Let's say I'm talking about suicide

Abstract

Talking about suicide has always been considered taboo by society. Despite this, and thanks to the awareness-raising work of psychiatrists, psychologists and nurses, among other professionals, more and more people are talking and hearing about 'the action or result of killing oneself', which is the meaning that the term has in Spanish from the Latin sui 'of oneself' and -cidium '-cide'.

A few days ago, the overwhelming reality that suicide has become the leading cause of unnatural death among adolescents appeared on the front page of several media outlets. According to INE data collected in 2019, it is the second leading cause of death in minors aged 15 and older, behind only cancer. This means that 41.94% of deaths in this age group are due to suicide. And it is not only among adolescents; suicide is the leading cause of death in Spain between the ages of 15 and 29, according to data provided by the INE that same year. Before the pandemic, it was already the second leading cause of death among adolescents but, even now that it has become the first, society is unaware of this fact and is surprised when it comes across the reality through its own experience or through the sporadic information that, from time to time, assaults the news screens or the pages of the newspapers. The surprise is accompanied by confusion, pain and bewilderment, since people in these age groups are supposedly full of life and illusions. As a mental health professional, this fact reminds us of the battle ahead of us against the stubborn and taciturn enemy of mental health stigmatization.

José Antonio Luengo, Secretary of the Governing Board of the Madrid College of Psychology, is right, in my opinion, when he states that "suicide in adolescence is a real public health problem". As such a problem, we must invest in its prevention and in the early detection of warning signs that may indicate an imminent risk of suicide. Without a strategy to prevent suicidal behavior, we will not be able to address the problem in a relevant way. Thus, for example, the first interventions against this new threat to the health of young people should begin in schools and colleges. In these educational settings, where this age group spends a large part of its time, the signs or signals can be detected that are manifested prior to suicidal behavior in adolescents. Special attention should be paid to bullying, which can lead to self-harm attempts. For this reason, conferences on suicide prevention in adolescents, such as those given by the School Council of Madrid on April 28th, seem to me to be absolutely necessary tools to prevent the risk of this other silent pandemic. Thanks to these and other interventions, talking about suicide will become less and less taboo and we will contribute, as a society, to adolescents daring to verbalize their suicidal impulses.

In my opinion, mental health professionals, who deal daily and on the front line with self-injury attempts by children and adolescents, must undertake the arduous task of making parents and guardians understand that, beyond concerns about studies, drugs, sex, social networks, etc., there is also the concern about the risk of suicidal behavior in young people. Especially, from the child and adolescent mental health services, we must try to disprove hoaxes such as "if I don't talk about suicide, they won't do it" or "those who say they are going to commit suicide will never do it".

Among the reasons why suicide in adolescence is the leading cause of death among young people is the great emotional instability inherent to this stage of life. If to this reason we add the lack of self-control of adolescents or the low self-esteem of some young people, the risks of falling into suicidal behavior are significant. Therefore, if situations such as the aforementioned bullying at school or with peer groups, or belonging to dysfunctional families, or being exposed to stressful situations, the risk increases exponentially. At present, the pandemic caused by COVID-19 has put the general population under high pressure and has put a considerable strain on the mental health of the population in general and adolescents in particular, doubling the risk of suicide.

Since the beginning of the pandemic, mental health professionals have repeatedly said that each wave caused by COVID.19 is followed by a strong mental health undertow, which has been evidenced in psychiatric emergency departments, both for adults and adolescents. The increase in the demand for admission to the short hospitalization units for children and adolescents has led, at least in the Community of Madrid, to the appearance of a waiting list for admission to acute hospitalization health facilities that is a veritable tsunami that is not being talked about. Why this tsunami? Obviously, because children and adolescents are especially vulnerable to the changes that have occurred in lifestyles due to the pandemic, since they are not well or fully capable of emotionally managing such drastic changes in their environment and in their social and family life.

Without wishing to overwhelm the reader, here are some data on the tsunami. At the Hospital Sant Joan de Déu in Barcelona, there was a 47% increase in the number of patients seen in the emergency department for mental health reasons. As many as four suicide attempts a day were attended to in the children's emergency department of this hospital. In Madrid, at the Gregorio Marañón Hospital, the demand for hospitalization of children with mental health problems has grown by 400%, while at the Puerta de Hierro University Hospital the demand in the general emergency department has increased by 310%. The latest official data show that the demand for mental health appointments in Madrid doubled in April 2021 and urgent referrals to mental health services tripled.

Data such as the above invite us to reflect on the importance of proper management of these patients in emergency departments, as they generate a high care burden and are difficult patients to manage. The role of general emergency nurses and, in particular, pediatric nurses during these months has been fundamental and should be publicly emphasized. Now, hospitals such as Gregorio Marañón and Puerta de Hierro have taken a step forward in pursuit of excellence in care and are beginning to develop the figure of the specialist mental health nurse in hospital emergency departments to provide more direct care to patients and families and considerably reduce the risks inherent to these patients in times of crisis, in addition to other improvements in care such as reducing waiting times in the emergency department. Mental health specialist nurses in the emergency services also offer advice and personalized attention through telephone follow-up of patients discharged from child psychiatric emergencies until they are connected with the mental health center, thus reducing revolving doors and preventing the patient from getting lost in the cracks and nooks and crannies of the health system.

In short, for a better approach to suicidal behavior in adolescents, the figure of the mental health nurse in hospital emergency departments becomes a solid dike against tidal waves or tsunamis such as the current one, derived from COVID-19, or others that may occur in the future. Its incorporation into hospital emergency departments has multiple healthcare benefits. For example, it reduces the work overload of emergency nurses and makes possible specialized care for these patients and their families that would otherwise not be adequately covered. This relieves the pressure on emergency departments. In addition, it prevents the risk of absconding, reduces unnecessary physical restraint measures, facilitates the connection with the mental health circuit after emergency care and short hospitalization unit admissions when necessary. In short, these and other health care benefits, which we do not refer to here, make the figure of the specialist mental health nurse in the emergency department a prerogative of excellence for those hospitals that have decided to implement this service which, incidentally, also brings significant economic dividends for the health care system.

Confronting the taboo of adolescent suicide involves not only talking about what seems to be hidden from mention, but also undertaking actions that, through care or prevention, help to avoid or reduce self-injurious behavior in adolescents. It is of paramount importance to preserve the mental health of young people. To protect their health is to ensure the welfare of society, since mental illness entails enormous suffering and a reduction in the quality of life of people suffering from these disorders. I believe that I am not going too far if I emphasize the importance, in social and personal terms, of all of us working on the early detection of these disorders in adolescence and their appropriate management. I also believe that we must pay attention to the adults who care for or are in charge of our young people. For these parents or guardians, information campaigns and, in certain cases, professional help are necessary. The mental health of all of us is at stake.

Irene Anula Morales