hospital - Hagai Frid - August 17 2011
Haifa’s Elisha Hospital. Photo by Hagai Frid
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Tomer Appelbaum
Dr. Avshalom Aderet Photo by Tomer Appelbaum

A three-city pilot program to reduce the number of suicides appears to be on its way to nationwide expansion, and it could end up enlisting the help of taxi drivers and hairdressers. Under the pilot program, which lasted nearly two years, the number of suicides dropped from a combined tally of 17 in Ramle and Rehovot last year to five this year. There have been no suicides in Kafr Kana since 2010, although there were two suicides per year between 2006 and 2009.

Suicide is less prevalent in Israel than in some European countries - 9.6 men and 3.5 women per 100,000 people take their lives every year in Israel, compared with a high of 51.7 men in Russia and 9.2 women in Hungary. But more Israelis commit suicide in a typical year than are killed in traffic accidents.

"The new data show that the number of suicides is 20 percent to 30 percent higher than the number of those killed in traffic accidents, so we need a funded national program to deal with this phenomenon, similar to the program for traffic accident victims," said Lior Carmel, the director of the pilot project and a former director of the National Road Safety Authority.

About 400 people reportedly commit suicide in Israel each year, compared with the 356 people killed on the roads this year. But a comparison between death certificates and medical records conducted as part of the pilot program found that the real number is 19 percent to 22 percent higher, since many relatives don't want suicide listed as the cause of death on the death certificate. Immigrants constitute about one-third of the country's suicides.

The nationwide program, which is being promoted by the Health Ministry and which must still be brought before the cabinet for approval, is expected to cost NIS 40 million a year, after a gradual increase over five years. The NIS 5.6 million pilot was funded primarily by the Health Ministry and the American Jewish Joint Distribution Committee.

The program will train fessionals in certain fields - such as doctors, social workers and National Insurance Institute officials - to identify possible suicide risks and help them get the assistance they need.

Other so-called "doorkeepers" who will receive the training include workers who set the schedules for security companies, since security guards have been targeted as a risk group because they work long and often lonely hours - with a gun at their side.

In the long term, taxi drivers might also receive the training, as they do in a similar program in Scotland. And hairdressers, who have been trained to spot suicide risks in a South American program, might also be taught to do so here.

"Doorkeepers can be anyone who comes into contact with the population, who is capable of identifying unusual behavior associated with mental distress and a call for help, from certain body language to people saying, for instance, 'I'm sick of living' or 'I'm tired of life,'" said Carmel.

In the pilot program, doorkeepers located 150 residents considered to be suicide risks and referred them for mental health treatment. One-third were in grades seven through 12 and were identified by their schools; one-third were referred by the hospitals where they were being treated; and one-third were referred by health clinics or social services.

Across the country, dozens of Israeli children considered to be suicide risks are currently referred to emergency rooms instead of receiving the psychological treatment that better serves their needs.

In the pilot project, the number of ER referrals for at-risk students dropped by 90 percent, partly because school social workers were trained to deal with some situations on their own. In addition, three times more patients overall - and six times more immigrants - were referred to mental health facilities by staff at their local health clinics in the towns participating in the pilot than in other Israeli towns.

Once people deemed to be suicide risks get the referrals, they are given top priority. Instead of being forced to wait up to a year for an appointment with a psychiatrist, they receive a response from the mental health clinics within 72 hours.

"It was decided to identify people in the public psychiatric system who are showing suicidal tendencies, just like someone who comes to a general hospital with heart attack symptoms," said Carmel.

The treatment lasts about 12 sessions and focuses on short-term behavioral therapy.

Suicide: To discuss or not to discuss

The national plan to combat the phenomenon of suicide enjoys support from families of suicide victims. These families reject conventional wisdom that discussing suicide is liable to encourage more such cases.

Dr. Avshalom Aderet, whose 14-year-old son Eran committed suicide 14 years ago during his army service, is a board member of The Path of Life, a support group for families of suicide victims which lectures on army bases and schools. Aderet says the subject has to be discussed responsibly. Citing the case of entertainer Dudu Topaz, he says the media focused on how he killed himself rather than the pain that proceeded the act. “It amplifies the loneliness felt among potential suicide victims, and if there’s no discussion and no legitimization of talking about their distress, people kill themselves and more families enter this circle.”

He says the public has almost no awareness of the issue, and most people have no idea that over 400 people commit suicide in Israel annually.

How suicides are reported has drawn professional criticism at times. The news program “Fact” drew fire for airing the letters of a young girl who killed herself. In 2009, two months after Topaz killed himself, a 24 percent rise in suicide attempts was reported by Magen David Adom. “We need to talk about suicide but not to glorify it,” says the Health Ministry’s chief psychologist, Yemima Goldberg. “Suicides have to be reported responsibly, in order not to transmit the wrong message to the public.”

Identifying hot spots seen as key

Part of the national plan to combat suicides aims at identify places in Israel where people are more likely to take their own lives.

Professionals refer to these areas as hot spots, requiring special attention.

“These are sites that attract people who have suicidal tendencies,” said Yemima Goldberg, chief psychologist at the Health Ministry.

The Shalom Tower in Tel Aviv was once a spot from which many people jumped to their death. The Azrieli Center recently was discussed as a hot spot after reports emerged that the police were investigating alleged negligence related to a rise in suicide attempts from the towers in the last few years.

The Health Ministry has tried recently to have a fence put around part of the towers’ roofs.

“The tendency is not to publish the names of these places because they could raise the risk of suicide attempts from them,” said Goldberg.

Preventing access to such hot spots is one of the goals of the new plan.

“Studies show that preventing access to a hot spot lowers the aura of the place, and a new focal point is not necessarily opened,” explained Goldberg.

She noted how after a subway in Austria was fenced off, suicide activity did not gravitate elsewhere.

The European Journal of Public Health reported that after the installation of barriers at Clifton Suspension Bridge in Bristol, England, a once-popular suicide spot, the number of suicides in the city declined.

Health Ministry officials have been pursuing building codes that would require fencing of high places.

These include certain hospitals in the center of the country that have been used for suicide attempts.

Psychiatric hospitals also need more thorough protection − the ministry reported nine suicides in 2007 among psychiatric hosptial patients, down from 18 in 1998.