Why were rosary beads nestling a tatty Times cutting on my colleague’s desk? The headline read, ‘He saw all patients before ending his life’.

“Now you know.” Startled, I turned around. With teary eyes, he clutched the rosary beads and article as he spoke. “Dad suffered in silence, battling depression, sanctimoniousness, and marginalisation. He helped everyone. He worked hard. He made many happy. He was loved. He soldiered on. He got many ‘thank you’ cards. Yet, nobody ever started a conversation with him about his torments. He was human. He was found in his office by the ward. The church was packed, but nobody noticed. “Why?” His fists tightened. “If only they reached out.”

This gut-wrenching narrative is an increasing reality among professionals. This is the very narrative we must redesign. WHO, the International Association for Suicide Prevention, and Crisis Teams, are all hellbent more than ever before to jolt the world to ‘Change the Narrative’ and ‘#StartTheConversation’ to stem this taboo. 

In the US alone, a medic dies by suicide daily, while in the UK one dies every ten days. Twelve took their lives in Malta between 1970 and 2023. Some 500 educated Maltese professionals contemplate suicide annually. The rates are estimated to be higher among blue-collar workers. The general population suicide rates are thankfully lower here (6.1 vs. 14.3 per 100,000 in the US), thanks to the crisis line, texting, and Krizi app. However, people are not numbers. One loss is one too many. The objective remains zero suicides.

How could such pain go unnoticed? Can such turmoil be hidden? Sadly, it can. Psychological issues can affect everyone. They dull one’s cognitive functions. Fear of missing promotions, being labelled as incompetent, shame, burnout, or misplaced expectations by others are the main drivers for suicide. Hopelessness and helplessness set in. Despair follows. Without help, the narrative ends, tragically. 

Presently, nothing threatens mental health more than suicide, as worldwide figures point to an evolving crisis. What could have reasonably been done to save this life and that of so many others? 

Suicidology expert Professor Sir Louis Appelby, an adviser to our strategy and lead author of the UK’s 2023 National Suicide Prevention Strategy, broadens the question: “What more could we have done collectively — society, governments, workplaces, charities, schools and universities, the media, all of us?”

In this renaissance for self-harm management, tackling suicide assertively, scientifically, and strategically is the next big thing in mental health. Malta’s National Suicide Prevention Strategy contains 3 key objectives:

1. Reduce the suicide rate over the next ten years;

2. Improve support for people who have self-harmed; and

3. Improve support for people bereaved by suicide.

These are also the targets ensconced in our ‘Fondazzjoni Sokkors Fil-Pront’, which advocates, among other things, an office for suicide prevention, a Suicide Prevention Act, and a commitment to rope in national entities and coordinate them to maximise saving lives. 

Our strategy must mirror Biden’s 2024 strategy, incorporating four strategic directions:

1. Community-based suicide prevention, which includes reducing lethal means, safety for those at risk, postvention supports, and recruiting trained crisis managers at establishments akin to first aiders at work. Adjourning professionals to the acute crisis syndrome will identify key risk dimensions like entrapment, hyperarousal, and social withdrawal to strengthen risk assessments.

2. Treatment and crisis services. While there are nearly 1,000 crisis centres in the US, there isn’t one at Mater Dei Hospital. No dedicated emergency response vehicles are available either. 

3. Surveillance, quality improvement, and research. Malta is an ideal test bed to collect good-quality data, showcase research, and implement policies and projects to terminate suicide. 

4. Health equity in suicide prevention. Make no mistake: all stakeholders need to be involved in a dynamic manner, pooling resources and expertise as well as lived experiences (GPs, psychologists, VIPs, etc. are on board — watch this space). Otherwise, the strategy will never achieve its full potential. 

Focusing on relationship problems, isolation, illness, alcohol and drug abuse, and financial burden will address more than 75% of the causes of suicide. Myths don’t help. Suicide is never a sign of weakness or selfishness. People are not banished to hell if they die by suicide (a mother was tortured by this notion for years until a good priest assured her otherwise). Finally, with some unfortunate exceptions abroad, it is not a crime. 

“I miss him. I pray for him every night; I pray that others will talk.” My colleague is right. Start talking. Ask if they are suicidal. This won’t worsen things. Don’t lecture, scold, patronise, or belittle. This is the lowest ebb of their life. Stay with them until you get help. Support the implementation of the 200 suggestions in the strategy to prove that life is challenging but beautiful. Start the suicide conversation now.

If you are in crisis, call the free 24/7 crisis line (+356 99339966), use Facebook Messenger, or use the Krizi app. 

Dr Mark Xuereb is a psychiatrist who leads the Crisis Team.

Main photo: Fernando Cabral