As the world unites to mark Suicide Prevention Day on Monday, Malta will see the first phase of a National Suicide Prevention Policy being implemented – the enhancement of the National Suicide Crisis Line. Health professionals hope it will help significantly reduce the number of victims. Ramona Depares speaks to psychiatrist Mark Xuereb, who spearheaded the project.

Psychiatrist Mark Xuereb walks into the interview an hour-and-a-half late, but he has the best reason ever. He is fresh from an emergency intervention in which, together with members of the police force, he found himself climbing through an open window and forcing himself into a stranger’s home, while praying that he was in time to stop this stranger from ending his own life. Thankfully, he was.

“I received the cry for help early this morning on WhatsApp. The young man found our crisis line online and sent me a selfie that clearly showed me he was about to kill himself, and how.

“The photo was accompanied by a text message, explaining the reasons for his decision. I called the police immediately; they found out where his residence was and we rushed there. I only just left his side now; I have been with him all day,” Dr Xuereb recounts.

I am meeting with Dr Xuereb to talk about the enhancement of the dedicated National Suicide Helpline, which is set to take place on Monday to coincide with World Suicide Prevention day.

The pressing need for this measure is clear: through the Crisis Resolution Centre that he started in 2010, Dr Xuereb receives between 15 and 20 crisis calls a week. However, the psychiatrist is quick to point out that this is not really a question of numbers.

“If a national helpline saves even one life, that is enough. Human life is not quantifiable.

“However, as you can see from the statistics, the numbers are there. The World Health Organisation places depression, which is the most common cause that leads to suicidal ideation, as the topmost common illness today. It surpasses even heart disease and cancer in terms of burden for the patient and society.

“If we are going to talk numbers, this measure is certainly justified.”

The severity of the cases that Dr Xuereb receives each week range from a mother worried because her son is harming himself all the way up to “I am going to end it right now, tell me why I shouldn’t.” The calls are then filtered according to the needs of the individual.

“Reasons that push people across the edge vary, and most of them are the obvious ones that we have all read about before. Depression is the biggest factor, followed by triggers like a failed relationship, a failed business, loneliness...” Dr Xuereb adds.

Data gathered by the Crisis Resolution Team reveals that in Malta and Gozo there are at least 1,500 cases of suicidal ideation a year.

This is but the tip of the iceberg, the cases that the team knows about.

“Not everyone who thinks about suicide will go through with it, but for every person that succeeds in ending their life there are at least six other lives potentially ruined, for good.

“These are the family and friends, as well as the health workers, who are left to pick up the pieces, who spend the rest of their lives asking why this happened, why they didn’t figure it out in time, why they failed to save someone. These six people will also be at an increased risk of depression and suicidal ideation themselves, not to mention other practical problems such as dropping out of employment or schooling.”

For every person that succeeds in ending their life, there are at least six other lives at an increased risk of suicide and personality disorders

Dr Xuereb has been working with suicide attempt survivors and patients since graduating from Oxford under the tutelage of professor Keith Hawton, who has carried out award-winning research in the field of suicide prevention.

In Malta, Dr Xuereb established Crisis Resolution Malta, a multidisciplinary team working from a number of clinics that is made up of experienced professionals from various backgrounds.

Dr Xuereb pioneered the use of trans-cranial magnetic stimulation, or TMS, a ground-breaking technique that treats depression and suicidal ideation non-invasively.Dr Xuereb pioneered the use of trans-cranial magnetic stimulation, or TMS, a ground-breaking technique that treats depression and suicidal ideation non-invasively.

The Crisis Resolution network offers support to those who are going through a difficult time and employs nurses, psychotherapists, psychologists, counsellors, social workers, a lawyer, a doctor, a priest and a psychiatrist.

Dr Xuereb also pioneered the use of trans-cranial magnetic stimulation, or TMS, a ground-breaking technique that treats depression and suicidal ideation in a non-invasive manner.

“The idea is to provide immediate help when a person needs it most. Response is instant, and we have had many successful stories.”

He adds that the stigma associated with suicide attempts is so strong that speaking about the success stories is of the utmost importance. The public often assumes that once the thought has gathered momentum, coming back from the edge is impossible.

