If suicide comes from hopelessness, the scale of the problem in Ireland can lead to even deeper despair. The findings unveiled at the congress of the International Association for Suicide Prevention in Killarney this week have been grim.
A tenfold increase in suicides since the early 1960s, with the annual figure now at an average of 600 - 150 more than previously thought. Children as young as six presenting at Dublin hospitals with deliberate self-harm. Up to 100 people "bullied to death" in Irish workplaces each year. Half of the 800 drownings in the Republic in the five years up to 2005 attributed to suicide.
It is easy to be numbed by such terrible statistics and by the depths of pain that these deaths both express and cause. Most of us, if we are lucky enough not to have been forced to confront the subject, prefer not to think about it. If we do think about it, we may take refuge in vague generalities about modern alienation or in a sense that what is happening is both mysterious and unavoidable. Yet the new research should wake us up to the reality that suicide is a political issue. No one believes that all suicides are preventable or that there is any one solution to the problem. There is, however, much that can be done and the State is patently failing to do it.
Suicide is usually a process rather than an act. There are often warning signs like self-harm, and they offer the chance for intervention. Yet more than 1,700 patients a year who present to accident and emergency units after deliberately harming themselves do not receive any form of psychiatric assessment or aftercare. Psychiatric services for children are scandalously inadequate, with long waiting lists. Almost 300 children and adolescents were admitted or detained in adult psychiatric hospitals last year, contrary to international best practice and appropriate models of care. The Minister for State Dr Jimmy Devins acknowledged at the conference that these services for children give serious cause for concern, but the larger reality is that the provision of mental health care is a shamefully low priority.
Spending on mental health has dropped from 13 per cent of the overall health budget in 1984 to 7 per cent now. There are fine intentions in the Government's mental health strategy, A Vision for Change, but the 2006 report from the acting Inspector of Mental Health Services, Dr Susan Finnerty, noted: "The lack of coherent overall plans for services over the next five years is worrying. The ad hoc nature of mental health provision has been noted in the past and there is no sign currently that this situation will change. There is genuine frustration and disillusionment from those delivering the service..."
Government policies to tackle bullying and substance abuse can help to alleviate our suicide crisis in the long term, but the most urgent need is for a decent mental health service. As Jonathan Swift noted when he left money to found a psychiatric hospital in Dublin, no nation needs it so much.