Suicide prevention in the Netherlands

[pieter]

Nov 5, 2020

The Vrije Universiteit Amsterdam wants to contribute to a better world with its education and research. The VU offers high-quality, meaningful and challenging (post) academic education. With its education, the VU contributes to the society of today and tomorrow by training students for meaningful positions in society.

[pieter]

[pieter]

[pieter]

Suicide

28 August 2023

Key facts

- More than 700 000 people die due to suicide every year.
- For every suicide there are many more people who attempt suicide. A prior suicide attempt is an important risk factor for suicide in the general population.
- Suicide is the fourth leading cause of death among 15–29-year-olds.
- Seventy-seven per cent of global suicides occur in low- and middle-income countries.
- Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally.


Overview

Every year 703 000 people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the fourth leading cause of death among 15–29-year-olds globally in 2019.

Suicide does not just occur in high-income countries but is a global phenomenon in all regions of the world. In fact, over 77% of global suicides occurred in low- and middle-income countries in 2019.

Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multisectoral suicide prevention strategy is needed.

Who is at risk?

While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) and a previous suicide attempt is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.

In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners.

Methods of suicide

It is estimated that around 20% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries. Other common methods of suicide are hanging and firearms.

As indicated in LIVE LIFE: An implementation guide for suicide prevention in countries, knowledge of the most commonly used suicide methods is important to devise prevention strategies which have shown to be effective, such as restriction of access to means of suicide.

Prevention and control

Suicides are preventable. There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. LIVE LIFE, WHO’s approach to suicide prevention, recommends the following key effective evidence-based interventions:

limit access to the means of suicide (e.g. pesticides, firearms, certain medications);
interact with the media for responsible reporting of suicide;
foster socio-emotional life skills in adolescents; and
early identify, assess, manage and follow up anyone who is affected by suicidal behaviours.
These need to go hand-in-hand with the following foundational pillars: situation analysis, multisectoral collaboration, awareness raising, capacity building, financing, surveillance and monitoring and evaluation.

Suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defence, politics, and the media. These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide.

Challenges and obstacles

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. The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it. To date, only a few countries have included suicide prevention among their health priorities and only 38 countries report having a national suicide prevention strategy.

Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.

Data quality

Globally, the availability and quality of data on suicide and suicide attempts is poor. Only some 80 Member States have good-quality vital registration data that can be used directly to estimate suicide rates. This problem of poor-quality mortality data is not unique to suicide, but given the sensitivity of suicide – and the illegality of suicidal behaviour in some countries – it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death.

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.


WHO response

WHO recognizes suicide as a public health priority. The first WHO world suicide report, Preventing suicide: a global imperative, published in 2014, aims to increase the awareness of the public health significance of suicide and suicide attempts and to make suicide prevention a high priority on the global public health agenda. It also aims to encourage and support countries to develop or strengthen comprehensive suicide prevention strategies in a multisectoral public health approach.

Suicide is one of the priority conditions in the WHO Mental Health Gap Action Programme (mhGAP) launched in 2008, which provides evidence-based technical guidance to scale up service provision and care in countries for mental, neurological and substance use disorders. In the WHO Mental Health Action Plan 2013–2030, WHO Member States have committed themselves to working towards the global target of reducing the suicide rate in countries by one third by 2030.

In addition, the suicide mortality rate is an indicator of target 3.4 of the Sustainable Development Goals: by 2030, to reduce by one third premature mortality from noncommunicable diseases through prevention and treatment, and promote mental health and well-being.

[pieter]

[pieter]

[pieter]

January 2007

Obbe Terpstra is 86. He has no terminal illness but his quality of life is deteriorating, he wants to die in a dignified way. This exclusive report follows him as he prepares to commit suicide.

"I want to die. I am not allowed but I want to", states Obbe Terpstra. He watched his wife die of cancer and doesn't want to end up like that. But helping someone commit suicide is a criminal offence. His son, Albert, knows of his plans but hasn't been involved with the preparations. "He doesn't want us to see him as a drooling old man. He wants us to remember him as he is now." A month later, Obbe swallows barbiturates. "He was extremely happy. The atmosphere was like a birthday party", recalls Albert. By sharing their story, Albert and Obbe hope they will re-open the debate on euthanasia.

[karl]

Pieter

Suicide is such a terrible waste of life, primarily a long-term solution to a short time situation, for life is only time it is to be, but death is forever.

It is good this is brought into the light for public awareness and double good that there are organizations you have brought out as a light upon this situation.

Karl