Tuesday, November 26, 2013

Israel launches first-ever national suicide-prevention council

Israel launches first-ever national suicide-prevention council
New council to reduce suicide rate includes representatives of government, HMOs, NGOs, academia and the army.
By Ido Efrati 
Haaretz - Nov. 26, 2013

The Health Ministry has established the country's first-ever national suicide-prevention council. The council will assist in carrying out national suicide-prevention programs. based on a successful pilot program conducted in three communities — Ramle, Rehovot and Kafr Kana — that ended about eighteen months ago.

The findings of the trial program showed that training gatekeepers to locate residents at risk decreases the number of suicides. People who are identified by the trained gatekeepers as potential suicide risks are referred to public mental-health clinics run by the Health Ministry for urgent appraisal, using a rapid referral procedure.

The 25-member council, headed by Professor Gil Zalsman, deputy-director of Geha Psychiatric Hospital in Petah Tikva, met last Thursday for the first time. Its members, who were appointed by Health Minister Yael German, include representatives of government ministries, HMOs, academia, the prison service, the army, the public, non-profit organizations and professionals. Its establishment is part of a broad master-plan for dealing with the issue of suicide. Talks are underway with the finance ministry for the estimated NIS 40 million per year that implementation of the plan will require.

The goals of the program are to identify people at risk, provide information and train therapists and gatekeepers, according to Dr. Boaz Lev, deputy director-general of the Health Ministry. It also aims to restrict access to items that could be used to commit suicide, such as weapons, medications and places that are likely locations for suicide.

“We must break the conspiracy of silence and create public discourse and awareness,” said Lev, who headed the steering committee that introduced the pilot program in the three communities in March 2012. Instances of suicide were significantly underreported and took place at a 20 to 35 percent rate higher rate than the statistics show, he added.

In Israel, more than 500 people (roughly twice the traffic-accident fatality rate) commit suicide every year and more than 5,000 people are hospitalized after having attempted suicide. The latest official statistics, which were published by the Knesset’s Research and Information Center last month and cover the years 2007 to 2010, show an increase of roughly 40 percent, from 290 cases of suicide in 2007 to 431 in 2010.

Still, the number of reported suicides is lower than the actual rate. The reasons for such underreporting, which have to do with stigma, shame and insurance considerations, among other things, cause health officials in many places around the world to assume that the number of actual suicides is about 25 percent higher than those that are reported. Suicide is the second-highest cause of death in Israel among males aged 15 to 24 and the third-highest cause of death in the 25 to 44 age bracket, with the suicide rate among new immigrants markedly higher than in the rest of the population.

At the start of the council’s meeting on Thursday, German said, “The time has come to push aside the stigmas that have become attached to the issue of suicide and stop sweeping the subject under the rug. Families whose members commit suicide should not have to live with a feeling that they carry the mark of Cain on their foreheads.” She added, “Suicide is not a contagious disease. We must talk about it and put it on the agenda, and do everything possible to reduce its occurrence.”

The results of the pilot program were also discussed at a meeting of the relevant cabinet ministers early this month, rsulting in a proposal that will be submitted to the cabinet soon. Besides German, the signatories to the proposal include Social Affairs Minister Meir Cohen, Education Minister Shay Piron, Immigrant Absorption Minister Sofa Landver and Pensioner Affairs Minister Uri Orbach. The Prime Minister’s Office is involved with the master plan as well. If the plan should be approved and carried out, the suicide-prevention council will be expanded to include an interministerial steering committee, a dedicated unit at the Health Ministry and a ministerial committee, among other agencies.

“The day the council was established is a special day, and I say that as one who has been working in this field for more than 20 years,” said Zalsman, the council chairman. “This is the first time that something is being done about the issue at the government level. Just like we’ve taken the approach that traffic accidents are not predestined, when it comes to suicide there are many examples worldwide of how to lower the suicide rate by means of simple actions."

"For example, the British reduced the number of pills in a bottle of painkillers, bringing down the suicide rate by 29 percent. Many times, suicide is an impulse, and if a person can’t obtain the means to do it, they’ll give up on the idea.” Zalsman added, “There are areas throughout the world that are described as ‘hot spots’ — places where people commit suicide, such as the Golden Gate Bridge in San Francisco, where 1,300 people commit suicide per year. Nets were installed there to prevent people from jumping, together with telephones to suicide hotlines, and the suicide rate declined to zero. People did not go on to the next bridge to commit suicide. They simply gave up on the idea.”

One model that the council draws inspiration from is the army’s suicide-prevention program, whose findings were presented to the council members in the opening session. According to various estimates, the army has succeeded in reducing the number of suicides from a high of 40 to 50 per year to a single-digit number by means of a system-wide change of approach that includes educating commanding officers, expanding the mental-health system and assertive treatment.

Although German took up the challenge as soon as she began her term as health minister, non-profit organizations have been working for years to raise public awareness about suicide and its prevention. One such organization is Bishvil Hahayim (Path to Life), which supports families in which a member committed suicide. “The pilot is supposed to be part of a national program, but things got stuck once it ended,” says its chairman, Dr. Avshalom Aderet, who is also a member of the new suicide-prevention council. “There is still the matter of the budget, but the fact that five cabinet ministries came on board says that after 65 years, the state will take responsibility for what happens here.”

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