Israel Takes on Suicides: 130,000 'Gatekeepers' to Identify Those at Risk

Similar program in Scotland led to 20 percent drop in suicides over a decade.

Ido Efrati
Ido Efrati
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The police at the scene of a murder-suicide in Israel, March 2016.
The police at the scene of a murder-suicide in Israel, March 2016. At least 500 people commit suicide in Israel every year, according to the Health Ministry.Credit: Ofer Vaknin
Ido Efrati
Ido Efrati

The Health Ministry is planning to train more than 130,000 people over the next few years to help identify those at risk of suicide, with the aim of reducing the phenomenon.

Workers will be trained from a variety of fields, including health and welfare, education, youth workers, and those working with new immigrants, the elderly and members of the LGBT community.

The steps were announced three years after a national plan to combat suicide was approved by the government, and two years after a suicide prevention unit was established within the Health Ministry.

The ministry has now issued a tender for an organization to implement the program, with the aim of rolling it out throughout the country this year.

In the two years since the suicide prevention unit – which consists of only four employees – was founded, it has instituted various activities with psychologists and welfare and education workers. But the program is the first official, tangible step toward broad implementation of the plan.

According to the ministry, some 500 people commit suicide every year, with a further 6,000 hospitalized for attempted suicide. Due to under-reporting, these figures are believed to be 23 percent lower than the actual number.

Suicide is the second most common cause of death among Israeli males aged between 15 and 24, and the third most prevalent cause among men aged 25-44. The suicide rate among immigrants is much higher than the general population: immigrants constitute one third of all suicides in Israel.

Other elements of the program will include expanding suicide prevention hotlines; monitoring and analyzing data on the subject, and improving continuity of treatment; and instituting a public information campaign to raise awareness, after years during which the subject was kept far from the public gaze.

From the tender, it appears that the core of the program will involve using “gatekeepers.” These workers will then be able to identify people with suicidal tendencies and refer them for immediate treatment. The gatekeepers are vital contact points – for example, family doctors, nurses at well-baby clinics who recognize women with severe postpartum depression, educators – who will be given the necessary tools to hold preliminary conversations and make referrals.

“Alongside restricting the availability of the means to commit suicide, gatekeepers are the most significant tools in limiting suicide,” said lawyer Shoshi Hertz, head of the suicide prevention unit. “A person who undergoes training as a gatekeeper will know how to identify people at risk of suicide and refer them quickly to treatment. Sometimes, attention and the right questions – such as a direct question about suicidal tendencies – can save a life.”

Hertz said a similar program in Scotland contributed to a 20 percent drop in suicides over a decade.

The Health Ministry has already conducted a pilot program training gatekeepers in three communities. They acted quickly to refer those at risk to public mental health clinics and for treatment, and suicide rates dropped.

The training will last about 40 hours, depending on the worker’s role and the population they serve. According to the tender, training will be from a “multicultural approach.”

The program will also train police officers; National Insurance Institute personnel; volunteers who work with the elderly; judges and lawyers; unemployment bureau clerks; members of the clergy; and Social Equality Ministry employees. It will also train people who work with populations known to be at higher risk of suicide, such as members of the LGBT community, divorced men and divorced fathers, and victims of sexual violence.

The program will train workers to initiate phone calls to the elderly, and create an infrastructure that will allow continuity of rapid referral and treatment as soon as distress that could lead to suicide is detected.

The issuing of the tender means the program will be implemented by an outside body and not the Health Ministry directly. It is still unclear which agencies will be best suited to perform the task. Hertz said her unit will be a strong guiding hand and involved in every stage of the process and in every detail, to make sure the program is successfully implemented.

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