Interview: Soraya Carvalho

The psychologist and psychoanalyst, Soraya Carvalho, presented the lecture "Death Can Wait - Ethical and Clinical Specificities of Suicide", at the Academic Unit Brotas, on the 6th of August. The activity celebrated the 15th anniversary of the Psychopedagogical Care Center - NAPP. Check out the interview.

 
Soraya Carvalho - Psychologist and psychoanalyst, coordinator of the Center
Study and Prevention of Suicide (NEPS/SESAB).

According to his speech in the lecture "Can Death Wait?", suicide is seen today as a public health problem. How to intervene and treat patients without confronting them with the desire not to be treated? 

Soraya Carvalho – Suicide is considered a serious public health problem worldwide, due to its alarming rates across the planet. According to the WHO, there are 1 million suicides per year in the world, which is equivalent to one suicide every 40 seconds and, according to the last WHO report, published in 2014, in absolute numbers, Brazil occupies the 8th place in the ranking worldwide. Intervening and treating people who have already decided to die is a challenge not only for the psychologist, but for every health professional, mainly because these patients usually do not want to be treated, which is why they do not seek or demand treatment, but they are taken by family or friends. Thus, the first and decisive step in the clinical management of these patients is to make a demand for treatment arise. For this to happen, the patient should not, at first, be confronted with his desire, but be invited to talk about his suffering, and only later, when the transference is already established, the analyst can ask the question about the desire. 

NEPS is also a prevention center. What is the prevention of the act of suicide?

Soraya Carvalho – Studies show a high correlation between suicide and mental disorder, with depression being the most prevalent disorder. For this reason, the treatment of mental disorders is an essential strategy for suicide prevention. The NEPS – Suicide Prevention and Study Nucleus is a mental health clinic and one of the services offered by CIAVE – Anti-Poison Information Center, Reference Center in Toxicology of the State of Bahia, which works in an annex of the Hospital Geral Roberto Santos. Suicide prevention carried out by NEPS consists of psychotherapeutic, psychiatric and occupational therapy follow-up aimed at patients with severe depression and at risk of suicide, who have or have not already attempted against their own lives. However, I believe that the suicide prevention that we propose at NEPS does not simply consist in offering different treatments, but rather in welcoming these subjects who are in crisis situations, immersed in an immeasurable anguish and who see death as the only one way out to deliver them from their suffering. The proposal consists in offering a place where they can be listened to with attention, interest and neutrality and can build new bonds with people in the groups that participate in NEPS. In short, a place where they can speak and be listened to with respect and dignity.

You mentioned some cases where health professionals themselves lack the knowledge and capacity to approach the patient. What is currently done in this regard in order to minimize poor service? 

Soraya Carvalho – CIAVE/NEPS, over seven years, has developed several training courses in the area of ​​clinical toxicology and in the specific area of ​​suicide, "Approach to the suicidal patient", aimed at general health professionals, physicians, nurses, psychologists, social workers etc. and community agents, in the capital and in the interior of the state. Unfortunately, the frequency of medical professionals in these courses is always very low throughout Brazil. We are currently designing a training course for mental health professionals. But, without a doubt, the work of training general health teams to work with suicide is still in its infancy. We still have a lot to do.  

Often, due to prejudice or ignorance, the family denies the patient's state of mental illness (which may be, for example, in a situation of severe depression). Should the therapist communicate with the family about the patient's condition?

Soraya Carvalho – Yes, when we are faced with severe depression, we know that the risk of suicide is high, so it is essential to talk to the patient and convince them about the importance of contacting their family to inform them about the seriousness of the case. Normally, we offer the patient the possibility to be present during the service with their relatives, but we give them the right not to want to participate. We must always agree with him what will be dealt with and, if he does not want to be present, make him aware of what was covered in his absence.  

How can services like NAPP (which are part of educational institutions) serve as suicide prevention centers?

Soraya Carvalho – According to the founder of the NAPP, Prof. Mônica Daltro, the creation of the NAPP was motivated by a harsh reality: the high incidence of suicide cases among medical students in the most diverse faculties. The NAPP was initially created to meet this demand, but over these 15 years, the extension of its work went beyond the initial idea and today it can be observed in different spheres. 

Studies show that suicide among young people aged 15 to 29 is the second leading cause of death in the world. In some countries, it is the first cause and, in Brazil, it is the third, second only to homicides and deaths in traffic. Now, if suicide mortality among young people is so high and if we consider that in this age group most of them are in a school or college, the offer of services such as NAPP in educational institutions is extremely important for prevention of suicide. So, on this 15th anniversary, I want to wish: "LONG LIFE TO NAPP!"