Suicide prevention: "Expansion of existing communication channels" is crucial

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Germany's Federal Ministry of Health has presented a national suicide prevention strategy that has been called for for years. It also provides for telephone and online counseling services for relatives and professionals. The option of anonymous counseling services is to be retained, and a suicide register with pseudonymized data is to be set up. Lauterbach wants to record suicides and attempted suicides as well as as much data as possible on risk factors in order to ‘take an evidence-based approach to suicides’.

In this way, ‘methods and hotspots that are typically subject to change over time’ can be identified at an early stage. According to the BMG, the decisive factor is often whether ‘suicide opportunities’ are available. In countries with a high availability of firearms, for example, restricting access to them had an effect. Reducing the size of painkiller packs or restricting access to places frequently used for suicide also had an impact. The register should also help to identify new risk groups quickly.

According to the BMG, the number of suicides in Germany has stagnated at 9,000 to 10,000 per year since around 2008, with men committing three quarters of all suicides. "Behind suicidal thoughts is often not the feeling 'I don't want to live anymore', but rather 'I don't want to live like this anymore'", says the National Suicide Prevention Strategy. According to the Federal Ministry of Health, this aims to overcome the social taboo of death and suicide, destigmatize mental illness and better bundle support services to provide more targeted help and prevention.

In the future, Germany-wide crisis service emergency numbers are to be available around the clock for people with acute suicidal tendencies. There will also be networking and coordination of suicide prevention. The tasks of the planned coordination office will include, for example, the creation of a website with "in-depth information on suicide prevention for affected people, relatives, and professionals", in which the Federal Centre for Health Education and the National Suicide Prevention Program (NaSPro) will also be involved.

Uncertainties regarding funding

Details on the structure and composition of the national coordination office, as well as the financing of low-threshold help, have not yet been clarified. According to the NaSPro statement, "it is urgent that the funding and promotion of suicide prevention be included in the budget consultations for 2025, which begin at the start of June. The first step would be the establishment of a nationwide telephone number and a federal funding program for the development of suicide prevention in Germany".

Telefonseelsorge Deutschland and the online counseling service for children and young people, Krisenchat, are also calling on the federal government to "significantly expand and secure the support services for people in life crises". According to the report, anonymous, free and low-threshold structures are important in order to prevent suicides – the decisive factor here is "short-term accessibility via all existing communication channels". The available services must make it easier for those seeking advice to make contact; they must not represent an additional technical or psychological barrier," says Helmut Ellensohn, Chairman of the Telefonseelsorge Deutschland. In addition to the above-mentioned services, the numbers against grief, Jugendnotmail and Pausentaste also offer help.

Online counseling and telephone counseling overloaded

In 2023, suicidal thoughts or intentions were expressed in 108,000 of around one million counseling calls to the telephone counseling service. "In 2023, Krisenchat helped almost 3,500 people seeking help who said they were suffering from suicidal thoughts and crises. That's almost 20 percent of all those seeking help from Krisenchat," Krisenchat Managing Director Kai Lanz explains. In individual cases, even eight-year-olds contact Krisenchat.

The number of new cases turning to Krisenchat with suicidal thoughts and suicidal crisis is on the rise. According to Lanz, many children and young people cannot be counseled due to capacity constraints. "The entire psychosocial care system is overloaded," says Lanz. This is why the telephone counselling service and Krisenchat are calling for help to secure and expand counseling services.

Accompanying scientific evaluation planned

At the same time, the federal government's planned measures are also to be scientifically evaluated. Suicide research to date, for example, has not been able to prove any influence on the suicide rate due to the "sharp increase in the prescription of antidepressants since the mid-1990s". Large "systematic meta-analyses with up to 87,500 study patients" have shown that patients "who receive an antidepressant in randomized and double-blind drug studies commit at least as many suicide attempts and suicides as the study participants who were assigned placebo", according to the implementation strategy for suicide prevention in Germany (PDF).

Note: In Germany, you can find help and support for problems of all kinds, including questions about bullying and suicide, at telefonseelsorge.de and by phone on 0800 1110111. The number against grief (children's and youth helpline) is 116 111. In Austria, there are also free help services, including the children's helpline on 0800 567 567 and Rat auf Draht on 147, especially for children. The same telephone number in Switzerland leads to Pro Juventute.

(mack)