Suicide prevention remains a universal challenge. Every year, suicide is among the top 3 leading causes of death globally for people of all ages. It is responsible for over 800,000 deaths, (1 every 40 seconds). Every life lost represents someone’s partner, child, parent, friend or colleague. For each suicide approximately 135 people suffer intense grief. This amounts to 108 million people per year who are profoundly impacted by suicidal behaviour. Suicidal behaviour includes suicide, and also encompasses suicidal ideation and attempts. For every suicide, 25 people make a suicide attempt and many more have serious thoughts of suicide.
Malta and Gozo are unfortunately no exception as between two and four men, women and youths kill themselves every month. Research conducted by Crisis Resolution Malta (CRM), the island’s pioneering specialist 24/7 crisis team reports that over 1,000 people report suicidal thinking, 1,200 people self-harm and close to 7,500 loved ones are affected by such acts annually.
The loved ones in particular are more prone to mental illness (60%), dropping out of education (80%), employment (65%), social marginalisation (90%) and suicide (40%). Despite the unavoidable covid-19 first wave, CRM spearheaded a crisis support campaign as early as November 2019 - weeks after the virus surfaced in Wuhan - by offering its free 24/7 crisis line to prevent suicide and self-harm behaviour nationally.
The calls came in at a rate of 1 every 10 minutes. Despite the increase in crisis calls managed by our 10 year veteran crisis professionals, we are humbled by the fact that, like Taiwan, our suicide rate (about 7 per 100, 000 population) was controlled and even dipped slightly during the past months. We are now resolutely prepared for the next wave, whilst being very aware that our medical, law enforcement and ancillary services personnel are being to tire. We are also revving up to help the fearful and vulnerable in our society who are bracing themselves for a supposed third wave. They all need our help and it starts with a smile, a listening ear and a message of hope.
Suicide is the result of a convergence of genetic, psychological, social and cultural and other risk factors, sometimes combined with experiences of trauma and loss. People who take their own lives represent a heterogeneous group, with unique, complex and multifaceted causal influences preceding their final act. Such heterogeneity presents challenges for suicide prevention experts. These challenges can be overcome by adopting a multilevel and cohesive approach to suicide prevention. Preventing suicide is often possible and everyone is a key crisis member to prevent this potentially preventable tragedy.
You can make a difference - as a member of society, as a child, as a parent, as a friend, as a colleague or as a neighbour. There are many things that you can do daily, and also today, on World Suicide Prevention Day (WSPD), to prevent suicidal behaviour. You can raise awareness about the issue, educate yourself and others about the causes of suicide and warning signs for suicide, show compassion and care for those who are in distress in your community, question the stigma associated with suicide, suicidal behaviour and mental health problems and share your own experiences.
It takes work to prevent suicide. The positive benefits of this work are infinite and sustainable and can have a massive impact. The work can affect not only those in distress but also their loved ones, those working in the area and also society as a whole. We must endeavour to develop evidence based suicide prevention activities that reach those who are struggling in every part of the world. Joining together is critical to preventing suicide. Preventing suicide requires the efforts of many. It takes family, friends, co-workers, community members, educators, religious leaders, healthcare professionals, political officials and governments. Suicide prevention requires integrative strategies that encompass work at the individual, systems and community level. Malta has a draft suicide prevention strategy which fits in snugly into the well created mental health strategy.
Research suggests that suicide prevention efforts will be much more effective if they span multiple levels and incorporate multiple interventions. This requires the involvement of interventions that occur in communities and involve social and policy reforms, as well as interventions that are delivered directly to individuals. To reach our common goal in preventing suicidal behaviour we as the public, we as organisations, we as legislators and we as members of society must work collaboratively, in a coordinated fashion, using a multidisciplinary approach. Everyone can make a contribution in preventing suicide.
Suicidal behaviour is universal, knows no boundaries so it affects everyone. The millions of people affected each year by suicidal behaviour have exclusive insight and unique voices. Their experiences are invaluable for informing suicide prevention measures and influencing the provision of supports for suicidal people and those around them. The involvement of people with lived experience of suicide in research, evaluation and intervention are central for crisis teams to help save lives with ancillary stakeholders.
A simplified national crisis line, a walk-in crisis centre, a crisis app, campaigning to have a Suicide Prevention Act and a suicide prevention course are all potential projects to be managed by a forthcoming local suicide prevention foundation. Besides, media reports of people who successfully overcame suicide, support for those who lost loved ones and minimising access to lethal methods (e.g. locking roof doors, restricted access to poisons and weapons) are other foundation objectives.
This year’s WSPD theme is in fact, “Working Together to Prevent Suicide.” It highlights the most essential ingredient for effective global suicide prevention- collaboration. We all have a role to play and together we can collectively address the challenges presented by suicidal behaviour in society today. Be a member of the crisis team. You cannot care about your loved ones if you don’t care about suicide. If you are in crisis, call the free 24/7 crisis line +356 99339966.
Dr Mark Xuereb is a Crisis Psychiatrist