The national suicide prevention plan, an electoral commitment that is "urgent" to fulfill: "We have to try to stop people from thinking about killing themselves"

Of every 100 deaths in the world, one is due to suicide (703,000 per year). In Spain, 11 people take their lives every day believing that there is no other way out of their pain.. There is in most cases, but they can't see it. Today, like every September 10, World Prevention Day is commemorated so that this message becomes stronger: helping to find an alternative to death is a collective task and not achieving it is a social failure.

Massive demonstration in Madrid to demand a national plan for suicide prevention. Atlas

Suicide is the leading cause of external mortality in the country. For every person killed in a traffic accident, there are three who have taken their own lives.. Experts have long demanded a change of outlook in the political sphere so that suicide becomes a priority, that it is not limited only to the field of mental health and that it is addressed as a public health problem from a comprehensive perspective.

Spain still lacks a state-level plan and the work of prevention and intervention has fallen to the Autonomous Communities under the argument that they have transferred health responsibilities.. From the Government, the only step to implement a national strategy was taken by Carmen Montón in 2018 but her resignation left it in the drawer of oblivion. Last October, UPN tried to push it through the Senate and its proposal was shot down.

The growing increase in deaths and suicidal ideation and the impact of the pandemic on the mental health of the population seems to have generated, however, greater awareness. In April, Congress approved that family members of people at risk had the right to leave to care for them and for the first time in the electoral programs of June 23, the main political forces committed to strengthening the measures.. Both PP and Sumar promise to articulate a national strategy, the PSOE one focused on combating suicide among young people and VOX to reinforce existing programs.

There is no investment in activating quality and sufficient resources in prevention, intervention and postvention.

Magdalena Pérez Trenado, clinical psychologist. Telephone of Hope.

“We cannot continue to be oblivious to one of the biggest problems that society suffers, which has effectively increased after the pandemic,” acknowledged the leader of the PP, Alberto Núñez Feijóo, in the campaign, empathizing with the pain of a death by suicide.. “I know well the impact on the family. You never forget that, you will never get over it. More and more Spaniards know and had a friend who took his own life. Our obligation to act and do it as soon as possible.”

“It is necessary and urgent”

While waiting to know the plan of the future executive, whoever ultimately governs, prevention experts explain why it is necessary and what initiatives it should include.

“It is necessary and urgent” that it be implemented, says Magdalena Pérez Trenado, clinical psychologist, volunteer at the Telephone of Hope as national person responsible for suicide prevention, recalling that in countries where strategies have been developed “consensus and developed with will and responsibility real policy” rates have been reduced significantly. Under this conviction, this entity, which has been offering listening and empathy to people in crisis for more than 50 years, has been promoting the 'Let's make a plan' initiative together with the National Platform for the Study and Prevention of Suicide for more than a year. urging political forces to take action '[READ THE MANIFESTO]'.

Pérez Trenado, who dedicates a large part of his life to “healing emotional wounds and creating networks that sustain,” warns that despite the “worrying” death tolls, there is no investment in “activating quality and sufficient resources” in prevention, intervention and postvention. All the Autonomous Communities have specific plans, but “many fail to follow some WHO recommendations, most of them in relation to financial resources, which is why they demand that a part be dedicated to prevention in the” general State budgets. of suicide in this country” and a National Suicide Plan is drawn up that “integrates, serves as a reference and coordinates” all the regional plans: “That everyone, wherever we live, has quality help resources. May we move forward learning from each other, together and coordinated.”. This state strategy, he insists, must move away from any “partisan” temptation and not become a “new political tool to get votes”: “Suffering, extreme emotional pain, does not understand colors or ideologies, we cannot and should not do of this plan a short-term strategy that has political benefit as its goal.

Magdalena Pérez believes that in recent years the silence on suicide has been broken but there is still “a long way to go” and calls for “taking action”, so that this current greater awareness “is transformed into real policies that allow prevention.” , save lives and take care of people”.

She is one of those dozens of people who every day try to offer hope to others who want to hold on to life but no longer know how to do so.. And from this listening to pain arises the conviction that to combat suicide and pain, “deep changes” are required in social, employment, housing, and health policies…: “A person who is and feels deeply alone can easily become disconnected, isolated and lose the will to live; a person who needs to work in several places in precarious working conditions to raise their children with hardly any time to see them will not be able to remain emotionally strong for long; a person who need specialized mental health care; they cannot wait weeks, sometimes months, to have a first consultation, or have brief appointments very spaced out in time when what they need is continuity to sustain themselves; a primary care professional has it very complicated to detect suicidal tendency in a consultation with an average of six minutes maximum for each patient and without specific training that gives them resources and security, which can be translated by the professional into fear, helplessness and/or avoidance of the more in-depth encounter due to not being able to do it with time and quality.

