Examples of prevention plans and actions at the local level
The Mental Health Strategy of the National Health System (SNS) 2019-2024 includes as a strategic line the comprehensive approach to the prevention of suicidal behavior in Spain. A line of work that the Ministry presented in September 2019 and began to work with four groups: different heads of institutions; scientific and professional societies; the media and press associations; and civil society itself, represented by patient and user associations.
The autonomous communities, with competences in health, and the provincial and municipal administrations have been developing programs and actions for years, working in a network with different health and social institutions, security bodies and associations. In Catalonia, it is worth highlighting the first prevention programs developed by the teams from the Hospital de la Santa Creu i Sant Pau and those from the Parc Taulí.
«You can always leave it for tomorrow»
The Health Department of the Generalitat de Catalunya, through its Plan Director de Salut Mental i Addiccions, is finalizing its own national suicide prevention plan. “What this plan aims to do,” explains Jordi Blanch Andreu, director of the Plan Director de Salut Mental i Addiccions, “is to work, among others, on the most important points of action that go through the improvement of primary care, as a point case detection; awareness-raising work on the stigma associated with suicide, information to the general population and networking with non-health agents such as police, firefighters or social services "..
This will be the first comprehensive suicide prevention plan developed by the Government of Catalonia, which was already a pioneer in the implementation of the Code Risc Suicidi (CRS), in 2014. The CRS has become a benchmark in Europe as a program of care for people at risk of suicide. In 5 years of operation, the CRS has treated 12,596 people with episodes of suicidal behavior. Of these, 88% have made a single attempt episode thanks to, among others, subsequent follow-up.
For Blanch, achieving the linkage of high-risk people with the mental health system is already an objective achieved throughout these years of operation.
The Codi Risc Suïcidi has done very well especially in this connection, but it remains to be seen if it has resulted in a decrease in the causes of consummated suicide since we are not seeing this yet.
Jordi Blanch Andreu, director of mental health and addictions
Areas of improvement
Despite the good functioning of the program, the system suffers from some technical deficiencies that are being worked on, such as improving the procedure for registering cases throughout the territory or being able to access information on the causes of death of people who have been on the show. “We have a very powerful system for registering attempts and we are capable of knowing, with considerable sociodemographic detail, how many suicide attempts there have been in Catalonia. We also know the people who have left the system because they have died. What we do not know is how many are by completed suicide. It is confidential information from a legal point of view, but we are studying the formulas to be able to have this information and to know if the CRS is efficient ”, explains Jordi Blanch.
Another great added difficulty is the reliability of the data and that is common in all mental health: more than half of the people who need treatment do not receive it and, of those who are in treatment, a significant percentage do not receive the appropriate one. as stated in the SNS's Mental Health Strategy itself. So you never have the full picture of the size of the problem.
A Public Health Problem
While the Plan Director of Mental Health and Addictions made progress in its suicide prevention plan, the COVID-19 pandemic arrived. “We need more time to review the data that we have been collecting”, reflects Jordi Blanch, “we see a very important reduction in the cases detected, but this does not mean that there are no attempts, but rather that they are cases that are not treated in psychiatric emergencies , which is where they register right now. It is one of the issues that we must resolve, expand the registration points.
From plan to action
«"The pandemic has helped, in a certain way, to put mental health at the forefront because never before had a world situation of this uncertainty and stress been experienced", explains Pilar Solanes Salse, Director of Envelliment and Cures of the Barcelona City Council. This situation made it possible to launch a mental health crash plan in the Catalan city, with a budget of 1.5 million euros, focused on five lines of action that seek:
- More people who know how to protect their mental health during crisis and more people prepared to face adversity.
- More capacity to detect, accompany and, if necessary, guide people who suffer from the most common problems and mental ailments towards support services.
- Specific support for groups, collectives and territories that are especially suffering the impact of the Covid-19 crisis.
- More services for the prevention and care of suicidal behavior.
- Support and accompaniment for grief
The shock plan of the city of Barcelona came to complement the Mental Health Plan that, although led by the municipal council, relies on the networking of social and health institutions, associations and various entities that work under a single philosophy: analyze and act for the promotion and prevention of mental health and for the improvement of the quality of life of people with mental health problems. Among the participating institutions are also the Mental Health Network of Sant Joan de Déu.
Cities must get involved in suicide prevention
Pilar Solanes Salse, Director of the Barcelona City Council Health Program.
"You cannot make a good prevention plan without the knowledge and proximity of the city and its agents, with the community, who are those who know the hot spots, who can contact families and help," she adds. The Director d'Envelliment i Cures of the Barcelona City Council affirms that they always work under the same motto: more mental health policies in the city and more cities in mental health policies. This motto is impregnated, says Solanes, in all the mental health policy that the Barcelona city council projects.
More than 100 calls to the suicide prevention phone in a month
At the beginning of August, two services dedicated to suicide prevention were activated: a suicide prevention telephone number (24/365), by the Fundació Ajuda i Esperança.
According to data provided by the Barcelona City Council, the Barcelona suicide prevention telephone number has registered 101 calls in its first month, 36 of which were from people with suicidal behavior. The 112 special services have been activated on two occasions.
A care service has also been launched for families, friends and people in the work environment of those who live at risk of suicide and for people who are survivors of suicide, that is, those who have lost someone close to this cause, in the Barcelona Cuida space. This point of care is managed by the associations After Suicide - Survivors Association (DSAS) and the Catalan Association for the Prevention of Suicide (ACPS).
The road has been long, it has taken years of activism, of small prevention and awareness actions from the administration and from associations linked to the phenomenon of suicide. "Suicide is the height of stigma, but in recent years we have been working so that, now, with some courage, concrete prevention actions can be proposed", explains the municipal representative, "all administrations must have suicide prevention on the agenda ».
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