THREE STEPS TO CHANGE LIVES. How we can act effectively to reduce suicide in Ireland

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1 THREE STEPS TO CHANGE LIVES How we can act effectively to reduce suicide in Ireland

2 THREE STEPS TO CHANGE LIVES

3 HOW WE CAN ACT EFFECTIVELY TO REDUCE SUICIDE IN IRELAND More than 450 people die by suicide in the Republic of Ireland each year and some groups are more at risk of suicide than others. The causes of suicide are complex but we do know that there are factors which increase the risk for specific groups and individuals. These include deprivation, having a mental health problem, alcohol misuse and being bereaved by suicide. Over 80% of those who die by suicide are men and men aged between 45 and 64 have the highest rate of suicide. The risk of dying by suicide is 5 times greater in the lowest socioeconomic group, compared to the highest. Suicide can be seen as a health inequality; an unjust and avoidable difference in health and length of life that results from being poorer and disadvantaged. Data from 2013 and 2014 suggests that suicide rates may be starting to decline. A sustained commitment to suicide reduction is needed to ensure that this continues. We need an approach which promotes mental health and wellbeing, timely support, and which reduces inequality. Samaritans exists to reduce the number of people who die by suicide. We are asking for a strong political commitment to help us achieve this aim. Together, we can make a difference to the rate of suicide and find ways to respond to people who are struggling to cope. We believe action needs to be targeted in 3 key areas: 1 Making suicide reduction a priority 2 3 Addressing gaps in mental health service delivery Tackling alcohol misuse

4 THREE STEPS TO CHANGE LIVES 1 Make suicide reduction a priority The causes of suicide are complex and there is no single reason why someone takes their own life. Social, economic, psychological and cultural factors, along with the stigma associated with seeking help, can all impact on suicidal behaviour. Reducing suicide in Ireland requires strong political commitment and leadership. We are calling on all parties and representatives to make suicide reduction a political priority. Measures should include: Committing to implementing Connecting for Life In June 2015, the Government launched Connecting for Life: Ireland s Strategy to Reduce Suicide The strategy recognises the need for a coordinated response from different sectors of society and collaboration between Government Departments, state agencies, non-governmental organisations (NGOs) working in the area of suicide prevention and local communities. It puts in place structures for cross-departmental action and an integrated policy response to suicide and local plans to reduce suicide. When implemented, the strategy has the potential to reduce suicide and self-harm in Ireland and achieve the 10% reduction in suicide by 2020 (as recommended by the World Health Organisation) adopted as part of the strategy. The approach taken in the strategy is far-reaching and leadership is required to ensure its implementation. We call on all political parties to commit to the implementation of Connecting for Life. Making suicide reduction a public policy priority Suicide reduction is a public health problem which is influenced by a range of social, personal and economic factors. Certain groups are at increased risk of suicide in Ireland: those who are socially marginalised, people with mental health problems, middle-aged men and women, young people and the economically disadvantaged. There are many social and economic factors which can influence mental health problems, ability to cope and suicide; for example, access to education, employment status, income, and housing situation. A whole-of-government approach with actions across its departments and agencies is required. Suicide reduction must be a public policy priority across all policy areas. Providing ring-fenced funding for suicide reduction Connecting for Life must be adequately resourced to ensure effective implementation. While much can be achieved by closer collaboration between services and agencies, sustained funding will be required to successfully implement the strategy. The national programmes and local action plans outlined in the strategy need to be sufficiently resourced. Funding allocated for suicide reduction in Ireland must be ring-fenced if we want to make a real impact on suicide rates.

