Plenary, 20 Mar 2003

Meeting date: Thursday, March 20, 2003

Official Report 592KB pdf

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Suicide Emergency Telephone Hotline

The final item of business today is a members' business debate on motion S1M-3897, in the name of Kenny Gibson, on a suicide emergency telephone hotline.

Motion debated,

That the Parliament notes with concern that in 2000 there were 880 reported suicides in Scotland, 676 males and 204 females, although the true figure could be higher; is conscious that many thousands of other people attempt to take their own lives each year; regrets that only a minority of the population know the telephone number of the Samaritans or any other organisation they could contact for help when feeling suicidal; believes that, to assist in achieving the goal of a 20% reduction in the incidence of suicide by 2013 set by the Scottish Executive in its National Strategy and Action Plan to Prevent Suicide in Scotland, everyone should be made aware of an all-Scotland telephone number to call for help; acknowledges that in the United States anyone can call a nationwide toll free number from anywhere in the country, 1-800-SUICIDE or 911, to ask for help which is provided swiftly if they say they are in "suicidal danger"; believes that the Scottish Executive should set up a suicide prevention crisis hotline, whereby calls from suicidal individuals are treated as an emergency, through using the existing 999 emergency number from which they can be referred directly to a dedicated suicide prevention 24 hour hotline, and further acknowledges that the purpose of this line would be to save lives through dissuading suicidal people from killing themselves and that the Executive should, once such a line was established, take steps to let the public know about it.

This is a timely debate following our debate on the passage of the Mental Health (Care and Treatment) (Scotland) Bill, during which the subject of suicide was occasionally touched on.

In speaking to the motion today, I must first thank Mark O'Dowd and Gavin Brown of Glasgow Junior Chamber of Commerce, who first proposed a national suicide helpline called "project suicide". I also thank the 21 MSPs who signed the motion. Junior Chamber Scotland is now fully behind the idea and the chairman of Bishops Solicitors has agreed to become the project's legal adviser.

I also congratulate the Daily Record on its high-profile "save our kids" appeal. Following the tragic suicide of 12-year-old Emma Morrison, the Daily Record has raised £40,000 from readers to help Penumbra assist suicidal teenagers receive the counselling services that they need. I wish the Daily Record all the best in its campaign to raise £200,000.

Scotland has an appalling suicide problem. In 2000, at least 880 people committed suicide—the actual number may have topped 1,000. In addition, at least 1,500 people attempted to commit suicide. Those are horrific figures for such a small country. Scotland has a suicide rate of 18 per 100,000, which is twice that of England. Our suicide rate is also 50 per cent higher than that in the United States, despite the greater opportunity for suicide there because of the widespread availability of firearms. Since 1991, Scotland's suicide rate has increased by an alarming 26 per cent. More young men now die by their own hand through suicide than die through drug overdoses and car crashes combined.

The reasons for an individual taking his or her own life are often highly complex. Within the limited time available, I do not intend to explore the reasons why the difference in suicide rates between England and Scotland is so acute or why people chose to kill themselves. Those issues were explored in my previous debate on suicide on 6 April 2000. Today, I wish to consider a proven method of saving lives through suicide prevention.

What people in crisis need is an easy-to-remember telephone number that people at risk of suicide can call for help. The number must be not only free but easily recognised and remembered nationwide. It is important that a hotline gets everything right. There can be no accidental disconnections or stressed operators, because callers needs urgent help. The call may be the person's last lifeline, so the ability to connect directly to a trained crisis worker is important.

A person on the brink of suicide may not think clearly or reach for the phone book. They run through all the options in their head and if they cannot think of anything, they kill themselves. That is why a well-publicised, easy-access freephone number is so vital, as it will pop into the mind instantly and save lives. Currently, Scotland lacks a national freephone number that someone can call in the event of a suicidal crisis. The telephone numbers of organisations such as the Samaritans are not widely known. American research has shown that having to contact directory inquiries may inhibit a suicidal caller from making such a call.

Both the United States and Australia have set up national suicide hotlines that operate under umbrella networks that link crisis centres across each country. That type of programme is affordable, easily adaptable and works effectively to reduce suicide rates.

