125 Suicide prevention in Ukraine

According to the WHO official data, for the period from 1986 to 1996, there was a dramatic rise in suicide rates in the Ukraine, from 18.47 to 29.43 per 100,000. Since 1997, there has been a steady lowering of suicide rates, and the latest available data, in 2006, is 19.54. per 100,000. Nevertheless, today, the Ukraine remains the country with ‘high’ suicide rates, where suicide in males is almost five times higher than in females, and in rural areas suicide rates are almost twice as high as in the urban environment.

There is no national suicide-prevention programme in Ukraine (Suicide Prevention in Europe 2002). Suicide prevention is only mentioned in the National Health Promotion Plan and Conception of Mental Health Care, with crisis centre development as the main measure (European Network on Mental Health 2001). On the other hand, Ukraine has signed the Mental Health Declaration and Action Plan for Europe (European Ministerial Conference 2005), and recently a task-force under WHO liaison office was established to formulate how to reform the mental health care system in Ukraine for better integration into European context. As in many developing countries (Vijayakumar et al. 2005), suicide prevention activity in Ukraine is supported, mainly, by the so-called ‘third sector’, i.e. non-governmental organizations (NGOs) and volunteer organizations. While in the wider public domain, suicide remains stigmatized. The army, police (militia) and penitentiary system are implementing internal monitoring and preventive measures regarding suicide attempts and completed suicide, and have internal suicide-prevention plans of action.

Our experience in building prevention programmes started with research, accumulation of professional experience and hotline services, which were established in Odessa and all over the Ukraine, with the translation of several books by Western authors into Russian, and the publication of papers in suicidology during the 1990s. This was supported by the establishment of the academic course of suicidology at the Odessa National Mechnikov University. It was also important that Odessa NGO Human Ecological Health, presently also centre at Odessa University started actively participating in the WHO Europe suicide attempts monitoring study and prevention network, thus ensuring a methodological basis and international links. Practical work started in 1999, when Human Ecological Health was invited to implement prevention measures in one of the big Ukrainian Army units, which was facing suicidal crisis, with nine deaths of soldiers and officers during a 1-year period. From the very beginning, we have chosen the educational model of preventionstrategy, and after a series of seminars for commanders and medical staff, we were able to show that intensive education, together with prevention resources dissemination, can lower completed suicides in a given environment (Rozanov et al. 2002). But only sustainable activity can ensure success in prevention. It was a challenge, and the next step was to enhance efforts in fund-raising to sustain preventive measures.

Future expansion of education in suicide prevention, with financial support from the Swedish East European Committee, and with scientific and methodological support from the National Swedish Prevention of Suicide and Mental Ill-Health (NASP) at Karolinska Institute in Sweden, was connected with the penitentiary system of Ukraine, and later focused on other relevant groups, such as medical doctors (e.g. psychiatrists, family doctors, ambulance doctors, reanimation unit specialists), school teachers and psychologists, telephone hotline volunteers, HIV/AIDS rehabilitation centre volunteers, Red Cross patronage personnel, and mass media representatives. From the very beginning, the format of the seminars was based on ‘training of trainers’ methodology, providing to participants, using a variety of resources and electronic methodological material, further dissemination of the knowledge required, and encouraging them to start their own local programmes. Educational staff knowledge was enhanced through participation in NASP's KIRT courses (Karolinska Institute Research and Training). From the very beginning, one of the prerequisites was to cover not only Odessa but also other cities of Ukraine. An important achievement was that a network of suicide prevention specialists was created during the projects' implementation period, which now embraces twenty-six people in fifteen cities of Ukraine. A primary outcome of the projects was the successful enhancement of the participants' knowledge, and their confidence in dealing with the problem of suicide and suicide prevention. An important outcome was the preparation and dissemination of a number of high-quality suicide-prevention booklets. These included six WHO suicide prevention resources (World Health Organization 2000a–f, 2006a, b), which were translated into Russian, and other resources developed by the teaching group: about 4000 copies. The scientific skills of suicide prevention specialists were also promoted by the active involvement in a large project on gene–environmental interactions in suicidal behaviours (Wasserman et al. 2008)

As a result of those experiences, a new initiative was taken to formulate a proposal for the National Suicide-Prevention Strategy for the Ukraine. This was supported by the national network of trained specialists, establishment of relations and links to many ministries, interested agencies, nested programmes and volunteer groups. A proposal for the National Suicide-Prevention Plan was developed by the working group in Ukraine, and with active support from NASP and the International Steering Committee, which embraced suicidologists from Sweden, Germany, Estonia and Israel. The published document was discussed extensively in the professional and wide public auditoriums via meeting and round tables in the Ukraine, which provided a variety of suggestions on further implementation of the plan.

In summary, it can be stated that education, especially ‘training of trainers’ technology, together with resource dissemination and network establishment, is a useful model for suicide prevention in countries without a national suicide-prevention strategy, and a good starting point for future system change towards building such a strategy and its implementation on the basis of wide discussion.