World Suicide Prevention Day 2021: How to help

Every few seconds, someone loses their life to suicide. The figures are alarming since according to the World Health Organization, more than 700,000 people die by suicide each year. Suicides and suicide attempts have a ripple effect that impacts on families, friends, colleagues, communities and societies.

Work that is interesting and fulfilling is good for mental health, but a negative working environment or work-related stressors can lead to physical and mental health problems. However, much can be done to prevent suicide at individual, community and national levels. It is important for employers and others in positions of responsibility in the workplace to put in place measures to promote the good mental health of their employees, and to have a plan for supporting employees and colleagues with mental health conditions or who may be at risk of suicide.

Suicides at sea: Where we stand

Seafarers are amongst occupational groups with the highest risk of stress. While stress and anxiety affect a lot of people, their impacts could be more severe to seafarers due to the nature of their work. In the shipping world, mental health issues relate to the nature of seafarers’ job which is characterized not only by intensive work hours, but also by isolation, being away from family for too long, fatigue, and many others.

Recently, a research showed an increase in suicide attempts among seafarers since the beginning of 2020, in a time when COVID-19 pandemic left thousands of seafarers stranded onboard for prolonged periods away from family, adding to the already emerging issue of crew mental health. What is more, last year ISWAN noted that reports of seafarers stranded on cruise ships taking their own lives have highlighted the dearth of reliable information about suicides at sea.

As such, the shipping industry has increased its focus on seafarers’ mental health in the last years, referring to the major human and financial risks that could arise in case a seafarer had a mental health crisis while on duty.

Key statistics on suicide among seafarers:

• Every 40 seconds, someone in the world loses their life to suicide, said the World Health Organization, who shed focus on suicide prevention on the occasion of the World Mental Health Day 2019.
• A 2018 study by Sailor’s Society and Yale University to more than 1,000 seafarers showed that over 25% of seafarers suffered from severe depression and nearly half of them (45%) had not asked anybody for help.
• A 2020 wellness survey by Filistos ASCOT SA and partners on 4,989 seafarers revealed a significant increase in depressive symptoms and showed that the percent of people that have seriously thought about ending their own life in 2020 has more than doubled amongst seafarers. Preliminary data show there is an increase on suicide attempts since the beginning of 2020, especially since March. This number is extremely high, and interventions must be planned and put into action.
• A compilation of 20 published reports covering the years 1960–2009, showed that 1,011 seafarer deaths out of 17,026 total seafarer deaths were by suicide – for a percentage of 5.9% of all deaths. They ranged from a low of 3.1% to a high of 18.0%.
• A second compilation of 12 reports of deaths due to illness from 1992–2007, showed 590 seafarer deaths by suicide out of 4,573 deaths due to illness, or 13.1% of deaths. In these 12 studies the percentages ranged from a low of 5.7% to a high of 27.5%.

Signs to look out for

• Expressing thoughts or feelings about wanting to end their life, or talking about feeling hopeless or having no reason to live;

• Talking about feelings of loneliness, withdrawal from others or social isolation, being a burden to others, or in unbearable pain;

• Agitation, violence, distress, or difficulty communicating (observed during a consultation or mentioned as problems);

• A change in eating or sleeping habits;

• Signs of cutting or self-harm;

• Arranging end-of-life personal affairs, such as writing a will; and/or

• Absence of supportive family members or other psychosocial support.

4 Effective Interventions that can prevent suicide

WHO advocates for countries to take action to prevent suicide, ideally through a comprehensive national suicide prevention strategy. Governments and communities can contribute to suicide prevention by implementing LIVE LIFE – WHO’s approach to starting suicide prevention so that countries can build on it further to develop a comprehensive national suicide prevention strategy.

The guide focuses on the following interventions as effective ways to prevent suicides:

1. Limit access to the means of suicide
2. Interact with the media for responsible reporting of suicide
3. Foster socio-emotional life skills in adolescents
4. Early identify, assess, manage and follow up anyone who is affected by suicidal behaviours.

What you can do to prevent suicide

• Allocate sufficient time to talk to the person in a private space
• Show empathy and try to establish a positive rapport
• Lead into the topic gradually, to gauge the current mental state of the person before asking directly if they have thoughts about suicide.
• Asking about suicide does not provoke suicide, but can reduce anxiety and helps the person feel understood.
• If the person confirms that they have thought of or are thinking about suicide, ask follow-up questions to ascertain whether they have made concrete plans.
• If the person has suicidal thoughts or plans, but the plan is not concrete or immediate offer emotional support and encourage them to talk about their suicidal feelings; explore reasons and ways to stay alive;
• Provide them with details of a mental health specialist if possible, and maintain regular contact, initially by making another appointment;
• Reach out to family or friends and community resources, and provide details of community services including crisis lines.
• Ιf the person has a concrete plan, including the means and the intention to die, stay with the person, remove the means of suicide, consult a mental health specialist,
• Stay with the person to ensure that they are not left alone until further specialist support is in place.

Challenges and obstacles

#1 Stigma and taboo
Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need. Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide. In this context, the International Association for Suicide Prevention has recently lauched the report, Decriminalising Suicide: Saving Lives, Reducing Stigma, examining the civil laws which criminalise suicide and the implications they have around the world.

#2 Data quality
WHO estimates that the availability and quality of data on suicide and suicide attempts is poor at a global level. As such, improved surveillance and monitoring of suicide and suicide attempts is required for effective suicide prevention strategies. Cross-national differences in the patterns of suicide, and changes in the rates, characteristics and methods of suicide, highlight the need for each country to improve the comprehensiveness, quality and timeliness of their suicide-related data. This includes vital registration of suicide, hospital-based registries of suicide attempts and nationally-representative surveys collecting information about self-reported suicide attempts.

Key considerations

Research has shown that many people who die by suicide have seen a health worker in the previous month. Therefore, all health workers have an important role to play in recognizing, assessing and supporting people who are at risk of suicide.

Also, WHO highlights that media reports have the potential to either strengthen or damage suicide prevention efforts. Responsible reporting about suicide can help educate the public about suicide and its prevention, offer hope to people at risk, reduce stigma and inspire an open and positive dialogue.

It is important to always consider and assess for risk factors for suicide. These include previous suicide attempts, depression, alcohol or drug use problems, other mental health conditions such as psychosis or bipolar disorder, severe emotional distress, chronic pain or illness, experiences of trauma (e.g. sexual and interpersonal violence, war, abuse, discrimination), recent loss (e.g. unemployment, bereavement, relationship break-up) or financial problems.

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