0:02 [Music] my name is Dan Chism I'm the program manager for mental health here at the WHI regional office for Europe in UN City event that we are holding for all UN City on-site staff on-site as well as we are broadcasting this for the benefit of wh our country offices and it's also been recorded so for anyone you can't make it today so today is World Mental Health Day and the topic for this year's celebrating that event is suicide and it's prevention so we decided to organize this hour-long lunchtime event
0:48 in order to talk about the problem of suicide as a public health challenge we will also hear some personal testimonies about the impact the effect of self-harm and suicide at the individual level and then we'll still have some time at the end for talking about what can be done on-site here but by each of us to both support people who may be struggling or if you yourself are struggling where you can get help here or elsewhere so I will pass the microphone now to dr. Benton Nicholson who's the director of the
1:34 division of non communicable diseases and promotion of health over the life course so meant a thank you Dan welcome everybody and thank you down for setting up this very very important meeting so as you all know that we are gathered here today actually to talk about something that is very sad it's serious and it's also a sobering public health issue and I think you know you can already see that so many people have put the ball into this cylinder and I think we are not at all sort of reaching out to all the people and I have seen the faces of people sort of dropping the ball so it is really
2:19 something extremely serious and it's not only of course about people themself the individual that are doing the suicide it's also about their families and the society and all of us I would say so even if it's visible and of course we all agree it's dreadful maybe even more serious is that it's also invisible it is a lot of people that feel the stigma if they have experienced this in their families they don't seek advice they seek advice too late and and we really need to do something about this when I saw the numbers I couldn't almost believe them but and
3:05 then has reassured me that this is the numbers so it is actually 140,000 deaths per year that is attributable to suicide in double a show European region when you look into the numbers you will see that not all countries have the same challenge but some countries are really really really challenged about this and also you can see that there are gender differences so it is especially males and some of you know that we have already addressed males in the European region through the male health strategy and I think this really proves that it is needed to have a gender perspective as well I think the other thing you need
3:53 to know and hopefully remember is that this is also about protecting the next generation because it is a rising tendency to see suicide and suicide attempts among our children and adolescents so nearly one in five young people aged 10 to 19 years are estimated to have mental health conditions and 15% of all deaths in these age groups are due to suicide and in low and middle income countries in the region suicide is number one and among other countries it is number two in this age group so we believe that we have some measures we we can do more to
4:38 promote and prevent but the challenge for many governments is that this is not done in the health sector alone this is a typical multi sectoral need for an approach we have to line up with and join up with the of course the the education sector with development sector with the financing sector and so on and so forth to be able to do that and also of course we need to see that governments really and develop strategies and at the moment it's only 15 out of the 52 countries that has a strategy so we think that sort of celebrating this day even if it is a sad
5:26 message is a way for us to bring this discussion out of the shadows and also to improve the awareness and also to use the sort of the slogan of the day to focus for 40 seconds of action and together see what we can do for suicide prevention thank you Dan forward to you [Music] that's better I'll just continue to say something about the about the campaign and just build a bit on what what Ben
6:12 Tate was saying before we moved to our other members of our panel so I've got a couple of slides which we can just about see so the 40 seconds it's it's a powerful statistic so every 40 seconds someone in the world loses their life to suicide so that's three every two minutes that's 90 per hour that's 800,000 per year in the world out of which about 140,000 are in this region in Europe so it's a huge number and for every completed suicide we know that there are
7:00 at least 20 attempted suicides so these are often more hidden and that's a bit reflected in the cylinder you will see that there is nowhere near 20 times more white balls as there are red balls we'd often don't know about the attempted suicides that take place so this was one of the messages I think that comes out from this little mini campaign that we have done this this this week with the the help of the team and Tina's around somewhere who masterminded this fantastic idea of putting this cylinder just denote every person that people working here and know who have either completed or attempted suicide it really helps to personalize
