For an Egyptian struggling with suicidal thoughts, there are several hurdles to seeking help.
As suicide is widely considered a sin and a sign of weakness, family and friends often judge and reprehend the person reaching out for help. Even if a person breaks these barriers and decides to seek help, they may find that there’s no help out there for them.
Government statistics indicate that suicide attempts have spiked in recent years and continue to rise. In the months leading up to Saturday’s World Mental Health Day, several stories of suicide have featured prominently in Egyptian newspapers.
Unlike the almost daily suicide cases that often pass by unnoticed, these public suicides were loud enough to grab the public’s attention, placing a spotlight on the dire economic conditions, injustice and other hardships that have led these people’s decision to end their lives.
According to a report by the Central Agency for Public Mobilization and Statistics (CAPMAS), Egypt witnessed 400,000 attempted suicides in 2011 — quadruple the number that was announced the year before. Statistics from the two previous years also showed an annual increase.
Amid rising suicide rates, Ahmed Abul Wafa, a spokesperson for the Ministry of Health’s General Secretariat for Mental Health, told Mada Masr that the ministry is currently developing new mechanisms to deal with suicide, in terms of both prevention and treatment.
However, the ministry is fighting an uphill battle in a society that widely stigmatizes both suicide and mental illness.
Abul Wafa says that the secretariat is currently circulating “suicide guidelines” to all state psychiatric hospitals on how to deal with cases of suicide. He says they hope to expand the circulation to general hospitals as well, adding that the ministry is close to approving the activation of suicide hotlines within its plan for the coming period.
Egypt’s only suicide hotline operated for around 10 years before shutting down due to a lack of funds and volunteers in 2005, according to a former volunteer with the organization. The hotline was an affiliate to Befrienders Worldwide, a volunteer-based organization which offers emotional support to people with mental health issues with the aim of preventing suicide.
Since then, no other hotlines have been made available for people with suicidal thoughts. Moreover, primary healthcare units lack the basic awareness and training to deal with such cases, even if the person was to physically head there and ask for help.
According to psychiatrist Sally Toma, the social stigma and judgment tied to mental illness and suicide extends even inside the healthcare institution.
Toma is involved with a program designed by Medecins du Monde, in collaboration with the Egyptian Health Ministry, aiming to train health care professionals in primary healthcare units to respond to mental health cases. During the need assessment carried out across the country for the program, Toma said that it was revealed that healthcare professionals in clinics nationwide have no awareness of mental illness or how to treat it.
She says the doctors and nurses themselves repeat stereotypes about mentally ill patients, calling them crazy and possessed. This leaves people in need of treatment and unable to afford private healthcare with the central Abbaseya Hospital, where Toma says patients end up abandoned and neglected for decades.
A widespread religious belief in Egyptian society that those who kill themselves die as apostates can also lead to judgment of a person admitting to having suicidal thoughts, making them less likely to ask for help.
Abul Wafa says that while general practitioners study psychiatry as part of their training, whether they are sufficiently trained to deal with suicide attempts remains a question. He adds that the general secretariat has no authority over the primary health care units where people who are considering suicide or have already attempted end up. He says that the secretariat offers them training on demand.
As for psychiatric hospitals, he asserts that they deal with suicide attempts as emergencies and regular training is provided for their doctors.
Yousry Khalil, who headed the Befrienders call center in Cairo in 2003, says that the center trained volunteers on active listening aiming to provide callers with support and help them work through their thoughts. He says that the anonymity of the service encouraged people to seek help without fear of stigma and provided them with much-needed acceptance.
Khalil said that the age group between 20 and 30 was the most prevalent among callers.
However, society’s limited sympathies to mental health issues was a factor in the office eventually having to close down due to the lack of donations and volunteers.