In 2018, more than three thousand people in Spain decided to end their lives, a figure that doubles the number of deaths from traffic accidents. In the latter case, the prevention campaigns carried out periodically have borne fruit, and road mortality is decreasing every year. The same does not happen with suicide, a taboo, delicate subject, one of those that you prefer not to talk about, or look the other way, and whose presence in the media and public debate is always dressed in a sensationalist touch that does not help nothing to prevent the problem.
September 10 is World Suicide Prevention Day, an event that aims to raise awareness among the world population of this problem and try to prevent it. In this framework, El Global , Gaceta Médica, Muy Interesante and Marie Claire, with the support of Janssen, have organized a thematic meeting to give voice to six experts in the field of mental health.
The data
Suicide affects about 800,000 people in the world each year, a figure that is equivalent to one attempt every 40 seconds . “A goal of the World Health Organization is to reduce suicide attempts worldwide by 10%,” explained Ana González-Pinto, president of the Spanish Society of Biological Psychiatry (SEPB).
In our country, it is considered that we have average suicide mortality rates (9%). “ We have improved social awareness, training and the responsibility of clinicians when it comes to protecting people at higher risk ,” emphasized Julio Bobes , resident of the Spanish Society of Psychiatry (SEP) . However, it is also necessary to pay attention to suicide attempts: “it is a more hidden, more sensitive data,” explains Itziar Ceballos, manager of the Biscayan Association of Family Members and People with Mental Illness (AVIFES), “there is even talk of 16,000 people who have tried to end their life ”.
Regarding the population groups with a higher risk of suicide, Ceballos indicated that “there are more men than women, the percentage is unequal. It is said that the population at risk is adolescents, but it seems to me that the case of the population over 60 years of age is also very relevant. “
González-Pinto recalled, in this sense, that we speak of “the second cause of death after cancer in adolescents, above traffic accidents,” even so, specifying that the gender difference is not significant since death from this type of accidents also affects men more than women. “There are people at high risk of suicide, sometimes with aggressive diagnosis, limiting diseases, with multiple pathologies” who are therefore more exposed, according to Bobes.
More attention needs to be paid to mental health
In our country, 40-50% of psychiatric emergencies correspond to suicide attempts. What makes a person want to kill themselves? The causes are multiple, and that is why the experts agree that we should not talk about suicide but about suicides, in the plural, because each case is unique and has its particular complexity. “When we talk about global figures, there is no idea of complexity, it removes rationality “, reflects Ceballos.
“Suicide is associated with despair and lack of hope, it is a symptom of depression, but it can also be associated with other diseases,” explained González-Pinto. “If we talk about risk factors, depression is present in almost 90% of cases.” Rafael Casquero, a member of the SEMERGEN Mental Health Group, insisted on this link: “depression is considered a very important factor, although there are other causes that are frequent, such as drug use or alcoholism.” The reverse process also occurs: “ a mental illness can trigger drug use. And, of course, there are other pathologies such as personality disorders, schizophrenia, or certain eating disorders.
Suicide, everyone’s problem
As we mentioned at the beginning, and due to the taboo that surrounds this problem, it could be thought that suicide is an issue that corresponds to the private sphere, but experts agree in stating the opposite: suicide is a public health problem, and should be treated as such.
The effects of a suicide (or a suicide attempt) are, in any case, devastating both for the immediate environment and for the wider environment: “a person you love has died, and that produces an impact: anguish appears, uncertainty and of course a feeling of guilt ”, says Ceballos. It affects a close circle of ten or twenty family members, but it also reaches friends and the work environment. ” The impact is not only produced in the nuclear environment, it affects a lot of people who at some point think ‘why?’ ” Hence the importance of management and assimilation, since the short, medium or long-term consequences of a suicide can be devastating. “If we are not able to provide support and be aware of what is happening, problems will appear”, reflects the expert, and more so if it is a family member as close as a father or mother. Accompanying those close to you in this grieving process in a specific way is also essential.
Prevention is the key
Carlos Mur, managing director of the Fuenlabrada University Hospital, specified that, as with any other primary care problem, “it is necessary to detect risk factors and take into account the prevention of recidivism.” For Casquero, “in primary care, the key is communication with the person. It should be reinforced at the social level by establishing new social ties that have been disintegrating ”. The objective? Strengthen communication between doctor and patient. And it is that, although it is not something habitual in the consultations of the health centers. The expert recalls that “all doctors should ask or know how their patients are in the mood”.
And not only in the health field: suicide prevention should be cross-cutting. “Prevention cannot be complete if there is no capacity to work from the sector,” says Ceballos. “It is an interesting opportunity to get into the educational topic, and take advantage of it to address the mental health issue. We know that teenagers are watching suicide episodes in series, we have to work on these issues in the classrooms. It is important that specific policies are promoted and involve more social agents ”.
A new approach
Suicide is a global problem that must be made visible in society. In this sense, Jesús Celada, general director of Disability Support Policies, specified that many cases of suicides, as they come from people with mental health problems, find little understanding in society: “ mental disability itself is a phenomenon that is not adequately reported. In the 60-70s, people with disabilities were hidden at home ”, recalls the expert. The progress since then has been important but, even so, a greater effort is necessary: “disability and suicide, for communication purposes must go hand in hand, also bearing in mind that frustrated suicide attempts end, in some cases, in disability.” The idea is that “telling the experience of the person who has lived it makes this reality more visible”, Celada emphasizes.
Social networks should also be our allies when it comes to preventing suicide: “We have to ally ourselves and use the networks as one more tool,” says Ceballos. “Victims tend, in fact, to go to them and many times it is a valuable tool that, well managed, can help prevention and detection.”
Social networks can also be a double-edged sword. Casquero stressed that “the internet and networks are very powerful, sometimes for the worse.” “It is not by chance that there are more suicides in the youth population,” confirmed Jesús Celada. Being digital natives, their access is easier. “Prevention and social inclusion are key to preventing suicide .” We are therefore faced with a double-edged sword, as young people can suffer from a certain frustration linked to little recognition or even harassment.
Conclusion: end the stigma
In short, to address the problem of suicide from a more humane and comprehensive perspective, education and early care are necessary, as well as communicating and making the issue visible from another perspective that does not fall into yellowishness.
For Ceballos, “we cannot help thinking that people with mental health problems have a stigma. On the other hand, death is not an issue that is openly discussed “
“The existence of very powerful awareness campaigns on social networks that have managed to reduce traffic accidents, by when a global awareness about the problem of suicide?” reflects Mur.
“Every person in the world seeks to be accepted by the environment,” says Casquero. “In our case, in health care, we should look for the tools so that anyone can have more possibilities to express themselves and communicate,” he concludes.
