Colombia must take measures for the pandemic that is looming after the health crisis that has been experienced as a result of the new coronavirus: the mental health pandemic.
This is warned by the president of the Colombian Association of Psychiatry, Astrid Isabel Arrieta Molinares, who points out that they should not be strategies only for talks, but rather complete, well-structured programs, especially for specific populations of which the Ministry of Health should be directly in charge : the population that is on the front line battling Covid -19, that of doctors and all health personnel, and the population of relatives of people who died from this disease and that of the families of those who commit suicide.
“It should be mandatory to receive all programs to help health personnel in clinics and hospitals,” says the psychiatrist from Barranquilla, who adds that the Ministry of Health has money for mental health that must be used for specific programs, with follow-ups and research, with results. For example, for the topic of suicide, make it a complete program, with, in this case, the mourning subprogram.
“It should be mandatory for the Government, with the strategy it believes, that the EPS give priority and have complete and specific programs in the prevention of suicide, that it uses several channels: with the media, the EPS and the direct campaign with territorial entities and research associated with these campaigns to measure their impacts ”.
What is the outlook for mental health in Colombia?
The leading cause of death in the world is suicide. In Colombia it is violence and for every violent death there are five people who are going to have a mental health problem. Imagine how the figures will be in our country.
Suicide rates in Colombia during 2017, 2018 and 2019, had remained at 4 per 100,000 inhabitants and rose to 6 per 100,000.
The main causes of consultation were depression, drug dependence and anxiety disorders.
The pandemic arrives and even taking as a reference what was happening in China, Italy, Spain, one never imagines such a big problem. But I said it since March, that the second pandemic to come was the mental health pandemic.
Why did you talk about a mental health pandemic?
Let’s take this as a reference: a sudden death, a person who was apparently fine, normal, complicates the grief. An unprocessed, unprocessed grief produces depression. And this is the leading cause of suicide. You can make the inference of the problem so great that we are going to have by the number of deaths that there are every day due to the pandemic.
How do you think the suicide scene in Colombia has changed as a result of this health crisis?
In the first half of 2020, the rates fall or remain the same. Barranquilla was one of the first cities to have COVID infections and reached a high peak, in which ICUs reached one hundred percent occupancy.
In Barranquilla, the suicide attempt and suicide increased. I’m not saying this is going to happen across the country. But that happened when everyone was locked up. And in the rest of Colombia there is the same possibility.
At that time there were no studies in Colombia. There already are. Violence within the family and against women increased 85%. There was an ICBF study that showed that the population most compromised with depression and anxiety was adolescents.
And an investigation with doctors and health workers, as of a cut-off date in July, reveals that we doctors were more likely to suffer from depression and we had more completed suicides by men and more suicide attempts by women compared to the general population.
I always said: there must be a specific protection program for this population. There is a group of people who are dying, there is another who is facing the situation and there is another group that is isolated because they have the disease. There is the group of those who were in ICU and leave and are survivors with great fear.
What tools do you share for doctors and health workers to take care of their mental health?
We launched the Help those who Help campaign, which is aimed at health professionals, with a box of emotional tools. As it was found that doctors were ill with depression, anxiety disorders, that they had problems falling asleep and that they had to focus on self-care, we provided help for this and even, some items that are given to a third person so that can help the doctor and have access to a solution or an appointment.
On the website of the Colombian Association of Psychiatry, in the Help those who Help Campaign, there is a link that says Toolbox. There are four modules: one that deals with the subject of depression; another, depression and anxiety; another, self-care and another, is aimed at family members, friends, and third parties to help.
What is in each module?
When going to depression, the user, through a scale, can know if it is between moderate or severe depression. If you must have a medical appointment.
If the person keeps going down, he finds an explanation about the depression, its symptoms and then gives him techniques called cognitive behavioral therapies.
If, for example, you have anxiety, watching a video you are advised in which way to distract your attention or what music is suitable to lower it. Or, failing that, mindfulness techniques to relax, fall asleep, have meditation or full rest, which help in states of depression, anxiety and insomnia.
The self-care module gives advice on how to eat well, exercise, sleep better. Each one gives not just theory but a link so you can use feel-good techniques. And the last module is that of third parties who help that doctor or that other person in the health sector.
The video has attracted attention …
Yes, it is a video in which the doctor is told: you are not a super hero, you are a human being, you have a greater chance of getting sick, committing suicide, getting sick and infecting others and we are going to give you this help for management of depression, anxiety, insomnia and self-care.
It is an interactive tool. It gives the person the ability to classify the disease. He says: ‘watch out: check now’, ‘don’t go into serious depression’, ‘you’re consuming a lot of alcohol’.
And it gives techniques that are validated to help while the person gets help. If the doctor cannot get it and is in the ICU or the internal medicine room and a colleague sees him anxious, he can play the video or the music and say: ‘do this technique while you receive help’.
What should the general population know about the subject of suicide?
The most common cause of suicide in 95% are psychiatric diseases and of these, those that are most likely to cause suicide attempts or completed suicides are major depressive disorder and bipolar affective disorder.
Hence, to prevent suicide, the first thing to combat is the first cause. The campaign of the numeral ‘Prevent is asking’ is then configured and the first action is to remove the greatest stigma, which is to refrain from asking about suicide.
We are 1,400 psychiatrists in the country, the Colombian population is millions; never, even if we triple, we will reach it to cover. But if I manage to get a father, son, mother, brother or another to ask that person who has seen changes, as strange, who does not speak, who no longer participates in activities: Do you feel good? Is something the matter? Have you thought about committing suicide? I remove the paradigm. Asking about suicide does not cause suicide.
That is the first paradigm that must be removed. The person just by saying that he has been thinking about it lowers that possibility. So there are questions that save lives. Or failing that, I help her to seek help, because, if she has depression, the person will not have the strength to seek help, that is known as abulia, which is the lack of will, of desire, of interest. That is cerebral.
The belief is that whoever is going to kill himself is not announcing it …
That is another paradigm, that is a lie. The one who is going to kill himself announces it in different ways: either he calls you to say goodbye, or to ask how you are, or he gives you things from him. When a man tries, he uses effective techniques: he hangs himself or shoots himself. Women try it more times. For every three attempts by a woman there is one completed suicide by a man.
There are impulsive suicides that are those of adolescents, because he got angry with his mother, for example. The point was not to commit suicide, but out of rage he does things against his life and ends up making lethal combinations of drugs.
If I have elements with which a teenager can be harmed, there is a greater chance that he will commit a complete suicide. If I stop having items such as guns in the house, the probability drops there.
Signs of depression
1. The person has locked himself in the house.
2. Does not go out to activities.
3. Is usually sad or crying.
4. The activities you used to enjoy stopped liking you.
5. He has thought about death, has manifested it in some way: I am bored, I wish it would disappear, I wish I would go far away where they would never find me. Those are passive ideations of death and they progress.
It can have manifestations of lower added value: ‘I am useless’, ‘what do I do in this world’. You can have an active idea of death: I wish I died. Hopelessness ideation: ‘there is no future’. Suicidal ideation: ‘I’m going to kill myself’. Suicidal plan: ‘I’m going to kill myself on such a day, using these things’. And almost always, if not one hundred percent of the cases, the person announces it, says goodbye: ‘if we don’t see each other, I love you very much’, they are more sensitive.
Therefore, if someone talks about suicide, pay attention to it. Avoid teasing. It is as if you are laughing at a cancer patient who says his hair is falling out with chemotherapy. It’s making fun of someone who is sick. When someone has a suicidal ideation it is a product
of a disease that has already studied biological causes ”.