The American system is called Hopeline USA. It was established in 1998 by Reese Butler after the death of his wife by suicide. Hopeline is an umbrella organisation that links crisis centres throughout the USA. When the Hopeline number is dialled, the caller is immediately linked to the closest crisis centre without an intermediary. If there is no answer after four rings, the caller is transferred to another centre. That is done eight times before the system hangs up. That means that, on every call, the person can be put through to eight separate centres within 32 rings. As a result, the probability of a caller reaching a person to talk to is extremely high.

I ask Mr Gibson to reassure me on the important question of whether there would be duplication. The Samaritans have a long-established and very good reputation in dealing with the tragic problem of suicide. Are we not in danger of duplicating and, perhaps, of not making the most of the Samaritans' expertise? Should we not be giving that organisation more support?

I hoped to touch on that matter as I went on. The Samaritans exists to listen to people. If someone phones the Samaritans and tells them that they want to commit suicide, they do not believe that it is their job to talk people out of it. Their job is to listen and, if someone decides not to kill themselves, as far as the Samaritans are concerned, that is their choice. The organisation helps many people but we are talking about a more interactive service. I will go into that in more detail.

Hopeline uses two numbers: a toll-free number—1-800-SUICIDE—and 911. Those numbers are easily remembered and heavily publicised. It is vital that the number is easy to recognise, free, and operates 24/7. At Hopeline, trained crisis workers carry out a lethality assessment as soon as a call is received. Callers who are not considered to be at immediate risk are referred to a local crisis centre once the reason for calling is determined. If the caller is at high risk, the decision for intervention is made by the on-call supervisor who dispatches help.

Hopeline started with private money but now has a three-year grant for research and development as well as overhead costs. The project currently costs approximately $1.7 million per year to run: $1 million goes on administration, including publicity, and $700,000 goes to telephone and computer use and development, yet the organisation covers the whole USA. With new telephone and computer technology, the cost is virtually the same whether there is just one region or the entire nation is linked.

Hopeline gets 600 calls per day and received 650,273 calls between 1998, when it began, and 1 March this year. It approaches crisis centres to get them involved and linked to the network. A crisis centre requires at least 200,000 hours of training to become a part of the network. There are other strict guidelines for becoming part of the network. For example, each crisis centre maintains a database of hundreds of services currently available in the community in which it is located, ranging from intervention centres, shelters for runaway youths, domestic emergency departments of general and psychiatric hospitals, and specifically focused education and outreach programmes, such as school-based suicide prevention and crisis response teams.

The basic tenet is that every citizen has the right to necessary assistance in a life-threatening crisis. That value reflects the philosophy that active intervention must be used in such situations. Crisis intervention services offer an effective means of reducing harm to oneself or others by providing primary suicide prevention, bereavement assistance to survivors, intervention and community information about those issues.

Secondary prevention and intervention are also provided for persons who have attempted suicide, for the chronically self-destructive person and for victims of violence. Components of services in life-threatening crises are lethality assessments, rescue services, services for victims of violence or suicide survivors and community education. The bottom line is to keep the individual alive. Dispatch teams, including professional workers, are sent to save people. The suicidal person might then be examined by psychiatric liaison, or he or she might be hospitalised, often followed by out-patient therapy, both for the suicidal person and for his or her family. Intervention and the breaking of confidentiality are used only as a last resort after all other options to save a life are exhausted. If consent for help is still not given, intervention will occur without it.

At all times, callers are dealt with on a non-judgmental basis. Crisis workers offer a balanced and realistic attitude to the person and do not expect to save all potential suicide victims by themselves or to fix all their problems.

The Australian system, which is based on the American one, is called LIFE—living is for everyone. Since its establishment with Government support, suicide rates are at their lowest for a decade. Last year, there were 132 fewer suicides than in the previous year. Its motto is that one suicide is a suicide too many.

According to researchers at the University of Montreal, studies have shown that the suicide rate in areas in which a hotline is available declines faster than in areas where there is no hotline. Other studies have found that hotlines have a beneficial effect in helping attempters to avoid repeated non-lethal suicidal behaviour. With technological advances, setting up hotlines has becoming increasingly simple and inexpensive.

The Executive has a national strategy and action plan to prevent suicide in Scotland—it is called choose life. Unfortunately, in my view the strategy lacks ambition and is currently funded only for three years. For example, the target of reducing suicide rates in Scotland by 20 per cent over 10 years will still leave Scotland with a higher suicide rate than in 1991, and a rate that is 60 per cent higher than that in England. We must aim higher.

