One of the most fulfilling aspects of my work as a psychologist, previously as an IDF mental health officer and currently as a therapist in a combat stress reaction unit, is the ability to sit with a suicidal person, on the edge of unbearable despair, breathe hope into them, and help them find their way back to life. This is important and difficult work that requires resources, not only from the therapist, but also from the treatment system and from the patient’s supportive environment. Only together can we save lives.
This week marked World Suicide Prevention Day, an issue of utmost importance, especially in this period when we are witnessing suicides among soldiers returning from combat, though not only them.
While in the IDF and in the general public, there has been no overall rise in suicide cases, we know from many studies that there has been a significant increase in distress levels and in requests for assistance due to mental distress. Moreover, during wartime, even if there is no immediate increase in suicide rates, there is an expected rise in suicides afterward.
In any case, we know that suicide is the endpoint of a spectrum of distress – some mild and some very severe, but all requiring treatment and support in order not to intensify and reach suicidal risk. Even without the title of “suicidal,” it is very important to treat them. This is true for soldiers in combat zones and for every person in the country living under the current reality, filled with pressure, loss, and uncertainty.
The increasing availability of weapons is also a concern in terms of suicidal risk.
IDF needs better suicide prevention
Suicide prevention must not be considered a “one-time effort,” but a continuous and ongoing process with prevention and monitoring programs and meaningful and intensive treatment for those at risk. This requires functioning healthcare systems.
In the army, in recent years, the availability and number of mental health officers has been increased, and they are even placed in the field during the war. In the field, “gatekeepers,” generally commanders who have been trained, identify suicidal risk early, a move that has been proven in the prevention of suicides. In the civilian system, the national suicide prevention program has been operating for years, including training “gatekeepers” and developing suicide prevention programs in the health funds.
HOWEVER, THE gap between planning and implementation is significant and unfortunate – the budget of the national program has been cut over the years, making its implementation difficult. In addition, people seeking help encounter a public system in collapse: a severe shortage of positions, partial staffing of existing positions, and severe burnout among therapists.
How can we deal with suicide if someone who turns to community mental health care has to wait months and even longer, only to receive a response that is sometimes minimal? This is also true for educational psychologists – the current estimate is one psychologist for every 1,000 children. In today’s reality and reported distress, this is simply a disaster.
The burnout associated with working in the public health system is known to anyone who works in it. There is a great deal of “firefighting,” and within the overload of tasks, it is so easy to miss – even when it comes to suicide. After a suicide, people always ask, and rightly so: How did no one see?
Sometimes it really is difficult, even impossible, to notice, but sometimes the system simply was not there.
Among 1,000 cases, it is much easier to miss. I remember this gap, between the pounding heart and sacred sense of responsibility that accompanies dedicated treatment of a suicidal person, and the routine in which you are pulled into all the other tasks and find yourself asking: Where will I fit this follow-up into the schedule?
The Health Ministry is suggesting various solutions, such as certifying practitioners with only superficial training (“mental health supporters”) or shortening the training of professionals. These solutions are extremely concerning: Beyond harming the quality of care, they may actually endanger lives if a suicidal person receives treatment from a practitioner lacking sufficient training.
It seems that, as with mental distress in general, more than a single awareness day is needed when it comes to suicide. A comprehensive recovery of the public psychology system in Israel is required to strengthen the ability to carry out prevention, treatment, and long-term follow-up; ensure positions and fill existing ones; and provide guidance and support for professionals.
The new agreement for psychologists in the public system is a step in the right direction, but still far from sufficient.
All this must happen. We have the right to demand it – not only on Suicide Prevention Day, but throughout the year. Only thus can we safeguard the mental health of ourselves and our children, which is already being gravely harmed by the reality in the country today. Only thus can we truly prevent suicide.
The writer is a clinical psychologist, a former IDF mental health officer, and a member of the Forum of Organizations for Public Psychology.