7:49 the issue and make us realise that this is an issue that affects not just one or two people as a rare event that happens to other people no it affects a lot of people I mean there's at least a thousand Bulls in there and this is over of course of four days and we don't know how many people participated in this actively and in a way that doesn't matter what matters is that there are thousand balls in there for what is a small community of people working so this is part of the the need is to raise awareness about about the issue so Bente mentioned something about the numbers I don't if you can see these too well but basically two points here
8:35 that Europe as a region compared to some of the other regions of w-h-o has one of the highest rates in the world particularly you can see this yellow spike which is the male rate of suicide in european region in other regions of the world it's actually more balanced you know that between males and females but it's very very high in amongst males in this region on the right hand side you see all of the countries of this region sort of ranked by the the rate of suicide the red in the middle is for both sexes the the green is the female rate and the blue is the male rate so you can see again very visit visibly the difference between males and females and particular attention to the almost
9:22 exponential rate of suicide amongst males at the top part of that graph which is countries including Lithuania Belarus Russian Federation Ukraine Latvia and one or two others and they're part of the what are driving some of these very high rates in the in the region so the forty seconds of action that we will encouraging all of you to to participate in today is around the improvement improving the awareness about the about the issue the gravity of the issue and work understanding more about what can actually be done and also by participating in this helped to address the stigma around the issue and
10:10 some examples on the right doesn't matter whether you are the UN secretary-general who were hoping we'll participate in about an hour's time if we can put ourselves between him and the rest of the building or you're an employer or just a colleague or a friend or a family member who could help someone in need so I think you know one of the things we want to stress is that you know suicides are preventable they're not an accident waiting to happen they are all preventable so that means that we really need to understand more about the that the risk factors behind that it's extraordinarily complicated set of risk factors around individual characteristics about social determinants of health as well as maybe broader environmental or you know macro
10:56 kind of issues some of these are mentioned here so you can think of it more as these are particular groups of individuals for example who have had previous problems with mental health issues might be suffering from chronic pain or might have a substance use disorder people who are exposed to conflict violence are at increased risk and also people who are often vulnerable to discrimination including refugees and and migrants so this is the wh OHS package of interventions for suicide
11:42 prevention it's called live life and it contains a number of kind of active elements which would be including the reducing the access to the means of self-harm or suicide so in the USA that might be five firearms in particular in many parts of Asia the main cause of suicide is through ingested play plays innings pesticide poisoning so there would be reducing access to highly hazardous pesticides another very important part is is the role played by media in responsible reporting as opposed to sensationalist reporting of suicide because we know that after a suicide of a celebrity for example this can often lead to a spike of other
12:28 suicides copycats are called suicides then there's the young particularly in this region again we see over in the glut in the world we see some decline in the overall rate of suicide but in places like Europe we see an increase in the rate of suicide amongst young people which is a huge concern and so building up the the life skills the resilience the coping strategies of coping skills of young people is extremely important as a preventive mechanism and finally of course we need better services you know mental health services so people when they go to a GP or a counselor there are people who know how to to respond effectively and then the final point I'll just say here these are some of the
13:13 things that need to happen you know both at a national level it's obviously important to have a bent I was mentioning very few countries have a dedicated sort of plan or strategy about how to handle this like in so many other parts of health is a huge requirement to work together between different sectors so education I was talking about the young about the social services and other welfare service as well as the healthcare sector okay so I think at this point I will go back to my moderators chair and invite Louise who's working for one of us and you could perhaps just say a mobile for a moment say what one of us does before telling us about your lived experience
13:58 with this issue thank you okay yes and thank you for the opportunity to be here today it's very important topic and it's yeah very important that we talked about it talk about this and my name is Louisa I'm an ambassador for one of us Danis anti-stigma campaign um which works against stigma and making more awareness about mental illness and that we need to talk more about it breaking taboo and silence about mental illness and I'm here today to tell you
