Session 2007/2008 Third Report The Committee for Health, Social Services and Public Safety Report on the Inquiry into the Prevention of Suicide and Self Harm Volume One TOGETHER WITH THE MINUTES OF PROCEEDINGS AND MINUTES OF EVIDENCE RELATING TO THE REPORT Ordered by The Committee for Health, Social Services and Public Safety to be printed 1 May 2008 Report: 27/07/08R Committee for Health, Social Services and Public Safety PUBLISHED BY AUTHORITY OF THE NORTHERN IRELAND ASSEMBLY BELFAST: THE STATIONERY OFFICE £20.00 This document is available in a range of alternative formats. For more information please contact the Northern Ireland Assembly, Printed Paper Office, Parliament Buildings, Stormont, Belfast, BT4 3XX Tel: 028 9052 1078 Committee for Health, Social Services and Public Safety Membership and Powers The Committee for Health, Social Services and Public Safety is a Statutory Departmental Committee established in accordance with paragraphs 8 and 9 of the Belfast Agreement, section 29 of the Northern Ireland Act 1998 and under Standing Order 46. The Committee has power to: . Consider and advise on Departmental budgets and annual plans in the context of the overall budget allocation; . Consider relevant secondary legislation and take the Committee stage of primary legislation; . Call for persons and papers; . Initiate inquires and make reports; and . Consider and advise on any matters brought to the Committee by the Minister for Health, Social Services and Public Safety The Committee has 11 members including a Chairperson and Deputy Chairperson and a quorum of 5. The membership of the Committee since 9 May 2007 has been as follows: Mrs Iris Robinson MP (Chairperson) Ms Michelle O’Neill (Deputy Chairperson) Mr Thomas Buchanan Mrs Carmel Hanna Rev Dr Robert Coulter Dr Kieran Deeny Mr Alex Easton Mr Tommy Gallagher Mr John McCallister Ms Carál Ní Chuilín Ms Sue Ramsey Table of Contents Volume One Executive Summary Summary of Recommendations 1. Introduction 2. Background Suicide Self Harm 3. Trends Northern Ireland International Comparison Self Harm 4. Strategic Approach to Suicide Prevention Implementation Structure Evaluation and Review Funding Targets 5. Stakeholder Involvement Development of the Strategy Ongoing involvement through SSIB Families and Community Groups Cross-Departmental Role Role of Schools and Colleges Role of Churches Role of Sport and Exercise Role of Local Authorities 6. Services and Support Training ASIST Training Training for clergy and church workers Training for PSNI Telephone Helpline Self Harm Service Talking Therapies 7. Experience Elsewhere 8. Other Issues Role of Media Public Information Campaign Chill Out Room Card Before you Leave Communication Support for Frontline Staff 9. Conclusion Appendix 1: Minutes of Proceedings Appendix 2: Minutes of Evidence Volume Two Appendix 3 Written Submissions Appendix 4 Other Evidence Considered by the Committee Appendix 5 List of Witnesses who Gave Oral Evidence to the Committee Executive Summary The number of suicides in Northern Ireland has been increasing in recent years. Currently, about 195 people take their own life each year while a further 4,500 people are admitted to hospital having attempted suicide or inflicted serious injury from engaging in deliberate self-harm. Launched in October 2006, a national suicide prevention strategy entitled Protect Life: a shared vision has been developed within the context of a rise in the number of people dying by suicide and engaging in self-harm. Protect Life represents a major step forward in the efforts to reduce this needless waste of life. However, suicide is not a matter of figures or statistics but each person who takes their own life is a life prematurely cut short and a tragedy and a trauma beyond words for the family, for their friends and relatives, and for society as a whole. The Committee has examined the scope and appropriateness of the strategy and its implementation to date. The level of engagement, particularly with community groups and families bereaved by suicide, in drawing up the strategy has been extensive and lessons have been learned from international best practice. Throughout its Inquiry, the Committee discovered a substantial level of commitment and endeavour in delivering the full implementation of the strategy and ensuring improvements in levels of support for those affected by suicide. The Committee identified a number of areas where it believes the strategy can be strengthened and enhanced. These include the following: . There is a recognition that one size does not fit all and the focus of the strategy needs to be refined to take account of the significant suicide risk among older people and those living in rural areas. Central co-ordination and delivery of the strategy could be improved by the establishment of a designated suicide prevention director. This would help to build a higher degree of expertise and experience in planning and delivering the strategy, working closely with the Suicide Strategy Implementation Body and taking account of the views of key stakeholders, and providing a direct central contact