I’m annoyed. Mike isn’t answering. He’s rostered to work. A&E want me for the umpteenth admission. I groan. Time passes. My frustration grows. If Mike doesn’t appear, I’ll have to sort his wards. Something is not right.

I call a common friend asking him to go to Mike’s. Then, just as I step into a ward, I get a call. “Come now… he’s…” I didn’t need to hear more.

I inform my colleagues. They go pale. I dash out. My 4WD hurtles up the M40 as I shout into my mobile, directing an ambulance with resuscitation kit to the residence. The ambulance arrives first. Trev, the nurse stands outside Mike’s bedroom with watery eyes. Relatives arrive.

The scene I witnessed is etched in my mind forever. It’s a scene nobody should experience. Mike is unfortunately one of many who suffered in silence and didn’t speak out. Yet, 13 go through this harrowing death daily in the UK, 30 in India, nine in Australia, 45 in Russia, 132 in the US and 158 in the EU.

Furthermore, for every suicide, 20 are trying. For every completed suicide or attempt, six loved ones spend a lifetime anguishing over why they didn’t realise and whether they could have prevented this tragedy. They are at increased risk of marginalisation and mental illness. Previous attempts make you 100 more times more likely to die by suicide. A loved one who died by suicide is also a risk factor for suicide. Malta is no exception, with two completed and 40 attempts monthly.

Suicide percolates through generations. Up until middle age, it is the commonest cause of non-accidental deaths surpassing heart disease, cancer, homicide and COVID. It is the public health issue which is generally given least importance. It is the point of no return where hope is lost. When people don’t open up, suicide is the ultimate, fatal irreversible outcome.

Hope is key and this is why WHO, in collaboration with the International Association For Suicide Prevention (IASP), twinned with crisis teams globally to ‘Create Hope Through Action’. The latter theme adapted locally to ‘Plant a seed of hope’ is what we owe people like Mike.

If mental health is stigmatised, then suicide is the mother of all stigmata (it is a crime in some countries). We preach ad nauseam that people are not numbers and that even one suicide is one too many. So, how can we choke this preventable tragedy?

Previous attempts make you 100 more times more likely to die by suicide

If hope is key, then the key to hope is to act by reincarnating the much needed National Suicide Prevention Strategy, a “powerful call to action and reminder that there is an alternative to suicide”.

Forever the vehement cri de coeur and brainchild of the team since 2015, the document has since been upgraded through the latest guidance on suicide prevention (Live Life, WHO, 2021). Upon the authorities’ exhortation, we submitted eight strategic, evidence-based modus operandi schemata for Malta and Gozo beyond World Suicide Prevention Month. These domains are underpinned by a culture of recovery, growth, and development. They focus on reducing the risk of suicide in high risk groups, tailoring crisis teams for vulnerable groups, reducing access to means of suicide, providing better information and support to those bereaved or affected by suicide, supporting the media by providing sensitive approaches to suicidal behaviour (thus decreasing the suicide rate), supporting good Maltese research and providing a monitoring system, providing self-harm cessation measures and aiming for zero suicides post hospital discharge – another risk factor for suicide.

The schemata provide the basis to conceive ideas in the Fondazzjoni Sokkors Fil- Pront’s pilot committee’s melting pot. Sokkors needs to sit in a bespoke Office for Suicide Prevention to pool mental health organisations’ contributions. These too deal with suicide indirectly and need to be team players. Yet, resources need to be bolstered: €65 million of the last budget were allocated towards mental health care. In contrast, €1.4 billion was set aside for the Australian Suicide Prevention Strategy alone.

In a world where self-harm is on the increase, the investment is well worth it as mental illness taxes the State’s economy with the largest number of days off work, hospital occupancy, social benefits and poor productivity, compared to physical illness.

Our strategy endeavours to show we care, as reflected in WHO’s May assembly, citing “Saving lives, driving health for all”. Integration of mental and physical health care; prioritisation of prevention while strengthening treatment and optimisation of intervention synergies across social-ecological levels were principal components ensconced in a Suicide Prevention Act (‘Gone too soon’, The Lancet Psychiatry, 2023).

The latter would legislate the need for crisis first-aiders in every organisation and ensure that the eight domains are developed and safeguarded. It would also encourage the collaboration with AI and Google Health as is already purportedly happening in the US to ensure that suicidal posts are traced and supplanted with hope- laden texts, replete with crisis line information and apps such as our very own successful Kriżi app.

We could gloat about the 800 lives the team physically saved in the past 13 years but that would not do justice to the need to tirelessly instil hope in those who, like Mike,  lost it.

Help us give hope. Help us enact the hope strategy.

If you or someone you know is in crisis or suicidal, call us 24/7 on +356 9933 9966 or download our Free Kriżi app. We can help.

Mark XuerebMark Xuereb

Mark Xuereb is a psychiatrist and leads the Crisis Team.

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