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The curse and miracle of Kupiškis

Lithuania has the highest suicide rate in all of Europe. The country underwent a difficult transition after the fall of the Soviet Union and still struggles with problems from the past. However, things are changing and an unlikely group from a small town is now leading the charge.

It is a three hour bus ride from the nation’s capital, Vilnius, to the north-eastern part of Lithuania. The trip through the country is picturesque. In an old bus on a bumpy road, we pass by idyllic woods and shining lakes. When we arrive to our destination, a 1.5 metre tall sign greets us –“Welcome to Kupiškis.”

At first glance, Kupiškis looks like any other city in a rural area. The bus station is old and grey and is the only connection to the rest of the country. A large church and its two tall towers can be seen from most of the city. The main street takes you through the city to the municipal building, a cultural centre, a tourist information point and a few local shops.

October 31, 2017 - Emil Staulund Larsen Noah Groves - Issue 6 2017MagazineStories and ideas

The derelict bus station in Kupiškis is the only connection of the city to the rest of the country. Photo: Emil Staulund Larsen

Paulius Pranckūnas was born in Kupiškis and has lived here most of his life. He has worked as a tourist manager. He is also a councilman and owns a café outside of the city where he sells coffee and turquoise coloured donuts next to an artificial lagoon. He knows the city and its villagers. For him, Kupiškis is not a close-knit community: “There are different types of people who do not want to talk together, do not want to celebrate together, and do not want to do anything together with people whom they don’t know. This is a problem in all Lithuania, not just Kupiškis”.

An unfortunate record

But something lurks underneath the surface of this quite ordinary city. A local tells us that a priest once called the city “the valley of death”.

“Maybe Kupiškis is just the wrong place. Maybe something wrong happened here in the past. It is an historic fact we had witches here. Maybe it somehow affected us,” Pranckūnas ponders.

It is not that the people of Kupiškis talk about the city as a cursed place, but something is off. Pranckūnas sits with half a smile and half a serious face. He is not convinced himself, but on the other hand he is not excluding anything.

One thing is clear though. “Everybody knew that we had a problem. We did not speak about it, but we knew it,” he admits. Lithuania has the highest suicide rate in Europe, at 29 per 100,000 people. This is almost ten times higher than Greece (which has the lowest suicide rate in Europe) and is higher than other European countries like Poland, Russia and Latvia. At one point, Lithuania had the highest suicide rate in the world.

Lithuania’s cultural background is a contributor to its high suicide rate. Suicidologist and professor at the University of Vilnius, Danutė Gailienė, argues that the Lithuanian mind-set, which comes partly from the Soviet era, is a key factor.

“Lithuanians blame themselves,” she says. “They do not trust others and do not look for help. They think they have to solve their problems on their own. We see a lot of people who have unresolved trauma and they do not look for help or think it is a problem for others.” Gailienė also mentions Lithuania’s strong ties to the Catholic Church. Today, three out of four Lithuanians are Catholic. Yet, the church condemns victims of suicide and can refuse to bury them.

Like many places around the world, the rural parts of Lithuania have a much higher suicide rate than urban areas. This was also the case with Kupiškis – a small city which has since managed to turn itself into the country’s poster child for suicide prevention.

Circle of problems

The many metal sculptures and the large church should have been the city’s famous hallmarks, but instead Kupiškis made its name for a grim reason. In a country with the highest suicide rate in Europe, Kupiškis had the highest suicide rate in all of Lithuania in 2015.

“It was very sad,” says Dainius Bardauskas, the mayor of the Kupiškis District Municipality who seems reluctant to talk about suicide at all. “The problem was coming from the fact that there was no work. People had nothing to do and they drank too much alcohol.” Twenty-one people died by suicide in the district in 2015. In a municipality with just over 23,000 inhabitants, the suicide rate was 113.8 per 100,000 people, which is about four times the national average and almost eight times higher than the rate in Vilnius.

“It’s not just one challenge, but a circle of problems. We have to try to change the mentality, what we think of ourselves and other people. There are lots of problems in our culture. We are not talking much about it,” Bardauskas says. The mayor has focused on developing the city in order to improve the suicide problem. His programme included investment in jobs, sport and culture, in order to create a more positive environment. Even the mayor’s mood quickly changed when the conversation shifted from suicide to the city’s local basketball team.

But there are others who are more willing to talk about the city’s suicide problem and are taking a proactive approach to combat the issue. We came across a small group of dedicated locals who have organised to liberate Kupiškis of its unwanted distinction. The volunteers have set up a telephone hotline for local residents who want to discuss their feelings with someone anonymously.

Since the average age of those who die by suicide in Kupiškis is 65 for men and 68 for women – a statistic that reflects the country at large – the hotline was set up mainly for elders. The project is run by Violeta Šabrinskienė, who says: “The seniors are using the hotline. They understand they can share their feelings. The calls are mainly about emotions but there are several cases related to suicide.” She also adds that many of the people who call feel lonely and neglected by their families. Many who are terminally ill end up killing themselves.

Life-saving algorithm

Gaila Matulytė is another dedicated local in Kupiškis. She is a member of the city council and writes for the local newspaper. She is also the head of an NGO group called the Consultancy and Initiative Centre. The NGO visits communities and institutions such as schools and orphanages around Kupiškis where they talk about suicide and mental health. They talk to families and children and listen to their concerns. The symbol of the group is a small chair. The goal is for communities to work together to create this chair. Each community is visited four times and each time they assemble a new part of the chair, with the final session asking what can be done with the chair and how can one talk with others.

