations could be an important aspect of training for our priests. Some priests are instinctively extremely good at doing that, others, particularly those who have to deal with it for the first time, find it difficult.

Rev Roy Cooper:
I suspect that, at times, some families have a sense of guilt. In some respects, therefore, they are not hurt by what is said about their son or daughter, but rather by thoughts that they did something, failed to hear them, despised what they were like or undermined them. Obviously, the Church has its ritual for dealing with grief in the form of services; however, although I have never had to deal with families suffering as a consequence of suicide and I am speaking hypothetically, I feel that such people require pastoral care in their homes — not in order to dissect the situation, but to build a relationship that will allow them to talk about what they are really feeling.

The parents often carry a feeling of guilt, and their reaction is a way of hitting out. They think that we are attacking them because they were inadequate mothers or fathers. There must be a period of pastoral care for such people in order that they can feel safe enough to open up.

Mr Conway:
The situation can be likened to GPs diagnosing meningitis — they may only encounter it once in their career, but they must get it right. Ms Ramsey is right — I agree with her — that the final words about a family’s loved one at a church service are the words that the family will go away with and carry into the next day, month or year.

Roy referred to the book, ‘From Despair to Hope’, which deals with suicide in a systematic and pastoral manner. I am not defending anybody, but there are two or three days to prepare for a service — there is no rehearsal. The responsibility is there and the consciousness is at a level that it has never been before. I hope that you find that encouraging.

Archbishop Harper:
I wish to pick up on something. The sharing of information and resources was mentioned, and, perhaps, the Churches should take a more systematic approach. That is a good idea, and for an additional reason. By working together in a training programme, people build up personal networks and become better at relating to the clergy of other denominations. The ability to be able to network across the community is very important. You can not only gain insights and share information but you have the opportunity to get to know people whom you might want to call on for assistance when dealing with a difficult situation. The benefits of that apply not only to clergy but to all church workers, including youth workers.

In addition, I am concerned about the aftercare provision for clergy who have dealt with significantly traumatic incidents, some of which may not be traumatic in how they present themselves, but which are traumatic in the enormous maelstrom of emotions that must be navigated.

The Chairperson:
That is an important point. The Committee visited Scotland, and Dr Paul Miller, a consultant psychiatrist who presented evidence, spoke about his weekly attendance at the “Who Cares for the Professionals?” initiative, which should be rolled out not only for the professional healthcare sector but across the spectrum of clergy and laypeople in order to demonstrate that someone is also there for them. They have to deal with people who open up to them about the most traumatic and dreadful stories and situations. It is important that someone should be there for them.

Archbishop Harper:
May I add to that? There are fewer clergy than there used to be in most parochial situations. It is almost analogous to the old model of medical care in which there was a single practitioner. Most medical practitioners are now in groups so that they have a support system of colleagues and a wider support system around them. Many clergy are not in that situation now, so they have to look for those support systems elsewhere. That support does not necessarily come directly from the next-door neighbour; it might come from a whole range of other opportunities.

Rev Dr John Finlay:
May I ask Lindsay to say something about our pastoral care committee?

Mr Conway:
We have acknowledged that that situation exists, and we have talked about it on different levels with the Archbishop. The Presbyterian Church in Ireland has taken that forward and has considered the pastoral care of ministers and manse families, and those in full-time work. It has looked not only at church models, which are well-rehearsed in relation to the pastor pastorum groups that Archbishop Harper mentioned, but at an external body that could examine those issues totally independently from the Church. We look at how we relate to a professional service, so that an anonymous service will be there to link in to for ministers and manse families. That is progress, at least.

Rev Roy Cooper:
We have some of those structures in various dioceses too.

Rev Dr John Finlay:
May I respond to a point that Sue Ramsey made? Please understand that I am not being defensive. There are exceptions; none of us is perfect, and we all need to learn — we accept that. Normally, however, Churches generally deal sympathetically and sensitively, through their services and their ministry, when an issue like this arises and they are involved in it. I am sure that Sue will agree with that.

Ms S Ramsey:
I do agree, but we must also take on board the sensitivities of families. The use of the phrase “committed suicide” has a negative impact on families. That point was made in the evidence session as well.

Rev John McClure:
I have known too many people who have lost their lives, and there was not a bad one among them — they were beautiful people. The phrase “committed suicide” came up only in the past three or four years, and that was in west Belfast. I know the people there, and they are great. It is a word that we all use. Society was totally ignorant of suicide. It is only in the past couple of years that we have gained knowledge. In the Church of Ireland, when someone takes his or her own life, we are there to help the minister to know what to say and what not to say, and to help him afterwards, because it is a totally draining experience. The Church of Ireland offers that support. You are right, Sue. We have to be careful, because the families are very sensitive.

