118 Suicide prevention in Germany

The suicide rate in Germany is around the European average; nevertheless, in Germany the third highest absolute number of suicides is committed in Europe (after France and Poland). In 2005, there were 10.260 suicides (7.523 males and 2.737 females; 18.7 and 6.5/100.000, respectively). There are marked regional differences that have been observed for many years, and the suicides reflect a Hungarian pattern (increasing rates with increasing age).

There are many initiatives, as well as institutions, all over the country, which cover a broad spectrum ranging from telephone services and crisis intervention centres to inpatient facilities. I will, therefore, focus on the most important and influential activity of the last years, i.e. the implementation of a national suicide prevention programme (NaSPro, Nationales Suizidpräventionsprogramm).

Starting as an initiative of the German Association for Suicide Prevention (DGS) in 2002, the NaSPro has achieved increasing attention and cooperation in the country. It is chaired by Professor Armin Schmidtke (Würzburg), and the secretary is Georg Fiedler (Hamburg). From the first, NaSPro had been organized as a broad and integrative approach, acknowledging that suicidal behaviour is a multifaceted phenomenon, which necessitates including experts from different fields of science, as well as practitioners, relatives' organizations, representatives of political, religious and other organizations that might contribute to the task of suicide prevention.

The chosen structure of the NaSPro includes actions on a horizontal level, which means for certain target groups such as adolescents, elderly etc., as well as a vertical level, comprising specific interventions, e. g. media initiatives, reducing availability of means. An executive group consists of experts and interested people; an independent scientific board (consisting of national as well as international experts that are not directly involved in the activities) guarantees the scientific basis.

The next step was the formulation of working groups, who focus their suicide-prevention work on specific risk groups, settings or structures. Currently, there are seventeen working groups, with topics including addiction, the elderly, networking, specific risk groups, primary prevention, the workplace, and the armed forces.

The working groups work independently, so progress in the different groups varies, as do the focus and the approaches to the task of suicide prevention. In this work, the WHO guidelines are utilized (WHO 2009).

More than eighty organizations support the NaSPro and participate in different activities; with members of very different backgrounds and affiliations cooperating. There have been several conferences, and general meetings each year, of the NaSPro-initiative to coordinate and stimulate ongoing projects. Press conferences are organized in connection with the World Suicide Prevention Day on 10 September.

Another focus is the attempt to comprehend different training activities: a German academy for suicide prevention has been founded, one working group collects material concerning different educational activities that are already in existence, and works to improve training courses for various types of training. The Academy also provides material for the training of specific professional groups, such as nurses in old people's homes.

Other activities focus on the availability of means to commit suicide, e.g. car exhaust fumes, medications, registering hotspots.

The number of activities is large and comprises an enormous variety. The NaSPro is embedded in national as well as international structures, thus guaranteeing a constant exchange of expert opinions on different projects, and the rapid integration of new developments in suicide prevention. There is also considerable political support, including the federal committee on health in the German Bundestag.

It is too early for conclusions at the moment, but we can say that the NaSPro is a very promising initiative, which has already increased public awareness, the general interest in suicide prevention in Germany, and among particular groups, to a considerable degree, which hopefully will be of value for the task of suicide prevention.