This section includes the initiatives carried out by each Spanish Autonomous Community to deal with suicide in its different facets. There is neither national coordination nor national suicide prevention plan so far. Some Communities do not present an integrated plan for suicide prevention at the present time.
Andalusia
In Andalusia there is currently no specific plan or systematic action protocol for suicidal behavior. However, some lines of work have been developed for the prevention and care of suicidal behavior:
1. Local Network for Suicide Prevention and a training package for primary care professionals.
2. Development of technical documents: General guidelines for suicide prevention; Ethical guidelines for suicide prevention programs based on new technologies; and tools for suicide prevention in different settings.
3. Development of a catalog of resources and tools for self-help groups for suicide survivors.
Aragon
Aragon Suicide Prevention Strategy (ExPreSA)
The Government of Aragon has proposed in 2020 a Framework Document to develop a strategy for the prevention of suicidal behavior and the registration and monitoring of patients at risk with two strategic lines:
1. Strategic line of universal and selective prevention
2. Strategic line of intervention, which has two objectives: a) to have a record of completed suicides and to articulate a suicide risk alert code in the electronic medical record of Aragon, and b) to formalize and prioritize the continuity of care in the autolytic risk and in the social environment of people who have committed suicide.
Asturias
Protocol for the detection and management of cases of people at risk of suicide
In Asturias there is a protocol for the detection and management of cases of people at risk of suicide that guarantees immediate care for those with high suicidal ideation, being treated in less than 10 days.
The protocol includes clinical care of at least one year of follow-up for those patients who have made a suicide attempt or are at risk of suicide, organized in the following phases:
1. Acute phase: First appointment (within 10 days after request) and appointments every 1-2 weeks during the first month.
2. Subacute phase: appointments every 2 weeks until the third month of follow-up.
3. Remission phase: monthly appointment up to 12 months with evaluation for exit or continuation of the protocol after the year is over.
Balearic Islands
Suicide Observatory
The Suicide Observatory was created in 2017 with the aim of establishing an autonomous project for the prevention of suicide. The priority of the observatory in the last year (2021) has been that all public health hospitals have suicide care and prevention teams.
The suicide care and prevention teams are multidisciplinary teams that offer intensive and specific treatment to people at high risk or who have made a previous suicide attempt. It consists of outpatient care lasting 3 to 6 months in which individual, group, and family therapeutic interventions are offered.
The Observatory also proposes a Guide for the prevention and the first approach to suicidal behavior in educational centers to detect students at risk and know how to deal with the problem, as well as a Protocol of action in case of detecting the risk of self-harm.
The protocol includes identifying whether the behavior detected is suicidal ideation, self-injurious behavior, or an imminent risk, and contacting both the families and the corresponding healthcare facility according to the level of risk (low, medium, or high).
Canary Islands
Canary Islands Mental Health Plan 2019-2023
The Canary Islands Mental Health Plan 2019-2023 includes a strategic line specifically dedicated to suicide prevention.
The prevention and action plan is currently in the preparation phase and proposes 6 general objectives and 24 activities, among which are: Development of unique action protocols for patients with suicidal risk both in hospital emergency services and in psychiatric internment units; and the planning and feasibility study of an ultra-short hospitalization unit for patients with considerable and uncertain suicide risk.
Cantabria
High resolution program for the management of suicidal behavior and suicide prevention
The program consists of patients with suicidal ideation or suicide risk, after visiting the emergency room, being treated immediately, getting an appointment within 24-72 hours after discharge from the emergency room and intensive follow-up.
Castilla-La Mancha
Castilla-La Mancha Mental Health Plan 2018-2025
The Mental Health Plan of Castilla-La Mancha 2018-2025 proposes in Axis III on Sustainability, promotion and prevention a specific objective of Suicide Prevention whose lines of action are aimed at the development and application of strategies for the prevention of depression and suicide, placing greater emphasis on the groups most at risk.
Castilla and León
Strategy for the prevention of suicidal behavior 2021-2025
The Strategy for the Prevention of Suicidal Behavior in Castilla and León aims to "Reduce the incidence and prevalence of suicide in Castilla and León; guaranteeing adequate care for the person and their relatives, through a comprehensive approach to the prevention, care and follow-up of suicidal behavior.”
To achieve this objective, the Strategy has 71 measures framed in 5 strategic lines:
1. Universal prevention
2. Selective prevention
3. Indicated prevention
4. Epidemiological Surveillance and Research
5. Training
The indicated prevention measures include strategies aimed at the most vulnerable individuals; Those who show premature signs or have already made a suicide attempt. One of the objectives of this strategic line is to evaluate and update the previous protocol: "Process of prevention and attention to suicidal behavior in Castilla and León".
Said protocol proposed by the Castilla and León General Directorate of Healthcare determines action in both primary care and emergency services.
Regarding the detection and care of suicidal behavior in primary care:
- Urgent psychiatric referral for patients who: 1. have made a suicide attempt that does not require medical treatment, 2. are at high risk of suicidal behavior, or 3. have high suicidal ideation in conjunction with another serious mental illness or elaborate plan.
- Referral and consultation to Mental Health within 7 days for patients with medium risk.
- Referral to Mental Health services on a regular basis for low-risk patients.
On the other hand, all patients who arrive at the emergency service due to suicidal ideation or attempt must be seen within one hour and receive an assessment by the psychiatric professional to determine if a hospital admission is required or refer to the service of Mental Health (within 7 days).
