«Suicide attempts have increased tenfold»

Mr Berger, suicide is the most common cause of death among young people in this country after accidental death. Are the figures rising?

While the number of completed suicides among young people remains fairly stable, suicide attempts appear to be on the rise. In our emergency department alone, consultations have increased tenfold over the past ten years.

In 2018, we had 690 emergencies, two thirds of which were suicide attempts or suicidal cases in the broadest sense, although the definition of a suicide attempt is not so simple: Is walking to the railway station already a suicidal act or only when a young person is lying on the tracks? Or do his actions have to result in medical treatment in order to fulfil the criteria?

How many young people take their own lives in Switzerland every year?

In the under-15 age group, completed suicide is an extremely rare occurrence and is limited to a few cases per year in Switzerland. Among 15 to 18-year-olds, we have been counting around 30 suicides per year for some time, although the figures vary considerably from year to year. The figure is twice as high for 19 to 25-year-olds. This means that two teenagers or young adults commit suicide every week in Switzerland, which is very worrying. In addition, the number of suicide attempts is 10 to 20 times higher.

Girls are more likely to take an overdose of tablets, boys are more likely to throw themselves in front of the train.

How do young people take their own lives?

While girls are more likely to overdose on pills or slit their wrists, boys choose more aggressive methods such as jumping off a bridge or in front of a train or using a firearm. This is probably the main reason why more boys die from suicide attempts, while more girls try to take their own lives but survive the attempt.

So should the majority of suicide attempts by girls be understood as cries for help that are not really motivated by the intention to die?

The emotional pain is usually very great until someone tries to take their own life. In addition, young people often do not realise how dangerous a suicidal act can be. Taking certain painkillers, even at low doses, can also lead to liver failure with a delay of two to three days. In my experience, every suicidal act must be taken seriously, especially because a suicide attempt represents the greatest risk for a suicide that is later completed.

What do you mean?

Once a person has attempted to take their own life, the risk is several times higher that they will complete suicide at some point. Around one in three to four people attempt suicide again in the following year. The brain learns through good and bad experiences. Once it has been in a suicidal mode, there appears to be an increased risk of a similar state being activated again. Around half of those affected suffer from a depressive illness at the time of the completed suicide. And in the year before the suicide, the criteria for a mental disorder are met in up to 90 per cent of cases.

Why are mental illnesses such as depression so common among young people?

Puberty, which now begins two to three years earlier and lasts significantly longer than 100 years ago, marks the start of a phase of change on a biological, psychological and social level. With the onset of puberty, the frontal brain becomes a huge construction site. A large proportion of the neural connections that are no longer needed are eliminated. And those that are needed are strengthened. Depending on which part of the brain is currently developing, you are more or less in balance.

90 per cent of young people go through this phase without any major damage. But there are also those 10 per cent who are vulnerable due to their genetic make-up or their life history. Then all it takes is one or two additional stress factors such as ADHD, a partial performance disorder or family problems, and the whole system runs the risk of becoming unbalanced.

Young people today have a variety of options, but hardly any role models.

What factors besides depression can lead to suicide?

A suicide attempt or suicide is usually a complex phenomenon. Addictive substances are often involved, especially in young people. However, social factors such as a lack of career prospects, family problems, bullying or the loss of a loved one can also play a role. There is probably also a genetic component, both for psychiatric illnesses and for suicidal behaviour as such. In addition, adolescents with impulsive traits are at risk in their personality structure, as are those who struggle to build and maintain healthy relationships.

Can the rising numbers also be attributed to a social
development?

Young people today have to deal with a variety of opportunities that did not even exist a few generations ago. Identity development is a major challenge. In addition, there are hardly any role models left to show how young people today can deal with the challenges they face. Many of those affected lack values that could provide guidance for adolescents in this important phase of their lives .

Why are the figures in this country so high in international comparison? Is this really due to the freely available military weapons, as we often hear?

That's the case for adults. And I also know families whose children have committed suicide with their father's army weapon. I can't prove that the suicide could have been prevented by different gun laws, but this should give us pause for thought. But unsecured railway crossings and high bridges are also an important issue.

They address the so-called suicide hotspots.

Studies show that where these were secured with nets, for example, the numbers fell without these hotspots having moved to another location.

What do young people feel when they think about taking their own lives?

People at risk of suicide often describe the state before a suicidal act as unbearable mental pain; they suffer greatly. They are therefore in a state of acute stress, in a dead end, so to speak, that restricts their thoughts and feelings with only one emergency exit - suicide. Suicide experts also speak of a suicide mode in this phase.

In suicide mode, the person affected can no longer distance themselves from their feelings, they completely dominate them.

So suicide is not based on a desire to die?

In the rarest of cases. The door to this emergency exit is opened at a time of extreme distress with the desire to end this unbearable suffering. As a rule, this pain has dominated the young person for weeks, perhaps even months. And then all it takes is one triggering event. This could be a break-up with the person who has prevented them from taking this step. But bullying or criticism that is perceived as unfair can also be enough to trigger an avalanche that overwhelms the young person. In this state, they can no longer distance themselves from their feelings; they completely dominate them.

