To Be or Not to Be? That Is Not Really a Question

Given the prevalence of intentional self-harm as one of the most common causes of death for young people, how can we contribute to suicide prevention?

To Be or Not to Be? That Is Not Really a Question
On the lane. Prague, 2019

The physical health of Europeans is improving, yet the same cannot be said for mental health. Whereas public health has been a priority, it is mostly focused on physical health and disease prevention, with mental health being secondary. Nonetheless, suicide accounts for 1.4 percent of deaths worldwide and is the second most prominent cause of death amongst young people. The act of suicide should not be considered an individual issue, but rather one that affects that person’s family, their surroundings and society in general.

Despite suicide rates decreasing globally over the past 20 years, Europe has the highest suicide rate (15.4 deaths per 100,000 inhabitants) in the world. In Lithuania, Latvia, and Belgium that same rate is 31.9, 21.2 and 20.7 respectively. Suicide attempts are even higher, with the World Health Organisation (WHO) estimating that for every successful suicide there may have been more than 20 attempts.

Given this data, the importance of establishing suicide prevention and addressing the underlying causes of suicide, particularly amongst the young population is evident. Still, for suicide to be successfully prevented and addressed, it should be first understood and interpreted as both a psychological and social phenomenon with deep societal implications.

We All Care

Member States are behind the development of national suicide prevention policies, considering that they lie within their competence. More specifically many National Ministries of Health, Education or Social Welfare have launched various initiatives towards that direction.

The Directorate-General for Health and Food Safety (DG-SANTE) is the European Commission’s department responsible for ensuring public health across Europe and harmonising national healthcare policies, including mental health.

The World Health Organisation (WHO) has been at the forefront of suicide prevention globally. In one of its reports, it draws attention to the preventable nature of suicide, urging States to develop national suicide prevention policies, in accordance with the Mental Health Action Plan adopted.

Many NGOs are active in the field of suicide prevention, aiming to support individuals expressing suicidal thoughts, survivors and their families by bringing them in contact with mental health professionals. Most commonly, they offer emergency helplines and short-term psychological support.

Face To Face

Despite suicide being closely related to mental health, that is far from saying that individuals who attempt to end their life suffer from a certain mental illness. Suicide may also be caused by severe emotional distress as a result of a traumatising experience or unfavourable factor within one’s environment. Suicide is also met in people who are facing financial problems, rejection, violence or substance abuse. When talking about youth, bullying has been one of the leading reasons for leading teenagers to end their life.

Keeping in mind the stigmatisation of mental illness and the taboo of suicide, many individuals are reluctant to seek professional help or share their distress in fear of labeled as mentally ill. People with depression or suicidal thoughts are often viewed with contempt and not given proper medical attention and emotional support. With suicide being viewed as a permanent way out of their suffering, seeking help may seem unnecessary or harmful, especially when individuals with the best intentions inadvertently worsen the situation by a judgmental attitude or by neglect. For people who are already expressing suicidal thoughts over a prolonged period of time, some prevention methods may be largely ineffective because care seekers feel like their treatment is not bringing any progress to their situation, making them skeptical regarding the potential of future care. Thus, suicide prevention should be focused both on emergency prevention, but also on retroactively preventing said individuals from acting out thoughts of self-harm and tackling the issue at its earliest stage.

Most importantly, suicidal people need a place where they can share their thoughts without judgment. Nonetheless, access to effective prevention mechanisms and appropriate healthcare is often restricted. National healthcare systems are severely unequipped to support individuals in the long term, leading to isolationist practices focused on psychotropic treatment, rather than prevention and rehabilitation. This is partially due to a lack of knowledge amongst mental health professionals on the topic of suicide. More often than not, the role of suicide care is delegated to various NGOs, helplines and individual psychologists that despite their undeniable effectiveness are unable to reach out to individuals affected on the scale needed.

Young people are especially affected by this trend as it is increasingly difficult for them to seek adequate help and share their distress with someone else. Victims of bullying, abuse, rejection or depression are often hesitant to openly discuss their cause of distress in the first place, let alone express their suicidal thoughts... Yet, with a substantial number of teenagers admitting to self-harm, a practice correlated with suicidal tendencies, it is obvious current structures, such as schools, are unable to provide adequate support.

Likewise, despite suicide and self-harm having been extensively studied by professionals, both from an epidemiological point of view and as a social phenomenon, individual cases of attempted suicide often go under-investigated by relevant authorities. They focus on treatment, rather than the motives and context that lead to such an act. This is particularly present in educational institutions, where staff lack adequate training to support young students and in some cases, even exacerbating the situation.

Help Is On The Way

The many EU Member States have adopted national suicide prevention programs. Finland was the first country to implement such a program, starting in 1986, with countries such as England, Ireland, and Sweden adopting similar initiatives. In particular, Sweden’s revolutionary policy aims to prevent suicide by lifting people out of a position of vulnerability, training health professionals and increasing awareness on the topic amongst the population. Additionally, The Netherlands has integrated its suicide prevention network into one organisation for crisis help, anonymous therapy, advice to close people, training for professionals, public awareness and research on effective prevention.

The European Commission launched the European Framework for Action on Mental Health and Wellbeing as a platform to support the Member States in implementing comprehensive mental health care by sharing evidence, research and best practices in mental health. In addition, the EU Compass for Action on Mental Health and Well-Being aims to research, collect and exchange information on mental health with relevant stakeholders and Non-Governmental Actions, focusing on issues such as suicide prevention and mental health in youth and education.

The European Mental Health Action Plan is one of the policy plans proposed by the WHO. It aims at helping States in developing national programs targeted at improving mental well-being, making mental healthcare more affordable, effective and accessible, while respecting citizens’ dignity and human rights.

This Is Not The End

Consequently, suicide is not a private matter but remains a major public health challenge for society to address. Suicide prevention programs are unable to resolve the issue by themselves as they fail to address the elemental causes of suicidal behaviour in a concrete manner. With mental health being mistakenly associated with mental illness, internalised stigma and inability to reach out to effective mechanisms, the way we view suicide prevention should be fundamentally redefined. This is particularly valid for young people who are unable to externalise their personal distress and are often led to depression and suicide due to external factors that could have been otherwise resolved.

And always remember that To Be Is The Answer!

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Mariam Pagava
See all posts by Mariam Pagava