14:46 my personal story about about my mother and and her experiences with suicide attempts and how I experienced those attempts yeah as I said my name is Louisa and I'm 27 years old I'm a trained nurse I worked a few years at a mental health ward for children and adolescent and today I'm studying for a master's in psychology and health promotion and health strategies and I'm ambassador for one of us where I'm also a trainee in connection to my education
15:31 yeah first I want to tell you a little bit about my mom she is diagnosed with schizoaffective disorder which means that she has have episode with both psychotic and depressive episodes in her life and she has been ill for most of my life and as I remember so when I look back at my childhood and in my youth I remember her as very isolated and she couldn't participate in my life like a normal mom and she couldn't couldn't go to parent meetings or to go shopping
16:18 with me go to the impacts and all those things that a normal mom would do um because there were too many people and too much noise and she couldn't deal with that um I remember her as very angry and mostly because me and my little sister were making too much noise or we somehow disturbed her um she was very sad and I don't know why she was sad she she always just looked very sad and cried a lot but mostly she was just tired she slept all all day long and all laid in her bed all day mm yeah and when she was most affected
17:07 by her mental illness she got admitted to a mental health world several times mostly because that she had thoughts about taking her own life and when she was depressed or psychotic and yeah and I want to tell you about two episodes where she had tried to take her own life and and how I experienced that those episodes um the first one I've chosen is when I was about 14 years old and I came home I had been in a sleepover with my friends and I came home and my mom was home alone and she was sleeping and
17:54 nothing usual about that she always did that so I just decided that I wanted to clean up my room and decided to move move a big bookcase I had and when the bookcase was in the middle of the room I realized that I couldn't move it alone so I tried to wake up my mom so that she could help me and but I couldn't wake her up um and I didn't think about that I just thought she was sleeping very deep she did that mostly because of her medicine and but this time I got so frustrated that she just couldn't wake up and help me for a moment and just be a normal mom and I got so angry and
18:42 frustrated I was just sitting on the bed and cried while she was sleep sleeping and awhile as I said here on the bed my stepdad called home and asked how my mother was um and I said that she was asleep but I couldn't wake her up I didn't realize at that moment that something was wrong but he knew then that something was wrong wrong and he came home and couldn't wake her up either either and called an ambulance and a bunch of doctors came and examined her and took her in the ambulance into the hospital and in that moment I didn't really know what was going on and what was wrong with her but we didn't talked about it afterwards
19:31 there was a lot of silence that day I stayed home with my stepdad and my little sister my little sister is six years younger than me we hugged that day and we got to bed but we didn't talked about what happened I think that it was first the next day I realized that he had taken a overdose of her medicine and and afterward she got admitted to a mental health ward and the second episode was a few years later when I was around 16 years old and my mom has been stable for a while and hasn't been depressed or psychotic in for a period and it was a beautiful day
20:16 in the fall like today and the Sun was rising and we lived near a lake and a big forest and it was obvious state to go for a walk in the nature and my mom wanted to go for a walk and nothing strange about that but the only problem was that she had no intention of returning home after she has been gone for a while me and my sister were a little bored and also a little worried why she hasn't returned yet and so we took up icicles and took a ride around in the area to look for her but we couldn't find her anywhere and we went back home and told my stepdad my
21:01 sister's dead that we couldn't find her anywhere and he got worried too and tried to call her but she didn't answer her phone he tried to call friends and family but nobody had seen her and took the car and drove around and again and looked for her but couldn't find her and he called the police but they couldn't help us because she hadn't been gone for so long and so they couldn't put out a missing person report but they would try to track her down on her phone but they could only do that if she answered her phone when we called her but she didn't um and it was getting
21:48 darker and colder and we just kept looking and when it was it completely dark and he still hasn't returned we was really worried and the only thing we could do was to take some warm warm clothes on and take some flashlights and then we went to the forest and the forest was completely dark and we walked out there me my sister and my stepdad and looking for her and at that moment I I was sure that we would find her dead I remember that we came to to the beach in the forest and my stepdad said that me
22:34 and my sister have to wait while he was looking at the water and in that moment I was sure that he would find her dead in the water but he didn't and we couldn't find her in the forest it was impossible so we went back and my grim grandparents came home to us why my stepdad was out keep looking for her and why we we were at home and me and my sister got a text message from a mom and she wrote something like that she loved us and that we have to take care of ourself and each other and it this was clearly a goodbye message so we called the police again and they would send out
