German suicide prevention plan hopes to help more men

On average, twenty-eight people take their lives each day in Germany — one every 56 minutes.* That's more than the number of homicides, traffic accident fatalities and deaths from HIV/AIDs and illicit drugs put together.

While Germany's suicide rate has halved since the beginning of the 1980s, it has remained largely constant over the last two decades. Health Minister Karl Lauterbach has now presented the country's first national suicide prevention strategy, naming older men as an important focus group.

"We have to overcome the taboo about death and suicide, destigmatize mental health illness and better combine support services," he said during the plan's presentation on May 2.

He said the majority of suicides can be traced back to mental health issues.

"It's frequently an impulsive decision and it is not just the individual alone who is affected. Often children, in particular, suffer, the entire family."

Health Minister Karl Lauterbach stressed that each suicide attempt affects entire familiesImage: Michele Tantussi/Getty Images

Among the recommendations are a national center to coordinate advisory services and special training for health care workers. Construction measures to stop people accessing suicide hotspots and a unique national hotline number, specifically for suicide prevention, are also under consideration — adding to the crisis helpline, the Telefonseelsorge, which already exists in Germany, operating under three different numbers.

A central anonymized data register that includes information on attempted suicides is also being considered.

Most professionals working in the field welcome the introduction of a national strategy, but they are critical about the lack of concrete detail and the absence of a funding plan.

Depression, substance abuse and being single or widowed are the biggest risk factors for male suicideImage: Thomas Trutschel/photothek/picture alliance

Male depression 'systematically underdiagnosed'

Social scientist Anne Maria Möller-Leimkühler, from the Men's Health Foundation (Stiftung Männergesundheit) welcomed the acknowledgment of men's needs. "Suicide prevention has always been a bit gender blind," said Möller-Leimkühler.

While depression is recognized as the biggest risk factor for male suicide, followed by substance abuse and being single or widowed, it is systematically underdiagnosed, she said.

"Men suffering from depression can present completely different symptoms than women and that is not standard knowledge in psychiatry. Men often react to the start of depression with increased aggressiveness, with fits of rage, with increased alcohol consumption, with risky behavior, with hyperactivity. Things that conform with masculinity, but are not primarily attributed to depression and thus go unrecognized," said Möller-Leimkühler

In 2022, suicide rates among men were highest among 55 to 60-year-olds and 80 to 85-year-olds — with numbers significantly rising from the age of 50. But male rates were higher in all age groups except those under the age of 15 where girls outnumbered boys.

Many men don't realize what is going on with themselves or are loathe to seek help because it conflicts with norms of masculinity, according to Möller-Leimkühler. She said general practitioners were an important port of call for older men, in particular, and should be trained to identify men at risk.

In addition, she said a lot more could be done to provide more easily accessible and less costly services, such as men's sheds, a community movement that originated in Australia where men can get together over a woodworking project or the like. Help could also be offered in places that men tend to frequent anyway, like barbers' shops — an idea that has sprung up in the UK.

More suicide attempts among younger people

Diana Kotte is the national coordinator of [U25], a prizewinning suicide prevention service offering online counseling for young people. Managed and partly funded by the Catholic Caritas Association, it trains some 1,400 young volunteers a year to operate the service. But it is overrun with requests.

Kotte stressed the importance of focusing on the number of suicide attempts and not just the number of suicides.

For every suicide, it is estimated there are some ten attempted suicides — often with serious health implications. Kotte said attempted suicides were highest among the under-25s and suicide the second most common cause of death.

She feels the national suicide prevention strategy fails the under-25s. "It's a huge deficit that this target group is not being looked at, although we very much know from recent studies of young people just how troubled this age group is. We cannot simply expect young people to go to the end of the queue again," she told DW.

Mental health services need financial footing

U25 has been co-funded by the German Health Ministry for 20 years, but this may run out at the end of this year.

A significant number of organizations and services for suicide prevention already exist in Germany, but many still rely on donations and charity funding, are largely voluntary or operate on a temporary project basis.

Ute Lewitzka, chair of the German Foundation for Suicide Prevention (DGS), stressed that it is vital the national strategy is put on a firm legislative and financial footing.

"Even if I have a central coordination point, it doesn't help me if I don't have anyone at the periphery who can care for patients or those affected," said Lewitzka, who heads the suicidality section at the German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology (DGPPN).

The majority of people considering taking their life can be helped. Yet in Germany, you can wait months to get psychotherapy or an appointment with a psychiatrist. One in three therapists are over the age of 60 and may soon retire.

Ines Keita, from the German Foundation for Depression Support and Suicide Prevention (Stiftung Deutsche Depressionshilfe und Suizidprävention), said it was essential to ensure that there was enough low-threshold support and medical provision for everyone.

Edited by Rina Goldenberg

*Editor's note: If you are suffering from serious emotional strain or suicidal thoughts, do not hesitate to seek professional help. You can find information on where to find such help, no matter where you live in the world, at this website: https://www.befrienders.org/

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