Situation and needs for addressing suicide prevention

Suicide remains one of the major public health problems in our society. It is estimated to account for more than 120,000 preventable deaths per year in the European Region, according to the World Health Organization's (WHO) European Health Report 2024. It is also the leading cause of death among young people (15-29 years old). Although the average number of suicide deaths in Europe between 2015 and 2021 decreased by 16.2%, some countries have experienced an increase. This is the case in Spain, with an 8.6% increase, according to this recent report. Spain is one of seven countries that have seen an increase in cases, along with the United Kingdom (+14.3%), Norway (13.5%), North Macedonia (13.3%), France (3.5%), Finland (3.2%), and Georgia (+1.6%).

In this context, the Health Committee of the Spanish Senate has received various experts on the subject within the framework of the presentation on mental health and suicide prevention.

The intervention of Dr. Francisco Villar , coordinator of the program for the care of suicidal behavior in minors at the Sant Joan de Déu Hospital in Barcelona and with more than 12 years of experience attending to children and adolescents, and their families, when a suicide attempt occurs, is highlighted.

In his presentation, Dr. Villar highlighted the numerous improvements made in Spain over the last decade regarding the prevention and care of people with suicidal thoughts. Among these interventions, he emphasized the efforts to achieve immediate follow-up after a suicide attempt, such as the Codi Risc Suicidi ( Suicide Risk Code) in Catalonia , which guarantees follow-up care within 72 hours, and the parallel support teams implemented in the Balearic Islands. The establishment of suicide prevention hotlines , with government involvement, has also marked a milestone in prevention. Other improvements include increased coordination among health, education, and social services at various levels, and the commendable work of survivor associations in providing training and support.

Despite these advances, Dr. Villar highlights the worrying increase in cases among children and adolescents.

"At Sant Joan de Déu Hospital in Barcelona, we have gone from 250 cases treated in the emergency department in 2014 to more than 1,000 annually in recent years," said Dr. Francisco Villar.

In her speech, she recalled the four aspects that the WHO identifies as key to suicide prevention:

• "Preventing access to methods , 'surely the intervention that has saved the most lives,'" explains Villar.
• Access to information about suicide methods is a significant issue . While the media has understood the issue, and numerous guides exist with recommendations on how to discuss suicide in the media , this doesn't prevent teenagers from accessing this information. "Teenagers are receiving information about the most lethal methods used in suicide attempts. This has greatly complicated the approach; pediatric care has become much more complex because interventions are longer. You already know where these kids get this information," the psychologist reflects. "The boys and girls who are suffering find satisfaction and feel understood in these online communities (many are other young people who are suffering and share their thoughts without considering the impact they have on others). This is making our lives much more difficult because it delays seeking help from those we can actually help."
• Finding mechanisms for quickly identifying children and young people who are suffering . In this regard, Dr. Villar reflects on "how the possibility of parents, educational teams, or the community being role models for these children and young people has been lost."
• Defending life means focusing on protective factors rather than eliminating risk factors. "We must confront risks, without a doubt, but we must protect those factors that allow people to acquire the skills to make the world a habitable place," Villar points out.

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Although the phenomenon of suicide is multifactorial, Villar offers some proposals that, in his opinion, can improve the situation in the case of children and adolescents:

• Regulation of access to screens and social networks for children and adolescents.
• Promote screen-free education in early stages to strengthen reading and comprehension.
• Information campaigns to raise awareness among families about the risks of early screen use.
• Greater support for affected families and educators.

For a Comprehensive Law on Suicide Prevention

Miguel Guerrero Díaz , coordinator of the Cicero Suicide Prevention Unit at the Virgen de la Victoria University Hospital in Malaga, has also reviewed the historical context of suicide prevention since Spain committed to the WHO to develop a National Suicide Prevention Plan, although this did not arrive until 2025.

Guerrero has urged the legislative branch "to urgently create a legal framework that guarantees suicide prevention in Spain, establishing the necessary structural measures and resources to address this social problem in a comprehensive and effective manner. It is essential to reduce the suicide mortality rate in our country and optimize the care provided by the National Health System."

In his presentation, Miguel Guerrero emphasized that suicide is not only a mental health problem, but a social and multidimensional problem that requires a psychosocial and community perspective, not just a medical or psychiatric one.

He also pointed out some key factors in the area of prevention:

• Risk factors not only medical : social inequality, violence, abuse, job insecurity.
• Gender perspective : 80% of completed suicides are by men, but public policies are not specifically designed for them.
• Ageism and neglect of the elderly : although the media focuses on young people, the highest suicide rates are among the elderly.
  

Risk and protective factors against suicide in older people

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• Uneven geographical distribution: regions such as Galicia, Asturias, Andalusia and the Canary Islands have higher rates.

As proposed actions, Guerrero suggests implementing a Comprehensive Suicide Prevention Law with guaranteed resources, expanding prevention beyond the psychiatric field, including social and community approaches; strengthening specific policies for the highest risk groups (men, older people, vulnerable communities), and learning from other countries where national plans have been more effective in reducing suicides.

Talking and active listening as the most effective method in emergency services

This session also provided firsthand insight into the actions of emergency services in cases of suicidal crises, presented by Sergio Tubío Rey, president of the International Association of Firefighters and Emergency Psychology of Madrid . Tubío debunked some myths surrounding these emergency interventions that have spread through social media (impossible tackles, rappelling to push the person down, etc.) and which are, precisely, "everything that should not be done in these situations." "Our objective must be to treat the person with the utmost humanity," Tubío explained, "the simplest tools are the most effective: humanity, empathy, and compassion."

The various risks involved in an intervention of this nature have been reviewed, including the emotional impact on emergency services personnel. Among the most pressing needs identified by the president of the International Association of Firefighters and Emergency Psychology in Madrid are:

• Training.
• Joint action protocols.
• Investment in material and human resources, especially to mitigate the differences in resources depending on whether it is an urban or rural area.
• Homogeneous intervention plans throughout the country.
• Emotional health plans for the participants.