Abstract
Taboos surrounding suicide still exist in Spain and prevent people from talking about it, writes
Guerrero’s words reflect the patina of rejection and shame that still covers the treatment of suicide in Spain.
According to data from the National Statistics Institute (INE), 3,679 people took their own lives in 2017. That figure – the highest in the last 12 years – means that an average of 10 people die by suicide every day in Spain. And there might be many more.
Javier Jiménez, a clinical psychologist and member of the Asociación de Investigación, Prevención e Intervención del Suicido Network, which works to prevent suicides, told Index: “There are about 8,000 accidental deaths in Spain every year and it is very difficult to prove which of them are suicides. Many suicides are registered by the Judicial Commission as accidents, such as ‘accidental drug intake’ or ‘accidental fall’, because there is neither a farewell note nor a witness to confirm them.”
Suicide is the main reason for deaths in Spain which are not the result of disease, double the number caused by traffic accidents.
Next year will mark the end of the World Health Organisation’s mental health action plan 2013-2020, which saw member states committing themselves to work towards reducing suicide rates by 10%. However, in Spain, suicide remains not only a social taboo but a political, media and educational one, too.
The origin can be found in Spain’s religious heritage. As Jiménez said: “For 1,500 years, both the victims and their families have been severely punished. Until 1984, a person who had committed suicide could not be buried in a Christian cemetery.”
Families hid suicides so as not to be marked by the stigma of sin, and the tradition has evolved into what Susana al-Halabí, professor of the department of psychology at the University of Oviedo, calls the current “philosophy of happiness”, which “generates a breeding ground for hopelessness”. According to al-Halabí: “In the era of social media and feigned happiness, those suffering feel abandoned: lacking a space to express themselves to have their suffering validated by others.”
The social taboo is also reflected in media coverage.
Coral Larrosa is vice-president of the National Association of Health Reporters and a health journalist for TV channel Telecinco. “There has always been kind of a tacit agreement whereby suicides were not reported to avoid imitation,” she said.
This refers to the so-called Werther effect, the imitative effect of suicidal behaviour. On the other side is the Papageno effect, which says that good information related to suicide may have a preventive effect.
International bodies such as the WHO, which states that “responsible reporting of suicide in the media has been shown to be effective in limiting imitation among vulnerable people”, and The Lancet Psychiatry journal are trying to reverse the trend of ignoring suicides.
Larrosa says that outlets are now being told that not reporting suicides does nothing to discourage others, adding: “We have to report not only on the event itself but on mental health, while giving tools to people who may be going through it.”
To this end, guidelines for suicide coverage have been published recently. Recommendations from the Mental Health Observatory include avoiding describing the method used and highlighting information on where to seek help.
The WHO also offers resources for media professionals, but this document has not been translated into Spanish and it is up to local or regional associations to adapt these guidelines.
Larrosa feels this puts a lot of responsibility on the media. “We are not health or justice workers. The administration cannot leave its responsibility of reaching society in the hands of the media,” she said.
There are many apparent deficiencies in the treatment of suicidal behaviour in the country.
First, there is no prevention plan at a national level, despite legislative initiatives such as the motion promoted in 2017 by the Unión del Pueblo Navarro party, which called for a national suicide prevention plan.
The motion was approved by Congress, but the resignation of Carmen Montón, the then minister of health, paralysed the process.
Even universities fail to adequately talk about suicide. There is no suicide treatment and prevention course at any of the 29 Spanish psychology faculties, with only Seville’s Pablo de Olavide University offering an online master’s degree in suicide prevention. The Acting Against Suicide workshop at the Universidad Autónoma de Madrid and the summer course in prevention and intervention in suicidal behaviour at the University of Castilla-La Mancha are the only others on offer.
Independently, the Spanish Foundation for the Prevention of Suicide has launched the Institute of Training in Suicidology.
“Thousands of psychologists are graduating every year without preparation in this area,” said Jiménez. “We must teach how to detect, intervene and treat suicidal behaviour.”
In response to this educational gap, psychologist Aminta Pedrosa decided to contact all faculties of psychology, medicine, nursing, social work and occupational therapy with a proposal to include training in suicidal and self-harming behaviour in their curriculum. Only five faculties showed interest.
“Everything is left to the personal initiative of professors who decide to talk about suicide,” Pedrosa said.
And this is not easy, because the taboo exists also among professionals, who are cautious of tackling the issues with their patients for fear of exacerbating them.
As a consequence, care for those affected is largely in the hands of independent non-profit associations.
“At AIPIS, we are totally overwhelmed – even people from South America write to us,” said Jiménez.
In addition to the lack of human resources, there is no public funding. “Not only do we not receive financial support, we are not given any premises for, for example, training activities.”
But some regional governments and independent groups are mobilising to try to help solve the problem.
CREDIT: Jessica Durrant/Ikon
In the Extremadura region, a protocol to detect suicidal behaviour is being implemented in 2020. The Balearic Islands’ government is promoting a protocol to prevent suicide in schools and, in Catalonia, the Codi Risc Suïcidi (Suicide Risk Code) programme has been
working since 2014, ensuring a homogeneous response by emergency services.
So how can suicide figures be reduced? Breaking the taboo through communication seems essential. As Pedrosa says: “The number of victims of traffic accidents has been greatly reduced since communication campaigns have been carried out, and the same can be achieved for suicide.”
Al-Halabí highlights the “emotional ventilation” generated by talking about suicide.
“Sharing those thoughts is a great relief for people who suffer them,” she said. “There is a myth that if a person talks about suicide, the chances of carrying it through might increase. On the contrary, it creates an opportunity for that person to ask for help.”
