Aware welcomes this public consultation on Ireland’s next suicide reduction policy. Aware has supported people living with depression, bipolar and related mood conditions for 40 years. Certainly, over the course of the past 40 years, more and more people across the country are identifying mental health difficulties. For instance, more than half of all adults (53%) surveyed for Aware’s 2024 National Survey reported what they believe was an experience of depression over their lifetime.^[1] And in line with this, more and more people are seeking support for their mental health.

We see this in the uptake of our own services as well as in statutory mental health services [2]. Equally, Ireland has the highest difficulty in accessing mental health services in Europe, according to the European Union Eurobarometer Report from October 2023. Across the EU, 25% of respondents report that either they themselves, or a family member have encountered one or more issues accessing mental health services. In Ireland, 44% experienced difficulty.^[3] . Delays in accessing treatment are linked to poorer outcomes, particularly for individuals living with conditions such as bipolar disorder—who face an increased risk of suicide—and those with moderate to severe depression

Therefore in the first instance of developing a new suicide reduction policy, we see the integration of this policy across existing mental health services and policy as a key priority. Of central importance, as per Connecting for Life 2015-2020 (extended to 2025) is the provision of high quality services for people vulnerable to suicide. A new policy needs to be integrated into existing work on Sharing the Vision, SlainteCare and the Crisis Resolution Services MOC with regard to the timely access to mental health services , and especially to those in crisis or at higher risk of suicide.

It is critical that the policy explicitly identifies and responds to groups at heightened risk of suicide. For example, those experiencing economic disadvantage face both a greater burden of mental health difficulties and greater barriers in accessing care. Other priority populations include individuals living with severe mental illness (such as bipolar disorder), people with a history of self-harm, members of the LGBTQ+ community, ethnic minorities, individuals with disabilities, and those impacted by homelessness or substance use. Addressing the unique needs of these groups will ensure the policy is both equitable and effective, and will support the delivery of targeted, outcomes-driven interventions where they are most needed.

This is likely to involve further work on best practice development of responses to suicidal thoughts and behaviours in mental health services, as well as access to a range of multidisciplinary support, beyond the paradigm of a psychiatric biomedical model.

It is necessary and important to roll out training on suicide awareness and prevention outside of mental heath services and we hope the next policy contributes this work. We are cognisant however that it is equally important that should a person present as suicidal at their GP surgery for example, that following a Safetalk informed conversation, there is somewhere safe and accessible they can seek support from. Where there are a range of therapeutic options available to them.

GPs are often the primary source of access to wider mental health supports, however they are also subject to considerable demand and may not always have the time they require, to have a good or meaningful mental health conversation. This highlights the need for effective, alternative community-based supports to help address crisis issues at the earliest possible stage.

The collation of more information and research needs to be a priority for the incumbent policy, with funding allocated to this. Suicide is complex and multifaceted and as such, requires more in depth exploration of the unique experiences of people across the country who may have experienced thoughts of wanting to end their life, an experience of acting on these thoughts, experience of mental health services in response, or indeed those who have a lost a loved one to suicide. We need to hear as many voices as possible in this discussion, to move our understanding forward.

A core aspect of Aware’s mission in mental health has been tackling the stigma surrounding mental health issues. Unfortunately, stigma continues to be a major barrier to accessing mental health services across Ireland. This is especially true when it comes to seeking crisis services, which are limited in availability throughout the country. For many individuals, the options available in such situations are often restricted to psychiatric medication or psychiatric admission, leaving little room for alternative forms of care.

Stigma also can lead challenges in knowing the true number of deaths by suicide. We see a focus on reducing stigma in this area as a key priority for the incoming policy.

We are proud to offer a Solace Café/ crisis support service in Dublin and would expect this policy to support in the expansion and model development, i.e. recovery based peer support, of these crucial services. We also hope to continue to support in the delivery of non clinical crisis support services, with our recent application to deliver the Waterford Solace Café.

In summary we are hopeful about the continuing work on suicide reduction this policy update reflects. It is crucial that both the previous policy goals and any new objectives are effectively implemented. We encourage the authors to develop a comprehensive strategy for the implementation, review, and assessment of this policy. A key component of this is a commitment to adequately funding mental health services, which are currently allocated only 6% of the overall health budget. Aligning funding with the commitment to act, implement, and review these policy goals will be essential to achieving our shared objective of reducing deaths by suicide.

[1] Conducted by Amárach Research with a nationally representative sample of 1,200 adults, April 2024.

[2] Douglas L, Feeney L. Thirty years of referrals to a community mental health service. Irish Journal of Psychological Medicine. 2016;33(2):105-109. doi:10.1017/ipm.2015.28)

[3] Flash Eurobarometer 530 Mental Health June 2023 Report