This was the question clinicians, researchers, politicians and dependents sought to answer in a seminar during Arendalsuka in August.
– The most significant risk factor for committing suicide is to suffer from mental problems of any kind, says researcher Fredrik Walby at the National Centre for Suicide Research and Prevention (NSSF).
More than 90 % of people committing suicide suffer from mental distress or mental illness.
– Mental agony and illness are quite central drivers for suicide. This is rather self-evident – if not, why would you wish to leave this life behind?
The most important actions we can take is to make more people seek help and to implement prevention and intervention efforts on several levels. We need to involve the GP, strengthen the existing efforts at combating depression and above all strengthen the focus on suicide prevention in the mental health care system.
Suicides in Norway
– A registry study we conducted found that close to half of people who committed suicide, have been in contact with the specialist health care services and mental health care system in the year leading up to their suicide, says Fredrik Walby.
Data from the Norwegian Institute of Public Health indicates that nearly nine out of ten people were in contact with primary health care services in the year leading up to their suicide. Women are more likely to seek treatment than men, and less than half were in contact with these services in the month before.
When the Norwegian Institute of Public Health presented what they considered to be Norway’s ten main public health challenges, mental illnesses and self-harm and suicide were number six and seven on their list, respectively.
– To prevent suicide, we must undertake more systematic treatment of patients who are part of the mental health care system, and patients that voluntarily inflict self-harm, in addition to increasing public awareness of these issues, says Walby.
Multilevel prevention initiatives
The efforts to restrict access to suicide methods is a key part of the prevention work.
– We have achieved great results and a dramatic reduction in Norway with regards to access to drugs and weapons. These are among the most efficient measures we can implement, says Walby.
Experience shows that people are more likely to seek help when they are more informed about where to go, and how. Targeted information about risks and multi-level treatment options can reach more patients.
– We have to increase awareness about the fact that professional help, which can achieve real results is available, both among those who suffer and among key stakeholders in the local communities, the police, and in the prison system. We have made enormous investments in developing mental health care at several levels, but we’re not always successful in communicating this fact to those who suffer, says the NSSF researcher.
Improving the quality and range of mental health care for adults
For suicides where the person has been in touch with specialist health services, they have usually been involved with the mental health care system for adults. This is where they treat serious cases of psychopathology, often related to suicidal behaviour, and it comprises a large part of the specialist health services.
– Risk of suicide is one of the main reasons why people are referred to the mental health care system. Because of this we need to improve the quality and scope of the available treatment, says Walby.
Depression and suicidal behaviour are closely interlinked
One of the means to achieve this is to work more actively and systematically with treating depression. Depression is the most common psychological issue linked to suicide.
– We know that depression and suicidal behaviour are closely interlinked. It is a matter of hopelessness, sadness, and harbouring difficult emotions – but also the fact that depression is so widespread. Around one-quarter of the population will suffer from depression at some point in their lifetime. If we are to prevent suicides, we must deal with depression, Walby points out.
One way to do this is to use a web-based treatment initiative which allows patients to work through their depression together with a therapist.
– Web-based treatment interventions like these are initiatives which have a relatively good effect on mild and moderate levels of depression, which are after all the more common conditions, says Walby.
iFightDepression – a web based self-help tool
– iFightDepression is an Internet-based self-help tool for people suffering from mild and moderate levels of depression. It contains broad and up-to-date information about depression and opportunities for help, says professor Lars Mehlum at NSSF.
The tool is to increase the user’s understanding of the way thoughts, emotions, bodily reactions and behaviours are intertwined, and thereby become more aware of how their sleeping patterns can affect their emotional state. The users record their own activities and how various activities affect their moods and emotional state.
– This tool helps the user bring about changes in moods, thoughts and behaviour, increase their activity levels, solve problems and change negative thought patterns. The patients carry out the work and the exercises at their own pace, while receiving guidance from their GP, psychologist, or other health care professionals, Mehlum explains.
A national suicide monitoring system
NSSF has worked over a 15-year period to obtain better data on suicides occurring during mental health treatment and in the context of other sectors of the specialist health care system.
– We are now launching a national monitoring system where we look at suicide among patients in the mental health care system and in the multi-disciplinary specialised substance abuse treatment sector. Here we’ve linked the Norwegian Cause of Death registry and the Norwegian Patient Registry, says Walby.
This monitoring system will identify the circumstances for these incidents and systematically chart what the patients who become victims to suicide have in common.
– The question is though, do we actually reach those who are the most vulnerable? Do we reach the men, those with only brief hospital stays and those who used to be high functioning, but suddenly experience serious difficulties? The monitoring system will definitely be able to provide us with more data on this, concludes Walby.