Brazilian researchers publish suicide prevention guidelines for the public.

By Fernanda Bassette, from the Einstein Agency  Brazilian researchers have published a new document with guidelines to help the general public—those not necessarily working in healthcare—to identify, address, and refer an acquaintance with suicidal thoughts for appropriate treatment, since most cases are associated with some type of mental health disorder.

The document aligns with official data: contrary to developed countries, the number of suicides in Latin America and Brazil has been increasing in recent years, according to the World Health Organization (WHO). In Brazil, records are approaching 14 cases per year, meaning that on average 38 people take their own lives every day. 

The guidelines

Experts explain in a simple and didactic way how to act if an acquaintance is having suicidal thoughts. They cite some important warning signs, such as identifying someone who: 

• whether threatening to hurt or kill themselves, or talking about wanting to die.
• whether they are looking for ways to kill themselves, such as searching for pills, weapons, or other means.
• whether talking or writing about death, dying, or suicide
• You may feel trapped, as if there is no way out.
• is distancing themselves from friends, family, and society;

Furthermore, the document teaches how to approach and address the person at risk. It says, for example, that the question should be direct and without prejudice. For example, the person should ask "Are you having suicidal thoughts?" and never "You're not thinking of doing something stupid, are you?". The first responder should assure the person that they are there to listen and that they want to help them. 

The guidelines include a table with listening tips (such as listening attentively, patiently, and with empathy) and what never to say when talking to someone at risk of suicide, such as not minimizing the problems reported, not interrupting them with their own stories, and not saying that the person is "bluffing." Finally, the document encourages the person to seek help. 

Regarding the creation of the document

Translated and adapted from the guidelines of the "Mental Health First Aid" program, which has existed in Australia since 2000, the Brazilian version is the result of a collaboration that has existed since 2018 between Brazilian and Australian researchers. 

Here, scientists worked to arrive at a national interpretation of the model, according to the culture and particularities of each country. The Brazilian document was named "Guidelines for suicidal thoughts and behaviors in Brazil" and was published in the scientific journal "BMC Psychiatry".

Before being released, the official text was evaluated by a group of 60 Brazilians – 30 of whom were healthcare professionals specializing in suicide and 30 people with experience related to suicide (either personally, surviving an attempt, or supporting a family member). 

"In our culture, there is a very strong family connection. Therefore, in high-risk cases, we include the issue of the involvement of friends and family to help," explained psychiatrist Alexandre Andrade Loch, a professor of postgraduate studies at the Institute of Psychiatry of the Hospital das Clínicas of the Faculty of Medicine of USP (IPq-FMUSP), one of the specialists who participated in the preparation of this document. 

"It's very common for people who suspect someone is at risk [of taking their own life] not to know how to act, how to approach them, or where to seek help. Even healthcare professionals encounter difficulties initially. That's why this manual was organized and conceived by people who have already been through this situation, so that it can suggest the best possible course of action," explained Loch. 

Although already published in a scientific journal, the training model that will be used here is not yet publicly available – it is expected to be so at the beginning of next year. According to Loch, there is a master's thesis underway at the Institute of Psychiatry at USP to define the best course format for making this information available.  

"The idea is that this training can be applied in schools, workplaces, and companies, but we don't yet know for how long: whether it would be weeks or months. What we do know, from Australia's experience, is that the more information people have, the less prejudice there is towards mental health problems," Loch stated. 

According to psychiatrist Elton Kanomata, from the Albert Einstein Israelite Hospital, the existence of a document for the general public is fundamental because often the person at risk of suicide does not identify themselves in that situation and does not seek help.

"Having a document that facilitates the identification of people at risk is important because many of these people are in denial, they think they don't have any mental health problems. Or when they recognize that they have legitimate suffering, they feel ashamed because there is still a lot of taboo and stigma surrounding suicide. This causes the person to worsen their condition," warns the doctor. 

Kanomata also said that suicidal ideation is not constant; it fluctuates over time and worsens during periods of increased stress. Therefore, the involvement of friends and family in identifying these cases is crucial.  

"Suicide goes against the instinctive principles of any living being, which are survival and self-preservation. The fact that a person attempts suicide, says they want to die, ends up provoking an unpleasant feeling in other people, generating a certain distancing. That is why the support and acceptance of the family is so important," he stated. 

September Yellow 

Since 2014, the Brazilian Psychiatric Association (ABP), in partnership with the Federal Council of Medicine (CFM), has used the month of September as a period for suicide prevention – an initiative known as Yellow September, with actions throughout the country to draw attention to the issue, similar to Pink October (for breast cancer prevention) and Blue November (for prostate cancer). 

This year, the campaign's motto was "Life is the best choice," highlighting that many suicide cases could have been prevented if people in crisis had had access to psychiatric treatment and quality information. 

More people commit suicide every year than die from HIV and malaria, for example, according to the WHO. Among young people aged 15 to 29, suicide was the fourth leading cause of death, after traffic accidents, tuberculosis, and interpersonal violence.

"There is still a lot of stigma surrounding suicide. What we want with this document is for people to understand that a person who commits suicide didn't make that decision overnight. It's a process that has been happening for some time; the person is becoming ill and needs help. Suicide is just the tip of the iceberg," said Loch.

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