23:22 some dogs and policemen in the forest to look for her and in this moment I was sure that this was it now I didn't have a mom anymore but fortunately our mom suddenly answered her phone and while we called her and the police could track her down and find her and actually my step that took out and found her in the forest she was sitting cold and distant and he brought her home and she walked to the toilet and I followed her and I asked her what what did you do in the forest and she just shaked her head and said nothing and then she went to bed and the same
24:09 thing could we do and then we could just go to school and work the next day like nothing happened I couldn't I stayed home that day to watch my mom but as you can hear there was a lot of silence and when these episodes haven't and we never talked about what happened and we still hasn't talked about it as a family I have talked with my mom about them she can't remember them but she has told me that it was it wasn't her who wanted to die it was because of voices in her head that told her to take her own life but at that time I didn't know that I had just thought that she wanted to leave us
24:55 that she didn't want it to be wrong anymore or that she didn't loved us and but because that we never talked about this I got a depression when I was 20 years old I needed to deal with all these emotions and feelings that I've had in connection to my mother's illness in in connection to these episodes I got a lot of therapy and some antidepressant medication and after six months I was okay again but it is still difficult to think about these episodes and my sister is still struggling today and our family still needs to be more open and talk about this but it is difficult
25:47 yeah today my mom is well and she has partly recovered from her mental illness she only has a few symptoms but she can control them and today she has the ability to be a caring mom and do all the normal things and one would do and that she couldn't do when I was a child these pictures is my stepdad my little sister and my mom you can see em yeah and I'm telling my story is in one of us ambassador and to encourage other to be more open and to talk about things that are difficult and not make any silence and Sebu about mental illness because it's only getting worse when we don't talk about it yeah your personal story
26:47 it takes a lot of cover it courage and brave I was saying what amount of courage and bravery it takes to actually talk about these issues but what was striking is that not only the terrible consequences on you and other family members of such acts of self over a long period of time the impact on others but the the fact that as a family you aren't able to talk about it and so I think that's precisely the kind of message we want to sort of convey as you did at the end that it's okay to talk and it's also okay to be not okay and therefore to
27:34 talk about not being okay so so this was really a very very nice example of that thank you for your for your time and I think we now pass to Julie who will talk a bit about that that she and others do is the from the life lifeline NGO thank you thank you my name is Julie I work at the Danish lifeline here in Copenhagen we are an anonymous counselling service we have around 200 volunteers who work each day each night we are open until 4:00 in the
28:19 morning with responding to calls emails chats with people who have suicidal ideation not necessarily all of them have that but as a preventive measure we speak to everyone who contacts us we respond to about 14,000 people each year so that's quite a lot I am a psychologist and my responsibility is to train our volunteers to supervise them and to come out and teach the whole world about suicide prevention as I'm doing here today and I only have ten minutes and I'm completely stressed about it because it's a huge topic so if I speak too fast it's because I want to tell you everything I know in ten minutes and I know that's impossible but I'll try to give the key points at least so
29:06 please forgive me if I speak too fast I want to talk about some of the things that a really important when we talk about suicide these are the myths about suicide because all these myths work as a let's say a measure that helps that doesn't make us prevent suicide because we don't do what is necessary because we are afraid to do it so one of them is that there's a huge miss myth that suicide only affects individuals with a mental health condition like Louise's mother which is far from the truth everyone everyone can become suicidal of course if you have a mental illness many of your symptoms will be driven from
29:52 suicidal symptoms and you will have a deep hopelessness concerning will I ever become well again but everyone confronted with crisis life crisis divorced physical in as anything that sort of makes your life unstable can become suicidal it's not just for the people who suffer from mental illness next talking about suicide will leave to an encourage suicide this is one of I usually say one of the most dangerous myths that exists and it exists in everyone all of us in health care professionals I teach a lot of nurses doctors psychologists and
