Preventing someone from taking his own life does not have to wait until he’s
standing on the edge of a roof and looking down. One is much more likely to
succeed if those at risk for suicide are identified early on and helped out of
their desperation and depression to understand that life is nevertheless worth
An inter-ministry committee set up in 2005 developed a pilot
program under the leadership of the Health Ministry, now about to enter its
fourth year of implementation in three locations around the country, that has
already shown some progress in this regard. Between 2013 and 2015, it will
gradually expand to the rest of the country.
Official statistics show
that some 400 people (residents and tourists, adults and minors) commit suicide
in Israel in an average year (although the actual figure is estimated to be 20
percent higher) while annual road deaths average 370, says Yemima Goldberg,
director of the National Suicide Prevention Program.
More than 6,000
Israelis reach emergency departments in an average year after attempted suicide,
and it is estimated that there are another 2,000 unreported attempts by those
who do not go to the hospital for treatment.
Every month, Magen David
Adom is alerted to some 600 calls due to attempted or actual suicide. As these
incidents are accompanied by much social stigma, it is difficult for the
authorities to collect accurate data.
“While the government spends NIS
300 million a year to reduce the human toll on the roads, just NIS 37m. will be
spent on the suicide prevention program,” continued the ministry’s chief
Goldberg, a clinical psychologist who graduated from Tel
Aviv University, is in charge of 500 psychologists working in the public health
system and responsible for registering all such professionals. She has been
involved with plans to reduce suicide since 2004, a year before becoming
chairman of the inter-ministry committee.
Her department is very small,
with a deputy director and three-and-a-half job slots for administrative
She is grateful for what she has, but wishes she had a larger
staff, such as exist in many countries, such as Scotland, where she made a
professional visit. Her department, she notes, is also involved in promoting the
treatment of children subjected to sexual abuse, victims of domestic violence
and other problems.
A few years before her arrival, the ministry had
produced a sophisticated “kit,” complete with detailed booklets and slides,
aimed at promoting the reduction of suicide among children and youths. However,
Goldberg says the kit was not a training program but only a tool to promote
awareness in schools. “I suppose it helped somewhat,” she adds.
seven years ago, Dan Naveh represented Israel at a Helsinki meeting of health
ministers from around the world where they signed a commitment to develop and
implement suicide prevention programs. Goldberg assembled a number of agencies
by the issue in addition to her own ministry. These included the Education
Ministry; Welfare and Social Services Ministry; Immigrant Absorption Ministry;
Industry, Trade and Employment Ministry; academic institutions; the Jewish
Agency and voluntary organizations. Others, including the Israel Defense Forces,
joined as time went on. Health Ministry associate direcor-general Dr. Boaz Lev
provided much of the impetus towards action in minimizing suicide.
decided that there was enough talking; the time for doing something had come,”
Goldberg recalled. “We went to the Knesset and appeared before the Knesset
Finance Committee, which was then chaired by MK Ya’acov Litzman [who is now
deputy health minister]. He understood it was the state’s responsibility and
agreed to allocate money for a project to prevent suicides.”
the multi-year pilot project will total NIS 6m.
“We studied in depth what
was being done in the rest of the world and found a number of effective
The pilot project targeted three populations – the elderly,
youth and immigrants [that is, recent arrivals from the former Soviet Union and
Thus it focused on Rehovot, Ramle and Kafr Kanna (in the
Galilee). Rehovot has numerous immigrants; Ramle is a mixed city with Jews and
Arabs and Kafr Kanna is solely Arab.
A quarter of the funds came from the
American Joint Distribution Committee, which hired a manager for the pilot
program, and the rest from the Health Ministry.
“We built the
infrastructure and trained people for their jobs. We had to persuade the schools
to let us in, and preparations took a year,” says Goldberg.
project began in 2009 and was supposed to become a formal program in 2012,
Goldberg says, but when it was realized that not enough time had passed for
effective evaluation of the program, the steering committee decided to add 2012
and start the national program in 2013, with gradual expansion around the
country and an annual cost of NIS 37m.