Scotland has excellent anti-suicide organisations, such as Breathing Space—a telephone helpline funded by the Executive, which aims to provide an anonymous and confidential point of contact that is easy to access. It is an excellent service, but although the hotline has received 6,500 calls since its inception, it can be hard to reach. Nevertheless, its success shows the need for an all-Scotland, easily accessible network. Money was allocated for Breathing Space for only three years, beginning in 2001. There are no immediate plans to extend the funding, which is due to run out shortly. The helpline, which serves greater Glasgow and Argyll and Bute, is available only from early evening until 2am. It is important for a helpline to operate 24/7.

A number of crisis centres and organisations provide help, including not just Breathing Space, but the British Association for Counselling and Psychotherapy, ChildLine, Depression Alliance Scotland, the NHS helpline, the Samaritans, Stresswatch Scotland, and the University of Edinburgh's nightline. Linking those organisations nationally is vital.

The 999 emergency service at present covers police, fire, ambulance, coastguard, mountain rescue and cave rescue. Under current practice, as many as three public telecommunications operators may handle one call. Some people are placed in long queues of up to 10 minutes before being connected with the proper authority. If someone is suicidal, they need a crisis worker right away. Further resourcing of the emergency services is therefore essential if a hotline is to work effectively. However, with the support of the Scottish Executive and the minister, any problems can be overcome and many lives can be saved.

Kenny Gibson has raised an important topic. I listened with interest and learned a lot about the way in which suicide lines operate in other countries. At the end of his speech, he hit on the main point that I would like to make. It is important to organise and co-ordinate all the groups that are already involved in the area, both voluntary, such as the Samaritans, and professional, such as social work departments.

One of the things that we are not always good at in this country is combining the voluntary and the statutory. We risk duplication and waste. The Samaritans do not supply exactly the same service as the one that Kenny Gibson proposes, but they give good advice and help to people who are in the earlier stages of deep depression that might lead to suicide. My plea is that we should go ahead with a helpline, but try to co-ordinate existing services and build on them. We should have a phone number that everyone can remember. Perhaps we could also put some resources into making the phone numbers of the Samaritans and other organisations better known, which would not cost all that much.

From what Kenny Gibson said about costings, I took it that the people in America are volunteers, not paid staff, although obviously some paid staff help to run the helpline. Training is important in the American system, as Kenny Gibson said, and I know that organisations such as the Samaritans have good training. Really well-trained volunteers can play a huge part, with the support of paid people.

The issue is important. The fact that so many people commit suicide—especially so many young people—is a blot on our country. I have known, or have known of, bright young students whom one would have thought had their whole lives before them but who committed suicide. There is obviously some defect in our society that we have to address. Why do so many people in Scotland commit suicide? It is not due only to Calvinism, drink or the usual things that we blame. We have to deal with that.

Kenny Gibson has raised an important issue. I strongly support a co-ordinated attack—if that is the right phrase—on suicide. In that way, we could make life in Scotland a lot better.

I would not pretend to have much knowledge of this subject but I have just reviewed in my head the few instances of suicide that I have come across in my lifetime. I remember meeting, at the age of six, older boys—probably about 10 years older than me—who were obviously grief stricken because one of their friends, whose younger relatives I knew, had died the previous night. It was not until about 10 years later that I found out that that boy had hanged himself. To this day, I do not know whether his family knew why the boy did it. I assume that it remained totally unexplained.

The next example that I have was when I was a young teacher. A mother of two children, one of whom was in primary school and the other in secondary school, was pregnant when her husband was killed in a car crash. After the baby was born, she hanged herself. That is explicable as a combination of grief and post-natal depression.

Once, I opened a note that told me that the person who wrote it was going to kill themselves. Although I was not that person's parent, I felt a huge sense of failure, responsibility and misery. As it turned out, however, it was more of a cry for help than a reality. Although a suicide attempt was made, at least the person was able to explain how they felt and get some kind of support.

In the past two or three months, a former colleague phoned me to tell me that the son of another former colleague had, totally inexplicably, killed himself. He was a bright, go-ahead young student. On the phone with that parent, I shared a good deal of misery.

The reasons why people commit suicide are difficult to understand. I have never felt that bad about anything, although I have had ups and downs. Grief, bewilderment, a broken heart, self doubt, guilt, hopelessness, seemingly insurmountable challenges or self expectations that have not been met—all of those can impinge on people and make them think of suicide.