30:38 everyone says well if I talk about suicide if I ask them about suicide won't I just give them the good idea that suicide is an option for them and nothing could be far from the truth motorboating far from the truth you cannot give inject or anything the like other people's suicidal thoughts it comes because they are in a place where they cannot come out of and that makes them become suicidal not you I mean we can't give each other any thoughts so why do we believe that we can give each other suicidal thoughts it's a mystery to me and this is a dangerous one because it prevents health care professionals all of us in asking about
31:25 it and that's one of the reasons why we don't talk about it we are so afraid that we will sort of do harm do more harm and actually it's the opposite talking about it makes the stigma lessen it makes it easier to talk about it makes it easier to seek help and we know from research and from our experience at the Danish lifeline that talking about it actually decreases the risk we can see that when people contact us a lot of them on what we consider high risk they have clear plans for their suicide and we are able a lot of times to talk them down the risk so that we end somewhere else then when we start so talking about it helps the next myth is that suicide
32:12 mostly happens suddenly without warning we all know the the notion that I didn't see it coming I never thought that this would actually be something that he or she would do how can it be we didn't we think we didn't see the warning signs but they are there we know that around 60 to 80 percent of all suicidals have talked about it shown it directly or indirectly we're just not good enough to see it it can be said I think we have we have an urge to comfort so if someone you know tells you I feel really bad I I don't feel like being here anymore our first urge is to sort of this will
33:00 be better don't feel that way this will be better so we do not acknowledge the deep hopelessness that this person feels and that makes them feel even more suicidal because I am now saying it and it's just comforted away so we need to be able to dare to ask so if you are saying that you don't want to live anymore are you actually thinking about suicide do you have any plans in order for it to sort of lessen from the heart sort of see we can see that it's not anywhere people say they can say it indirectly or directly they can say I want to kill myself which is a very direct statement
33:45 it can also be I just I just want to crawl into my bed and not get up every morning that's also a suicide message it can also be in the observed behavior if people suddenly withdraw from everything if they've been very social and suddenly withdraw isolate themselves it can be a sign I'm not saying that everyone who is withdrawing from social events is suicidal but it makes our alarm clocks buzz if they suddenly do not take care of themselves they do not attend to their own personal hygiene this can also be a warning sign if they become promiscuous do a lot of things that they would never have done before you know a very a very strict change in behavior is
34:32 also an indication that something is wrong and people always ask me what do you do when you see that when you hear it or see something how do you how do you sort of attack that I don't say why don't you ask I have noticed that you are withdrawing from everything is it because you don't feel very well no I don't feel well okay are you thinking about suicide and when I teach about this everyone says that's very I'm not like comfortable that would be a very strong word and I don't see it it's because I'm I've been working with this for ages I know why it's difficult but it's because that we are afraid of listening to the answer we are afraid of listening to what what happens if they actually say yes I am
35:18 considering suicide what will happen to us then we're afraid to ask and we're afraid to listen but remember that listening and talking about it actually helps the last myth there are a lot of myths I've only chosen four of them but the last one is that most suicides happen around the winter holiday season we get a lot of questions concerning that maybe during the winter Christmas holiday don't people kill themselves a lot there no they kill themselves in the springtime springtime because if you've had a depression and you are waiting for it to become relieved during spring and it doesn't it's still there
36:03 all hope is gone that's when you do it not when everyone else is together on Christmas Eve is when you had to hope and that hope is taken away from you whereas other people say if you go through the the time period of getting relieved more relieved you actually get the energy to do it so when you're deep down in your depression you don't have the energy to do it but when it's sort of is relieved you have the energy to do it so that's why springtime is very important I know and I I would just you have said one of my most of the things I have the card there from your intern and I think I only have have it's not the yellow one yet is it No what I want to talk about you were you
36:50 were talking about the risk factors but one of the things I think is important to highlight is the first one a previous suicide attempt because if you have once crossed that line the risk that you will do it again is higher so if you know that someone you know has tried once be aware when they certain fall down again because there is a higher risk that if you have crossed the line if you have forced your bodies to come there where they where it can stand the pain or stand the drowning or whatever you are able to do it again and one of the other things that listening to your story Louise is actually if she hadn't talked about it in a high risk as well being related I believe to someone with
