Suicide used to be a classified subject in Estonia, as in all 15 of the former Soviet republics. Psychiatric textbooks referred to suicide as a symptom of severe mental illness on a par with psychosis. Suicidal people were compulsorily committed to psychiatric hospitals and medicated under a strict regime. Psychological and social approaches were prohibited.
Epidemiological research was not allowed to develop in the Soviet Union. Mortality and demographic data were kept secret in statistical offices. All draft articles for scientific journals were censored in special ministerial departments, and facts classified as state secrets or data liable to ruin the illusory image of consummate welfare were deleted or excluded from the records. Literature on suicide sent to us by post from Finland, at our request, by Professor Jouko Lönnqvist between 1982 and 1986 never arrived.
In 1988, during the Gorbachev reform era, permission (applied for by the undersigned) was granted for a Suicide Research Group within the framework of the re-established Estonian Medical Association (EMA), and for access to statistical data. According to our calculations, the overall suicide rate for the population was roughly 33–35 per 100,000 inhabitants; but the closed society meant that we had no idea whether this rate was high or low in comparison with other countries.
In 1989, the EMA organised Forum Medicorum Estoniae, to which Estonian physicians all over the world were invited. About 100 expatriate doctors attended this Forum. It was an epoch-making, emotionally loaded meeting where numerous collaborations between Estonian doctors in the home country and abroad, in medical practice and research, were set up. On behalf of the undersigned, Dr Ants Anderson, assisted by Dr Jerker Hansson (Sweden), contacted the prominent Swedish psychiatrist and suicidologist Professor Danuta Wasserman, who became the matron of introducing suicide research in Estonia. Strengthened by our growing knowledge and experience, and with the moral and financial support we had received, we worked on unobtrusively. There were no basis for suicidology in the USSR for exception of a small underground research group headed by Dr Aina Grigorievna Ambrumova in Moscow, who delivered a few publications to undersigned against a written receipt.
The Baltic republics regained their independence in 1991. At last, creative freedom was ours. In 1993, Professor Danuta Wasserman’s assistance, moral support of Estonian high authorities of that time (Laur Karu, Vello Ilmoja, Marju Lauristin, Andres Kork, Siiri Oviir) and financial support from the Stockholm County Council “Stockholm Care” (Sture Sjölund, Jerzy Wasserman) helped the EMA Suicide Research Group to evolve into ERSI, the NGO Estonian-Swedish Institute of Suicidology () in Tallinn. Close collaboration with the Swedish National Prevention of Suicide and Mental Ill-Health (NASP) at Karolinska Institute and Stockholm County Council’s Center for Suicide Research and Prevention paved the way for ERSI’s official status as an Estonian institution and commencement of public activities. The inauguration ceremony took place on 1 February 1993, in the grand hall of Magdalena Hospital in Tallinn. Since 2005, ERSI’s official full name has been ‘the Estonian-Swedish Mental Health and Suicidology Institute’, to reflect the understanding that suicide prevention should start from the early stages of the suicide process.
On 8 February 1993, our suicidology courses began. Our enthusiasm and the advanced level of our educational programmes have attracted ever more students. Various institutions, including universities, have commissioned a growing number of lectures on suicide-related topics in a variety of specialities. Besides knowledge transfer in Estonia, courses were held for psychiatrists and other mental-health specialists from St Petersburg and Kaliningrad in 1996–2004.
Activities aimed at integrating suicide awareness in Estonian society have been a important component of our work. We have used the opportunities to overcome the taboo and stigma associated with suicidal behaviour. We have informed Estonian politicians and authorities of the magnitude of suicidal behaviour and alerted them to this important public-health problem. We have drafted the suicide prevention programme commissioned by the Estonian Ministry of Social Affairs, and implemented activities among the risk groups. Step by step, there has been a major increase in suicide awareness. Our work and suicide-related topics have a high profile in the media, with numerous interviews on TV, radio, newspapers and journals. We have maintained close contacts with NASP, WHO, the European Commission, the American Foundation for Suicide Prevention and the International Academy for Suicide Research; attended congresses, conferences and courses; and communicated with colleagues from other countries. By these means, we have improved our knowledge and obtained the experience we needed to promote the field.
We now have an excellent interdisciplinary team of specialists (in psychiatry, public health, statistics, psychology, sociology, social work) who promote mental health and develop suicide research and prevention in collaboration with local and international stakeholders. ERSI is a partner in numerous projects under the auspices of WHO (in the Multicentre Parasuicide study, SUPRE-MISS) and the European Commission (EAAD, ProMenPol, MONSUE, EMIP, IMHPA, and forthcoming OSPI and SAYLE). Since 2001, ERSI has been one of the units of the Estonian Centre of Behavioural and Health Sciences. Since 2004, ERSI has been registered with the Estonian Ministry of Education and Research as a research and development (R&D) institution. Today, the Estonian Ministry of Social Affairs is instrumental in ensuring that increasing attention is paid to suicide prevention and mental-health protection, while mental ill-health and suicide are treated as serious public-health problems. Numerous students have now prepared their theses under the supervision of our specialists. Our ‘Lifeline’ (Eluliin) project (1995-1997), with ‘Befrienders International’ (London), is successfully pursuing its independent course.
Judging the effectiveness of suicide prevention by suicide rates and trends, we note that the suicide rate in Estonia has decreased steadily since 1995. It is now the lowest among the Baltic States and Russia, having been on a par with these neighbouring countries’ rates just a few years ago.
Suicidology in Estonia today, and our progress in suicide research and prevention, have been made possible by the supportive attitude of our friends in Sweden, in particular to Professor Danuta Wasserman. She was the stimulating and highly professional tutor of the undersigned during the doctoral studies and professorship at Karolinska Institute. As ERSI’s active honorary president and scientific consultant, she has been an encouraging mentor to our young researchers. We have also relied heavily on the kind assistance and friendliness of our colleagues at NASP, and we are sincerely grateful to Professor Jerzy Wasserman for his constructive ideas and our intellectual discussions.
We are grateful to two WHO high officials, Professors Jose Manuel Bertolote and Wolfgang Rutz, for stimulating, supporting and appreciating our development. We thank our partners in the WHO and European Commission projects and all our colleagues who generously and warmly shared their knowledge, helping to develop suicide research and prevention in our country. It is impossible to thank personally all the private individuals and organisations that have supported ERSI during all these years. But to any readers who have contributed, we give our thanks.
Our work would not have been possible without financial support from NASP (Karolinska Institute), Stockholm Care, the East Europe Committee of the Swedish Health Care Community (SEEC), Swedish Research Council (grant to undersigned in international competition to hold Professorship at NASP, Karolinska Institute), WHO, the European Commission, PHARE, World Psychiatric Association (WPA), American Foundation for Suicide Prevention (AFSP), Rockefeller Foundation, Suicide Prevention International (SPI), the German Federal Ministry of Education and Research, University of Würzburg (Professor Armin Schmidtke), National Public Health Institute of Finland (NPHI), the Estonian Science Foundation, the Estonian Ministry of Social Affairs, the Estonian Health Insurance Fund, the Council of Gambling Tax in Estonia, the Tallinn City Government, the Office of the Minister for Population and Ethnic Affairs, the Estonian Ministry of Defence and Eesti Talleks.
Our ambitious, cohesive and highly capable team now provide a guarantee of ERSI’s advanced professional level and continued development. We face the future with high expectations.
founder and director of ERSI