Mental health is an integral part of health and is essential for a population’s quality of life and well-being. Positive mental health allows people to realise their full potential, cope with the stresses of life, work productively and contribute to the communities in which they live.

Mental illness is the leading cause of disability globally. It is estimated that more than half the population will suffer from at least one mental disorder at some point in their lives. Thus, mental disorders present a significant public health problem with marked consequences not only for those affected and their families, but also in terms of the social, economic and financial costs at a national level.

World mental health day is celebrated today. This year’s theme is suicide prevention. The suicide mortality rate is an indicator of target 3.4 of the Sustainable Development Goals, outlining that, by 2030, one third of all premature mortality from noncommunicable disease should be reduced through prevention and treatment, and through the promotion of mental health and wellbeing.

Every year, close to 800,000 people take their own life. For every suicide, there are many more people who attempt suicide that does not end in death but which instead results in self-injury. Every suicide is a tragedy that has long-lasting effects on the families and the people left behind and their communities and countries at large.

Suicide occurs throughout the lifespan and was the second leading cause of death among 15- to 29-year olds globally in 2016. Suicide is a serious public health problem; however, the good news is that it can be preventable with timely, evidence-based interventions.

Who is at risk?

Social, psychological, cultural and other factors can interact to increase a person’s vulnerability to suicidal behaviour. A prior suicide attempt is the single most important risk factor for suicide in the general population. There is a link between suicide and mental disorders, particularly depression, problematic substance use, job loss, trauma or abuse, and chronic pain or illness including cancer, diabetes and HIV/AIDS.

Every suicide is a tragedy that has long-lasting effects

Awareness of suicide as a public health issue needs to be raised through a multidimensional approach that takes account of the social, psychological and cultural impacts. Males have a higher suicide rate with a male to female ratio of 5:1. It is not clear why more men than women complete suicide. Some suggest that men are more likely to ‘get on with things’ and to keep their thoughts and feelings to themselves. They are also more likely to choose suicide methods that have a lower chance of survival.

There is a culture that makes it seem as though men will be portrayed as weak if they seek help. Breaking these barriers would enable people, especially men, to get timely help, and this would hopefully reduce the risk of suicide.

LGBTQ individuals are also more at risk of committing suicide due to the fact that they often experience discrimination, bullying, homophobia, biphobia and transphobia.

If you or a loved one has suicidal thoughts, don’t worry – help is at hand. There is a Psychiatric Emergency Service offered from the A&E department at Mater Dei Hospital for crisis situations. Other actions in less acute situations include reaching out to a close friend or loved one about your thoughts and feelings or seeking help from your doctor or other health care provider.

You could also make a plan for life by writing a ‘safety plan’ with your mental health provider that you can refer to when you’re considering suicide or are in a crisis. It is important to learn how to recognise your warning signs early so as to put the plan into action. Try specific healthy and enjoyable activities when negative thoughts start to intrude and review why your life is valuable and your reasons to live.

Seeking timely help would definitely improve your outcomes and help you overcome these difficult moments. Taking action pays.

What is being done?

Mental health is a key priority for Malta, and the Mental Health Strategy 2020-2030 launched last July offers guidance for investment and reform in mental health services, thus improving patient safety and wellbeing.

These reforms include strengthening the emergency service offered from the A&E department at Mater Dei Hospital to respond effectively to crisis situations. Policies are being reviewed to improve supervision and care of high-risk inpatients in order to enhance their safety.

The Strategy also outlines working with the Health Promotion and Disease Prevention Directorate to promote mental health and well-being and to raise awareness on suicide prevention.

The Health and Wellbeing Centre at the University of Malta and the Wellbeing Hub at MCAST were set up to provide support for students. Discussions are underway to set up a working group to develop and implement evidence-based strategies for the prevention of self-harm and suicide.

A concerted effort involving all stakeholders is required to enhance the mental health and well-being of the population. As the adage goes – there is no health without mental health.

Antonella Sammut is Resident Specialist, Public Health Medicine.

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