Although suicide is a complex issue, breaking down the taboo is of utmost importance for a country to progress in preventing suicide.

Speaking to The Malta Independent, the President of the Maltese Association of Psychiatry (MAP) Nigel Camilleri said that, “we need to talk about suicide and mental health more often, and mental health has to be considered in all social care and welfare policies as it is crucial in a society that people are well educated on the matter.”

According to the World Health Organisation (WHO), close to 800,000 people die due to suicide yearly, and there are many more who attempt suicide.

Suicide is a global phenomenon that can happen to anyone in all regions of the world as no one is immune to mental health disorders and it can affect anyone regardless of race, ethnicity, religion, socio-economic background, age and gender.

The WHO registered that 79% of global suicides occurred in low- and middle-income countries in 2016, and it is the third leading cause of death in 15-19-year olds.

For World Suicide Prevention Day, marked on 10 September, the Commissioner for Mental Health John M Cachia said that two to three people in Malta die by suicide each month with around 90% of such deaths being males.

More than 75% of suicidal people tell someone what they are going to do and when they are going to do it. This is where suicide prevention starts, Cachia said.

Parents should talk to their children about it

Camilleri (above) explained that the same way parents talk with their adolescents when they are growing up about topics such as sex education, drugs and alcohol, children need to be well educated on mental health as it is of utmost importance to address the matter.

In addition, the same way that parents take their children to a paediatrician for a check-up, they should start taking their children or adolescents to child mental health worker for a check-up as this is just as important, Camilleri said.

Psychiatrist Rachel Taylor East (below) spoke to this newsroom about the main purpose of the association, explaining that MAP is committed to reducing suicide and improving support for those bereaved or affected by suicide.

“We aim to achieve the highest standards of care through education, training, advocacy and research. We promote best practice in mental health services. We collaborate with key players in the mental health field and are champions for improvements in the quality of mental healthcare throughout all sectors of society.”

She explained that public education and advocacy “is at the heart of our activities.”

“We strive to maximise our influence on mental health and related policies for Malta, and we will collaborate with relevant bodies to promote evidence-based suicide prevention initiatives,” she said.

Camilleri added that, “last year, as an association, we worked with the Ministry of Education in order to introduce mental health literacy within the curriculum.”

Mental health literacy involves talking about topics such as stress and learning how to deal with it.

“We often hear that stress is increasing and we get the impression that stress is all bad, however, it is important to acknowledge the fact that stress is not all negative as one type of stress can makes us stronger and more resilient, whilst another type of stress can mentally destroy us as it is simply toxic.”

 

Priorities in suicide prevention

As an association, MAP has a number of priorities in suicide prevention. These include advocating for adequate recruitment and retention of the mental health workforce, including training, promoting the highest standards of assessing and responding to patients at risk of suicide or engaging in self-harm, promoting excellence in care of patients at risk of suicide, promoting appropriate media coverage of mental disorder to reduce stigma and suicide contagion, to lobby government to commit to a National Suicide Prevention Strategy and contribute to public policy, and lastly, to lobby mental health services to develop postvention: supporting families, friends professionals and peers.

Another important aspect which might be beneficial in preventing suicide involves carefully listening to others. It is important to keep in mind that such a situation should never be belittled and considered as a cry for help as this is simply demeaning.

Suicide prevention starts with recognizing the warning signs and taking them seriously.

Certain signs might include talk of death and suicide more often, or experiencing behavioural changes. Also, completely closing of things in an abnormal way could be a sign of someone thinking of suicide. This might include writing a suicide note, closing off accounts or wanting to write a will when they are relatively young and healthy.

In addition, people who think of ending their life generally make sure that everyone around them is fine. Therefore, the process is thought beforehand.

Apart from people who die by suicide, others who try to take their own life are important to acknowledge.

There is a greater chance that people who attempt suicide will do it again than the average population, Camilleri said.

 

Most victims are male

Research shows that in the past year about 10% of males and 15% of females had suicidal thoughts. The majority of suicides are carried out by males as they tend to be more violent and tend to use more violent means, therefore reducing access to means such as guns, chemicals or knives is also important.

Another reason why more males take their own life might be because they express less emotions and tend to keep everything bottled up inside, whilst women externalise and self-harm more than men.

Camilleri strongly stated that asking for help does not make someone a coward, but it makes them courageous instead.

Many studies have shown that the COVID-19 pandemic has brought about many mixed emotions including fear, distress, sadness, loneliness and instability.

Asked whether the pandemic has given rise to suicidal thoughts amongst people, both Camilleri and Taylor East explained that although there hasn’t been any local research to date regarding this, it is a fact that Malta Mental Health Services have seen an increase in people accessing secondary care due to the pandemic.

The drastic change in our new way of life has led to exacerbation of existing mental illness such as anxiety and depression.

International health organisations are referring to a Mental Health pandemic being the second wave of COVID-19. Governments are being urged to invest more in mental health care in order to be prepared and have the ability of dealing with such a situation.

“In Malta, we are not immune. Without mental health there can be no true physical health. The less the country invests in mental health, the worse the outcomes, including suicide. Therefore, as an association we want to see mental health at the heart of the public health agenda, especially at this time, as a response to the COVID-19 pandemic. We need to see services funded and expanded,” they said.

If the situation is not urgent and you are worried about someone who is in distress and is suicidal, one can seek professional advice from someone who understands such as a social worker, psychologist, nurse and psychiatrist, amongst others.

 

Professionals are also available on the Richmond Foundation mental health helpline (1770) or 24/7 online at Kellimni.com