Breaking taboos the first step to suicide prevention

Summary

To reduce the region’s suicide rate, the Flemish Expertise Centre on Suicide Prevention has come up with specific steps to help caregivers address the issue

Throw a lifeline

Suicide prevention starts with honest and direct talk – this is the core message of the Flemish government’s directive on suicide prevention. The directive is the first of its kind, providing caregivers with a detailed action plan on how to recognise and treat people with suicidal thoughts or behaviour.

Statistics in Flanders are a cause for concern, say experts. Every day in the region, 28 people attempt suicide, while another three die from it. The latter figure is 1.5 times more than the European average.

And those statistics have a knock-on effect. The risk of suicidal behaviour among relatives of someone who’s ended their life is eight times higher than the average person’s. And people who’ve lost colleagues to suicide run a risk three times higher.

In 2012, the government launched the Flemish Action Plan for the Prevention of Suicide. The series of policies, professional strategies and actions aimed to decrease the number of suicides by 2020 by at least 20%, compared to 2000.

Talk about it

In 2014, the Vlaams Expertisecentrum Suïcidepreventie, or Flemish Expertise Centre on the Prevention of Suicide (Vlesp), began putting together the region’s first-ever evidence-based directive on suicide prevention. Vlesp, located at Ghent University Hospital, serves as an advisory body to the government and organisations working on suicide prevention.

Three years on, the agency’s “multidisciplinary directive for the detection and treatment of suicidal behaviour” is ready, offering doctors, psychologists, therapists and nurses much-needed advice on how to treat patients with suicidal behaviour.

The experts started off by studying a similar prevention directive put in place by the Dutch government in 2012. It soon became clear that a simple adaptation of the directive wouldn’t be enough.

Caregivers must know there is no harm in asking direct questions. On the contrary, research shows patients feel relieved when the caregivers bring the issue up

- Eva Dumon of Vlesp

With five suicides a day, but a population almost three times that of Flanders, suicide rates in the Netherlands are much lower. According to Eva Dumon, one of the authors of the new directive, Vlesp focused instead on addressing the caregivers’ most pressing needs.

“Their question was: ‘How can we determine who might do it, because it is often very hard to tell’,” Dumon says. “In most cases the signals are very weak or vague.”

Further, while the patient is often too apprehensive to talk about suicide, she says, the caregivers are also too hesitant to discuss the issue. “Caregivers must know there is no harm in asking direct questions. On the contrary, research shows patients feel relieved when the caregivers bring the issue up.”

Only the beginning

Vlesp’s directive lists a number of questions that may appear blunt, but are very efficient in opening up the discussion, says Dumon. “Do you have frequent thoughts of committing suicide? Do you already have a specific plan in mind? We need to create openness to then work on the problems as they rise to the surface.”

Hesitance on behalf of caregivers and fear on the side of patients, she says, could be linked to culture. The taboo around the subject offers a possible explanation for the stark difference in suicide rates in Flanders and the Netherlands.

“The Dutch are known to be more open and direct, but there is also less of a stigma around mental health and talking about psychological problems.”

Professional care, she continues, is also more accessible in the Netherlands. “Therapy is covered by insurance, while the discussion about reimbursement has only recently started here in Flanders.”

Finger on the pulse

Recognising and addressing the problem is only the first step recommended by Vlesp. When suicidal thoughts are signalled, caretakers need to know what kinds of interventions are at their disposal. The directive suggests a number of pharmacological or therapeutic methods that have proved to lower the frequency of suicidal thoughts and behaviour.

The final recommended step is the most frequently neglected. All too often, after a suicide attempt, patients are released from the hospital’s emergency unit without a follow-up.

“Referring the patients to professionals isn’t enough,” Dumon explains. “Caregivers absolutely need to enter into dialogue and ask the patients if they are willing to see professionals for help in the first place.”

When a patient is passed on from one caregiver to another, there needs to be a much better follow-up on those transfers

- Eva Dumon

According to Dumon, the caregivers should contact the patient’s general practitioner. “Tell them what happened, ask if the GP is aware of the problems and call back later to see how things are developing.”

In the so-called care-chain, she continues, “when a patient is passed on from one caregiver to another, there needs to be a much better follow-up on those transfers. This is currently lacking”.

The directive’s website provides interactive e-learning modules, through which professionals can learn about the steps in more detail and get official accreditation. The aim is to spread the knowledge quickly. As suicide rates have stabilised in recent years, Dumon hopes they will now finally begin to fall.

Flanders’ Suicide Hotline can be reached at 1813 or through the website Zelfmoord1813 (in Dutch). For help in English, contact the Community Help Service at 02 648 40 14.

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