Eleven suicides daily — Spain's not-so-silent pandemic

The problem is not solely borne of the pandemic, which acted as a catalyst.

"Social-distancing measures have led to people being less able to create new support networks and strengthen existing ones," stressed Alejandro de la Torre, author of the study "Evolution of suicide in Spain in this millennium", in conversation with EUobserver.

But while levels of unwanted loneliness have increased, the stress related to the spread of the virus, the strain on workers such as healthcare professionals, or remote care — or even the interruption of such care — have not exactly been reasons to improve pre-existing conditions in the population.

Nor have economic pressures: inflation, financial uncertainty, rising interest rates, unemployment, etc etc.

Although speculative — because further research and data collection are lacking — the reasons seem to go beyond that, and have a structural dimension, according to de la Torre.

The number of traffic deaths in the 1990s was close to 23 per day. 30 years later, the figure has fallen to 4.38, almost a third of the number of suicides registered in Spain, according to the country's National Statistical Institute.

The true scale of these lost lives could be even larger, says Javier Jiménez, president of the Association for Suicide Research, Prevention and Intervention (AIPIS). Jiménez is a clinical psychologist who was not part of the study, but he points out there is no systematic method in place to collect this data accurately.

The situation appears critical, since the strategy followed by Spain so far to reduce these numbers has not worked.

No money, no attention

At the end of January, the psychologist Belén Hernández wrote to the director of the Spanish newspaper El Pais. Her words were quickly echoed across both the media and social networks.

The brief paragraph told how a 23-year-old young man with no financial resources and at a high risk of suicide had just left the consultation room with a prescription for anxiolytics and an appointment to be seen in a year's time. "If you don't have enough money to pay a private psychologist, suicide becomes an acceptable alternative," she wrote.

According to Eurostat, Spain had 11.8 psychologists working in hospitals per 100,000 inhabitants in 2020. A ratio only worse in Poland, Bulgaria and Malta.

With staff shortages and demand for this kind of care on the rise, waiting times can reach several months in many communities.

P.I.R. is the acronym of the test that gives access in Spain to the position of resident internal psychologist in the public health system. Herein lies part of the problem.

Last year, only 231 P.I.R. places were offered for thousands of graduates. "The vacancies are very limited," says Jiménez, who explains that with retirements coming up in the next few years, the shortfall in staff will become even worse.

Worse still, the clinical psychologist points out, there is a lack of proper training. In no university psychology curriculum is there a single specific subject that deals specifically with suicide. At the Complutense University of Madrid they have a few seminars, adds de la Torre.

Renew Europe has just published the results of a survey of young Europeans aged 18-30. Long waiting times were the main reason respondents cited as a barrier to accessing proper healthcare. This was followed by price and fear of stigma.

Within the EU, not all countries include psychological care within public health care despite the fact that in 2019 nearly 60,000 people committed suicide. In those that do, some link access to co-payment. In other words, a financial barrier to accessing this type of care.

More than half of those affected are adults aged between 40 and 64, who are more likely to be at the head of a family, plus particularly foreigners.

However, it is the youngest people who are not visible to the naked eye. Although the progression of the suicide rate among younger people has not increased so markedly, "there is evidence of an increase in risk factors and suicidal behaviour" in this sector of Spanish society, stresses the author of the study.

Not only in Spain. From 2018 to 2020, in Belgium, the prevalence of anxiety doubled among young people, the unemployed, and people living alone, who recorded higher rates of anxiety and depression.

Only 10 national suicide prevention plans in EU-27

Only ten EU member states had a national suicide prevention plan in place before the pandemic hit. Despite its alarming figures, Spain is not one of them.

Although mental health is a member state competence, coordinated public mental health programmes aimed at preventing and raising awareness of mental health on a large scale are more effective strategies than investing in much more costly treatments, according to the Renew policy paper.

"Mental health is also an economic factor," said the authors of the paper, in which they called for more holistic and coherent European health policies, with positive mental health objectives in other policy areas, such as employment, education, or the environment.

"Prevention has to be comprehensive," de la Torre underlined. From raising social awareness through publicity campaigns, to a good scientific budget and a funding allocation earmarked for research to show that this is a health priority.