An important point about the system that Kenny Gibson is proposing is that, however it is organised, the telephone number should have the immediacy of 999 and there should be somebody at the other end who can talk to the person and take information. Such a system could save lives.

The less happy outcome is that, despite the conversation and the counselling that might take place, the person might decide to kill himself or herself anyway. However, given that all the things that I suggested might cause people to think of suicide are the feelings that are felt by the bereaved families after the person has committed suicide, the system could be helpful in another way. Although it would not make up for the loss of the person's life, if the reasons for that person killing themselves were known and could be passed on to the bewildered and grief-stricken relatives of the deceased, the system would be valuable in that regard as well. The system would be helpful to those who are thinking of suicide and to those who have to live with the consequences of suicide.

I congratulate Kenny Gibson on securing this debate on a topic of great significance to me and to members across the chamber—this is not a party-political issue, but one that should attract united sympathy and support.

Members might not be aware of what prompted my interest in the incidence of suicide. My concerns were raised when I visited a charity in Glasgow that provides counselling and support services, not only to those contemplating suicide, but to the family members left behind when a suicide is successful.

I felt privileged to be invited to attend a meeting of a support group for mothers whose children had committed suicide. I heard from them about the lack of support that was available to them. I listened with horror as those women told me of their sons' or daughters' internal turmoil that led to their attempts to take their own lives, about their efforts to seek help for their children, about the pitiful lack of psychiatric support and about how they were coping.

They told me about the isolation that they felt, about people crossing the road to avoid them and of the whispered comments about their abilities as parents from people who did not understand their situation. The visit was one of the most emotionally draining that I have ever undertaken as an MSP. As Kenny Gibson pointed out, it is timeous that we debate the motion on the day that we pass the Mental Health (Care and Treatment) (Scotland) Bill.

Other members have also taken a keen interest in suicide prevention. I recall the sympathy for the cause that Richard Simpson expressed when we spoke to members of the Scottish youth parliament on 24 August last year. There can be no doubt that we must put in place services for our young people. We all lose as a result of the loss of life and the hopes dashed. Who knows what those young people could have achieved or what contribution they could have made if events in their lives had taken a different turn.

When I hear evidence on this subject, I am genuinely fearful for those who, despite exhibiting a calm and balanced demeanour when appearing at counselling sessions or using telephone helplines, can be tipped over the edge by the thoughtless comments of others who are unaware of their internal turmoil—months of work are then not enough.

Kenny Gibson asked the Parliament to note the loss of life. He also asked the Executive to set up a suicide prevention crisis hotline. I wholly support that objective. We need a number that is easy to remember and a hotline that gives ease of access and, crucially, direct access to support.

It is so easy for someone to take their own life. I have heard many versions of how people do so, from counsellors and from those who have been left behind. Members will have to believe me when I say that they do not want to hear the details.

I too want to pay tribute to the Daily Record "save our kids" campaign. I was aware of the original destination for the funds that were raised and appreciate the paper's continued support. Like Donald Gorrie and Colin Campbell, I have known people who have succeeded. When suicide touches our lives, we never forget it. I am wholly supportive of all efforts to address the plight of those who contemplate suicide. I commend the motion and I commend Kenny Gibson for bringing the issue to the attention of the Parliament.

I did not intend to speak in the debate. I came along to listen, but I thought it important that Kenny Gibson realises that he has cross-party support for his motion and for what he is trying to do.

I recall that, about four years ago, Kenny Gibson came along to support me in a members' business debate on under-age tobacco sales. We have made progress on that, as the Lord Advocate is undertaking pilot work to prosecute those who sell tobacco to those who are under-age. I hope that action is taken as a result of tonight's debate. As we approach the end of the first session, it is important to acknowledge that members' business debates have played an important role and made a contribution to the Parliament.

Kenny Gibson highlighted the problem of suicide prevention and active intervention. I am sure that all members would agree on that. Suicide affects all age groups and all social strata and I want to highlight the need to educate people about the warning signs.

I have previously raised the case of a constituent, but I will raise it again, as it is important. My constituent went to an accident and emergency ward and told a consultant that he was having suicidal thoughts and that he had made four previous suicide attempts. I was horrified to discover that the consultant had sent him home, telling him that he should pull his socks up.