“It gives hope to them. It drives me so much, the possibility to make change. The programme talks about the joy of life and why it is a great life to live,” she says energetically.

Another innovative programme is the fabled algorithm. Originated in Kupiškis, it is well known all over Lithuania and is even being adopted elsewhere. The algorithm’s founder, Valija Šap, has become a local hero in suicide prevention circles. The head of the Suicide Prevention Bureau in Vilnius even called her “a saint”. In her office among the many diplomas and psychology books is an award from Lithuania’s president, who met Šap to applaud her work.

Šap has now become the “face” of the Kupiškis Algorithm. She co-ordinates with the different institutions involved in implementing a programme with the algorithm including  psychologists, NGOs, the police force, the municipality, mental health services and the community. Šap identifies this as the main key to its success.

“Everyone believed in the idea that we have to bring together all the forces and efforts that we have. This was not decided by one group, everyone was involved in creating this algorithm. It was a collaboration – common work and a common result,” Šap explains while holding up the algorithm which, in physical form, fits on a single piece of A4 paper.

“There has been a change in attitudes towards suicide as a result,” she continues. “Suicide and suicidal thoughts were viewed as a call for attention, but now we see it as real pain that someone is dealing with and we pay more attention to it. We asked everyone to take every case seriously. After the first success stories, the first lifesaving situations, people were excited because we could see that it worked. We can help and recognise the risks.”

On the face of it, the Kupiškis Algorithm does not look like much, but this piece of paper might be the model for rest of Lithuania. The diagram consists of 26 boxes on how to act in a different situation. Šap points out and explains each of the boxes with the patience of a kindergarten teacher: “This is what you do if the person wants help at this stage; this is what you do if they don’t. This is what you do when they say one thing; this is what you do when they don’t.” It is simple, but has proven to be effective.

“This algorithm has become a pilot model for other municipalities who are implementing something similar. The two biggest cities, Vilnius and Kaunas, have also learned from this algorithm,” Šap says. “The essence remains the same. It can be different actors or suicide prevention centres. But the steps are exactly the same.” A group in the ministry of health is now trying to create an algorithm based on the Kupiškis Algorithm that could be applied throughout all of Lithuania.

Ambitious goals

But it is not without challenges to create an efficient suicide prevention programme. An important part of the programme includes free consultations with a psychologist. In the poorer regions, like Kupiškis, an appointment with a psychologist is not something everyone can afford. To help with the situation a mysterious entrepreneur named Valdas Calas has stepped in to provide funding for visits. The mayor, Bardauskas, is concerned that the governmental funding is not enough. He is grateful for people like Calas who are offering additional aid.

More help may be on its way, however. The Lithuanian government has put suicide on its agenda and aims to lower the suicide rate to around 20-30 per 100,000 per year by 2020, and to 12 per 100,000 by 2025 – a level similar to Sweden and France.

Yet, there is still no concrete plan on how to achieve this. The head of the Suicide Prevention Bureau, Marius Stricka, remains sceptical: “We have ambitious goals but no strategy on how we are going to achieve those goals.”

Over the last 18 months there have been three different health ministers, which Stricka describes as frustrating. The current minister, Aurelijus Veryga, worked as a professor in the Department of Health Psychology before taking office last October.

“With the new minister of health, there is new hope,” says Gailienė. “There are no results yet but there are negotiations, work in progress and hope for a national strategy.”

On the outskirts of Kupiškis is a hill where there once was a fort. It is reminiscent of the legend of Pilėnai – which tells the story of a Lithuanian fort in an unknown location, whose men fought bravely against invading Teutonic forces in 1336. But their heroic efforts were not enough. Facing defeat, the defenders burned their property and committed mass suicide. The legend has become a symbol of Lithuanian resistance and is being taught in school.

Hence, it seems that acceptance of suicide is in the Lithuanian consciousness. Studies, such as the one published in Suicidology Online in 2010, have shown that Lithuanian politicians had a more accepting view of suicide than politicians from other countries.[1] The same attitude has been seen among Lithuanian school kids in a study from 2005 published in BMC Public Health.[2] This study further suggests that there has been an increasing acceptance of suicide as a personal choice. In 1994, 36.6 per cent of school children agreed that it was an individual’s decision to choose between life and death. This number rose to 62.5 per cent in 2002.

These kinds of attitudes, however, seem to be changing. The government has put suicide prevention on its agenda and is searching for real solutions to the problem. One of them is found in Kupiškis. The silence in this small town has turned into hope, a shining example for the rest of the country. Through the work of passionate locals with a desire for change, the innocent city, with a not-so-flattering statistic, has now landed itself in the history book of Lithuania’s long and turbulent struggle with suicide.

Emil Staulund Larsen is a Danish freelance journalist focusing on European culture and politics.

Noah Groves is an Australian journalist who has spent the last year living and reporting in Europe.

[1] See: Skruibis, et al. “Attitudes towards suicide among regional politicians in Lithuania, Austria, Hungary, Norway and Sweden”. Suicidology Online 2010, vol. 1:79-87. http://www.suicidology-online.com/pdf/SOL-2010-1-79-87.pdf

[2] Zemaitiene N. and  Zaborskis A. “Suicidal tendencies and attitude towards freedom to choose suicide among Lithuanian schoolchildren: results from three cross-sectional studies in 1994, 1998, and 2002”.  BMC Public Health. 2005 Aug 11. Vol. 5:83.

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