In fact a psychiatrist who works within these first response structures in Malta explained, the number of cases that involve self-harm or attempted suicide that are treated within an emergency department may be as high as two per night.

“Every night that I was working at the hospital in Malta I used to have a minimum of two cases, if not more, who were attempted suicides.”

He went on to note that not all attempts have lethal intentions and are rather cries for attention and help.

Self-harm cases are responded to by assessing and treating the biological component as well as the psychological one. For instance, if a patient comes with an overdose, doctors would first need to detoxify the patient.

Then, there is a process of assessing whether the patient intended to die by suicide or was solely self-harming. An indicator of a fatal intention, for instance, is the presence of a suicide note.

In the latter case, the patient is usually sent home and receives follow up treatment from there. However, if the patient intended to die they are sent to Mount Carmel Hospital for treatment. This hospitalisation is only temporary in order to get the individual back on their feet.

VSM offers Suicide Prevention Outreach and Therapeutic Services (SPOT) to support people who have been affected by suicide as well as people who struggle with suicidal ideation – having thoughts about suicide. For long-term treatment and support, psychiatrists may refer those who are impacted by these incidents – including survivors and family members – to SPOT.

A police inspector within the crisis intervention unit, as well as many of the mental health professionals consulted by VSM for this report, insisted SPOT was “necessary”. They said that before it was established, supportive resources for people affected by suicide were limited. Today, they are referred to SPOT which offers consistent support.

The report emphasised the fact that suicide is multidimensional and so anticipating and responding to it is complex. The factors that ultimately lead to suicide are individual and diverse some are a result of long-standing mental health issues while others “just happens apparently out of nowhere”.

So, they need to be evaluated and responded to on a case-by-case basis.

Suicide as a prohibited subject

The report went on to address the way suicide is approached in public and it noted that the professionals addressed held varying opinions but they did agree on three points.

First is the argument that shame can be amplified by the fact that suicide is a prohibited subject in Malta – meaning it’s not talked about much if at all.

“I think that does more harm than good. We need to create enough space and awareness for people to feel ready to seek treatment. There should be more education and awareness about it. Consistent messages about what to do and what not to do are important.”

Second, is that the details of the case – how, where, and who – should not be reported so as not to “normalise” the act. Third is the risk of “copy-cat suicides”. People who contemplate suicide but have fear currently holding them back may gain the courage after noting that others are actively doing it.

“In my career I have never had a client who comments negatively about someone else who died of suicide, there is empathy and sympathy and sometimes some unhealthy admiration for those who have gone through with it,” another psychiatrist noted.

On this point, one psychiatrist did say that reporting on suicide is beneficial for family members suffering through a loss because of the comfort of knowing that others are suffering through a similar loss.

This is particularly interesting because, as it stands, Malta does not report on deaths caused by suicide. Whereby the police would always release information to the media about deaths that did not result from natural causes – be it through murder or an accident – it does not share anything related to suicides.

Suicide and society

VSM’s director Karl Grech further shed light on how society’s approach to suicide has evolved, saying that the community still has a long way to go.

He explained that the stigma is still very strong, arguing that people often perceive individuals who attempt or complete suicide as crazy and avoid associating with them.

This is dangerous because people going through these struggles require a lot of connection.

Meanwhile, there is a persistent and inaccurate fear that if a person were to open up about their suicidal ideations, they would be locked up in a psychiatric hospital.

“This is a myth, in which most of the time this is not the case, unless there is a serious level of threat to this individuals life.”

SPOT is funded through a public social partnership with the Ministry for the Family, Children’s Rights and Social Solidarity.

For individuals in need of professional assistance regarding mental health, it is advisable to contact either 1579, 1770, or visit Kellimni.com. If anyone has been affected by suicide, they can also contact VSM on 21228333 or [email protected].