Indeed, the Swedish Civil Contingencies Agency—a government body responsible for public safety, emergency management, and civil defense—recently launched campaigns to encourage Swedes to take more individual responsibility in times of emergency or crisis. In an agency survey, a majority of heads of local and regional emergency-management authorities said they believed most citizens would cope on their own for a maximum of 24 hours in the event of a crisis like a flood or wildfire. Respondents thought that at most half of all Swedes would help neighbors or strangers in the event that heat, water, or electricity were cut off. The others would expect someone else—a government official—to rush to their aid. The implication was that an over-reliance on the authorities might be hampering communal solidarity, individual resiliency, and plain decency.
Eberhard believes the zero-suicide program is not only unrealistic but also undesirable. “Of course all of us who work within psychiatry want to reduce suicide rates, but Vision Zero is a fantasy dreamt up by politicians with a lack of insight into science and into how psychiatry works,” he said.
Eberhard claimed that success in cutting suicide rates across the Western world in recent decades has largely been the result of two factors: antidepressants and early medical intervention. Excessive prescription can be a problem, he conceded, but radical improvements in treatments for depression and mental disorders, along with social shifts, have helped remove the stigma of seeking help.
Vision Zero schemes may seem like noble quests, he argued, but they constitute infinite pursuits for which citizens may pay a heavy price. “If we were to take this vision to its extreme, logical conclusion, then essentially the only way the state could reach the zero figure would be by forever bombarding psychiatric care with enormous amounts of money and locking up anyone who has ever mentioned having a thought about suicide,” said Eberhard, invoking a “logical conclusion” that, admittedly, hasn’t come to pass yet.
Already, Eberhard added, the zero-suicide plan has pushed many psychiatrists to embrace the precautionary principle: “Today, we’re simply too scared to release emotionally unstable patients—or those suffering from what is known as borderline personality disorder—because there is this pressure to prevent suicide at all costs, and so doctors and carers are afraid of being blamed if something happens to the patient once he or she leaves the hospital. The result is that, today, our institutional-care facilities are not mainly filled with people suffering from major depression, as was the case two decades ago, but with people who suffer from personality disorders, a milder diagnosis.”
Admitting such patients infringes on individual autonomy, Eberhard continued. But that’s not all. For patients who suffer from borderline personality disorder rather than clinical depression, in-patient care may prove an inappropriate and even dangerous intervention. Eberhard pointed to research showing that patients are particularly at risk of attempting suicide just after being released from the hospital. The experience exacerbates the fear of abandonment that many of these patients grapple with, since they abruptly go from having 24-7 care to being sent home alone with only occasional telephone contact with medical staff.