There is a big problem about a lack of information for groups outside the churches, such as those in west Belfast or the Public Initiative for the Prevention of Suicide and Self-harm (PIPS) project, about sharing information with each other. I know that there is a lot of disagreement among them about that. Martin Bell and I and a few others want to bring all those groups under one umbrella. I do not know whether we will be successful, but we must be brought in, because we are the first port of call, and we help the people who sit on those groups. However, the Churches have been excluded. That cannot go on.

The Chairperson:
That situation must be resolved. We said earlier that the churches were the first port of call for the families of the victims, and were tasked with bringing families through the trauma caused by the taking of a life.

I do not wish to be rude, but we must adhere to the time allotted. There are several speakers, but it is not necessary for everyone to address the issues related to the Churches. We are running out of time.

Dr Deeny:
You are very welcome, gentlemen. I will try to be brief. I am delighted that you are here. I speak as a member of this Committee and as someone who has been a GP for many years. I agree with the comments made by all four of you and by your colleagues. This not just a mental-health issue, as Archbishop Harper said. It is the duty of health professionals, the representatives of the Health Department, educators, Churches and community and voluntary groups to work together on this terrible issue.

As Bishop Walsh said, we too are like the Church. An interesting point was made about people being called to scenes of suicide — I have been called twice to suicides in the past few years, the memory of which will stay with me forever. In those two cases, there was no evidence of mental-health problems; unhappiness due to the break-up of relationships and an inability to cope with that seemed to be the reason. That is why it is great that suicide will be treated as a societal issue, and that we will deal with it as a society.

Doctors also have to deal with the aftermath of suicide and grief suffered by families, and, as Bishop Walsh said, people often visit us to talk. I totally agree about the problem of suicide in rural areas: down the years, a major problem has been caused by farmers becoming depressed. As with all problems resulting in death — for the most part, illnesses — the main issue about suicide is prevention and the part that we can play in that. Dr Finlay, it would be interesting to hear more about the youth project that you mentioned, because I am originally from Downpatrick, which is close to Ballynahinch.

Mental health problems play a major part in suicide, and it is our job — as health professionals — to detect and treat those problems if we get the opportunity. I agree that depression has been used to describe all types of symptoms such as unhappiness and the inability to cope with life. It is the job of health professionals to treat people with those problems. As I mentioned, talking therapies and the provision of facilities for young people to talk to professionals are very important. We must get rid of the macho male culture in this country — north and south. It is interesting that, although females talk a lot more, they self-harm more, yet there are more suicides among males. The macho image, of which I was guilty for most of my life, of men dealing with their problems on their own and not discussing them, must be dealt with.

We must get the message through in schools, without making judgements on those who have taken their own lives. Suicide is an illness, with an aftermath that devastates families. Relatives have told me that, if the person who committed suicide knew the devastation that it had caused to the family, he or she would not have done it. In schools, the affect that suicide has on families could be highlighted. That would not judge those who have taken their own life. I wonder if, at an early stage in schooling, we could send the message that the greatest gift that anyone receives is human life and that it is precious. Do young people not understand that? Is that a message that we should be sending in schools?

How can we provide more facilities like those in Ballynahinch? I work near Omagh, and it would be nice to have something similar for our young people to use. I know well the families of the two young men that I mentioned. If those young men had had someone to talk to, they might not have committed suicide. Education in schools that life is precious and that one suicide devastates many lives is also needed. It is important to send that message without judging those who have taken their own lives.

Rev Roy Cooper:
At the heart of the Church’s message is that people are of value, and that is shared with people Sunday by Sunday. Part of the problem is that when people feel that they are of no worth to their family or society, they question the point of continuing with life. We must find a new vocabulary to help people see that they are valued. That is not the whole answer, but we must begin by sending the message that we value those people because God does. I would start there.

Bishop Walsh:
The point that Dr Deeny made about the talking therapies is important. The Royal College of Psychiatrists’ report refers to the lack of facilities for talking therapies and that although psychiatrists can do a certain amount, there is a requirement to talk to patients after that treatment. That is a valid point and one that the Health Committee should take on board.

The Chairperson:
Yes, very much so.