point for all stakeholders. The funding provided to implement the strategy must remain ring-fenced for a number of years and community groups need a greater degree of financial certainty and sustainability to concentrate on providing their services. Preventing suicide and providing help and support for those affected is not solely a matter for the Department of Health, Social Services and Public Safety. Greater commitment and involvement is required from all other Departments. For example, the Department of Education can play an influential role in supporting primary and post- primary schools in the development of coping skills and character building which can better equip young people in confronting the challenges of modern life. The level of stakeholder involvement could be further enhanced by incorporating a greater role for churches and developing strong partnerships with local authorities and sporting bodies. A suicide prevention telephone helpline provides a vital lifeline for those in crisis but it must be backed up with sufficient referral and support services. The decision to set up a regional helpline, without an evaluation of the pilot in north and west Belfast and in the absence of an assessment of existing referral and support services to cope with a significant increase in calls, was considered premature. Extensive training has already taken place particularly through the ASIST (Applied Suicide Intervention Skills Training) programme. However, there is still a significant need for additional and improved training for those who may come into contact with people at risk of suicide. The Committee learned of many excellent services throughout Northern Ireland, provided by local community groups and others, that aim to prevent suicide and self-harm, to deal with those who may attempt suicide, and to cope with the aftermath of suicide and provide support to bereaved families. The Committee also saw exemplary models of counselling and other services in operation in Dublin and in Scotland and would urge the Minister to explore how these could be replicated in Northern Ireland by building on existing experience and capacity. It is well recognised that the media can play a positive role in raising awareness of issues relating to good mental health and can have an impact in combating any associated stigma. At the same time irresponsible reporting of suicides can increase the risk of copycat suicides. Increasingly concerns have also been raised about the influence of the internet and the prevalence of social networking sites that are used to promote suicide among young people. The Committee commends the efforts being made by the Minister to engage with the local media and with internet service providers. The awaited response by the Department of Health, Social Services and Public Safety to the recommendations in the Bamford Review of Mental Health and Learning Disability provides a unique opportunity to develop and strengthen links between the suicide strategy and the provision of mental health services. This is particularly important in relation to the development of child and adolescent mental health services. Summary of Recommendations 1. The development of the Protect Life suicide prevention strategy has been a major step forward in the battle to reduce the incidence of suicide in Northern Ireland. We recognise the benefits of the dual population and targeted approach but we believe that the focus of the targeted approach needs to be re-examined and redefined to include other priority groups, such as older people and those living in rural areas. (Paragraph 35) 2. We have major concerns that the current structure lacks a dedicated directorate to manage and act as a central focus for the implementation of the suicide prevention strategy. We call on the Minister to establish a designated suicide prevention directorate as part of the proposed new Regional Public Health Agency. (Paragraph 41) 3. It is of the utmost importance that robust review and evaluation arrangements are in place to examine the key elements of the strategy and learn lessons as the strategy develops. While provision for such review and evaluation was built into the strategy we have major concerns that this has not yet taken place. We call on the Minister to commission an urgent independent, time- bounded evaluation of the key elements without further delay and to take account of the findings of this Committee Report in the review of the strategy. (Paragraph 44) 4. We note the overall level of funding for implementation of the strategy and recognise that it compares favourably on a per capita basis with Scotland and the Republic of Ireland. We strongly urge the Minister to ensure that this funding remains ring-fenced for a number of years to sustain and implement the Protect Life strategy and that there is full transparency, accountability and scrutiny of how this funding is used.. (Paragraph 50) 5. We commend the sterling work carried out by community groups and we fully recognise the vital importance of their involvement in the strategy to reduce suicide and support bereaved families.