Catalonia
Suicide Prevention Plan of Catalonia 2021-2025
The main objective of this autonomous plan is the prevention of suicidal behaviour, adding to the integrated action and leadership of the health, social and social sectors.
The plan consists of 6 strategic lines:
1. Universal, selective, structural and structural warning of suicide.
2. Detection, access, immediate care, processing, and support processes in cases of suicidal intent.
3. Support for family members, other survivors and professionals.
4. Clinical safety and suicide prevention.
5. Support for epidemiological information management and monitoring.
6. Governance.
Extremadura
Suicide Code
The Suicide Code of the Extremadura Health System is a care protocol for people who have made a suicide attempt or are at medium or high risk of suicidal behavior.
When a high risk is estimated, the patient is referred to the Hospital Emergency Service where he is evaluated by a psychiatrist. Three possible scenarios are posed after the assessment:
a) Admission to the Brief Hospitalization Unit.
b) Discharge from the emergency service and activation of the medium risk suicide code that guarantees attention by the Mental Health Team in the next 72 hours.
c) Discharge with follow-up by Primary Care and/or Mental Health Team.
When a medium risk is estimated, the following healthcare itinerary is followed:
First month: Attention in the first 72 hours by a Mental Health Specialist Nursing; psychiatric care within 15 days and appointment for Social Work before the end of the month.
Second and third month: At least two follow-up appointments per month in the Mental Health Team (by phone and/or face-to-face).
Galicia
The Suicide Prevention Plan in Galicia has 7 strategic lines and 37 measures that aim to reduce the suicide rate and reduce the suffering of people who have made a suicide attempt and their families.
Among them, strategic line 3 "Prevention and approach to suicidal behavior", through measures 11 and 12, aims to establish an activation code that starts the care process for patients at risk of suicide and the guarantee of a rapid response and effective for the care of patients at risk of suicide in mental health, respectively.
La Rioja
I Suicide Prevention Plan in La Rioja
The Suicide Prevention Plan is one of the priority lines of the III Mental Health Plan (2016-2020) of La Rioja. The plan proposes 4 strategic lines with 39 measures.
Among the measures proposed by the first strategic line, "Detection, approach and prevention of suicidal behavior and intervention with people who have lost a loved one due to suicide" are:
- The establishment of an Activation Code to ensure prompt and effective care for patients at risk of suicide.
- Continuity of care through telephone follow-up.
- Psychotherapeutic interventions
Madrid
Atención al Riesgo Suicida (Attention to Suicide Risk) - ARSUIC
The ARSUIC Code was established in 2012 and consists of an outpatient appointment at the Mental Health Service within a maximum period of one week after discharge from the hospital or emergency room.
The Suicide Prevention Action Plan of the Community of Madrid 2023-2024 is integrated in the Prevention and Health Promotion Strategy “Madrid, a Healthy City 2021-2024" and proposes 5 strategic with 19 measures to develop it:
1. Know and understand suicidal behavior in the city of Madrid.
2. Inform and raise awareness about suicidal behavior.
3.Prevent risk factors and promote protective factors against suicide.
4. Act through preventive measures aimed at vulnerable groups.
5. Enhance the detection and prevention abilities in people at risk of suicidal behavior.
Murcia
Action program for the promotion and improvement of Mental Health in the Autonomous Community of the Region of Murcia 2019-2022
The Mental Health Plan 2019-2022 of the Community of Murcia proposes within Axis I (Promotion of Mental Health and Prevention of Mental Disorder) a strategic line aimed at the Prevention of suicide with 9 lines of action, among which are:
Line of action 1: Preparation of a protocol to intervene from primary care with patients at risk of suicidal behavior.
Line of action 2: Preparation of a referral protocol from primary care to Mental Health of patients with a high risk of suicide and suicide attempts.
Line of action 6: Improvement of the process of care continuity between public hospitals and Mental Health Centers for patients with suicidal behavior, especially in adolescence and in the geriatric population.
Navarre
Inter-institutional collaboration protocol for prevention and action against suicidal behaviors
Since 2014 there is a protocol for prevention and action against suicidal behavior that integrates and coordinates all the agents involved. In this way, when the autolytic risk is detected, the level of said risk must be assessed in order to refer it to the appropriate device:
Low level: Primary care and Mental Health Center
Middle level: Center for Mental Health and Intermediate Resources
High level: Hospitalization
The Navarre Mental Health Plan 2019-2023 proposes the Prevention of suicidal behavior as an objective, including the implementation of a Suicide Code to improve the identification and monitoring of patients under this code.
There is currently a telephone follow-up plan.
Basque Country
Suicide prevention strategy in the Basque Country
The strategy is made up of 9 areas of action and a total of 57 measures, including:
- Create an integrated action protocol for first-time professionals in suicidal crises.
- Systematize the training of first intervention and emergency professionals, referring to intervention in suicidal crisis and psychological first aid, within continuous training programs.
Valencia
Suicide Prevention Plan and management of suicidal behavior in the Valencian Community - Living is the way out
This prevention plan proposes 5 key strategies:
1. Promotion of positive mental health and prevention of suicidal behaviors
2. Detection of the risk of suicidal behavior
3. Management of suicidal behavior
4. Training
5. Information systems and epidemiological research