Today is World Suicide Prevention Day. While statistically the tendency of self-harm is increasing, there has been a decrease in suicides in Malta in the past three years. Jennifer Grech reports.

Every year, suicide is among the top-20 leading causes of death globally for people of all ages.

According to the World Health Organisation, approximately 800,000 people die by suicide each year worldwide, or one person every 40 seconds.

This makes suicide the second leading cause of death among 15- to 29-year-olds, and the 18th leading cause of death across all ages.

While reported suicide rates in Malta are lower than other European countries, they have significantly increased over the past decades, as opposed to the overall European and international decline between 2000 and 2012, according to Kelsey Renaud, psychology practitioner in the Health Ministry’s Mental Health Services.

Ms Renaud was speaking on the occasion of World Suicide Prevention Day. She had presented a dissertation to the Faculty for Social Wellbeing for her Master’s degree, entitled ‘Suicides in the Maltese Islands between 1995 and 2018’.

According to 2019 figures obtained from the Directorate for Health Information and Research, 0.7 per cent of all deaths among Maltese residents in 2017 were deaths by suicide.  The rate increased significantly in the 1990s and 2000s, and this trend warrants heightened attention, said Ms Renaud.

Certain considerations must be kept in mind when interpreting this rising trend, such as the use of different databases and less accurate reporting and classification in the past.

Also, magisterial ordering of autopsies may possibly have been less rigorous in earlier years.

Furthermore, while statistically the trend is still increasing, it may be observed that there has been a decrease in suicides in the past three years.

“However, one would need to examine the trend in the coming years in order to determine the statistical significance of this observation,” said Ms Renaud.

In her study, the total number of people who died by suicide was based on 635 individuals, 80 per cent male and 20 per cent female.

The average age was 46, with the minimum age being 14 and the maximum being 98.

The study provides a better understanding of suicide in the local context and its findings have implications for policy making.

“Firstly, more accurate and consistent classification and recording of suicide, according to intent, would be in order,” said Ms Renaud.

“Secondly, national data collection is recommended by setting up regular surveillance and a suicide database. This is essential to implement a national strategy or action plan for suicide prevention.”

More accurate and consistent reporting of suicide would be in order

This recommendation is in line with the Mental Health Strategy for Malta 2020-2030 (Ministry for Health, 2018) and the European Mental Health Action Plan 2013-2020 (WHO, 2015), both of which proposed the development and implementation of suicide prevention strategies that incorporate best evidence.

Ms Renaud’s study recommends improving the provision of mental health care and reducing stigma surrounding suicide and mental health, which causes shame and distress.

Given that almost half of the individuals in the study had never had contact with psychiatric services, psycho-education may also be important to help others recognise signs and refer individuals to the appropriate services.

Another recommendation Ms Renaud makes is for accessible psychological and psychiatric services to be adapted for individuals with a low socio-economic status, particularly residing in the Southern Harbour region.

Individuals with mental health problems, particularly depression, and individuals with a history of suicide attempts, require special attention.

“Furthermore, given this study’s findings, it is critical to carefully assess suicide risk prior to discharge from psychiatric services, and to support such transitions, especially in the first week following discharge,” continued Ms Renaud.

Prevention strategy

One important intervention recommended by Ms Renaud is to reduce the stigma surrounding suicide and mental health.

Increasing and improving the provision of mental health care is another important recommendation.

Local services must also be equipped to deal effectively with such crises.

“At all levels, it is important for professionals to be specifically trained in working with suicidal behaviour,” said Ms Renaud.

“Another suicide prevention strategy is reducing access to lethal means, such as setting up safety fences at suicide hotspots identified in the study.”

This would be important given that jumping from a height is one of the most commonly used suicide methods. The most common was found to be hanging, strangulation or suffocation

It has been reported that the number of deaths by suicide at the Mosta bridge has been drastically reduced ever since the fence was installed there in 2016 to prevent people from jumping.

Psychiatrist Mark Xuereb, who manages crisis teams that offer support to those contemplating suicide, said that the fence had proven its worth.

Helpline

Aġenzija Appoġġ offers emotional help through its round-the-clock support line, 179, for various issues, including suicide, both to those contemplating it and to relatives, especially after a loss.

Crisis Resolution Malta, a private network that consists of professionals from various backgrounds, also offers support surrounding suicide.

Persons who feels at risk of suicide are asked to contact the Crisis Resolution Malta 24/7 on 9933 9966 or e-mail: crisismalta@gmail.com or by contacting support workers available around-the-clock at kellimni.com.

Survivor services

Anthony Gatt

The loss of a close relative or a loved one is considered to be one of the most stressful life events. If the loss comes through suicide, this is even more devastating.

In some scenarios, suicide comes as a complete surprise, and this can be even more traumatising. Someone might appear very well functioning, possibly even super functioning. A person you might not suspect that is suffering so much may tend to bottle up their worries, anxieties and sadness. In such cases, close relatives will be utterly shocked and struggle immensely to make sense of what brought about the suicide. They might also experience deep guilt and remorse around knowing that their loved one was suffering so much and alone.

On the other hand, there are those situations when suicide occurs in the context of an apparent major depression. For the person contemplating suicide, the idea of suicide tends to bring relief from immense psychological pain, because it is perceived as a solution to end the suffering.

As a result, it is very normal for a person who is very depressed to have suicidal thoughts. In the tragic circumstances that suicide does occur, close relatives tend to experience myriad emotions as they absorb such a critical event. In the bereavement process, it is very natural for those left behind to try to make sense of the tragic event as they try to absorb, accept or adapt to the loss.

Sometimes some solace can come from knowing that the person who ended their life also ended their deep suffering. Acceptance comes from understanding the condition, ‘forgiving’ the person and at times also forgiving themselves.

In situations where it remains unclear whether the person intended to commit a suicide or not, the process of recovery and acceptance can become more difficult especially if the questions remain unanswered, like in the case of the person dying of drug overdose, who may have intended to end their life or else may have died accidently by ingesting more substances than their body could manage. 

In any case, it is best for those left behind to seek out support as they go through a gruelling bereavement process.

Empathic family and friends can do a lot of support, but professional support may be required to help process the loss especially when the relative feels they can’t cope with their predicament.

Anthony Gatt is a psychologist and director of Caritas Malta.