Latvia and Lithuania begin to tackle a chronic scourge: suicide
The September 2015 protests at Cathedral Square in Vilnius, during which hundreds of activists lied down to bring public and official attention to Lithuania’s high suicide rate, helped shift the discussion on how to handle the problem.
Mindaugas Kulbis/AP/File
Riga, Latvia
Latvia and Lithuania are two of the most westernized of the fifteen former Soviet republics, with robust economies and relatively sound democratic political systems.
Unfortunately, both countries share a less happy distinction when it comes to suicide. While they have made considerable progress in overcoming their global-high rates of suicide, significant obstacles remain. Perhaps the most stubborn is the stigma attached to mental illness and seeking help for it, a vestige of the Soviet era. But more recently, authorities in both countries have started to make modest headway against a longstanding reluctance to treat mental illness, including suicidal or potentially suicidal patients.
“The good news is that we have the lowest suicide mortality rate ever,” says Toms Pulmanis, vice dean of faculty in the school of public health at Rīga Stradiņš University, referring to the situation in Latvia. “The bad news is that our suicide rate is still amongst the highest in the world.”
Why We Wrote This
Few countries have had a greater problem with suicide rates than Latvia and Lithuania. But both have begun to recognize the extent of the issue and are finally pursuing the underlying causes.
“Yes, suicide rates are decreasing,” says Paulius Skruibis, a psychologist on the staff of Vilnius University, and one of the small, dedicated group of Lithuanian suicidologists. “But obviously we have a long way to go.”
Challenging old beliefs
Lithuania had 24.4 deaths by suicide per 100,000 population in 2017, the world’s highest rate, with Latvia not far behind with 18.1 per 100,000, according to the Organization for Economic Cooperation and Development.
This is a marked improvement for Lithuania in just a handful of years. In 2013, the country had a suicide rate of 31.9 per 100,000.
“Somehow suicide has become part of the Lithuanian story,” Vaiva Klimaitė, a psychologist at Vilnius City Mental Health Center told the Monitor in 2015.
That year, several hundred Lithuanians lay down in the capital’s Cathedral Square in a widely publicized protest over the lack of progress fighting suicide. That, along with the alarm raised by mental health professionals and increased attention from the media, spurred officials to start publicly addressing the issue.
“Over the last few years, the entire field of suicide prevention has become much more active in Lithuania, particularly in Vilnius,” says Dr. Skruibis. “We have a lot happening,” he adds. “We have extensive gatekeeper training. We have policies in place to decrease alcohol consumption.”
In April 2016, the mental health center established a new department of suicide prevention. Also, Vilnius initiated its first comprehensive suicide strategy, though Dr. Skruibis says that “We still need to scale it up to the national level.”
Antanas Grizas, the founder of Youth Line, a psychological outreach program, acknowledges the positive changes, at least on the municipal level, but feels there is a lack of attention from the national government. “I still see the Ministry of Health as presenting the situation as much less dangerous than it is.”
As in Lithuania, the tight-knit community of suicidologists and suicide prevention professionals in Latvia say the biggest obstacle to improving the country’s mental health and bringing the suicide rate further down are the persistent, regressive Soviet-era attitudes regarding suicide and mental health in general.
“During the Soviet time, people who opposed the system were often put in psychiatric clinics,” says Zane Avotiņa, director of Skalbes, a suicide prevention clinic and help line based in Riga. “That’s one of the reasons why people at risk are still reluctant to seek help.”
Another problematic legacy of the Soviet era, says Ms. Avotiņa, “is that many people can’t accept that depression is actually an illness. They think that people who are depressed are just lazy. ... There is a belief that adults should deal with their emotions and feelings by themselves.”
“Beginning of the road”
Ilze Viņķele, the Latvian minister of health, says she is trying to change that. “Suicide is one of the most extreme indicators of mental health,” she says, “and one which reflects many other factors, including the social and economic health of the country, as well as the culture of public interaction.”
Under Ms. Viņķele’s leadership the government has already taken a number of steps designed to both improve and expedite treatment for Latvians who are at risk of taking their lives.
“We are making progress in raising the profile of mental health,” says Elmārs Rancāns, the head of the psychology department at Rīga Stradiņš University. “New patient facilities are being opened. And multidisciplinary teams – not just doctors and nurses, but others, such as physical therapists – are becoming involved.”
In the meantime Ms. Viņķele is also considering a number of measures to both destigmatize psychotherapy and make it more available to younger Latvians, including developing free online cognitive behavioral therapy, as well as creating a dedicated mental health tent for music festivals.
“We are at the beginning of the road,” Ms. Viņķele says.