Bishop Walsh:
There is huge devastation for the family. Again, that is where the pastoral ministry of the priest and the clergy comes in. They spend time with the families. Priests have told me that the statutory agencies move in very quickly — community nurses, and so on, visit — but they are thin on the ground and are overstretched. After a few days, they have done their bit and move on — I do not want that to be misinterpreted. It is the clergy and the local parishioners who must be constantly with the families. That is where the real efficacy of the priests and the clergy comes in; they can spend time — and should be able to spend time — in the home with those families.

Archbishop Harper:
It is only when that time is spent that people, who may be in deep despair, feel that they have either the courage or the opportunity to share the problem. People are unlikely to share a problem with someone whom they do not know, or if they are fearful that that person will be judgemental or — worse — dismissive. The human relationship is important. Talking therapies is another issue that needs to be addressed seriously.

Rev Dr John Finlay:
I want to say a little more about the project in Ballynahinch. I said earlier that our problem was that there are people with whom we do not have contact in the first place because they are outside the immediate parameters of the Church. The Ballynahinch project addresses that problem at teenage level. It involves youth clubs and full-time youth workers, and it is interdenominational and cross-community. The project has involved the renovation of an old building, which is not connected to the Church. The Churches all have their own responsibility, but this building is separate from that. It is a neutral space, as far as religion is concerned, and a deliberate effort has been made to reach out to young people who do not go to Church youth clubs — those young people who are basically on the streets. It gives them a safe place to establish relationships. I was impressed by the wee room that has been set up, into which only one or two are allowed access — a counselling room, but I don’t know if they call it that. The project allows those young people to connect with people with whom they would not otherwise connect, and those running the project can be the eyes and ears, or can simply be available. To that extent, and in that localised situation, the project seems to have worked, because it arose out of a multiple-suicide situation.

However, on a different dimension, the cases of suicide of which I have experience involved young men in their twenties and thirties who are disconnected from the Church, and that presents a different challenge.

The Chairperson:
It is also worth nothing that we should be going to the where the masses are. In a recent visit to Scotland, the Committee learned of a very good model that targets men, in particular. Women are more likely to be self-harmers, but women can meet to talk. Men think that it not macho to cry or to express their feelings in the way that women do. The campaign targeted football grounds. Cards were distributed that encouraged men to talk and included telephone numbers for counselling groups, helplines and so on. That is an important element of reaching out before something dreadful happens, rather than simply picking up the pieces afterwards. The Committee felt that that is a good model to adapt for Northern Ireland.

Ms Ní Chuilín:
I welcome you all here today. I know Rev John McClure, who along with Rev Bill Shaw and Fr Aidan Troy, has done great work in North Belfast on suicide prevention.

To pick up on Sue’s earlier comment, I am old enough to remember a time when, if someone took their own life, no one ever mentioned the word “suicide”. I remember the experience of one family in particular, and how no one knew how to tell them that they were sorry for their loss. That is awful.

It is not promoting it, or condoning or condemning it. However, clergy being there, and being seen to be there, has made a difference to people. That might be a way of the Church or community making a connection and sustaining it.

I, and others, have completed the Assist training in conjunction with the Church and the youth of the area. When someone ends his or her life in north Belfast, as soon as the PSNI come on the scene they ask that a priest or a politician go to the family. They have taken on board people’s sensitivities. Roy Cooper mentioned value, and the Church’s presence in the community and voluntary sector, helping those who are volunteering, has been most beneficial. It is expected of next-door neighbours, parishioners and youth leaders to be involved in that sort of work. That is what they have always done. For the Church to become involved is not to for it to condone suicide, but rather to show that it understands. That involvement saves people from forever feeling pain because someone in their family has taken his or her own life. I do not use the phrase “commit suicide” because it implies committing sin.

I support the idea of making that training available for Churches. I have seen it work well, on a cross-community level, as well as inter- and intra-denominational levels. I am familiar with the work of both PIPS and of the west Belfast group. For that work to continue, the more people who avail of the Assist training, or any other training that brings awareness and a level of understanding, the better. More often than enough, we hear of suicide attempts after the event. We are looking at ways of preventing someone from making that awful decision and leaving family, friends and community to grieve for evermore.

The Committee is keen to promote the involvement of the Churches or the community in preventative work. The Churches have done well. None of us is perfect; we all want to do our bit and more. Keep up the good work.

The Chairperson:
Not so much a question as a compliment.

Ms Ní Chuilín:
Absolutely.

Mr McCallister:
I will be brief. It is excellent to have you all present.

I agree with much of what has been said. I certainly agree with Mr Cooper that, on a range of social issues, the Churches need to be as user-friendly as possible. In the past, they were not all as user-friendly as they might have been.

