The Maltese Association of Psychiatry (MAP) said that there is a possibility that this past year’s circumstances could lead to a higher number of suicide, especially if the expectations of society in keeping up appearances pressures people to feel more isolated and at risk of suicide.

In a statement published during the festive season, the MAP said that, “this year has not been easy for anyone. We have heard endless news reports, webinars and articles on mental health and the importance of self-care. After 9 months of having to adjust our lifestyles, we have reached what most of us are always looking forward to every year – Christmas and family time.”

“And yet, it is bittersweet remembering that this year will not be the same. It comes as no surprise that this year we have seen a surge of people seeking mental health services for a variety of reasons. There have been increased reports of anxiety, depression, alcohol and substance misuse, domestic violence and suicidal ideation,” it added.

Studies in Malta confirm that there have been more suicide attempts in the first few months of adapting to Covid-19 locally than the previous year, necessitating hospitalization.

A common myth is that suicide peaks around the winter holidays. The MAP highlighted that on the contrary, international evidence demonstrates that it tends to represent a low point of suicide rates, possibly as a result of togetherness and more family time during the festive season.

There is a better chance at socialising with numerous events and activities happening around this time, giving a sense of belonging, it added.

The association also highlighted that local data published in May 2020 showed that, over the span of 15 years, the trend is for suicides in Malta to peak around March and August with another slight increase in December. One similarity between August and December is that both months are synonymous with summer and winter fesitivites and events, respectively.

Suicide is a complex phenomenon. It is not, put simply, a mental health diagnosis – it is a human condition. Over time, mental health services have increased and there is more awareness, and yet, death by suicide still happens. One cannot simplify it to assume that it is the end-point of severe depression and/or the inevitable reaction to an adverse life event.

It can happen unexpectedly, taking one by surprise and makes one wonder whether one missed the signs at any point. Survivors of suicide attempts indicate that they did not necessarily want to die, but rather that it was perceived as the only way to end unbearable emotional pain. It is well documented that even people who are determined to end their life still often wish for an alternative solution, giving professionals the opportunity to act on rebuilding their hope for recovery.

To understand suicide, one needs to understand the facts. Various risk factors have been identified as potentially increasing the risk. Various demographic factors show a higher incidence of suicidality, such as teenagers and/or middle-older age groups, being male, single/separated/ divorced/widowed, socially isolated in rural areas and unemployment.

An underlying mental health condition can also increase the risk, especially depression, bipolar affective disorder, psychotic disorders, certain personality disorders, substance misuse and also chronic, debilitating physical illnesses. Having a family history of suicidal acts, major adverse childhood events, domestic violence and an unstable family life are other predisposing factors worth mentioning. Moreover, thoughts of suicide can be brought about by triggering life events such as financial losses, relationship breakups, loss of employment, death of a family member and any other experience that is perceived as traumatic for the individual.

 

How can I help?

The association stated that one cannot fully predict if a person will die by suicide – no matter how much you know about them or how long you’ve known them. However, there are some things one can do.

 

Learn to recognize the warning signs

The first step is to learn to recognise the warning signs so as to try and reduce the risks as much as possible.

“Hearing someone joking, talking about, or threathening death and/or suicide might be perceived as being nonsense; however, pay attention to the subtle signs as there may be an element of truth in it. Asking the individual directly about suicidal thoughts will not trigger them to act out. It might feel uncomfortable and you might not know what to do, but actually talking about it will help the person speak up,” the association said.

Many survivors of suicide attempts admit that if anyone had shown interest or compassion right before their act, they might not have done it. Joking or not, all suicide threats should be taken seriously, the asssociation warned.

 

Pay attention to the content of conversations

MAP highlighted that talking about feeling hopeless, being a burden, having no purpose in life, feeling trapped or in unbearable pain should make us all alert.

Someone’s behaviour may become increasingly anxious, restless or reckless, or they may use more drugs and/or alcohol. They might be complaining of lack of sleep or even spending too much time in bed.

“If you notice a change in someone’s personality such as becoming more withdrawn, isolated and thoughtful, reach out and talk to the person.”

Another common myth regarding suicide is that they are all impulsive acts.

“We might not have seen it coming or even suspected it, but the individual might have been thinking about taking their own lives weeks or months before the act. They might have done their research on ways to kill him/herself by seeking access to lethal means – whether it is online or physically in the moment of despair.”

MAP highlighted that many of us feel at a loss when someone expresses suicidal thoughts.

 

Ask the right questions when you suspect someone expressing suicidal thoughts

“You may not be sure what to do to help, whether you should take it seriously or if your intervention might make the situation worse. If you suspect it, ask the right questions. Listen attentively, be sensitive but direct, such as “How are you coping with everything that is going on?”, “Do you feel like giving up?”, “Do you feel life is not worth living anymore?”, “Are you having thoughts of dying or wanting to hurt yourself?”, “Have you thought about suicide?”, “Have you thought about how and when to do it?”

The association recommended that if someone suspects a friend or a loved one is at risk to themselves, do not try to handle it on your own. Talk calmly with the person, support them and express that you are concerned for their safety. Tell them that he/she should reach out for help and involve a trusted family member and ask for professional help.

If the situation is urgent, one can call the emergency number 112 and the Accident and Emergency Department will have a mental health professional and medical help available 24/7. If further support and guidance is required, one can call the Richmond helpline 1770, Appoġġ helpline 179 or the online support service on www.kellimni.com.