Alexandr Kasal is a graduate of the Department of Public and Social Policy at the Institute of Sociological Studies FSV UK. He currently works as a researcher at the National Institute of Mental Health, where he is the head of the Suicide Research and Prevention working group. He was a guest of our De Facto podcast and we bring you the English translation here:
What is the main goal of the Suicide Research and Prevention working group?
The main goal is to reduce the number of suicidal acts in Czechia.
What methods do you use to achieve this?
I would divide it into three branches. One of them is, of course, research activity, because the National Institute of Mental Health is primarily a research institution. We work with data, we do various surveys or look at data from health registers, for example, how experience or history of mental health illness is related to the risk of a suicide attempt. The second branch is a branch of enlightenment, communication, when we try to open up the topic a little bit, because we think it is shrouded in such a mystery, similar to mental illness. We try to bring it out into the light, talk about it openly, open a discussion. And the third branch is work with stakeholders, we try to speak into that practice, we try to bring some inspiration from abroad, and we also stand behind one national document, the National Action Plan for Suicide Prevention, which establishes priorities, a series of measures through which we would like to reduce those numbers.
In the National Action Plan for Suicide Prevention 2020-2030 you are working on implementation within a framework of a European project. Does it mean that you are trying to implement it in other countries as well, or that you are inspired by other countries?
It’s more the second option. The project, called ImpleMENTAL, includes 17 countries and the main goal is the transfer of some elements from Austria. The Austrians have about a hundred years of history of suicide prevention and a number of actually evaluated measures behind it. We try to transfer elements of the strategy based on the analysis of this local practice.
You mentioned that the working group focuses on the promotion of those topics among stakeholders, how is it going here in Czechia?
I think the adoption of the Action Plan is a proof that it succeeded. Anyone who is interested in the details can look at the website of the Ministry of Health, at some of the annual reports, or reports on implementation. We managed to draw attention to the fact that when we have an average of 3-4 people dying every day and these deaths can be prevented in many cases, it really is time to do something about it.
Why is the topic of suicides, but also of mental health in general, shrouded in mystery. Is it possible that the families of those people who died voluntarily or people who have mental health problems in general are ashamed of it?
It is partly a historical legacy, how psychiatry was perceived under the previous regime, how it was abused as a way to eliminate inconvenient people.. Historically, physical health was emphasized a lot, whereas going to a psychiatric hospital made you “crazy”, someone who couldn’t handle something, and I think we carry that to this day. But even in countries that don’t deal with this legacy, the willingness to actually seek help for mental health problems or suicidal thoughts that can go hand in hand with that is lower than in the area of physical health. It is relatively absurd of course, because if you break your leg, you won’t be pretending that you are completely fine, but it’s happening when it comes to mental health.
Recently, there was a news in the media that the number of suicides is increasing, last year there were 1302. What is the reason for this increase?
I don’t think it’s possible to pin it down to any specific variables. Behing every single death by suicide, there is a rather complex mix of causes. Contrary to popular belief, it doesn’t happen out of the blue in response, for example, to the fact that someone broke up with someone or someone was fired from work. It can rather be the final trigger, not the cause itself. The increase could be caused by the wider social development, the socio-economic situation, when the cost of living actually increases very quickly, then the situation in Ukraine, perhaps some delayed effect of the covid years, especially for children and the youngest population, hand in hand with limitation of social contacts. Then there are things like the availability of mental health care, how stigmatized this topic is, how much alcohol is used in society, which in turn increases impulsivity or can cause depression, so it’s actually a very complex package.
I assume that in those people who either attempt or commit suicide, we can perhaps observe some pattern of behavior, some clues that we can notice and pay attention to.
There are certainly cases when there is probably only a slim chance of noticing it, but in general the warning signs will simply be some deviation from the long-term average. This may indicate to us that we have more of a chance to notice it in someone who is close to us and who we know well. First, we can notice whether the person talks about it, expresses feelings of helplessness, whether they say things like “I don’t want to live anymore”, “I’m not good enough”, or even more explicitly “I’m thinking about suicide”. I would like to disprove the common myth that when someone talks about suicide, they don’t plan to do it. This is really not the case – if the person is talking about it, then it’s definitely a good idea to ask what’s going on and also help direct them to professional help. Second, there can be a change in behavior, for example, the person stops devoting themselves to their hobbies and starts to become more of an introvert, or vice versa, someone who is naturally an introvert has some extrovert-like behavior. And it’s good to ask in that case if something is going on.