That first step to move forward, he assures, is to “connect us all” to a National Plan that allows us to have human and material resources and strategies to continue building those “networks that sustain and sustain us, that allow us to prevent, care for and facilitate a social environment in the worth living.”

“Suicide prevention must be taken out of the white coat”

“A national prevention plan gives priority to this phenomenon and allows explicit recognition by the Government as a public health problem that requires a structural framework and an action model for its prevention,” explains Susana Al-Halabí, professor at the Department. of Psychology from the University of Oviedo and specialized for 15 years in the prevention of suicidal behavior. In his opinion, it is essential that this strategy, and the resources, be based on “scientific and technical criteria” and on the experience of experts from the WHO and other countries, as well as offering a “working framework” in which they are indicated. both the objectives, “what results we can expect in the short and long term”, as well as the groups involved, the collaborative agents and “what approach or conceptualization guides decision-making, since it is not the same to analyze suicidal behavior as a mental disorder linked to the clinical field, rather than considering it a problem anchored to the biographical context of people and, therefore, to political, social, economic factors, etc.”.

Currently, there are 40 countries that have articulated a state plan and among them are the US, Denmark, New Zealand, Austria, Switzerland, Ireland, Scotland, Germany, Finland and Norway.. Ireland is, according to this specialist, the European country that Spain should look to when developing a plan due to the years of “advantage” it has and its firm commitment to research.. And do so knowing that reducing deaths is a “complex issue that requires time”, that “multiple simultaneous measures must be taken to have a real impact” in the medium term, that “it is necessary to identify the human and economic resources” that can give results. and reduce death rates significantly.

CARLOS GARCIA POZO

Four proven effective ones were included by the WHO in its 2021 Living Life guide to guide governments in their national prevention strategies: limit access to the means of suicide; engage with the media to responsibly report on suicide; promote social and emotional life skills in adolescents; and early intervention for people with suicidal behavior.

Despite the delay in implementing prevention actions and the possible future difficulties, this expert's view is hopeful: “There are many professionals and institutions who are very critical of the gaps that still exist and I am aware that we are arriving late and there is much that needs to be done.” work, but it is also fair to recognize that there has been great progress”. And these steps forward include that the reality of suicide is addressed responsibly in some media, with specific coverage or campaigns on television and that help resources are included in the informative pieces.. Also 024, the telephone number to offer listening and help in the face of suicidal ideation that was launched by the Ministry of Health, which “although it is an insufficient and improvable measure, I want to believe that it is a step that is leaving its impact on the population.”

Through campaigns you can get people to lose their fear of speaking

Susana Al-Halabí, psychologist. Oviedo University

The dissemination of public campaigns, one of the actions that can promote a national plan, is, in his opinion, key to continue advancing. Through them it is possible for “people to lose their fear of asking”, of speaking, for the person who suffers to see that “what is happening to them, these ideas of suicide or this loss of meaning in life, is not something that something is wrong or “broken” in him or her”, that it can also happen to others who are going through difficult or painful situations and that it is a good idea to tell someone you trust to receive the support or care and help necessary in that moment. Pain, suffering, losses and difficulties are inevitable in life, but the fact that a person feels supported during these situations or processes is not.. Simplifying greatly, we could say that one of the differences between people who commit suicide and those who do not are usually not so much the type of painful circumstances as other factors such as the lack of a sense of belonging, feeling like a burden to others. , the support systems and resources we have to face the difficulties that plague us at a certain stage. It is more a question of social inequality than a mere mental health problem,” he says.

PREVENTION CAMPAIGN IN QUEBEC

“If a person tells us that they are unemployed, that they have suffered a loss or that they have been diagnosed with a serious illness, we would not think of hanging up on them or stopping calling them, but rather we would go and accompany them and ask them what they need,” he points out. Susana Al-Halabí. Receiving “support or a call changes a person's relationship with their thoughts” of death. In this sense, Susana Al-Halabí, coordinator with the psychologist Eduardo Fonseca Pedrero of the Manual of psychology of suicidal behavior (Editorial Pirámide, 2023), highlights that it is important to become aware of the “social problem that suicide constitutes beyond the fact that it represents a clinical factor”, that we stop seeing it as “a mere symptom of a mental disorder” and realize that “mutual care, support, values and the feeling of belonging is essential to understand this problem. “We must get him out of the white coat.”

In the opinion of this expert, it is essential to update the data surveillance systems and have the number of deaths by suicide in the current year to analyze whether the measures that are being implemented are effective or not.. The evaluation of results is an issue inherent to prevention science. Currently, there is a “delay” of one year since the INE usually publishes deaths by suicide from the previous year in December.. In that sense, he considers it essential that the records be unified and “destigmatized” to really know the number of people who take their own lives in Spain.

