When one of the patients of Alba Babot, a primary doctor in La Garriga (Barcelona), arrived at her office with “a disheveled appearance, unusual for him,” “all the alarms went off.” The background was worrying: he had a history of substance abuse for which he lost custody of his daughter, and a couple of weeks earlier his visitation regime had been suspended for falling asleep and not attending one, which had worsened his condition. mood and increased consumption. Shortly after, he arrived at the health center with injuries to his hands and wrists that revealed a fight. It was then that the doctor activated an involuntary psychiatric admission protocol. The risk of suicide seemed imminent.
The signs that warn that a person may be thinking about taking their own life are not always clear. And they can vary a lot. But half a dozen specialists consulted agree that this neglect in the physical appearance, the increase in alcohol and drug consumption, engaging in physically risky behavior (such as fights or extreme sports that were not common before) should put people on alert, especially if they occur in someone with a history of mental health problems. Others can also be detected that have to do with addressing end-of-life issues: giving away important belongings, leaving legal issues resolved, making a will or saying goodbye to friends, always in the context of people who are going through a bad time.
Sometimes it’s all much more subtle: greater isolation, disconnection, stopping making plans that the person used to like or seeing friends, but very often, there are also verbalizations. Phrases like: “I don’t know what I’m doing here”, “you would be better off without me”, “it would be better if I disappeared”, “I can’t take it anymore”. They should not be ignored, minimized or avoided. “We have to talk openly about the issue. Studies say that when a person brings to your attention that they may be going through a bad time or have a mood disorder compatible with depression, it is good to ask if they have thought about taking their own life. There is a belief that this can encourage the person to end up committing a suicidal act, but studies show the opposite, that putting the issue on the table helps to make the problem visible, to open up and give them space to be attended to,” he explains. Babot, who on the occasion of suicide prevention day (September 10), participates in the #StopSuicides campaign, promoted by the pharmaceutical company Lundbeck.
The context in Spain is that of a new record of suicides: 4,097 in 2022, according to the latest provisional statistics from the INE. It is an upward trend that has been recorded since 2018 and leaves the rate at 8.5 suicides per 100,000 inhabitants, the historical maximum, although substantially lower than that of most OECD countries (with an average of 12 in 2019). ) and very similar to other moments in the nineties and this century. One of the most pronounced and worrying increases has occurred in children between 10 and 14 years old, although the absolute numbers (22 in 2021) are much lower than in other age groups (those who take their own lives the most are men at from the age of 40, with a peak of 460 autolysis between the ages of 50 and 54), and fewer than in past times.
Among the youngest, there are other warning signs that worry specialists, such as the fact that one in 20 adolescents claims to have attempted suicide, according to the PsiCE (Psychology in Educational Contexts) study. A third of the autolysis attempts answered by the toxicological information telephone number are under 20 years of age. And calls to suicide hotline numbers among young people are skyrocketing, something that, in addition to more suicidal ideation, may have to do with a greater visibility of these resources.
Psychiatrist Víctor Pérez-Sola, national coordinator of the European Alliance Against Depression, sees a “very important trend” in young people’s attempts: “Many times what they are looking for is not real suicide but rather a life-changing one. They tell you: ‘No, I didn’t want to kill myself, I was suffering and I wanted it to stop happening.’ This communication aspect in young people is much greater. When older people try, they make very abrupt and very serious attempts. They manage to die much more frequently.”
Pérez-Sola explains that the environment of young and old people is usually different. The former are usually surrounded by healthy people, family and other people around them, and it is usually a specific life event that precipitates this behavior. Meanwhile, among older people, mental illnesses or serious social problems are common, as well as somatic illnesses that make them suffer. This is very often coupled with loneliness. “We put a lot of emphasis on young people because they are the ones who raise alarm signals, but it is true that in research projects or care for the elderly we are doing less, there are not such well-mounted campaigns and we should be very careful with somatic illness , pain and loneliness”, affirms the psychiatrist.
There is no national prevention plan that coordinates the actions of all the autonomous communities (as happens, for example, with drugs or AIDS), something that some professionals claim on the Let’s make a plan platform. But there are more and more measures: in 2022, 024 was launched, the first national telephone service for suicidal behaviour, which handles more than 300 calls a day. This same year, a permit to accompany people at risk has been approved.
Suicide prevention, in any case, is very complicated. As Guillermo Lahera, tenured professor of Psychiatry at the University of Alcalá, wrote this summer in EL PAÍS, 7 out of 10 people who die by suicide did not plan to do so just an hour before. “Because suicidal behavior is dynamic, changing, to some extent unpredictable, and a poor fit to our long-awaited linear models of prediction and intervention. Suicide is a behavior, not a disease, and its main preventive measure is the opposite of that applied to infections: unisolate, reconnect, contaminate yourself from others. Affective ties and communication channels are their main antidote”.
This is in line with what psychologist Antonio Mengual explains, who believes that the lack of community is a risk factor. “That is why group therapies are so important. We are in hell, but we row together,” he says. In the face of signs like those mentioned above, he advises, first of all, to refrain from telling the other person what he has to do. “Not to say that life goes on or to make value judgments, but to ask what is happening.” The second thing, offer help. Say, “What do you need me to do?” The third thing: propose seeking help from a professional. And, fourth, be more aware. “Many times we are not aware of the impact we have on other people. Even if we see that he does not answer, we can tell him, I have remembered you, I hope you are well. I have had patients who have told me that although they did not answer them because they did not have the strength or desire, these messages have saved their lives ”, he assures.
Cecilia Borràs, also a psychologist and president-founder of After Suicide–Survivors Association (DSAS), points out that validation of what the other perceives or feels is very important: “When we hear things like “I have no future,” we do not We can answer things like: “It’s not that big of a deal,” which are very common. You have to offer to talk, ask what is worrying them. By talking about suicide, no one is going to commit suicide, it must be done naturally, although it costs a lot.” Something very important is to buy time, since suicidal ideations come and go. “Instead of telling him not to do it, it is better to advise him to wait until tomorrow. And tomorrow, wait for the next day,” says Borràs.
As complicated as it can be to identify a person at risk of suicide, there is one very clear trait: those who have already tried are more likely to repeat it. They are people to whom those around them should pay special attention. In the case of Babot’s patient, it had already been done, and it was one of the reasons why they activated such a drastic measure as forced admission. At first, he confesses, it did not go well: “His behavior was harmful, both for him and for the rest of the patients at the ward, but later we were able to work with him and he is once again under control and in good condition.”
People with suicidal behavior and their families can call 024, a hotline of the Ministry of Health. They can also go to the Telephone of Hope (717 003 717), dedicated to the prevention of this problem. In cases that affect minors, the Anar Foundation has the telephone number 900 20 20 10 and the chat on the page https://www.anar.org/ for Help for Children and Adolescents.
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