The Finnish miracle: how the country halved its suicide rate – and saved countless lives | Finland

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It is now often known as the ‘world’s happiest country’, but Finland used to have one of the highest suicide rates in the world. From alcohol to antidepressants, here are the changes that made the difference

Thu 22 Feb 2024 15.00 CET

“Now he’s died,” said his mother’s voice down the phone. Instantly, Jaakko Teittinen knew that what he had feared for years had happened: his older brother, Tuomas, had taken his own life. He was 33.

In a state of shock, Jaakko left work to join his mother at Linnanmäki, a theme park in Helsinki, where she was spending the day with Tuomas’s two children, who lived in foster care and had no idea what had just happened. While his mother started to make arrangements, he went on the rides with his brother’s children, trying not to give away what was on his mind.

“I knew and the kids didn’t,” says Jaakko, recalling the tragic events of 29 July 2009 on a frozen winter’s morning in Helsinki. We are at Surunauha ry (translation: “grief ribbon”), a peer-support charity for those who have lost loved ones to suicide, where he now volunteers. His eyes look towards the ceiling, his voice tightens. “It was really surreal. That’s pretty much all that I remember about that day.”

Tuomas and Jaakko together.

The family had thought that Tuomas, who had been diagnosed with bipolar disorder 11 years before and had a history of suicide attempts, was still in hospital, where they had taken him, suicidal, a few days earlier. But it later materialised that he had convinced medical staff he was fine and managed to get discharged without the family being informed.

The brothers used to listen to music together – mostly prog rock, they liked Pink Floyd – and despite the shadow that mental illness cast over Tuomas’s life, he had a brilliant sense of humour. “He was funny, intelligent, he was nice company,” Jaakko says. “I used to go to his place and we would listen to music, a lot of music.”

‘Being public is important to me’ … Jaakko Teittinen. Photograph: Maija Astikainen/The Guardian

Some 15 years on, having undergone therapy, Jaakko is unusually open about his experiences. “There’s no big secret behind it,” he says.“Of course it’s hard to accept.” To carry such trauma alone was a huge burden, and by speaking about it he hopes to help others to share their experiences. “Being public is important to me.”

Despite nowadays more commonly being branded the “world’s happiest country”, Finland was only relatively recently known for having one of the highest suicide rates in the world. But over the past three decades, the country has halved the number of suicides through a series of national initiatives and interventions.

“This is 1990,” says Timo Partonen, a research professor at the Finnish Institute for Health and Welfare (THL), pointing to a graph on his laptop. “It was the darkest year in the history of Finland regarding suicide mortality.” That year, Finland recorded 1,512 deaths by suicide, according to the THL, in what was then a population of just under 5 million. By contrast, in 2022 Finland had 740 suicides, in a population of 5.6 million – more in line with (though slightly higher than) the EU average. But it has not been a straight-line trajectory. “There are some years that it goes up a bit, then the next year it goes down a bit, then it goes downwards, downwards, downwards, then it stops again,” Partonen says. “But of course we want to have better rates, so lower rates.”

Among the initiatives credited with helping to bring about this change is the national suicide prevention project, which ran between 1986 and 1996, and lowered suicide mortality by 13%. Partonen puts down the success of this programme to improved care for depressive disorder, quicker and earlier detection, and the advent of better treatments. Also introduced were best-practice guidelines on how to treat other psychiatric disorders, including alcohol abuse and personality disorders. While these had a positive impact, Partonen says many sufferers still do not receive any help because they do not seek it or their treatment gets discontinued.

But the THL is hoping to help shift the figures, which have plateaued in recent years, with a new prevention project running from 2020 to 2030. Its aim is to bring down suicide rates even further, partly by improving education for the public, journalists and healthcare providers.

With darkness already closing in on the snow- and ice-covered Helsinki streets, despite it still being afternoon, I ask Partonen whether Finland’s geographical position and weather conditions play a role. But, he says, the data suggests these are not factors. “In fact, the numbers of suicides are at their lowest during winter: December, January, February.” It is not clear why, but they tend to peak in spring and early summer. “There can be some environmental impact in the form of temperature, for example, or light exposure. So people know that if they have been depressed for months or even years, usually spring is the hardest time for them.”

The phenomenon, he says, is universal, with similar patterns found in the southern and northern hemispheres, eastern and western culture. “If you are depressed, your brain and body react differently to the increase in exposure to sunlight. It may make you suffer more from insomnia, for example. You become more restless, anxious, so the level of anxiety increases and it may worsen your depression.” The worst outcome of these conditions, for somebody with insufficient coping skills, treatment or support, could then be suicide.

After two suicide attempts as a young child, by the time Veli-Matti Vuorenmaa was a teenager, he had learned to bury his feelings. Thinking about the sexual abuse he had experienced made him angry, and beyond trying to joke about suicide with friends, there was nobody to talk to about how he felt. He was alone.  

“At first it was hell, plain and simple,” says the 33-year-old student. “But sometimes, well, I forgot about the most painful memories of my life. So, it became easier, but I never really felt good inside.”

