Interview with Alexander Muela - PhD in Psychology and Lecturer in the Department of Clinical and Health Psychology and Research Methodology in the Faculty of Psychology of the UPV/EHU
- How can suicide among young people be prevented?
Reducing suicide mortality is one of the World Health Organisation's (WHO) priorities. Proof of this is that it has been included as an indicator in the United Nations Sustainable Development Goals and in the WHO Mental Health Action Plan 2013-2030. In our view, suicide prevention among young people is a necessity that has not been addressed adequately due, among other reasons, to a lack of awareness of the importance of this public health issue. However, studies have found that youth suicide prevention programmes are effective in reducing suicide risk factors.
Early identification of suicidal thoughts and behaviours, and the effective care of those at risk, are crucial to ensure that people receive the care they need and deserve. Therefore, taking action at an early stage is key to any suicide prevention strategy. There is a need to develop and implement effective health policies and preventive strategies to address suicidal behaviour among teenagers and young adults, to identify and reduce the most prevalent risk factors as soon as possible, and to increase protective factors.
- So, are there different levels of suicide prevention?
Prevention strategies are often categorised into three distinct models: universal prevention, selective prevention, and indicated prevention. Universal prevention refers to programmes or actions aimed at the population as a whole that are implemented before the issue becomes a problem. Regarding suicidal behaviour, it would cover raising awareness regarding suicide and mental health.
Selective prevention is a type of early intervention that targets children and young people who display suicide risk factors. It is usually implemented in schools and in community-based psycho-social and healthcare services. Selective prevention programmes aim to train people in these contexts to acquire specific knowledge to detect young people who are at risk of suicide and refer them to specialised healthcare services.
This prevention is aimed at reducing the risk of suicidal behaviour in children with high-risk factors (depression, psychiatric comorbidity, suicidal ideation, suicidal planning, etc.) or who have already displayed severe suicidal behaviour, such as previous suicide attempts or non-suicidal self-harm.
- What does Gatekeeper mean concerning suicide prevention?
The term Gatekeeper refers to people who regularly come into contact with individuals who may be at risk of suicide and who, with specific training, can provide them with early assistance. The idea behind the gatekeeper concept is that anyone, not just mental health professionals, can be trained to recognise when someone is at risk and act as a first point of contact or gateway towards obtaining professional or emergency assistance. Therefore, a gatekeeper can be a family member, friend, educator, religious leader, law enforcement officer, or healthcare or social services personnel.
- What will you be working on specifically in the course?
The course will focus on Gatekeeper competency training. The main goal is for people to acquire skills to identify the warning signs of suicidal behaviour, to ask young people about their suicidal thoughts and/or intentions, to persuade them to get help, and to accompany them through the referral process to specialised healthcare services. This approach is based on the premise that suicide prevention is a shared community responsibility and that a broad network of trained Gatekeepers can play a crucial role in reducing suicide rates.
- Why would you encourage people to take this course?
There are many reasons to take the course, but I would highlight three main ones:
- Awareness and early detection: This course has been designed to equip people with the skills to identify suicide warning signs among young people. This aspect is crucial, as early detection can lead to timely interventions and significantly reduce the risk of suicide.
- Practical tools: The aim of this course is not only to raise awareness but also to provide practical tools and intervention strategies that people can use in real-life situations. This includes how to talk to a young person who is contemplating suicide, how to assess the risk, and how to refer the person to appropriate support services.
- Effective prevention: Research has shown that Gatekeeper training improves people's knowledge and skills regarding suicide prevention. This results in safer communities where people are better equipped to respond to situations involving suicidal crises.
Interview with Jon García-Ormaza - Psychiatrist at the Basque Health Service - Osakidetza; Head of Suicide Research at the Mental Health Network of Bizkaia; Member of the Mental Health Research Group of Biobizkaia; PhD in Neurosciences and Associate Professor at the Department of Neurosciences of the University of the Basque Country UPV/EHU.
No single cause ever drives a person to suicide. We start with a higher or lower baseline risk of suicidal crises determined by individual and environmental factors. For example, a person with mental health issues or a history of trauma may have a higher baseline risk. When high levels of distress and hopelessness arise, suicidal ideation may emerge if effective coping strategies are not in place. Fortunately, most people who actively manage their mental health overcome suicidal crises and remain connected to life. In this sense, personal, emotional, and cognitive adjustment skills or strategies are of great importance, as suicidal behaviour is often the result of an intense but fleeting emotional crisis.
- How many suicide deaths are there each year? Is there a high-risk profile?
If we look at the incidence rate, there are approximately nine suicides per 100,000 inhabitants per year in our context. Although the incidence is lower among young people, it is the second leading cause of death after cancer. The incidence increases sharply among men over 80 years of age. Three out of four people who commit suicide are men, and almost half of the people who commit suicide are between 40 and 60 years of age. The reluctance to talk about one's own suffering and/or to seek help, among other socio-cultural aspects, contributes to the higher risk among men.
- How has suicide among young people evolved in recent years?
We cannot categorically state that the number of fatalities has increased, but we are detecting increasingly more suicidal behaviour, including suicide attempts. This is not necessarily in itself a failure, as until now, most suicidal behaviour has been undetectable or hidden from our eyes. Several studies show that we only detected 10% of suicide attempts in our environment. The main reason lies in the prevalence of various myths that have rendered suicidal behaviour taboo, preventing us from talking and asking, in a normal manner and free from judgement or criticism, about the possibility of having or having had suicidal ideation. We are detecting more people in need of help because we are improving our ability to detect those at risk. Fortunately, an increasing number of people are no longer afraid to ask for help.