I represent a rural constituency and am part of a farming family. The evidence that the Committee heard in Scotland backs up what we have heard about isolation. It is a problem in all age groups and especially in rural areas.

I was interested to hear Dr Finlay’s comments on the Ballynahinch project. It is vital that the clergy are trained: what are your thoughts on how to expand training provision to youth leaders in the Boys’ Brigade, Girls’ Brigade and similar organisations? How do we make it available? The church is a centre of activity in rural areas; however, reaching those who do not live in such areas may be difficult. I am interested in reaching beyond the youth groups to older generations. We must cut across the responsibilities of Government Departments, voluntary organisations and Churches. It will take a team effort to address this difficult issue. How does one make it available to hard-to-reach sectors? It needs to permeate Churches, youth clubs, bowling clubs and whatever else is organised. How do we make the training available?

Rev Dr John Finlay:
Obviously it is a lot easier to prepare established programmes of training inside rather than outside, and that would not be difficult, because the structures are already in place to process information.

I do not have an answer to the other question, because we are all splashing our heads on how to connect with the people most likely to be in need.

Lindsay, do you want to say anything about training?

Mr Conway:
There is a challenge for the Boy’s Brigade, Girl’s Brigade, Scout and Guide Associations, who have a traditional approach of promoting healthy living through fitness and diet, etc, and they need to get out of those safety zones and deal with the various issues that affect children. They may just be having a bad day or feeling down and unhappy, and they use extreme language to describe that, but if we cannot reach them at the youth club, during badge work and all the other works that go on in youth organisations, we are missing an opportunity to make an impact.

Churches of all denominations have a major challenge in equipping those who go out and visit the lonely and isolated in their homes, because we know from the study that was released last week by Queen’s University that they are the most vulnerable.

The Presbyterian Church in Ireland counselling service came up with the idea of a mentor for those who are not engaging in bowls, or other activities, so that they will have someone to ring them every morning just to say “How are you?”, and last thing at night to ask “Are you ready for bed?”. I do not mean that we do not need thousands of pounds, but those schemes cost nothing in church life, whether at the level of elders, select vestry or at diocesan level. That is what it is about. It lets people know that someone cares. That is what churches are good at.

The Good Samaritan story ends with the Samaritan telling the innkeeper that he will pay him anything else he owes him on the way back, which refers to sustainability. It was not a one-off act, but one that could be expected to be repeated. That is what the church does.

Mrs Hanna:
You are very welcome, and it is good to see you here.

You all made clear the need for training, and, of course, that must be achieved. Bishop Walsh said that the clergy were often the first at the scene to give pastoral support, and I wonder if the suicide rate has anything to do with fewer young people going to church. Church provides a support system around the family, and that is why its involvement as a natural part of community groups is so important.

Dr O’Kane, with others in the Mater Hospital, is very involved in the talking therapies, and it will be good to hear how that pilot scheme will be rolled out, because it has been assessed as very successful.

Societal issues were mentioned. There is a feeling among young people that they should be happy and successful. Much of it is materialistic, so is it any wonder that young people feel that they are failures, who are not valued, when they do not have what others have?

The Committee had a presentation on the coping strategies, self esteem and values that are taught in schools, values in society, and how value is placed on young people. All of us have responsibilities in that regard; there are big societal issues, as well as alcohol and drug abuse, and their impact.

You said that the Churches also need help and that you need the wider Church to work with you, because you cannot do it all on your own. It is vital that you are part of the support that is available in the community.

The passing of information between groups has been mentioned, and there must be joined-up working. There is no point in duplicating services, or leaving a gap, or having a bit here and there. The work of the Churches must be linked with that of the healthcare professionals to ensure that it is along the right lines and that no gaps are left.

That applies to the new helpline. What is happening with that? Does it provide a signpost to appropriate services or offer direct support? Sometimes, when there is a feeling that something must be done quickly, people rush to act, rather than thinking through what would be the best course of action.

Carál mentioned the importance of language. Suicide used to be such a taboo subject that at one time it did not even appear on death certificates. When I was nursing, “committing suicide” was the phrase used, by which no harm or offence was intended. However, many issues centre on the use of language. Everyone knows that meeting a person who has been recently bereaved, whether through suicide or some other cause, is ritualistic because it is difficult to know what to say. I understand that it is impossible for the clergy to try to be all things to all people and send out a message of hope at the same time.

Thank you very much for coming today, and keep up the good work.

