"Hang in there one more day"

BarcelonaShe admits that she hesitated a lot before speaking and being photographed for this report. That she doesn't know how her neighbors will look at her after reading these lines. And that even her family warned her to think twice before coming forward. But she has finally decided to do so, because she hopes that whoever reads this and feels reflected will realize that they are not a freak; they will feel accompanied and will take the step to ask for help. Mònica Pallàs tried to kill herself twice and continues to have recurrent suicidal thoughts that torment her. "Mònica, hold on one more day" is what she says to herself every time she plunges into the abyss. She has held on. The goal is to save more lives.

Yes, to save lives - even if the phrase sounds grand. Because suicide is the first cause of death in Catalonia among men who are between 25 and 44 years of age, and the second among women of this same age, according to 2018 data from the Department of Health. The corresponding figures for 2019 have not yet been made public. In 2018 the Statistical Institute of Catalonia counted 522 suicides. Depression is the main cause of suicide; and in times of coronavirus, depression has become another pandemic.

"People know that if they have chest pains they have to go to the emergency room because they may suffer a heart attack. But they don't know that if they have a depression, one symptom is having suicidal thoughts", warns psychiatrist Aina Fernández Vidal, from the Sant Pau Hospital's suicide prevention program. In short, we have no idea, and this ignorance kills. And more so now. Dr. Fernandez Vidal says that since the end of lockdown, more and more patients are treated for attempted suicide. "There is a myth that if you talk about this subject you incite suicide. And the opposite is true: we have to talk about the seriousness of the problem".

It's precisely for this reason that Monica breaks her silence. She does so at the headquarters of the association Obertament (Openly), in Barcelona, of which she is a member, and which fights against the stigma and discrimination of people who suffer from a mental health problem. In fact, this is what she wants, to end the stigma. To begin with, seeing her already breaks all the patterns: at first glance she seems a happy person, even though she suffers from chronic depression.

Extreme loneliness and despair

"I won't explain how I tried to kill myself because it doesn't help anyone, and anyone who wants to kill himself already knows how to do it", she begins, measuring each word she utters. However, she does want to explain how she felt when those fateful thoughts martyred her: "A feeling of extreme loneliness, of despair, of not seeing any future". A suffering so deep, she says, that she only wanted it to end. Even if it meant taking her own life.

Mònica is aware that these suicidal ideas can come back like a boomerang because they are part of depression. But she also knows that climbing out of the pit is possible: "I recommend to people who are suffering from depression, when they have suicidal thoughts, to express them out loud and ask for help: go to the primary healthcare centre, call the Telephone of Hope or go to the psychiatric emergency room". Whatever. Or talk to a friend or family. "People don't want to talk about suicide because they don't know what to do about it. But you don't have to give solutions: just listen and go with them to get help", she insists.

Anna Lara wasn't so lucky. Her brother Jordi couldn't take it any longer: he committed suicide at the age of 33. He had a one-year-old son. Anna is now the secretary of the Supervivents (Survivors) association, which brings together relatives of people who have died by suicide, and which is called in this way because the pain suffered by relatives who lose a loved one to suicide is comparable to that of someone who has been in a concentration camp, according to the Association of Psychiatrists in the United States.

"You go over the conversations you had with that person, you wonder what you did wrong or what you didn't see. You feel like you're going crazy and you feel guilty for not realizing it", says Anna. In short, the guilt eats you up inside. It's a general feeling among family members of people who have killed themselves and among those who have tried and failed. Anna felt it and Mònica felt it. "We don't feel guilty when we have a toothache," says Obertament representative Ariadna Rogero, "or when we have a symptom of some other physical illness. So why does suicide make us feel this way?"

Anna's brother also had depression, but was not diagnosed. "Then you learn to detect non-verbal signs that serve as a warning, such as experiencing sudden physical changes, losing or gaining a lot of weight, going from being an open person to being closed, giving away belongings...", she explains. And also verbal signals: "There's a myth that whoever says they want to kill themselves won't do it. And it's not like that".

National prevention plan

It is precisely for this reason that psychiatrist Fernandez Vidal insists that a plan for suicide prevention is needed at the national level, just as a global strategy to reduce traffic accidents was once promoted. "We need to hold informative talks at schools and in communities, and set up specific care services", she says as an example. The psychologist from the Sagrat Cor Hospital in Martorell and deputy secretary of the governing board of the Official College of Psychology of Catalonia, Roger Ballescà, stresses that the problem is that, at the level of mental health, the health system in this country puts the bandage on when the wound is already there, instead of preventing it. "They try to put out fires when the fire is already quite widespread".

In Catalonia there are adult mental health centres (CSMA) which, as their name suggests, are specialised mental health centres but on an outpatient basis. To be treated by a CSMA, the patient has to be referred by their family doctor. And family doctors are totally overloaded, and even more so now with the pandemic. "In theory they can only spend 6 minutes on each visit, and in this time it is impossible to do psychological accompaniment, so we turn to drugs. Spain is one of the countries where most psychotropic drugs are taken", continues Ballescà.

Collapse

The CSMAs, on the other hand, are also collapsed. They usually visit patients once every two months, says the representative of the college of psychologists, and therapy sessions last only half an hour. "In a private psychologist's office, visits are every week or every two weeks, especially at the beginning", he says. And they last between 45 minutes and one hour. However, they are very expensive: 50 to 100 euros. "The picture is quite bleak but I do not want to convey an idea of impotence. We professionals are aware of the limitations. We could say that the treatment we offer is very good, but in a dose that is not therapeutic", admits Ballescà.

Mònica is lucky: her psychologist visits her at the CSMA every month. Perhaps because she has already crossed a red line. The goal now is that neither she nor anyone else crosses it again: to hold out for one more day.