Antonella Sammut - the lead author of the National Suicide Prevention Strategy (2025-2030) and a consultant in public mental health - wants people to be more open about discussing their mental health struggles. Speaking to this newsroom, she quashed the myth that opening up about one's suicidal thoughts may push a struggling person to attempting suicide.

The national strategy's lead author declared that one "can never be too open" and advocated for society to normalise mental health discussions from a young age, including in schools and within families.

"Opening up is already a step towards one's recovery," Dr Sammut said.

Sammut said she is pleased that discussing mental health with professionals is not considered a stigma among younger people, which may be the case with older generations.

"It's pleasant to hear that youngsters have been to therapy and talk about this - it's not a stigma anymore," she said.

She said that the more one nips the issue in bud the better, as early detection and intervention for mental health conditions can significantly improve an individual's prognosis and long-term outcomes.

Sammut said that a person with suicidal thoughts may alleviate some of the burden off their shoulders by simply speaking to someone they trust; however, she said that it is vital for such people to seek professional help.

Statistics highlight that males are significantly more at risk of suicide than females; local figures show that there are around nine male suicides for every female suicide, with similar trends being observed globally. In 2024, 28 people died by suicide in the Maltese islands - 25 of which were male and three were female. In 2023, this ratio stood at 8:1 locally as 24 of the 27 who died by suicide were male.

When asked why so many more males die by suicide than their female counterparts, Sammut listed various factors. Firstly, she said that it is likely that males find it more difficult to seek help in comparison to women and girls. Sammut said that this may be attributed to the cultural perception that men who cry or seek advice are weak and noted that this "doesn't help those with mental health struggles". She also observed that males may opt to take their own lives through more violent means, potentially because they may be more intent on completing the act.

Sammut noted that as the fabric of society has evolved over the years; many people are feeling increasingly isolated and are experiencing heightened loneliness. She said that this is very concerning when one considers that lonely people are at a higher risk of taking their own lives.

In Malta, some of the main sociodemographic risk factors for suicide (as confirmed by local studies) are if a person is male, aged between 30-60 years old, is either single or separated, and is either unemployed or a pensioner.

Determinants of suicide can be categorised into three distinct groupings: the social and cultural, the biological and psychological, and the environmental. The most common social and cultural determinants are lacking social support, feeling isolated and stigma. The most prominent environmental determinants are unemployment/financial loss, relational or social loss, and having a low education level.

Biological and psychological determinants are the broadest of the three categories and include engaging in self-harm, surviving a previous suicide attempt, having chronic pain or a major physical illness, having a history of mental health disorders, alcohol/substance abuse, having a family history of mental disorders and suicide attempt(s) and/or having a relative who died by suicide.

While discussing these determinants, Sammut recounted that professionals such as herself are concerned with the increase in self-harm among adolescents.

"We have a lot of adolescents who self-harm, it's becoming more common," she said.

The relationship between the use of substances and mental health disorders is complex, and hence, Sammut told this newsroom that the higher risk of suicide among people who use drugs calls for more research in this area to tailor policies and practices to address this risk.

Sammut said that a person's mental health and many common mental disorders are shaped by various social, economic and physical environments operating at different stages of life. Hence, people from difficult backgrounds are more at risk of having mental health issues. Moreover, persons with severe mental health disorders may not attain high level education, nor be able to work or hold a decent-paid job. Therefore, such people may live under suboptimal conditions as all of these factors could make them feel stuck and helpless in their situations, further negatively impacting their mental health.

The National Suicide Prevention Strategy

The central goal of the National Suicide Prevention Strategy (2025-2030) is to minimise the number of suicides around the Maltese islands, even though Malta's suicide rate is among the lowest in the European Union. Sammut wants people to understand that suicides are a public health problem and every death by suicide is a tragedy to the family, friends and their community; the positive thing is that suicide is preventable, she added.

In 2020, Eurostat published EU-wide statistics (based on data collected in 2017) on member states' respective suicide rates. Malta was tied with Greece with the second-lowest rate at five suicides per 100,000 people. In 2020, 0.9% of all deaths in the EU were attributed to suicide; this equates to the loss of life of 47,252 people by suicide that year across the continent. Suicide rates in Malta and across the EU have been thankfully decreasing over the past 12 years; the EU rate is on a steeper decline than Malta's, however, this could be attributed to our country's low figures.

Worldwide, suicide claims the lives of approximately 700,000 people annually (according to the WHO in 2021). The World Health Organization has also published, in recent years, that for every death caused by suicide, there are 20 suicide attempts.

The National Suicide Prevention Strategy was launched in March of this year and is being steered by the Ministry for Health and Active Ageing, though it requires the involvement of all stakeholders to be successful, she said. Assisting Sammut in its drafting were public health trainee Dr Karen Borg and mental health nurse Francesca Sammut.

"This strategy will only be successful if we have a whole of government approach and a whole of society approach, because suicide prevention needs collaboration between ministries, entities and services; we all need to work together," Sammut said.

This strategy, which was a deliverable of an EU Commission Joint Action on mental health, titled ImpleMENTAL, is based on scientific evidence and includes elements of the Austrian best-practice model - SUPRA.

The strategy is set to cost an estimated total of €2.08 million, over a five-year period. This is over and above the normal budget dedicated to Mental Health Services, whose estimated allocated budget for 2025 is of €71 million.

The National Suicide Prevention Strategy is underpinned by six main strategic areas: the coordination and implementation of suicide prevention activities, improving support and treatment to persons in crisis and training gatekeepers, restricting access to suicide means, improving societal mental health literacy through responsible media reporting and campaigns, endorsing mental health promotion and prevention activities, and ensuring quality assurance and expertise.

The overarching aims of the strategy are the provision of timely and accessible psychosocial care to persons at risk of suicide mainly through improving the emergency services, investing in the workforce, improving mental health literacy, and enhancing digital infrastructure to improve data collection to further inform the strategy.

At present, the strategy is for wider public consultation, until 16 May. Consultations with over 40 entities were carried out to inform this strategy. In particular, Sammut said that the authors of the strategy, and by extension the Health Ministry, is very grateful for experiences and narratives shared with them by persons who have been affected by or bereaved by suicide.

The strategy has a number of key performance indicators for each of the six strategic areas to help gauge its implementation process. These KPIs can be viewed within the available document which outlines the National Suicide Prevention Strategy itself.

Sammut stressed the importance of working with public and private family doctors as they are usually the first port of call for patients. She outlined that the collaboration with family doctors, strengthening their knowledge in the area of mental health, in combination with the recently acquired prescription rights for mental health medication on the government formulary all contribute to improve access to care and treatment for persons with mental health problems.

If you or anyone you know is feeling isolated and/or is having suicidal thoughts, please call the 24/7 helpline 1579 to speak to someone and be heard. Psychiatrists are also available around the clock at Mater Dei's A&D Department to support you - there truly is light at the end of the tunnel.