World Mental Health Day: suicide prevention in Ukraine

WHO/Malin Bring

Every 40 seconds, 1 person dies from suicide. As part of its campaign on suicide prevention and to mark World Mental Health Day on 10 October, WHO reports on the progress of suicide prevention at the primary health care level in Ukraine.

Empowering doctors to recognize the signs of depression and potential self-harm

Each year, up to 7000 people in Ukraine die by suicide. The data shows dramatic gender differences in deaths caused by self-harm – almost 80% of suicides in the country are by men. In many cases, doctors and health professionals at the primary health care level overlook tell-tale signs in their patients.

To support general health practitioners who are not mental health specialists, WHO has been conducting a series of trainings in the country. The trainings focus on the use of the WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide, a medical decision-making tool that allows non-mental health professionals to detect and manage mental health conditions, such as depression, anxiety and self-harm.

Tetiana Aksenchuk is a family doctor working in the primary health care centre in Kramatorsk, eastern Ukraine, who benefited from the training and follow-up coaching. She recognizes that since she received the training she has become more attentive to the mental health conditions of her patients.

“Recently, I saw one of my regular patients who suffered from episodes of back pain. When I started the examination, I couldn’t help noticing how depressed he was,” says Tetiana.

“His choice of words alerted me,” Tetiana continues. The man said he “had already had enough” and “it was probably time to die”. Although the patient denied his intent to take his own life, Tetiana insisted on psychosocial support interventions. “I helped the man to cope with the stress and advised him to spend more time on the activities he enjoyed. We agreed to continue talking about his feelings during the next visits, but I could tell that he already felt much better. I am happy that I could help him to take his first step towards healing,” Tetiana says.

“The man was very surprised to receive this type of support in addition to the usual treatment,” Tetiana adds.

Mental Health Gap Action Programme

mhGAP aims at scaling up services for mental, neurological and substance use disorders for countries, especially low- and middle-income.

“Self-harm is a complex behavioural phenomenon with many underlying risk factors spanning individual, communal and societal domains. Suicide prevention requires concerted commitment and actions from a range of sectors including health care, education and social protection,” says Dr Dan Chisholm, Programme Manager for Mental Health at WHO/Europe.

“By supporting the implementation of mhGAP, WHO and the Ukrainian Ministry of Health aim to greatly improve the identification of people who are at risk of self-harm at the primary health care level. So far, over 60 health-care professionals have completed the mhGAP training in Ukraine, and changes in their practice can make a difference in detection and treatment of commonly presenting mental health conditions,” explains Dr Alisa Ladyk-Bryzghalova, National Professional Officer on Mental Health at the WHO Country Office in Ukraine.

Strategizing efforts in self-harm prevention

The complexity of the issue of self-harm requires the implementation of suicide prevention strategies to complement capacity-building among the health-care workforce.

Raising awareness and building resilience at the community level can help to reduce stigma around mental health issues and encourage people with psychosocial disorders to seek help. “Educational activities at schools are proven to be effective in raising mental health literacy and preventing self-harm and suicides. For instance, implementation of the Youth Aware of Mental Health (YAM) programme for young people aged 14–16 years was found to reduce the risk of self-harm among youth by up to 50%,” concludes Dr Chisholm.