Topical Issue Debate - Self-Harm Incidence

Thursday, 10 November 2011

Dáil Éireann Debate
Vol. 746 No. 2

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Deputy Dan Neville: Information on Dan Neville  Zoom on Dan Neville  I welcome the opportunity to raise the issue of the report of the national registry of deliberate self harm, which is under the auspices of the National Suicide Research Foundation, on the level of attempted suicide and self-harming 2010. Last year, 11,966 presentations, involving 9,630 individuals, were made to hospitals due to deliberate self-harming. Taking the population into account, the age-standardised rate of individuals presenting to hospitals following deliberate self-harm in 2010 marked a significant 4% increase over the rate for 2009. Moreover, it constituted the fourth successive increase in the national rate of hospital-treated deliberate self harm. In 2010, the male rate of deliberate self-harm was 4% higher than was the case in 2009. This again is the fourth successive year in which male deliberate self-harm increased, and the female rate also increased by 4%.

The economic recession is likely to be a key contributor to the recent increases in hospital-related deliberate self-harm. Since 2007, that is, the year before the onset of the recession, the report states the male rate in deliberate self-harming presenting at accident and emergency units has increased by 27%, while the equivalent increase in female rates is 7%. While there is a number of notable changes in the deliberate self-harming rate between 2009 and 2010, the most striking one concerns the 20 to 24 age group. The rate for men in the aforementioned age group increased by 19% from 2009 to 2010, while the rate for women increased by 30%.

This reveals how significant is the increase in attempted suicide and deliberate self-harming that is developing. This issue is somewhat under the radar and I have been trying to raise it for six weeks. However, I appreciate the Ceann Comhairle’s office received 27 requests today and perhaps this issue is not topical. My purpose in introducing this issue is to make it topical. There also is a widespread variation in the male and female rates when examined by city and county. The lowest rates for females was recorded in County Leitrim, while the highest was in Limerick city. Relative to the national rate, a high rate of deliberate self-harm was recorded for male and female city residents, as well as men living in Sligo and women living in Longford, north Tipperary and south Dublin. I ask the Minister to look at some of the most common methods, because this is the key to involvement in this regard. Finally, the director of the National Suicide Research Foundation, Dr. Ella Arensman, and international research have shown that for each person who presents at an accident and emergency unit having deliberately self-harmed, at least six to seven others who self-harm do not present to such units. They present to their general practitioners, who do not report it at all, their families hide it because of the stigma or such people may not even report it to their own families. On that basis, between 70,000 and 80,000 people each year are deliberately self-harming in Ireland and this is a serious issue that must first be recognised by society.

Deputy Kathleen Lynch: Information on Kathleen Lynch  Zoom on Kathleen Lynch  I thank Deputy Neville for raising this important issue. It is not the first time he has done so and given his commitment to the subject, I dare say it will not be his last. At the outset, I note that just this morning, the Minister for Agriculture, Food and the Marine, Deputy Coveney, and I launched a leaflet on behalf of Shine and the IFA in respect of farm stress. While one sometimes is inclined to think of this issue as only pertaining to one particular group, it affects everyone in all sectors of society.

Over the years, all Members have been aware of deliberate self-harm but few realised the extent of the problem. It is difficult to imagine that 9,630 individuals, representing 11,966 pres[275]entations, presented to emergency departments in 2010 having self-harmed. It also is worrying that one fifth of all deliberate self-harm presentations were due to repeated acts. It also is important to recognise the aforementioned figures do not include those who engage in self-harm but who never present to an emergency department. Deliberate self-harm is a serious issue and it is hard for many people to understand the despair of a person who engages in deliberate self-injury. International studies have found self-injury to be one of the most significant risk factors associated with suicide and those who engage in self-harm are 20 times more likely to die by suicide eventually. Moreover, studies have shown that at least one third of all suicides have a history of self-injury. I believe early intervention with people who engage in deliberate self-harm would prevent some people from continuing to self-harm and could prevent some deaths by suicide. Several initiatives are ongoing and in development that take account of the recommendations of the recently published national registry of deliberate self harm report for 2010.