How do parents whose child has committed suicide feel?

As a rule, these mothers and fathers suffer greatly. Studies have shown that suicide is a life-changing event for an average of seven people close to the deceased. This includes parents, siblings and friends. Entire school classes are traumatised by a suicide.

How should teachers deal with such an event?

It is very important to have a good dialogue with the suicide victim's environment and to take a close look at the class structure. Which pupils had a close relationship with him? Was there bullying, for example? I recommend that teachers seek professional help. There are organisations that specialise in supporting this grieving process in schools or companies. Police officers are usually the first to arrive at the scene of a suicide, they know the counselling centres and also support the people around the deceased.

How many of these families have you already accompanied?

Supporting families after a suicide attempt by their child is part of our everyday work. Fortunately, dealing with completed suicides is a rarity. In my 25 years in the profession, I have looked after two sets of parents whose children have died after attempting to take their own lives. Those are very difficult moments. But even the attempt by a child to take their own life shocks parents and unsettles them deeply.

In many cases, it is possible to treat young people on an outpatient basis after a suicide attempt.

What questions do these mothers and fathers ask themselves?

The question of guilt often arises: What did I do wrong? In our work, we try to objectify the event and place the depression, which is often present, at the centre of the treatment. If circumstances allow, we work very closely with the family.

What do you do after a suicide attempt?

First and foremost, we listen to the young person and try to understand and alleviate their emotional pain. We try to understand the underlying story behind the suicide attempt and build a relationship, because we believe that this protects against further suicidal behaviour. We try to mobilise existing resources so that they do not attempt suicide again.

If necessary, we admit those affected to a psychiatric clinic after suicide attempts, but in many cases it is possible to provide outpatient support for young people in our crisis, clarification, emergency and triage centre until we can place them in longer-term therapy.

How can everyday family life be as «normal» as possible after such an event?

As a rule, we try to strengthen the young person and the family so that they can overcome this crisis together. Both sides must learn to build mutual trust and try to utilise existing resources. We make individual agreements between the parents and the children, for example that the parents can call their son at 10 p.m. if he is not home by then. This makes it predictable for both sides.

If parents were to call every ten minutes out of fear, would this be problematic?

I consider such contact purely on the subject of suicidal behaviour to be rather harmful. The child must have the opportunity to build up confidence in their ability to deal with suicidal behaviour and go their own way.

Another arrangement could be as follows: A trusted person accompanies you home and this person knows about your suicidal tendencies. You don't drink and if you do, this person can contact us. We will then pick you up from the party. Parents can't control everything, but they must be clear about what behaviour they don't want and communicate this. But even then there is no 100 per cent guarantee.

It is crucial that parents and children develop a supportive relationship before difficulties arise.

Do you confront these young people with the pain they inflict on those around them?

If they are emotionally stable, this can have a protective effect in individual cases. Many young people still have a responsibility for others, even if they no longer feel any for themselves. It's about objectifying suicide, making it clear that it is not a solution and that we therapists are there to help those affected to get out of this pain.

It is important to accept suicidal thoughts as part of the person's coping strategy and to help them find alternative strategies to deal with these thoughts. The early recognition and treatment of mental illness is also an important protective factor.

What can parents do to strengthen and protect their children?

It is crucial that parents do not just start talking to their children when there are difficulties, but create moments from an early age in which they have a good time with them. In this way, parents contribute to the development of a supportive relationship that allows access to the child even in times of crisis and leads to the parental presence being accepted by the child.

With young people, it takes a lot of creativity to find access in such moments of crisis. This is often achieved by doing things together, such as playing tennis or cooking. Children and young people generally seek closeness to their parents. They need to create the basis for this kind of access to develop.

And what do I do if my teenager doesn't respond to the offers to talk?

Then stay tuned. Part of our job as parents is to be unpleasant or embarrassing at times. Parents who always want to be nice pay a high price. Especially during puberty, there are times when behaviour is harmful to health. Let's take the topic of sleep: there is a correlation between sleep and mental illness. And we also know that many behaviours impair sleep.

The 14-year-old wants unlimited access to his mobile phone, but as a father I have to enforce that he gives up his smartphone about an hour before going to bed so that his brain can adjust to sleep. It's a struggle. Creating a structure is necessary, but much more stressful than telling the child: «Make your own decisions, you have to learn to be independent.»

This is not always easy.

Of course not. But a benevolent rigour is called for here. One of the challenges facing young people today is that the environment is less predictable than it used to be. For many young people, everything they want is immediately available. There are only two extremes: on the one hand, everything is possible - online - and on the other, children are locked into structures at an early age, both at school and in their free time. If you don't adhere to these, you fall out of normal development. The healthy middle ground is lost, and for me that's one reason why the number of mental illnesses in adolescence is on the rise.