On the Frontlines of Suicide in Greece

The overhanging shadow of the financial crisis is large but some of its impacts are less well-known than others. In Greece, the economic recession undermined the mental health of many Greeks who rapidly lost everything they had. The Klimaka suicide helpline was conceived at the beginning of the crisis to listen to those needing to be heard.

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Olga Theodorikakou emphasizes that mental health professionals are who pick up the phone behind the helpline of Klimaka. Photo: Nicole Proano.

One, zero, one eight. Four numbers that can be dialed on the phone by those deliberating ending their own lives. These numbers may also be dialed by a sibling, cousin or friend who may be afraid about losing someone to suicide. One, zero, one, eight. Four numbers that offer someone with whom they can talk, cry and even save their life, because on the other side of the line – on the front line – professional psychiatrists and psychologists from NGO Klimaka will be waiting for them.

Klimaka was founded in 2000 with the goal of providing mental health services. When the economic recession erupted in Greek homes eight years later, the NGO decided to create a 24-hour suicide prevention lifeline. “Unemployment or economic problems are stress factors that a vulnerable person has to confront,” explains the Head of Projects and Strategy Units NGO Klimaka, Olga Theodorikakou. “We knew that suicide was a matter of crisis. It was a matter of how a person feels for specific days, weeks, even months. If you could confront this crisis and the person would be treated, you could prevent suicide.”

Studies have shown that there is not a direct correlation between the rise of suicide rates and the economic crisis. However, since the first austerity measures were implement by the PASOK government – headed by former prime minister, George Papandreou – and especially after the implementation of the first bailout program, the attempts and acts of suicides have not stopped increasing.

“It is known that people who are susceptible to depression are more likely to worsen when they are in distress or are experiencing stressful situations. More people are under stressful situations in times of crises; financial difficulties can be hugely important in modern life. However, depression is very complex. Socio-economic conditions interact with personal circumstances and, of course, genetics in ways that we do not fully understand,” explains lecturer in Public Health at the Imperial College of London and co-author of ‘Medium-term impact of the economic crisis on mortality, health-related behaviors and access to healthcare in Greece,’ Mr. Filippos Filippidis.

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No Money Back

Between 2009 and 2013, the health expenditure declined by €5.2 billion – cut by over one third in real terms. With a lack in funding, mental health services struggled to keep up with the increasing burden of mental disorders. Since 2013, 40 suicides have even taken place in hospitals and health units.

Klimaka was also facing their own economic problems since, as an NGO, they did not receive any financial support from the government at that time.  However, the lack of assistance to mental illnesses related to suicides pushed them get a step ahead of government institutions by creating the helpline, for those lacking hope, in 2008.

“Although at least 90% of people who commit suicide have a mental health disorder, the lack of access to quality mental health services also has to do with the crisis. We had seen citizens’ initiatives provide services that were lacking, such as social pharmacies or social medical centers run by volunteers and doctors. We knew that [a helpline] was something that was missing from Greece, that there were no services like that in comparison with other countries like the UK,” explains Olga Theodorikakou.

Olga, who has been involved in this initiative since its inception, has witnessed how politicians were interested in using suicide to benefit their own political agenda. “[Majority] government in 2012 were denying that suicides were increasing. [The opposition] in 2012 were saying ‘we have 10,000 suicides that are being committed due to austerity measures,’ which is untrue,” Olga Theodorikakou explains. Rather than using suicide as a political tool, Klimaka called for a national suicide prevention strategy.

Instead, the government responded in a different way and Klimaka’s situation changed in 2012. The New Democracy government recognized their work and began funding them. Since then, Klimaka is funded under the Ministry of Health and one, zero, one, eight has become the national phone number for suicide prevention. Today, Klimaka’s helpline attends around 16,000 calls per year, though not all calls are from high-risk patients but also from family or friends seeking professional counselling.

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Olga Theodorikakou at her desk in her office in Athens. Photo: Nicole Proano
Breaking down walls

As with the majority of Balkan countries, there is a strong historical Christian Orthodox influence in Greece, where roughly 98% of the population, today, are officially considered Greek Orthodox. Death and religion are inseparably tied, influencing how people view suicide in Greek society. As professor Filippidis asserts, “suicide has not traditionally been socially accepted in Greece which can contribute to the low suicide rates.” Greece is one of the European countries with the lowest rates – second, in fact, just after Cyprus. In 2015, 529 suicides were registered in Greece while in countries such as the UK, 6,639 were recorded.

At Klimaka, Olga says they believe that the number of suicides is actually much larger than the one that is being published. Even though medical death records may indicate that a person has died because of an accident, in Olga’s experience, Klimaka knows that it may, in fact, be a suicide and the family has hidden the truth from fear of being stigmatized. “In some villages or even outside Athens, Greeks deny burying a person who has committed suicide.”

Because of this, Olga Theodorikakou emphasizes that one of their most important responsibilities is to make people understand that mental disorders are just like any other medical need and that in more than 90% of the cases, suicide can be prevented. “We have to give them the treatment needed. It is like any other medical need. If I have a headache, I will take a pill. If something else aches, I have to receive treatment. Mental health is something that may lead to death. It mostly has to do with impulse. That’s why prevention is so feasible.”

However, this goal becomes difficult because of two types of obstacles. On the one hand, there is no physical connection between the person calling for help and the Klimaka professionals behind the phone. “We know that if a person comes here, we do will do our best not to lose him or her,” Olga says. For the people Klimaka treats, the mental health professionals try to refer patients to centers on the patients’ side of the country where they can receive proper treatment. Olga explains that Klimaka’s biggest frustration is when there is no nearby available public health services to where Klimaka can refer patients for follow-up treatment.

On the other hand, Olga Theodorikakou says that people calling may be aggressive, “but they call because they need help and you have to give them the help they expect of you. You have to give them a solution. This is why they call. Especially people with suicide idealization – you have to give them another route. Theodorikakou explains, that most of the time people calling are ready to deflect, “and this shows how much suicide is really not a rational choice, because people change their minds very easily.”

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            One, Zero, One, Eight. The sign shows what number to call. Photo: Marisa López
Filling the gaps in times of crises

Even though Greece has one of the lowest number of recorded suicides, the situation is still extremely significant. In 2014, the number of recorded suicides were the country’s highest since 1960 – when this kind of data began being collected.

And despite the relatively low numbers, Olga Theodorikakou says that each suicide is a loss for society itself. “What we say is that Greece losses in a bureaucratic way as well. We lose people of a productive age, people that could contribute to society. Society has to do something about that.”

Overall, the number of cases of depression has increased at an alarming rate in Greece during the economic crisis with an estimated 500,000 people suffering from depression in 2015. As a result of personal debt and threats of home repossession, rates of involuntary psychiatric hospitalization by court order have been soaring in recent years, from 57% in 2012 to 75% in 2014.

Hopefully the GDP growth and the expected stabilization of the economic landscape with the end of the third bailout program will bring more hope for Greeks who have struggled to stay standing through all the economic struggles of the last decade.

Klimaka’s phone keeps ringing every day. In some seasons they receive a higher concentration of calls but not necessarily because of a rise in suicidal thoughts. More and more, knowledge of their work is being spread throughout the country. With more discussion, people will be more able to break taboos, face stigmas and ask for help.

One, zero, one, eight. A phone number that did not exist prior to the crisis but, today, is ready for anyone looking not to face their mental illness alone.

By Nicole Proano & Marisa López

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