In the report on the number of suicides, it was mentioned that the percentage of men significantly predominates in the number of suicides.
The disparity is truly dramatic. About four to one – there are four men for every one female death. And again, we don’t have an entirely obvious explanation, but the things that play the role are the higher impulsivity of men, the preference for more lethal methods and a lower willingness to seek help in case of mental health or relationship problems, so those untreated problems can have bigger and more dramatic consequences. There is also the still prevailing image of a man as someone who manages his problems and doesn’t ask for help much.
Sometimes you hear people talk about demonstrative suicide, i.e. that people who try to commit suicide and don’t succeed just cry for attention. Is it something that actually exists or is it a myth?
We definitely don’t have any data on that but in my opinion, even if it is so, it doesn’t in any way diminish the seriousness of the act. I would divert the question from whether it is demonstrative or serious, and rather encourage people to realize that one way or another it is a manifestation of some extreme crisis that could have come from various causes as we already discussed.
How important is working with data and data analysis in general in your job?
It is certainly important or at least you need a basic ability to understand data, to be able to read and analyze it. Its importance comes into play if we get to the point where we are carrying out some kind of study, so it is definitely better to have more detailed knowledge of analytical methods. On the other hand, we have a dedicated team for this, so if we are dealing with some more complex analyses, we tend to turn to them.
As part of a statistical analysis, you worked out the so-called hotspots, where there is an increased number of suicides on the railways. How we can intervene in such cases?
Those interventions can be of a more invasive character, such as physical barriers built in those places, or of a softer character, such as leaflets and signs with contacts for crisis assistance at those spots, or education of railway workers to increase their sensitivity and attention to someone acting suspiciously in some way (e.g. sitting in the station for a long time, being upset, crying), so they might be able and willing to reach out and offer support.
When you do this kind of work, do you have to keep a little distance from it?
I work often “only” in the language of numbers, so I think that in this sense it must be much more demanding work for psychologists and psychiatrists, but of course psychohygiene is definitely needed. It is necessary to relax or to focus more on something where we can see the direct impact, e.g., we organize discussions or we go to schools and we get positive feedback.
How do children, pupils or students in higher grades react to this topic? Are they open to such debates or at least more open than the older generations?
I think they are definitely more open than we were. I just went through a volunteer project where I’ve been to different schools and I was surprised how open the children are. We don’t go there with the topic of suicide but with the topic of mental health in general, and the risk or possibility of having suicidal thoughts is more like a subtopic. As a kid I probably wouldn’t have been as willing to talk about it or talk openly in front of my classmates that I had some problems, so I think the younger generation definitely is more open and I’m glad to see it.
That’s a positive step forward that the younger generation can talk about it, but even so, the statistics show the increase in the number of suicides also in that young age category.
IIf we look at it through the lens of proportions, then actually every fourth death in the age group 15 – 24 is suicide, so I think it’s really a wake-up call for us to focus more on that in conjunction with the low availability of mental health services for children and teenagers, lack of psychiatrists, child psychologists and psychologists at schools.
You also focus on a phenomenon called social psychiatry. Could you tell our readers briefly what it is?
This is just an older term that was used before we came up with the concept of public mental health. We focus on the mental health of the entire population and look at, e.g., societal determinants or social inequalities, especially in the incidence of mental illnesses. We don’t work with individual cases as psychologists do, but rather we’re looking at the bigger, broader ones like phenomena and effect of society.
Which social determinants can have a negative effect on mental health?
We have already touched on the issue of stigmatization and on the availability of services. We strive to make psychologists, psychiatrists and child psychiatrists readily available in the regions, which unfortunately still hasn’t happened. There is certainly the broader socio-economic situation, income inequality, quality of relationships, education, history of trauma and abuse in childhood – all this can increase the chance of developing mental health problems later in life.
Are you interested in the topic of mental health? Read also the interview with our therapist Anna-Marie Pospíšilová. Information about psychological help provided by FSV UK can be found here. FSV UK also launched the Well-being Working Group. Read more about their activities here.