Archbishop Harper:
Your comments are most helpful. You pointed out that fewer young people attend church than was formerly the case. I do not know whether it is significant, but it is true that fewer men attend church now, and I refer to Dr Deeny. If as many men as women attended church, we would probably have to install additional seats. There is a male issue as far as church attendance is concerned. You were also right about the culture of celebrity. That aspiration manifests itself not only in suicidal or self-harming behaviour, but in dietary behaviour, and so forth.

However, as you were speaking, it struck me that everyone in this room has heard of ChildLine, although we may not know the telephone number. However, if young people want to get in touch with a group that will listen to their issues, they know to look up ChildLine in the telephone directory. Therefore, the new helpline must have a strapline that communicates its services to young people — a trigger that enables people to act according to their needs at a particular time. If it is to be described as something along the lines of “a suicide and self-harm helpline”, we may forget the whole thing. Some thought must be given to the way in which the service is badged to ensure that people know how to access it.

Bishop Walsh:
It is true that there has been a fall in the number of people who attend church across all age groups. However, when it comes to death, there is a residual bond with the Church, and the first person in the community to whom a bereaved family turns is the clergyman or the priest. They are in the front line from the moment that death occurs — no matter what its cause.

To follow on from what Carmel said, I wonder if there is a problem with the link between the statutory agencies and the many different voluntary agencies that beaver away, often acting alone. There seems to be a gap between the two, and a better partnership may be required.

The Chairperson:
The Committee received some correspondence that flags up the issue of partnership. If some voluntary agencies that provide much relief and help through their outreach work in the community do not get money after March, they will collapse and close down. Their funding is running out, and they would prefer to be part of mainstream funding rather than having to wait each year to see whether they can survive.

Mrs Hanna:
Those pilot group schemes that have been evaluated as doing a good job should be eligible for mainstream funding.

The Chairperson:
I agree, and we will consider that carefully when we are completing our report.

Mr Gallagher:
I reiterate what the witnesses and others have said: we are all in this together, and it is a huge issue. No one has the answer to it, but we must all keep working at it. Therefore, I was stunned when I heard that some groups that provide support to people who are close to suicide exclude the Church. I cannot understand that; it does not make sense. Rev John Finlay said earlier, and I believe more strongly than ever, that there is a link between good mental health and a religious or spiritual dimension to a human being’s life.

Most of you have mentioned how important youth work, youth services and education are. You are probably more familiar than we are with the close link between youth services and education. Issues are being kicked around and being developed to do with where youth services are going in the future. Those services may not stay with education; they may be moved elsewhere. Do you feel that it is important in relation to the issue of suicide, and other issues, to keep a link between youth services and the education service?

Archbishop Harper:
I will respond in general, rather than specific terms. This is a cross-cutting issue. It is an issue for the medical profession and the hospitals; the educational service; voluntary organisations that work with young people; and voluntary organisations and statutory bodies that deal with elderly people. It is difficult to imagine how all of those concerns could be addressed by a single Department, but since the issue is a cross-cutting one, it requires a co-ordinated response, rather than an incoherent response. A start has been made on that, and, although perfection has not yet been achieved, it is better to deal with the issue in a joined-up fashion, not least to share information, but to use resources more efficiently. It is better than everyone doing their own thing and having to rely entirely on their own individual resources. It is a no-brainer.

The Chairperson:
Gentlemen, it has been really enlightening, constructive and helpful to have had you here this afternoon. I am more heartened than ever that, collectively and individually, you are doing so much to try to deal with the issue of suicide and self-harm. The Royal College of Psychiatrists said that there is no health without mental health. We must also recognise that healthy spiritual lives are also important. I was especially impressed by the efforts that are being made to engage with professionals, including mental-health professionals, in respect of the training events that are being facilitated by the Churches. Through one of my senior advisers, Dr Paul Miller, I am aware of the good work of the Church of Ireland Youth Department (CIYD). Dr Miller’s twin brother, Rev Robert Miller from Maghera, chairs the executive committee of the central board of the CIYD. I applaud that. Equally, I know that much work is being done by all of the Churches.

We must bear in mind, however, that it is not one issue; it is many issues. It requires many groups of people to become involved and connected, and to work in a seamless way. Often we use buzzwords, but life is precious — we all agree about that. The most important outcome for the Committee would be the prevention of people going down the road to completed suicide. Your points of view will be very helpful to us when we collate all of the submissions that we have received.

Even though the Rev Roy Cooper brought his little book that he had prepared earlier, I would ask the Churches to let the Committee have some of their advice literature. It will help us to formulate our end product, which is a report for the Minister.

Thank you very much for attending the Committee. I wish you all a safe and pleasant journey home.