That happened in a hospital that has access to counselling and psychological services. It demonstrated to me that, if someone has a broken leg or a serious illness or if they come in to accident and emergency with cardiac arrest, we will deal with them. However, if someone has a serious "mental health" problem, they remain invisible. I want to highlight the point that there is still a need to educate not only social service professionals, but health service professionals. I hope that tonight's debate will help to highlight both that issue and the problems faced by people who suffer from mental illness.

I commend Kenny Gibson for securing the debate and am happy to support him.

I also commend Kenny Gibson for securing the debate and congratulate him on all the work that he has carried out on this subject, before and since his election to the Parliament. He secured a member's business debate on the subject at the start of the Parliament and has doggedly kept at it. I welcome the idea of an emergency suicide hotline.

At the time, I welcomed the Executive's national strategy and action plan on suicide. I still do, and I hope that the minister will consider expanding it to incorporate some of these proposals and accept the national hotline as an idea that should be developed.

The two-day debate on the Mental Health (Care and Treatment) Bill, which was very welcome, highlighted the lack of psychiatric services. I think that the story that Irene Oldfather has just told is probably all too common. This morning, I phoned a partner nurse to ask about her experiences in this respect. I was horrified to learn that there is a real problem with 15-year-olds. Some hospitals will consider providing child psychiatric services to children who are 14 and under, but will provide adult psychiatric services only to those who are 16 or over. As a result, there is a lost year in which someone who might be crying out for help cannot access it.

The nurse also told me about the case of a teenager who, when she tried to access urgent psychiatric services, was asked, "Is it really urgent or can it wait a couple of weeks?" If someone is suicidal, the matter is urgent; it cannot wait.

We obviously have a statutory obligation to help people in such a situation. As Donald Gorrie pointed out, however, we must also recognise the contribution of the voluntary sector in that respect. Some marvellous things are happening in that sector to help people with their problems. For example, Kenny Gibson mentioned Stresswatch Scotland in Kilmarnock. I am a patron of that organisation and have been impressed by how their networks go out into local communities. Its support work is very much carried out at ground level by volunteers.

Another approach that I want to mention is a bit more innovative. Theatre NEMO—which was set up by Isabel McCue, and developed by her, her son Hugh and Tricia Mullen of the National Schizophrenia Fellowship Scotland—is a theatre group that is dedicated to helping people who have been affected by mental health problems. It is all about participation in the arts as a means of stimulation, self-help and building self-esteem. About 40 people and, importantly, their carers attend meetings of the organisation, and the amazing thing is that the shyest of people—those who really do not want to participate in life—participate fully in drama and the arts and become very descriptive when they are on stage. It is a wonderful way of building people's esteem.

South Lanarkshire Health Board has recognised the value of such an approach and has asked Theatre NEMO to put on two short plays at a forthcoming health board seminar. Perhaps when we come back to the next Parliament, we should think about how the performing arts can directly benefit communities. Certainly we should encourage such an approach. I should add that the company has recently received an equipment grant from the communities fund, which is good news. Another important point that Isabel McCue made is that, because Theatre NEMO is not seen as a mental health project, it does not have the kind of stigma that would stop many people attending.

Kenny Gibson's motion is worthy of support. Indeed, I ask the minister to support it. We took a big step forward today with the passing of the Mental Health (Care and Treatment) Bill. We would, however, like the Executive's action plan to be expanded to include the suicide hotline proposal and to enable us to consider other innovative ways in which we can help people who really feel that their lives are not worth living.

I congratulate Kenny Gibson on securing the debate, but I have reservations and concerns about his proposal.

I am very glad that the Parliament has debated the Mental Health (Care and Treatment) (Scotland) Bill for the past two days. In the full range of health care, mental health care is, in a sense, the poor relation. We would all be rather startled if a bill called the physical health bill were introduced in the Parliament. We would expect debates on specific issues such as cancer treatment, coronary heart disease and diabetes. The fact that we use the generic term "mental health" shows how little attention we pay to an extremely important area. That lies at the heart of my concern. Just as there are many types of mental illness, such as dementia and schizophrenia, which Linda Fabiani mentioned, so there are many causes of suicide.

My concern is that with a suicide prevention hotline there should be at the end of the phone people who are trained in specific areas. The primary reason for my concern relates to drug misuse, which is an area of great interest to me. Drug misuse and alcohol misuse, or any addictive condition, is a compulsive-obsessive disorder. That is as far as I will go with a definition, because I am neither a psychiatrist nor a doctor.