“A state plan will be welcome but it arrives late”

Stopping seeing suicidal behavior as a mental health problem is, for Andoni Anseán, president of the Spanish Foundation for the Prevention of Suicide and the Spanish Society of Suicidology, one of the essential steps to reduce deaths and injuries in Spain. Attempts. So that a national plan is not “doomed to failure” it should be done from that multidisciplinary approach, understanding prevention as “something that encompasses all spheres of life, personal, social and community” and with all the groups involved: “It has to see social services, education, occupational risk prevention, first intervention forces, citizen awareness…”

Concrete, operational actions that can be measured and evaluated must be included.

Andoni Ansean. Spanish Foundation for the Prevention of Suicide

After years demanding a national strategy, Anseán is very skeptical and doubts that a future government will implement it. It appears in the PP and Sumar programs but he does not perceive greater political will to face this reality with determination. “The plan has gone through all kinds of processes, from absolute majorities to non-law initiatives, and has never seen the light. With Carmen Montón we were close, but from the national political parties, on this issue, we can only expect promises.'

If it goes ahead, “it will be welcome but it will arrive late,” he warns, to establish a roadmap. “During all this type there has been enormous development by the Autonomous Communities of both the autonomous plans and the educational sector. And although a state plan is always desirable, it should have been done a long time ago to be able to fulfill that guiding and framing function.. Everyone already has their own approach. It has been a missed opportunity for the Ministry of Health. “He bet everything on the mental health strategy and it is a fundamental error in his approach.”

Nor does he trust that a hypothetical state program includes financial support: “There are no budgets for suicide prevention and I do not believe that it is the state plan that is going to provide it or force it to be created,” says Anseán, recalling the figure ” “anecdotal” of 100 million that Pedro Sánchez awarded to the mental health plan.

Hundreds of people in Madrid ask to strengthen protection against suicides. ALBERTO DI LOLLI

The regions have made progress in suicide prevention in recent years but there are “many differences between them, both in content and form,” says this expert, highlighting as an example to follow the commitment of the Balearic Islands and Galicia to the creation of a network of specific care teams for people at risk. Currently, remember, there is also no communication channel between the different autonomies that makes it possible to know and monitor what measures are being effective in the different regions, a monitoring that could be carried out in the Interterritorial Health Council but is not done.

For this psychologist, it is a priority that efforts at the state level focus on obtaining data on suicidal attempts or ideation among the Spanish population.. In the national health survey, he recalls, citizens are not asked if they have attempted to take their own life or have planned it, which shows, in his opinion, that “there is a lack of concern about suicidal behavior.”. It is also not known how many people in this country have tried to commit suicide because these are cases that are not recorded.. “It's not easy to do it” but “nothing is easy in suicidal behavior,” he warns.. “We have a much better chance of obtaining this information from the health field, what happens is that the national health system is not prepared to carry out an investigation and record cases of suicide attempts,” he explains, trusting that the extension and development of the Suicide codes that are beginning to be implemented in the Autonomous Communities can make this monitoring a reality.

In Spain, the observatory that exists on suicide and that annually analyzes the data published by the INE each year belongs to the foundation that Anseán presides.. The Ministry of Health does have powers to create one at the national level and offer an x-ray of this reality that puts on the table the magnitude of the problem.. Remember that when the Foundation began “there was nothing”. No autonomous plan had been developed and there was only one association of survivors in Spain that cared for relatives or close friends, the one created in Barcelona by Cecilia Borrás, After Suicide-Asoc. of Survivors -DSAS, after the death of his son. Today, 25 non-profit organizations follow in its wake throughout the country.. “Things have changed in a dizzying way, there have been great advances in all the Autonomous Communities, the media, the population, but we have to continue betting on it and taking care of the problem. I would be delighted to advance in the next ten years what we have advanced in the last ten years. What is incomprehensible is that one of the actions that have been left pending is the state plan,” he says.

“I get the feeling that if it is done now it is because it is unpresentable not to have it,” he says, demanding that it not remain a mere declaration of intentions and that it be done by articulating “concrete, operational actions that can be measured and evaluated.”. In any case, he assures, “the CCAA is doing its duties even without assistance from the state plan and will continue to do them in the absence of the state plan.”

Poster for the Samaritans association in London offering help to a person in crisis. “No one dares to talk about it and no one dares to ask you”

During the conversation, Andoni Anseán asks that a voice be given to the survivors, that group of people who have lost a person to suicide and who usually grieve alone, tormented by questions, guilt and under the weight of stigma.. Their main support network currently are the mutual aid groups that extend throughout Spain.