The program, continues Goldberg,
is based on the use of “gatekeepers” – teachers, educational advisers, social
workers, dormitory school counsellors, absorption workers, health fund
personnel, youth movement leaders and others who are not experts in suicide
prevention but who can readily detect signs of distress.
regularly used by the young are monitored for signs of distress, and gatekeepers
are called in if deemed necessary. Goldberg learned that hairdressers and even
taxi drivers are used in some countries to serve as a shoulder to cry on and can
alert the authorities of customers’ talk about suicide.
specially trained for the project were 600 gatekeepers; 300 psychiatrists,
psychologists, social workers and educational advisers; and 500 volunteers in
the Jewish (through ERAN, Emotional First Aid) and Arab sector (through the
Sahar organization). Some 150 street signs were set up, 1,000 flyers were
distributed and 300 posters were hung. Questionnaires also help identify people
at risk. As such a multiplicity of factors were involved, many sessions were
held to coordinate among them.
Early warning signs that a person may be
suicidal include extreme behavior, illogical fears, neglected appearance and
changes in the way they talks; depression, the use of drugs and alcohol; risky
acts such as running away from home, dangerous games in public and excessive
piercing; fighting, lying or vandalism; and a decline in studies, concentration
and an increase in absenteeism.
“We invested a lot in informational and
educational material in four languages,” says the ministry’s chief
Short video messages and other material to reduce stigma
were posted on websites. “We even produced a play in Amharic for Ethiopian
immigrants, using a director and actors from the community itself. They have so
far performed eight times in community and absorption centers, and they really
put the message across. The message is very powerful. We may produce a play in
Russian as well.”
Not only are people who attempt suicide at high risk of
trying again, but also people from families that suffered a loss in their family
due to suicide, she continues.
“We try to identify them so they do not
reach hospitals without being recognized at being at high risk. The main target
groups are not only the young, including soldiers, but also adults of all ages,
including the elderly. People who have been divorced or widowed, homosexuals and
people with mental problems are also at higher risk.
Insurance Institute help us with the elderly, while ERAN answers many anonymous
phone calls from distressed people of all ages who threaten suicide,” Goldberg
says. “The problem cuts across the entire social fabric, people of all ages,
cultures and religions.”
T h e gatekeepers have been trained to identify
those at risk, give them short (12-week) treatment including cognitive
behavioral therapy (CBT) and the less-familiar dialectical behavior therapy
(DBT) and interpersonal psychotherapy (IPT).
CBT is a psychotherapeutic
approach based on talk therapy that aims to solve problems concerning
dysfunctional emotions, behaviors and cognitions through a goal-oriented,
systematic procedure in the present. As there is evidence that this technique is
effective for the treatment of numerous emotional problems such as anxiety,
eating, mood and personality disorders, as well as substance abuse, it is a good
option for those who have attempted or considering suicide.
DBT is a
system of therapy originally developed by University of Washington psychologist
Marsha Linehan to treat people with borderline personality disorder. It melds
standard CBT with concepts of distress tolerance, acceptance and mindful
awareness related to meditation techniques.
Research has shown it can
help treat people with suicidal tendencies.
IPT is a time-limited
psychotherapy that focuses on interpersonal relationships and building
interpersonal skills. It originated with Harry Stack Sullivan, an American
psychiatrist and psychoanalyst born at the end of the 19th century who was
strongly influenced by sociology and social psychology. It developed in the late
1970s and 1980s as an outpatient treatment for adults who were diagnosed with
moderate or severe clinical depression.
New regulations require informing
parents that their child has attempted suicide. If they live in the pilot
project locations, they can be treated immediately, says Goldberg.
the hospital emergency departments in the three towns where the pilot operates
have been told what we offer.”
She reports a three-fold increase in the
number of people sent for treatment in clinics in areas included in the pilot
The JDC, working with an independent observer, has been
assessing the pilot project.
“It’s difficult to document a reduction in
suicide in the three towns in such a short time, but there are assessments by
people who give treatment who believe it has already helped. For example, there
were two suicides a year in Kafr Kanna in 2006 through 2009, but in 2010, there
“There has also been a reduction in Rehovot and Ramle, but we
need more time and research to learn whether this resulted from the proactive
approach of the pilot project,” she says.