5 HOW WE CAN ACT EFFECTIVELY TO REDUCE SUICIDE IN IRELAND 2 Address gaps in mental health service delivery Mental health problems significantly contribute to the development of suicidal feelings and behaviour. More than 90% of those dying by suicide have a mental illness or disorder at the time of death. It is important that people with mental health problems receive timely support regardless of at which point they come into contact with the health services. A shortage of mental health professionals and inadequate service provision heightens the risk of suicide and leaves at-risk groups unrecognised and more vulnerable to suicide. There must be integration between Primary Care and the Mental Health Services so that people can access the care that they need. Measures should include: Addressing the existing gaps in mental health services in Ireland through a new national mental health policy In 2006, the Government launched A Vision for Change, Ireland s mental health policy framework. It recommended that the approach to mental health care is person-centred, based in the community and committed to recovery. A Vision for Change covers the period from 2006 to While many gaps in the provision of mental health services remain, the policy framework provided much needed leadership in the area of mental health. It is essential that the Government continues to show leadership and commits to delivering and building on the model of mental health care outlined in A Vison for Change through a new national policy on mental health care. Ensuring that people with mental health problems can access treatment through primary care When someone experiences a mental health problem, their GP is usually the first point of contact when seeking help. GPs are responsible for identifying and assessing a person s mental health needs and either providing treatment in the primary care setting or referring to specialist mental health services. The Government must ensure that there are adequate mental health specialists available through primary care. The main method of treatment provided in the primary care setting is medication. We recommend that a wider range of options should be available. The Health and Safety Executive (HSE) Counselling in Primary Care Service (CIPC) was introduced nationally in 2013 to improve access to psychological therapy through primary care. Under the scheme, adults who hold a General Medical Services Card (GMS) can avail themselves of counselling for mild to moderate psychological difficulties. The CIPC Model should be extended so that people on low to moderate incomes can access timely psychological support.

6 THREE STEPS TO CHANGE LIVES GPs and primary care teams also play an important role in the community as gatekeepers. The majority of people who access the mental health services do so via referral from a GP. A Vision for Change advocated a shared care model where primary care teams and community mental health teams work together to ensure that individuals receive timely and appropriate access to treatment and support. In order for this model to work senior members of the Community Mental Health Team (CMHTS) are required to support primary care by providing advice and managing referrals. This process cannot work unless Community Mental Health teams have their full complement of staff. Providing ring-fenced funding for community mental health services and 24/7 crisis intervention services Ring-fenced funding must be put in place to ensure that community mental health services are fully resourced and that crisis intervention services are in place through the country. 3 Tackle alcohol misuse 65% of suicides are related to excessive drinking There is a strong link between alcohol misuse and suicide. Tackling alcohol misuse is a crucial part of suicide reduction. The misuse of alcohol makes people 8 times more likely to kill themselves. As many as 65% of suicides are related to excessive drinking and alcohol use is one of the highest risk factors for suicide. Suicide in Ireland cannot be reduced without addressing our unhealthy relationship with alcohol. Measures should include: Introducing a minimum unit pricing (MUP) policy The price of alcohol is directly linked to consumption levels and levels of alcohol related harm. The Government must commit to introducing MUP as outlined in the Public Health (Alcohol) Bill MUP makes it illegal to sell alcohol below a set minimum price. The MUP of an alcohol product is based on the number of grams of alcohol in the product. There is extensive international evidence showing that MUP policies are effective in reducing alcohol consumption, alcohol related harm and alcohol related deaths. MUP Ireland targets those most at risk of alcohol related harm without impacting on low risk or moderate drinkers. Improving integration between alcohol treatment, mental health services and suicide prevention services Many people experience both mental health and alcohol misuse problems. It can be difficult to determine whether a mental health problem is primary or secondary to alcohol misuse and this can complicate how a person is treated. Many people who present with both alcohol and mental health problems are suicidal. An integrated approach to service delivery and adequate resources is required to ensure that people are treated in the most appropriate setting whether that is in the community, addiction service or mental health services. Ensuring that suicide risk is assessed as part of screening and intervention for harmful drinkers Due to the strong link between alcohol misuse and suicidality, suicide risk should be routinely assessed as part of brief interventions for harmful drinkers by health and social care staff. All frontline staff should be provided with suicide prevention training.

7 HOW WE CAN ACT EFFECTIVELY TO REDUCE SUICIDE IN IRELAND

8 More than 450 people die by suicide in the Republic of Ireland each year and some groups are more at risk of suicide than others. To stop suicide taking such a toll on our communities, we must: 1 Make suicide reduction a priority 2 3 Address gaps in mental health service delivery Tackle alcohol misuse For more information please contact Samaritans Registered Office 4-5 Usher s Court, Usher s Quay, Dublin 8 T samaritans.ie A charity registered in Ireland no. CHY11880.

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