One does not know whether depression, for example, leads to drug misuse or drug misuse leads to depression; there is probably a mixture of both. The abuse of alcohol and hard drugs is seen as a kind of anaesthetic to cope with depression, which is perhaps brought on by an overload of problems with which an individual cannot cope. The 12-step fellowships adhere to the definition of alcohol or drug misuse as being a disease. It is certainly a mental illness and psychiatrists and specialists in the area talk about dual diagnosis; very often the addict has other severe problems, most usually mental health problems and also physical ones.

There is the problem of crashing or withdrawal after drug misuse. Depending on the type of class A drug used, very severe depression can result. Members might have seen the reports this week relating to the consequences of the use of MDMA, known as ecstasy, and the severe depression that the use of even one ecstasy pill can bring on. I never quite trust media reports, but I look forward to reading the scientific research on which the reports are based, as far as I am capable. As we know, something like half a million ecstasy pills are consumed for recreational purposes every weekend.

My particular concern is that we do not know the long-term or sometimes even the medium-term consequences of drug misuse, many of which may result in mental health problems. If somebody has been using drugs and is then in a highly depressed or crashing state, they need to speak to somebody who is an expert in that field.

Will the member give way?

I will give way in a second, although I do not think that I am allowed, because I am in my last minute or very close to the end.

We also have to consider addicts who reach so-called rock bottom before they get into recovery, as at that point the drugs do not work any more and they are frequently very depressed and need help.

I apologise to Mr Raffan for perhaps not clarifying the situation a wee bit earlier. The proposed hotline is about linking existing organisations. I mentioned a lethality assessment, whereby the person at the end of the phone is trained to assess, as far as is humanly possible, the situation a person is in and refers them to an appropriate organisation, such as the Samaritans. The person at the end of the phone might have to deal with someone who has taken a drugs overdose. In America, centres that are linked in have to have 200,000 hours of training. We are not talking about volunteers who have a few hours of training; we are talking about specialists who know what they are about and who know that they could provide the last chance to save someone's life.

You have up to six minutes, Mr Raffan.

I do not think that someone who had taken a drugs overdose would be on the line; they would be admitted to accident and emergency and it would be a question of dealing with the physical symptoms first, rather than the mental ones. What Kenny Gibson just said highlights the point that Donald Gorrie and Linda Fabiani made about having access to a range of organisations with specific expertise.

In fact, there is one just round the corner—Crew 2000 is very active in the club and rave scene in Edinburgh and it is expert in the physical as well as mental consequences of using MDMA and other recreational drugs.

The only other issue that I would raise in response to Mr Gibson is the cost of this initiative. There is some controversy about NHS 24, not least among specialist general practice nurses who feel that the £37 million would have been better invested in the practices so they could do this job. If the training is going to be as long as Mr Gibson requires, the cost of this hotline will be very high.

Like everyone else, I thank Kenneth Gibson for his doggedness. He has pursued this issue for years. As Irene Oldfather said, there may be opportunities to advance much of what has been said this evening, so I do not want to close the door on Kenneth's suggestion. Members have highlighted areas for further discussion, such as access, information and cost.

I would like to clarify what actions the Executive has taken in the past couple of years, particularly since debates have taken place in the Parliament, and perhaps to touch on points that members have raised. I welcome what Keith Raffan said. There is some correlation between drug and alcohol misuse and young people's suicides, but that is not the only story. It is an important element and it must be addressed, but there are many and varied other factors that impact on the significant increase in teen suicide.

Does the minister agree that one contributory factor is the extent of bullying in schools? I have been horrified at what I have heard when I have met the parents of children who have taken their own lives. We do not do enough to support children when they are being bullied at school.

In a previous capacity, I had to intervene to prevent a youngster's self-esteem being minimised because of bullying; that child was suicidal. I have also taught youngsters who have lost their lives through bullying or a lack of self-esteem or self-value in their own homes or communities.

Newspapers play a role. Members appreciate the work that has gone into the "save our kids" campaign in the Daily Record. Recently, there was controversy about one of the organisations that access funds from the Executive were intended to assist. Those funds are now going to Penumbra, a mental health charity, which will also receive project funding from the national programme on mental well-being. In that way, we can support that work.