For the next two decades Vuorenmaa continued in the same vein, suppressing any traumatic memories and pushing forward with life. But in 2020, the suicidal thoughts returned after being triggered during a social studies class at college. The teacher talked about how about 80% of sexual assaults go unreported. “And I realised: ‘Oh shit, that’s me.’”

For six months he continued not to talk, before seeking help at his college healthcare centre. While it helped a little, he says, the thoughts wouldn’t go away, and the following October, Vuorenmaa again attempted to take his life. Fortunately, he was unsuccessful, and later in the same week, he went to the Mieli suicide prevention centre in Helsinki for the first time, where, through Linity, a method specifically targeted at those who have attempted suicide, he took the first steps towards recovery.

The first session was filmed, which helped him gain a perspective he hadn’t been able to access before. “It really let me see myself as I was,” he says. “That I needed saving. That’s pretty much the best way of putting it.” This short intervention, followed by two years of therapy, has, he says, “brought my mind to a state that I could be 100% myself for the first time in my life”.

Vuorenmaa was so affected by his experiences at Mieli, an NGO that provides support to those who have attempted suicide and which runs a 24-hour crisis helpline, that he is now interning there and wants to work in helping children and young people as a career. He would love to see the Linity technique (also known as Attempted Suicide Short Intervention Programme, or Assip) implemented more widely.

While the Linity course was free of charge, the therapy came at a cost (about €55 (£47) a session) and he was fortunate to find a therapist quickly. Such is the shortage of therapists in Finland that it can take months of searching to find one. 

Harri Sihvola, 59, who trains professionals and others in suicide prevention for Mieli, including the Linity course, has witnessed the transformation of attitudes to suicide in his country first-hand. While it remains a taboo subject among many older people, the picture today is dramatically different to the one he grew up around in Kuopio, eastern Finland, and working in Helsinki as a social worker in the 90s.

Harri Sihvola (left), with director of crisis services Sanna Vesinkansa, at the Mieli crisis centre in Helsinki. Photograph: Maija Astikainen/The Guardian

Sihvola is softly spoken but direct. “My father was born in 1943 and he probably knows something like five to 15 people from his age group who took their own lives,” he says. While it was less widespread when Sihvola was growing up, he was just six years old when his aunt’s husband took his own life. “That was the first time that I faced the word ‘suicide’.”

He was 15 when the first person his own age took their own life. “And when adulthood came closer – 16, 17, 18 years old – it was a person or two per year.” When he was 25, he lost a close friend to suicide. “[For a] person who is born in ’64 and lived their youth in eastern Finland, I think I’m quite typical of that age group,” he says. 

A heavy drinking culture was a strong contributing factor then, he says. “Our suicide rate has gone down at the same rate that our drinking has gone down. So it’s strongly related. And now when, especially the youth, [people] don’t drink that much any more, of course they don’t have that many suicides.”

However, the most vulnerable groups now include young women: suicide attempts among those aged 14 to 25 are increasing. The highest proportion of attempts are still among middle-aged men, but the overall composition has shifted significantly towards females. In the 90s, 80% of all suicides involved males; now, among the under-25s, it is 60%. Sihvola says it could be down to the fact that “stereotypical male-female polarities have been lessened”.

The number of suicides among under-14s has also increased, from almost none to up to six people a year. While there is no scientific proof, Sihvola says, “that’s probably related to this special kind of bullying that people do on social media”. Social media can make it harder for teachers to keep track of friendship groups and who is influencing whom, but by the same token Sihvola believes it may have had a positive effect on loneliness.

Just a few decades ago, the word “suicide” was also almost unsayable – and unprintable. Soon after it opened in 1972, Mieli’s crisis centre in Helsinki changed its name from “suicide prevention centre” to “crisis prevention centre” because there were objections to publishing the word in the phone book. For many older Finnish people, Sihvola says, “suicide” is still a difficult word to say; as with the word “bear” – as in the animal – there is a sense that saying it will bring it closer.

The arrival of antidepressants in the 90s has also had a tremendous impact, he says. While before depression was viewed as a key risk factor for suicide, now a previous suicide attempt is the best indicator of increased risk. For this reason, he wants to see widespread implementation of safety planning systems for people who have previously tried to kill themselves.

Such has been the transformation of attitudes among the young that sometimes they are more comfortable talking about their mental health than trained professionals are to hear about it. “Young people talk about things more easily than ever before.”

To make further progress on suicide, people across the board – from health providers to schoolchildren – need to be comfortable asking others directly about suicidal thoughts. And, just as importantly, they need to be willing to listen to their answers. He advises people to avoid talking too much and not to ask too many questions. “If you ask questions you only hear answers; you don’t hear the story,” he says. “It’s not rocket science. It’s basic skills that everybody should have when they face difficult situations.”  

In the screen-oriented world of 21st-century living, is society getting better or worse at talking about suicide? “Better,” he says, without hesitation, saying he has never been more hopeful. “We are getting better all the time. We are preventing more suicides than ever in Finland.

• In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counsellor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org

• Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here.

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