120 Suicide prevention in Italy

National statistics on suicide deaths in Italy have been collected systematically from 1950 to 2003, which shows that the overall suicide rate has increased from 6 to 7 suicides per 100,000, with a slight gender imbalance, i.e. the female rate has decreased instead. In 2004, 3265 persons died due to suicide in Italy (Preti and Cascio 2006; ISTAT 2008).

According to the most recent available data, in Italy, the age and gender group with the highest rates of completed suicides are males aged 18–64. Completed suicides appear to be associated primarily to psychiatric disorders, and secondarily to physical illness; while if controlling for marital status, unmarried individuals carry higher rates of suicide (De Risio and Sarchiapone 2002).

Evidence from worldwide experience shows that national government plans often result in effective suicide prevention. Nevertheless, national prevention strategies have not been developed in Italy, and suicide prevention is delegated to non-governmental organizations, such as private agencies or associations, psychiatric associations and universities.

Therefore, to date several initiatives which address specific topics in suicide prevention exist, albeit they may not attain the comprehensiveness of a national prevention strategy.

Reasons for failed governmental support to suicide prevention may be the seemingly low suicide statistics compared to other European countries, but also the moral stigma of suicide that has been often associated with strong Catholic beliefs, reinforced in Italy by the presence of the Holy See within the State Capitol.

Initiatives aimed at preventing suicide are often channelled through prevention and treatment of depression, which is a high risk factor for attempting and completing suicide.

Continuous Medical Education (CME) courses for general practitioners on the treatment of depression, and prevention of suicide, have been locally organized by the University of Molise in 2006 and 2007.

The European Alliance Against Depression (EAAD) is also present and active in Italy in the Trentino region.

In Italy, national broadcasting morning programmes include general psychological reports, where issues related to suicide may occasionally arise, especially linked to recent news on suicidal events that affect public opinion. Also, commercial psychological magazines, sold in kiosks, sometimes deal with psychiatric topics and suicide.

Although specific school programmes, which target suicidal crises or other psychiatric issues have not been implemented so far in Italian schools. A General Psychological consultation service for pupils, which addresses problems related to suicidal behaviour is available; though, this service is usually provided on request by students or teachers only once or twice a week. Nonethless local initiatives have been started, with the aim of empowering psychological and psychiatric services in schools through specific programmes for detection and treatment of youth-related problems. This is the case with the Lecce school district, in southern Italy, where a programme for youth in distress which includes suicidal behaviours has been recently implemented. In some cases, schools are reached by university programmes and research projects, thus taking advantage of them, as is the case with the school district of Cagliari, Sardinia.

Suicide is a major concern among youth in Italy, where suicide ratio for adolescents has been rising since 1950. Youth is, therefore, a primary target for interventions by several organizations and agencies. A foundation has been recently established for supporting distress of the young: ‘Amico Charlie’. Its main headquarters are in Milan, and its main goal is to take care of young patients who are admitted for attempting suicide to the Fatebenefratelli Hospital of Milan. It also consists of a crisis centre for adolescents who display self-harm behaviours, and offers a counselling service for parents, teachers and survivors of suicide. It has an efficient, updated and helpful website (http://www.amicocharlie.it) where advice can be found on the treatment of suicidal behaviours, including what has to be done in case a specific referral for suicidal youth is needed. The foundation also organizes seminars and courses for teachers and social workers on recognizing early signs of suicidal risk in adolescents.

In Trieste, a private organization called ‘Progetto Amalia’ has been established, with the aim of specifically managing the distress of the elderly. Among its manifold targets, prevention of suicidal behaviours of the elderly is pre-eminent, and includes the ‘Telefono Speciale’ programme, which provides a telephone helpline with a toll-free number that offers service 24 hours a day. Telephone operators are not mental health professionals, but have received specific training for managing suicidal individuals and referring them to local mental health facilities. The organization was established as a private initiative of a local television company, but it is currently funded by the Italian Ministry of Health.

In Italy, firearms are lawfully sold only to individuals with a specific licence, with a mandatory psychiatric consultation when requesting such a licence. Psychoactive drugs are only sold with a prescription, which expires after three provisions. These well-established rules are intended to restrict access to common methods used for suicidal and self-harming behaviours (World Health Organization 2002, 2007, 2008).

The WHO, through its WHO/EURO Network on Suicide Prevention and Research, has been collecting data on attempted suicide from the catchment area of Molise, and previously, in the catchment area of Padua and Rome. Recently in 2007, the WHO's resource material Preventing suicide in jails and prisons has been translated into Italian (World Health Organization 2000).

The Italian Psychiatric Association comprises a section for the ‘Study and treatment of suicidal behaviour’, and the psychiatric clinic of the University of Padua has established an Association for ‘Study and Prevention of Suicide’ linked to the Section. The association's scientific aims comprise of the promotion of knowledge on suicide among physicians and in society. A scientific journal, both in Italian and English—Studies on aggression and suicide—publishes research articles on the biology and psychopathology of aggression and suicidal behaviours.