Suicide is a major public health problem in Switzerland, with 15,000 to 25,000 people attempting suicide every year while some 1,300 people kill themselves. However, prevention programmes to date have been piecemeal at best.
Without a federal law covering suicide, such as exists for road safety and tobacco use, there can be no national strategy and no federal funding allocated to the issue. It is up to the 26 stand-alone cantonal health systems and charities to address the problem.
«There is no legal basis on which we can do something on a national level about mental health and suicide,» Barbara Weil of the umbrella suicide prevention organisation Ipsilon told swissinfo.ch. «We have laws on addiction, tobacco use, transmissible diseases and there it is possible to have national programmes.»
At risk
According to Weil, key elements of prevention include the restriction of means of committing suicide, tackling the taboo of mental illness, and working with professionals, such as general practitioners and teachers, who come into contact with people who might be depressed or suicidal.
A recent study of suicide attempts in Basel throws light on who is most at risk (see infographic).
The study, which appeared in Swiss Medical Weekly, offers the first published representative data of a Swiss canton. It concluded that specific prevention efforts «should focus on persons at risk who were characterised as being younger, foreign, living alone and being unemployed».
Researchers identified two peak age groups for suicide attempts: 30 to 34 years followed by 20 to 24 for men, and 20 to 24 followed by 25 to 29 for women.
Aftercare
The highest risk group of all includes those who have already attempted suicide, more than half of whom will make repeat attempts, senior author of the study Anita Riecher-Rössler of Basel Psychiatric University Clinics told swissinfo.ch.
«As shown in our study, 98 per cent of the patients had a psychiatric diagnosis to start with. All of these people need very intensive aftercare, not only to prevent a repeated suicide attempt but also to treat the psychiatric disorder.»
With Switzerland’s exemplary health care system, surely this care is available? In theory yes, according to Riecher-Rössler – the care is offered, but people still slip through the cracks. Because of a strong emphasis in Switzerland on patient autonomy, «aftercare just stops when patients don’t turn up for appointments.»
Riecher-Rössler believes more needs to be done to restrict access to means of committing suicide. «There are a lot of possibilities in Switzerland, for example army guns [kept] at home and you still can get very toxic medication, such as paracetemol, over the counter.»
«We often have suicide attempts, not only with sleeping pills but with painkillers, which are very toxic, so that people who have taken a lot of them often can’t be rescued.»
Assisted suicide
From being one of Europe’s suicide black spots, the Swiss suicide rate has declined over the past two decades, reaching 12.5 per 100,000 population in 2009.
«In the Swiss mentality you have the opinion that I can do with my life and my body what I want to. This has an influence on how suicide problems are viewed in society. People think the act has been well thought through, that it’s an expression of free will and you can’t do anything about it, which of course is not the case,» Weil said.
«In my personal opinion there is a place for assisted suicide only when we are giving as much care to people who want to die through assisted suicide as we give people who have made a suicide attempt,» she added.
In May the European Court of Human Rights ordered Switzerland to clarify whether and under what conditions individuals not suffering from terminal illnesses should be helped to end their own lives medically.
In the Basel study, a second peak in suicide risk was observed in the elderly, most notably among men aged 85 to 89 and women aged 60 to 64.
«We are so focused on youth suicide prevention that we forget that the suicide rate skyrockets in elderly people. This is a huge problem. Because they are older, people say they’ve had their lives so it’s okay, which it’s not,» Weil said.
«The early detection of depression and suicidality in elderly people is needed just as much as for youngsters,» she added.
Help
One of the longest-running organisations dealing with suicide is the telephone helpline Die Dargebotene Hand (Helping Hand), set up in 1957. Today its remit is much broader, but there are still some 1,500 people a year who dial 143 seeking help for suicidal feelings.
«When suicidal people call us, it is a sign that they still want to keep a foothold in life, despite their wish to die. The conversation is about strengthening that foothold to make it possible to take the first step out of a suicidal crisis,» Franco Baumgartner of Die Dargebotene Hand told swissinfo.ch.
«It is very important that we respect the person’s suicidal wish and not immediately question it or try to talk the person out of it. People in an acute suicidal crisis mostly have a very narrow perception of reality. They see no other way out at that moment.»
According to Riecher-Rössler, most people are relieved to still be alive after a failed suicide attempt. «Very often they say: ‘I just couldn’t cope anymore, I just wanted to sleep, I didn’t want to die really, just wanted to get away from this dreadful situation’.»