MHM Magazine

Introduction. Suicide is a serious public mental health problemwith suicide rates increasing globally over the last decade and escalating rapidly since the COVID-19 pandemic. In South Africa SADAG has also seen a rapid escalation in calls to their suicide crisis line since the start of COVID 19. In 2018 48,344 people died by suicide in the USA. Suicide is also a leading cause of death amongst all age groups, and the second most common cause amongst young adults, ages 10-34 years. For each completed suicide, an estimated 29 attempts are made. Current research has shown that suicide is more than a mental health problem; it is also a socio-political disease. In most countries, suicide rates are highest in economically deprived populations. South Africa has the third-highest suicide rate of all African countries, at 23.5 per 100 000, according to the SA Federation for Mental Health. (Sept 2022) Covid-19 and suicide rates Mukthar and Candilis (2022) wrote a review, analysing the effects of the COVID 19 pandemic on suicide rates, and found that, although suicide rates were rising even before 2017, the impact of the COVID 19 pandemic had a definite influence on socio-economic and physical wellbeing of the global population, and that there was a further rise in suicidal behaviour linked to the impact of the pandemic. Their recommendations include that healthcare providers should not forget those who were affected by sequelae of the physical illness (Long COVID) and the emotional impact of the pandemic. We should continue the treatment and care for these individuals affected by COVID 19. They warn us that although we, as a society, want to move on after COVID, we should not abandon those who are still suffering the consequences. What about euthanasia? A subgroup of people who attempt suicide, consists of individuals who suffer from chronic or terminal medical illnesses. After serious consideration of their situation, they believe that they have no better option than suicide. In most cases, these people are successful in their suicide attempts. They would also consider euthanasia if the option was available. In these cases, the option of euthanasia would probably lead to a less traumatic experience for both the patient as well as their family. Why? Because suicide becomes a dirty secret of which nobody talks. We need a paradigm shift to seriously consider the wishes of these patients and having a rational discussion with them about it could be less harmful than trying to ignore this elephant in the room. Impulsive suicides are always preventable, but difficult to predict. Impulsive suicide attempts, often seen as “a cry for help”, occurs when an individual feels overwhelmed and desperate, and because of this emotional turmoil, are unable to rationally assess their situation and possible options. If we knew at this moment that the person was considering suicide, intervention would be possible and often successful. It is the unpredictable, impulsive nature of these attempts that makes it dangerous. In 90% of impulsive type of suicides, the person suffers from a psychiatric disorder, mostly undiagnosed and untreated depression. Mann, JJ, et al. conducted a systematic review and meta-analysis of articles published between September 2005 and December 2009. Their conclusion is that the best strategies to prevent suicide, includes: i. Training primary care practitioners to recognise and treat psychiatric illness. ii. Psycho-education regarding the threat of suicide for the general public and in schools. iii. Pre-discharge education and outreach follow-up for patients with psychiatric problems and suicide attempts who present at emergency departments. iv. Limitation of means to attempt suicide. Their review also showed that specific enquiry about suicidal ideation was not fruitful in predicting suicide attempts. On the other hand, discussing their problems and suicide ideation with patients, help to eventually convince them to seek help rather that attempt suicide. Conclusion. In all regards, the most successful way to treat suicide proves to be an open discussion with the patient and early diagnosis, intervention and treatment of psychiatric symptoms, especially depression. The role of suicide crisis lines is extremely important, helping patients to discuss suicidal ideation and alternative options. WE NEED A PARADIGM SHIFT IN OUR APPROACH TO MANAGE THE SUICIDE PANDEMIC EDITORIAL Dr Kobus Roux Psychiatrist Johannesburg kobusroux22@gmail.com Issue 5 | 2022 | MENTAL HEALTH MATTERS | 1 MHM