Lizette Rabe | Hope: a noun and a verb

10 September is World Suicide Prevention Day. This year’s slogan is "Create hope through action", writes Lizette Rabe.

"We have tried everything. Her medical team did everything they could. We encouraged her to go to gym a couple of times a week, for a stroll on the beach with our dog. She was a keen kite-surfer and would try out any breeze."

These were the recent words of a mother to me. Note: past tense.

This beloved daughter, sister, granddaughter, friend, is no more. She too became a victim of the "black dog".

She was only 21, on the brink of her dreams. Her parents and medical team tried everything. Yet, seemingly nothing could restrain the illness that eventually devoured her.

According to statistics, on the day that this young woman died, she was one of 23 South Africans who died of suicide. On the same day, approximately 230 tried, but did not "succeed", and therefore have a second chance.

Suicide rates among men more prevalent

One in every 100 deaths worldwide is caused by suicide, and almost one million people lose their lives to suicide each year.

Among young people between 15-29 suicide is the fourth leading cause of death (after road injury, TB and violence). More than twice as many men die of suicide, namely 12.6 per 100 000, compared to 5.4 per 100 000 women. Also: Suicide rates among men are more prevalent in high-income countries – 16.5 per 100 000.

When the World Health Organisation (WHO) recently launched a new suicide prevention guide, LIVE LIFE, Doctor Tedros Adhanom Ghebreyesus, director-general, said: "Attention to suicide prevention is even more important now, after many months living with the Covid-19 pandemic." The risk factors – job loss, financial stress and social isolation – are "still very much present".

READ | Opinion: Preventing suicide has to start with destigmatising the act of seeking support

The slogan of the International Association for Suicide Prevention (IASP) for 2021’s World Suicide Prevention Day (WSPD) is "creating hope through action".

"Hope" is both a noun and a verb – and hopefully we can save some from humankind’s most cruel illness. Or this "terrible disease", as British author Virginia Woolf wrote in her last letter to her husband before walking into the river Ouse in 1941:

 Woolf’s last sentence, research says, is one of the important factors in the suicidally triggered mind: That loved ones will be "better off" without them. That they are a burden.

NO! we say. NO! we are not better off without you! You can be saved. You can be cured. Tomorrow WILL be better than today. Please, give life – hope – another chance.

So, to you reading here, let’s create "hope through action". Let’s act to save lives.

The three A's

To make a difference, we need the three a’s: awareness, activism and action.

One easy action is just to ask someone: "Are you ok?" These three simple words might be the only action needed to help someone getting help. That is also the idea behind the RUOK campaign. And it is for a good reason on 9 September, just one day before WSPD. 

Create "hope through action" by simply asking whether someone is ok and start a conversation that can change a life. Maybe even save a life. You don’t need to be a psychologist, psychiatrist or medical doctor. Just reach out as family member, friend or colleague.

And encourage action: Ask them to see the family doctor, just as you would when they told you about other physical symptoms, like diabetes, or a heart condition. Then stay tuned-in. Check to see whether the person has acted. Because, as with other symptoms, they won’t go away if ignored.

READ | Opinion: Covid-19's silent toll and why words matter

Rather the opposite – they will become worse. And, please, never give up on someone with a mental illness. They are not “acting up” or suffering from a make-believe illness. Their most important organ, their brain, is experiencing a clinical, biological malfunction because life-supporting neurotransmitters are not secreted.

With Covid-19 it is critical that adolescents – 10- to 19-year-olds – need special attention. According to the WHO half of mental health conditions appear before age 14. Mental health and anti-bullying programmes to link support services for those in schools and universities when suicide risk is identified, are critical. It is crucial for risk identification, including follow-up measures, especially for those who have attempted suicide, or are perceived to be at risk, as a previous attempt is one of the most important risk factors.But that is why 2021’s WSPD slogan of "creating hope through action" is so apt. That simple four-letter word HOPE, being a noun and a verb, can save lives. Especially under Covid-19 and the pandemic’s psychological fall-out we need to go out of our way to create "hope through action".

Impact of the pandemic 

According to the UK’s Royal College of Psychiatrists the pandemic "poses the greatest threat to mental health since the Second World War", with its impact "felt for years after the virus has been brought under control".

A combination of Covid-19 and its social and economic consequences will have "a profound effect on mental health" long after the epidemic is reined in. Millions of people in the UK, including 1.5 million children, will need "new or additional mental health support as a direct result of the crisis". Another study found that one in four UK youngsters feel "unable to cope" in the pandemic.

For South Africa, we do not have those statistics, but one can, without a doubt, assume that the same scenario is playing out in our country – probably worse. Mental health support services are far less, which means the impact of the mental health pandemic will be much more severe. Long before Covid-19 the WHO has already predicted that depression would be the leading cause of health disability by 2030. Covid-19 has also accelerated that prediction.

Pre-pandemic figures indicate an alarming rise in mental health needs. A South African report indicated mental health spend has increased by 87% in the years between 2011 and 2016, reaching R2bn in 2016.

Hospitalisation costs 

Hospitalisation claims were R32m more than predicted. Depression contributed to over 40% of SA’s overall mental health disease burden. It was stressed that these figures represent only the tip of the “mental health iceberg”, as they only reflect spending by those who can afford private care.

Let’s all make a difference with hope as both a noun and a verb in these so challenging times. Let’s believe in ourselves. As author Ursula K le Guin said: "The worst walls are never the ones you find in your way. The worst walls are the ones you put there."

So let’s demolish those walls and empower ourselves with hope. Depression is a treatable disease and suicide a preventable tragedy. Please reach out. It could save someone’s life. When "I" is replaced by "we", illness becomes wellness.

- Lizette Rabe, professor at Stellenbosch University, is a mental health advocate who founded the Ithemba Foundation – ithemba means hope – to raise awareness of mental health and to support research. On 3 October the Hope Hike and Hope Bike will ring in October – HOPEtober – as Mental Health Awareness Month. As a virtual event, it means anyone, anywhere, can make a difference. Go to https://www.entryninja.com/events/76918-hope-hike-2021 or email ithembafoundation@mweb.co.za.

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