37:37 suicide increases the risk we call it suicidal transmission it's not that suicide is contagious but it is because Louise's mother is teaching her a coping strategy that if she doesn't talk about it which is wonderful that she has actually makes it a coping strategy for her as well so be aware of families with suicide yeah and I will go very briefly through there's a lot of psychological pain and I think I have cost upon it but the feeling of hopelessness the feeling that you are entrapped that there will be no other way out is something that we encounter all the time at the Lifeline they do not think that there is any way out and it's our job to try and give
38:24 them a way out that is not suicide we have talked about very briefly from my point of view what you didn't come across is the restriction of lethal weapons of lethal means we do a lot of taking away methods from the people who contact us if they are sitting with their pills in front of them we turn them to flush it out the toilet if they are sitting with a rope we tell them to put that rope in a drawer or somewhere else where they can't think about it when you see a train stations there will be fences Golden Gate Bridge put up a lot of fences to inhibit them using the method that they had chosen method restriction is one of the most preventive measures of all time so taking away their measure
39:11 them their method is really really important so keeping them safe you can see that's what you said as well all these treatment of depression and chain of care almost out of time but time for one or two questions for anyone might have from the from from the audience this afternoon any questions please thank you at what time I mean consider then we may know someone who is at risk
39:58 but they are adults and at which point can we suggest to seek help and what to do if they refuse to seek help because they are adults so we can't bring them anyway that is one of the most difficult things to persuade others to get help but by at least being there for them and and letting them know that you at least are not afraid of asking makes it easier for them to maybe understand that they need help but you should try to refer them if they need anonymous counseling it would be like a lifeline in either country tell them that there is always
40:47 another way they just they're just not able to see it right now but that you can be the bearer of hope for them you asked me how when when to do something and I think that the closer in plan people are if they have what we call set a method set a time set a and and and place yeah exactly then it's then it's dangerous the closer they are to their plan and if it's in within the next 48 hours we call it acute and we need to do something here and now but many people have suicidal thoughts without any plans and they are afraid that if they say it that you will actually contact the police or the
41:34 emergency department and that's not where they are they just want to talk they just want to be talked to and be held and be be relieved from their from their stress but the minute that you feel that their plans are set and that it's within a short timeframe then you need to act the law says so anyway so you need to follow them to the psychiatric ward if they if you can do that or call the police or someone who can take care of them but as a close related person to someone who is suicidal you also need to talk about it with someone else there is in Denmark at least an organisation who takes care of people related people
42:19 it's called Nevis ne fos but they help a lot of people who who are in a situation that they don't know how to help what to do how can I do it so trials are to find organizations that will take care of you as the relation next - did that answer your question okay [Music] other question there's a yeah a question an interesting one from one of our out posted offices and the question is what would you say one should do when someone refuses life-saving treatment if that counts a suicide in the end it is the
43:08 individuals own responsibility you can only help this far you cannot take over their life but I would take any measure to try to convince them that they need help that help is there that I will be there for them that I will listen to them and then I help them get help and that I want them to stay alive because they are a valid person in my life but at the end of the day you cannot force people to get help if they don't want to and you can't commit get them committed to to a psychiatric board unless there are in danger for themselves or for others so that is really a distinction that is
43:53 very difficult because well if you add risk at suicide aren't you at at a risk of yourself but I'm afraid to say that many psychiatric wards won't admit people unless they actually have herself harmed so it's not just the ideation that makes them be admitted to a psychiatric ward and that is something that maybe on a political level would be needed to to be addressed okay so I think we need to draw things to a close we've ranged from everything from suicide as a global public health challenge and a SDG indicator down to extremely personal stories of the impact
44:38 of self-harm and suicide at the individual family community level and we've also talked a bit about the things that we can all do and learn and how to be better listeners and we have some very good practical tips and suggestions about about that so I think it's been a great session so I'd like to very much thank the all of the the panelists and the colleagues here for their time and to you for participating in the session and if you want to share this with other friends colleagues please feel free to do so
45:24 you