However, Dr Xuereb assures me that this is not so.

I speak to two of these success stories; both are leading happy and satisfying lives, fully functioning within society and eager to help in any way they can.

The first one is a middle-aged man who, spurred on by feelings of loneliness and the belief that he would never find someone to share his life with, tried to end his life some four years ago. The man was found by the police in one of the more popular suicide hotspots around the island after a phone call tipped them off.

Dr Xuereb’s crisis team was called in. A holistic treatment programme was devised. Today, the man is in a happy, stable relationship and about to start a family.

The other person I speak to is a younger woman who, a few years ago, could not cope with the breakdown of a long-term relationship, debt and a severe drug addiction. Having made up her mind that her life was over, she called the police station and informed the officer on duty that she was about to end her life, and that she had left a letter for her family in a particular drawer at home.

Once again, the crisis team’s intervention was enlisted and the young woman was stopped in the nick of time. Today, she has enrolled at the university, enjoys a hectic social life and – still grateful for the invaluable help she received to start afresh – is very active with support groups. She shows me the letter she wrote to her family, which she kept.

As I read phrases like “I cannot bear this weight any more” and “The struggle to live is too hard,” it is easy to see that the level of desperation the young woman was going through must have been unbearable.

But, looking at her as she speaks to me today, it is impossible to see in her the same person who wrote this letter. She is bubbly and articulate; she cannot stop telling me how every day is an exciting challenge. As difficult as it is to imagine someone bouncing back to life after such a trauma, it is clear that – aided by professional treatment – this woman has succeeded.

“Thank goodness, the success stories are plenty. This is one of the most important messages we can try to pass on to those who are going through a difficult time. Things are never as hopeless as they seem,” Dr Xuereb says.

The strategy endeavours to meet the WHO target to cut suicide rates by 10 per cent by 2020

His experiences through Crisis Resolution Malta led him to draft, together with his team, a National Suicide Prevention Strategy. After years of perfecting it, the proposal was presented to the government in 2015. Now the benefits of this proposal are set to take a more concrete form with the establishment of a crisis line combined with the already-existing Support Line 179, which will work in tandem with other entities.

“There are various stakeholders on board with this initiative, including Civil Protection and Victim Support Malta. We have been working towards raising more awareness about this 24-on-7 crisis line, which is fully nationalised and manned by a team of professional volunteers, and we aim to achieve this through liaising with more entities with a view to continuing to enhance the service, which will be offered free.”

The crisis line offers assistance both to those who are going through a crisis themselves and to the people close to them. It can also be used by anyone who suspects that someone is in danger of causing harm to themselves.

The initiative will see all the stakeholders working in tandem at a national level in order to offer immediate assistance.

“The plan is for every police station to be aware of the new crisis line; the police are usually the first port of call in these instances. They are the unsung heroes, together with the health and social workers who work on the frontlines.

“The number will liaise with the existing support line 179, which already does sterling work. We hope that this will reduce some of the pressure from that area in order that each team will be in a position to focus on cases in a targeted manner.”

The plan is for the crisis line to both react to emergencies and also resolve cases after filtering patients to make sure they get the right specialised service. Before, the lack of a focused helpline meant that suicide cases would get referred to one of the national clinics, where a risk assessment would be held. Depending on the outcome, there was a high likelihood of the patient being committed to a mental health care institution like Mount Carmel.

“Malta has already introduced an evidence-based home-treatment model, which has had very positive results abroad. We aim to enhance it and reach more people, thus removing the stigma associated with commitment to an institution. This, in turn, drastically improves long-term prognosis.”

This, Dr Xuereb adds, is but part of a wider plan that will see the implementation of the broader National Suicide Prevention Strategy, which rests on six key points: reducing the risk in high-risk groups, improving mental health in specific groups, reducing access to the means of suicide, provi-ding a support system to those bereaved, supporting the media in delivering a sensitive approach to suicide and supporting research.

The strategy endeavours to meet the WHO target to cut suicide rates by 10 per cent by 2020.

If you are having suicidal thoughts or know anyone who is in need of help, the National Suicide Crisis Line can be reached on 9933 9966 at any time of the day or night. A team of professionals is also available through You can also find Crisis Resolution Malta on Facebook.


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