133 Suicide prevention in Peru

Peru has a multi-ethnic population and an estimated 28 million inhabitants spread across a national territory, which comprises three principal regions: the coast, the highlands, and the Amazon rainforest.

Peru has started to recover from the effects of two decades of extensive human rights violations due to civil war, which has mentally affected the entire population. There are at least about 22,000 families or 132,000 individuals in need of mental health care as a result of the violence generated by terrorist and military actions. Psychological effects such as prolonged fear, distrust of neighbours, the breakdown of families, loss of property, postponed grief and desperation (Fraser 2004) have contributed to the deterioration of the mental health of the general population, including increased rates of post-traumatic stress disorder, depression, and associated health disorders. The Harvard University Gazette reported that the reduction of the social capital created higher rates of hopelessness, demoralization, diminished quality of life, and waves of forced migration, mainly from rural areas to the cities; and this has had its effect on the mental health of the Peruvian population (Harvard Gazette Archives 2006).

Peruvian mental health professionals are confronted with a population made of grandparents who witnessed the sudden decay of a promising country, parents who lived most of their lives under the years of terror and violence created by the civil war, and children and teenagers who do not know why their parents are so sad, aggressive, defensive or anxious.

In rural areas, the high unemployment rates, gender inequalities, low education, lack of availability of mental health services and generalized poverty make these populations very vulnerable to violence and associated mental health problems.

In urban areas, the high crime and unemployment rates, the high demands on academic performance especially from children in primary and high schools, lack of family support, strict parental styles, and drug and alcohol abuse or sexual and psychological abuse of children and teenagers, makes this population very vulnerable to mental ill health.

The approximate suicide rate in the country in 2006 was 2–3 per 100,000 inhabitants, which is relatively low compared to the suicide rates in developed countries, and other Latin American countries. Regarding suicide attempts, data from 2005 show a total of 630 reported suicide attempts in the country. The distribution follows the international trend of higher suicide attempts among females, N = 466 (74%), than in males, N = 164 (26%). The National Institute of Mental Health, and its Suicide Prevention Program in Peru, are the entities keeping the registers with the data for mortality and morbidity by suicide and suicide attempt, and reporting them to the Peruvian Ministry of Health (2005) every year.

The scientific study of suicidal behaviour, and the activities concerning suicide prevention in Peru, began in 1994. The National Institute of Mental Health, through its suicide prevention programme, runs a project comprising a multidisciplinary team of professionals who are currently studying the sociodemographic components, and the epidemiology of suicidal behaviour in the country.

This is a large-scale and long-term study. Different patterns of suicidal behaviour in the Peruvian population, and the risk and protective factors present in the various ethnic groups, are just beginning to be understood. At the moment, the project has dispatched study teams to gather epidemiological data on suicidal ideation and suicide attempts in metropolitan Lima, the highlands, the jungle and, most recently, to the settlements along the national borders.

To report suicide completion, or to diagnose suicide attempt, the guidelines from the WHO are followed. The official procedure was approved by the Ministry of Health in its Guide to suicide prevention and treatment (2006). The intervention strategies are decided according to the SAFE-T model (American Psychiatric Association Practice Guidelines for the Assessment and Treatment of Patients with Suicidal Behaviors), which recommended five points for easy and fast assessment, and interventions for suicide attempters.

After this diagnostic phase, therapeutic psychological intervention for individuals, groups and families, as well as therapeutic coaching and art therapy to suicide attempters and individuals with suicidal ideation, is offered. A suicide-prevention hotline in Lima, which gives psychological support, follow-ups and referrals, and is managed by professionals specifically trained in crisis intervention, is in use.

The media educates the public about suicide, basically, on how to recognize individuals at risk, and to provide referrals to mental health hospitals. The Ministry of Women and the People's Defence Agency (a Peruvian organization that defends the rights of women, children and teenagers) are involved in promoting fast and adequate treatment of individuals who have suffered sexual and/or physical abuse and are at risk for suicide.

At the moment, the primary and secondary school teachers, pedagogues, and tutors are trained to recognize students at risk. Once a year, public and free of charge depression screenings in Lima, and in other large cities, are performed, and people who are considered to be at higher risk for suicide are contacted.

The main obstacles that suicide prevention activities encounter in Peru are the lack of a permanent budget from the government, undiagnosed and untreated depression in the population, a policy for depression and suicide prevention campaigns, the under-reporting of suicides and suicide attempts (especially in cities far from Lima), the lack of trained personnel for preventive activities, and the stigmatization of suicidal behaviour.