“The plans are to provide more professionals for those of us who remain and to prevent

Alberto Gomez. Survivor.

Alberto Gómez went to one of them three years ago after two decades suffering practically in silence the death of his brother at the age of 25, “without saying the word suicide or the word Eduardo”. He goes once a month to the Catalan association DSAS and there he finds listening without judgment, understanding and incentives to move forward.. “I will never be able to repay them for what they have done for me.”. Those two hours are pure life,” he says, demanding psychological attention and support for anyone who suffers an experience as traumatic as losing a family member to suicide: “The plans involve providing more professionals for survivors and for prevention, than the kids don't think about it. “That they take care of us, that they accompany us, that there are thousands as my coordinator.”

Alberto is a journalist and as such he also took refuge in words as therapy to give shape to that world of emotions and vital experiences that have marked his life.. In a few months he will publish Against Silence, a book that reflects the “experiences and sorrows” of grieving for suicide, of surviving each day a death so “hard to assimilate”: “It is a tsunami of loneliness and terrifying silence because no one you dare to talk about it and no one dares to ask you. “It's a scar that opens when you least expect it.”

“With such alarming numbers (of suicide), all help is insufficient. There is not enough help or resources and professionals to prevent nor are there tools or resources for the people who have been left behind.. Small entities that juggle to be able to serve many people,” he laments.

“Let's do things with seriousness, knowledge and depth”

Isabel Irigoyen Recalde is a psychiatrist and has been in charge of the development and implementation of the Aragon regional suicide prevention plan for three years.. He knows well the difficulties, the resources that are necessary and the many spaces for improvement in the fight against suffering.

We must promote the mental health of all citizens at every stage of their lives.

Isabel Irigoyen Recalde, psychiatrist

“Mental health is worsening in all age groups, especially among the youngest” and it is very worrying “because they are going to be the adults and parents of the future”. In the consultations, no major changes are observed with respect to the “pathologies”, which practically “remain the same” (depression, bipolar disorder, schizophrenia) but there has been an increase in emotional discomfort and there will come a time, he warns, when ” “It will not be acceptable” for either public or private healthcare.. In his opinion, we must try to face it “not only by relying on healthcare” but by trying to ensure that citizens “know themselves better, can manage their emotions, rely on other things and not everyone needs healthcare.”. Ni psychotropic drugs. This expert warns that there is “excessive psychiatrization” and the citizens themselves demand “quick solutions” for the discomfort and “that is a serious error for which we will be able to pay dearly in the future.”

Irigoyen emphasizes in this sense that it would be a mistake “to make a state approach to a suicide prevention plan that ignores how to promote the mental health of all citizens at each stage of their life.”. “We have to try to stop people from thinking about killing themselves, to strengthen your self-concept, your way of solving day-to-day difficulties.”

In Spain, suicide prevention has begun to be addressed “very late” and in a “population that we call tertiary”, that is, people who already have the idea of taking their own life, he explains.. They are the ones the different regional intervention plans focus on and “obviously we have to do it because we have to reach at least that last moment to try to stop it” but a national level plan has to do “primary prevention”, prevention of diseases mental health and depression, which is what “causes one in every two suicides”, with awareness campaigns and promotion and strengthening of citizens' mental health through the media. “If this is not done we would have a very final state prevention plan, which does not go to the origin of the problem but rather to try to prevent people from killing themselves.”

Irigoyen emphasizes that the first thing to do when preparing this plan is to make a comparative study of the different autonomous plans and study the results, what has worked best in each region: “See what has been done until now and take advantage of it”. This strategy at a general level must establish homogeneity in some measures and raise awareness and disseminate content on mental health to society in general and specifically to the at-risk population, such as those under 16 years of age.

There is no need to be afraid to talk about death or refer specifically to suicide.. Doing it naturally in conversations in our environment, in an empathetic way, listening, without judging, is a “very useful” way of detecting “hopelessness” and both “passive” ideation (thinking about death but without the intention of killing oneself). or “active” (thinking about suicide), he says.

This expert does consider that there is greater political awareness “but those who have to make decisions are not well informed”. “An in-depth culture of what suicide is, where it comes from and how we can intervene has not yet been created.. There is a lot of ignorance about mental health. Politicians have to be well advised by professionals,” he emphasizes, using as an example the implementation of the 024 telephone line, “which clearly could be improved since it was born.”. “Let's do things with seriousness, knowledge and depth, with a good scientific and technical foundation behind. You cannot ideologize a mental health plan or a suicide prevention plan and we run that risk. Regardless of whether it is one political current or another, they have to seek advice from professionals from different fields because if not, they will surely be biased and will not commit the problem from all sides.”. And it is urgent to do it. Eleven people die every day.