  4 o’clock

The National Office for Suicide Prevention, NOSP, is working to progress a more unified and consistent response to self-harm presentations in emergency departments. A self-harm awareness training programme is also being developed which will be rolled out nationally in the coming years, beginning next year. The HSE clinical care national lead on mental health is working with key stakeholders to develop a uniform approach to self-harm assessments in emergency departments in order that all those who present will receive the most appropriate care and treatment. In addition, a pilot project is under way in the Cork Hospital Group to train all appropriate clinical staff in self-harm and suicide management and it is planned that in due course this will be rolled out to other hospitals. The NOSP has also funded a number of suicide community assessment nurses, SCAN, who work primarily with GPs to provide early intervention services for clients in suicidal crisis and thus avoid admission to hospital. A number of voluntary organisations also provide services for those who self-harm.

The total annual funding available to support suicide prevention initiatives is in the region of €9 million. This includes the annual budget of €4.1 million for the national office, with the balance of €5 million used to fund resource officers for suicide prevention, self-harm nurses in hospital emergency departments and the development of local suicide prevention initiatives. The additional €1 million provided for the national office this year is being used to develop the number and range of training and awareness programmes, improve and standardise the response to deliberate self-harm, develop the capacity of GPs to respond to suicidal behaviour and ensure helpline supports for those in emotional distress are co-ordinated and widely publicised.

I acknowledge there is great commitment in many sectors to tackle this serious health and social issue. The Government’s commitment to the development of mental health services in line with A Vision for Change and Reach Out was clearly shown in the programme for Government which provides for the ring-fencing of €35 million annually within the overall health budget to develop community mental health services, ensure early access to more appropriate services for adults and children and implement Reach Out, the suicide strategy within A Vision for Change. We must all continue to work together — researchers, policy makers and service providers — to identify people at risk and ensure appropriate services are in place to provide the help and support needed. Everybody recognises that this is a crisis issue within communities and the Government will do its very best to address it.

Deputy Dan Neville: Information on Dan Neville  Zoom on Dan Neville  I welcome the Minister of State’s commitment and again welcome the Taoiseach’s commitment two weeks ago to ring-fence €35 million annually within the overall [276]health budget to develop community mental health services in line with A Vision for Change, a vital issue in the development of the mental health services.

The National Office for Suicide Prevention has asked that priority be given to effective interventions at multiple levels, including the early identification of people at risk of self-harm by introducing evidence-based depression, self-harm and suicide awareness and skills training for professionals working in health care and community based services. It is also recommended that we seek to prevent repeated self-harm by introducing uniform procedures for assessment and the after-care of deliberate self-harm patients presenting at hospital emergency departments. In order to deal effectively with the needs of deliberate self-harm patients following discharge from hospital, it is recommended that a wider range of evidence-based treatment programmes should be made available for this high risk group, the focus on which is vital. I have seen programmes in other countries for this group of people who are discharged from hospital. It is vital to inform the general public about the symptoms of depression, warning signs of suicidal behaviour and relevant help services through positive mental health promotion campaigns. While there have been some such campaigns, the issue of promoting mental health awareness and de-stigmatising mental illness has to be re-examined because it is vital that we tackle the very serious issue of attempted suicide, deliberate self-harm and completedsuicide.

Deputy Kathleen Lynch: Information on Kathleen Lynch  Zoom on Kathleen Lynch  I cannot disagree with anything the Deputy said. This is a crucial group, one we have identified. There are, of course, others within the group who never come to the attention of the medical profession, but, nevertheless, it is an issue about which we will have to do something very quickly. The training programmes we are rolling out, including the pilot programme in Cork, will give us the expertise we need both to identify and treat patients. I could not agree with the Deputy more that when people are released from care and discharged back into the community, follow-up, if only a telephone call to have someone to make that connection, is vital. We simply cannot abandon people as soon as they are discharged from care because, clearly, they are in distress or they would not have been admitted to the service in the first place. We hope the €35 million which the Taoiseach has guaranteed us will be available from the health budget will be used to put in place the people we need to deliver this service.

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