Kenny Gibson has mentioned the dramatic difference between the statistics for Scotland and for the rest of the UK. We must address that difference. We could probably spend many sociological nights analysing the factors that affect it, which range from addiction levels to the way in which we in Scotland consume or mix alcohol and drugs.

Some of our youngsters have an unfortunate sense of nihilism. As Donald Gorrie said, there are many folk who are very talented and who one would think have opportunity and creativity in their lives, but the down side of that is the depression that can result in suicide. I know about icons for young people. Ian Curtis of Joy Division and Kurt Cobain of Nirvana are examples of individuals whose other health problems impacted on their sense of self-esteem and resulted in the tragic loss of their lives at a young age.

There are many issues that we must try to address. I want to comment on some of the specific matters that members have mentioned. I am concerned about Linda Fabiani's question about whether a 15-year-old is getting appropriate access because they might fall between psychiatric support services for children and those for adults. I will certainly take up that issue for Linda if she will write to me about it.

Some strategies are being adopted. In Glasgow, there is a nurse-led service at the Victoria hospital, which serves the south side of the city. It provides an opportunity to address the issues of adolescents who are harming themselves and at risk of suicide. That service can be developed as innovative practice is rolled out to GPs across Scotland.

Kenny Gibson mentioned the choose life programme. It represents a substantial investment of more than £12 million over the next three years and we would like to see it continue. We intend to extend the first three years—from 2001 to 2004—of breathing space funding beyond 2004 under a national programme to try to ensure that we address lessons that we learn from the project's development in Strathclyde and Glasgow. On accessibility, the statistics are not dissimilar to those relating to equivalent helplines. We believe that there is strength in that respect.

We launched the choose life strategy in December 2002. Like many members, we recognised that existing organisations engage in many of the activities in question. There is no doubt that the quality of training and the level of expertise across the range need to be improved. Individuals have many skills that the Samaritans have identified ways to deal with. We are in discussions with the Samaritans in the United Kingdom to address how they can deal with the exceptional circumstances in Scotland, consider the statistics and be more than just the conventional listening organisation that people have perceived them to be in the past. Perhaps the Samaritans can consider ways of being more proactive in addressing concerns that members have raised.

We have an opportunity to learn lessons from the programme, which we certainly want to move forward. There are conventional 999 emergency services helplines. Two or three members rightly said that much more effective knowledge and experience is needed, even if only to allow people to refer people onwards and ensure that they get to the most appropriate places.

One important issue that has not been dealt with in the debate but which we need to reflect on more carefully is that people might like a local service and an understanding of the communities from which they phone. I would be happy to address that issue with the health team and other colleagues. The downside of such a service is that people might know the person who is seeking support. A balanced choice must be made. Perhaps there might be a plurality of choices and people can make distinctions.

Obviously, the review of mental health services that is taking place in many health boards in Scotland provides an opportunity to improve the quality of services that people receive—and particularly the services that young people receive. The attitude and behaviour of some adolescents results in their being seen as challenging or threatening. We need to have greater understanding.

Equally, we need to recognise ways in which there can be a resource base that can meet needs. Keith Raffan touched on an issue that bears further explanation. Kenny Gibson sought a commitment from the Executive in respect of resources and staff. I do not want to exclude discussing that matter and would be happy to discuss it in the future.

I want to conclude with some key points. Part of the Mental Health (Care and Treatment) (Scotland) Bill tried to de-stigmatise mental ill health. National campaigns are committed to recognising that each of us might face mental illness. Undoubtedly, we all have personal and professional experience of individuals who have had to deal with ill health and mental ill health. We need to try to find a better way of addressing such matters.

Many other aspects of Scottish life contribute to many statistics that Kenny Gibson mentioned. We are in the final week and a half of the first session of the Parliament. Beyond May, the future of each member may be challenging. Perhaps we may seek services as a result of the stress of the election campaigns. The central issue is that some small areas in which we have made a contribution can genuinely make a difference for the people of Scotland in the long term. I am happy to engage in dialogue with Kenny Gibson and any other members who seek to deal with the matter now or beyond May, if I am returned to the Parliament.

That concludes the debate on telephone hotlines.

There is a note from the security staff, who recommend that members leave by the lifts and through the public entrance at Mylne's Court, as there is a large demonstration on the pavement outside. Members have the choice.

Meeting closed at 17:44.