Suicidality, or the risk of suicide, is often marked by suicidal ideation or intent. Unfortunately, this is a global issue. 

That said, while suicidal ideation and contributing mental health conditions such as major depressive disorder affect people across demographics, studies show that historically marginalized communities are especially vulnerable. 

Refugees and Internally Displaced Persons (IDPs) are an example of groups that have faced external trauma and are at high risk for suicide.

New clients at CVT Ethiopia are an example of this risk. Just within the 2024 calendar year, about one-fourth of intakes reported suicidal thoughts. Per the CVT research team that compiled this data, these numbers span both age ranges and sex. 

According to studies and CVT experts like Medhanye Alem, clinical program director with CVT Ethiopia, this is due to several factors such as:

• Ongoing community violence
• Previous exposure to torture and harm
• Separation from or loss of family and community 
• Development of chronic disease or substance abuse
• Displacement from home, often with no solid plans for return

“Many of the refugees have personally encountered torture or persecution back home. Their experience of torture leaves them with post-traumatic distress stress disorder or other severe kinds of mental health conditions, which contribute to the suicidality we have seen,” Medhanye said. 

“As refugees, many have lived for years in an under-resourced, very volatile environment. Their process of resettlement may have been rejected, it may be unsafe to return back home, they don’t see the future.”

In addition to contributing to or exacerbating pre-existing mental health conditions, all of these factors can lead to hopelessness. If unaddressed, this hopelessness can lead to attempted or completed suicide. 

Approach to high-risk communities

Medhanye shared his experience working with refugees and conflict-affected communities in Tigray, highlighting the notable prevalence of suicidality among Eritrean refugees in Ethiopia. 

Because the program recognizes the significance of suicidality within these populations, they approach support with three strategy types:

• Prevention
• Intervention
• Postvention

Each approach is important and poses a vital role in supporting Ethiopian refugees and IDPs in crisis or high-risk situations.

Prevention

CVT Ethiopia’s prevention strategy involves raising community awareness and empowering community leaders to identify risk factors and symptoms of suicide. 

Providing this community-wide support and education has the goal of helping to bring refugee and IDP communities together. This leads to better support of one another and lower chances of impacted individuals harming themselves. 

Intervention

Intervention occurs for individuals who have been marked as a risk for self-harm during an assessment. Medhanye detailed the program’s intervention strategy, which includes conducting a risk assessment and creating a safety plan with clients dealing with active suicidal ideation or self-harm plans.

“We determine if it’s mild, moderate, or severe, and then based on the assessment results, we do safety planning to make sure those plans don’t happen,” said Medhanye. 

According to the Clinical Program Director, approaches are tailored to the community, context, and population age. 

“For example, for our interventions in Amhara or Tigray, we see religion playing a big role [in the community]. So, much of our response is going to engage religious leaders,” Medhanye said.

Suicide is usually very stigmatized and is not something that’s widely discussed.”

“By involving religious leaders, we explore ways to reinforce help-seeking behaviors.”

Postvention

Unfortunately, despite CVT’s very intentional role with trauma-affected communities, completed suicides can still occur.

These events prove hard on everyone within the community. This includes the families of those who passed, others within the community, and witnesses.

Realizing the importance of supporting a community after this sort of loss, CVT Ethiopia introduced a postvention strategy to support families and communities affected by suicide.

Postvention is defined as an organized response after a suicide, with the ultimate goal of supporting all who are or could be affecting by the loss. Medhanye stressed the importance of strategies like this to support the grieving families and community members, noting a pattern of increased suicide attempts following a suicide completion.

Supporting CVT colleagues’ well-being

No matter how well-trained a person may be, offering support to an impacted person, group, or community following a completed suicide can be a heavy and emotional task. 

“When we’ve been engaged in the response following the incidents, [colleagues] also exhibit intense emotions and feelings. They find it very difficult,” Medhanye shared.

Recognizing the importance of supporting everyone involved in a suicide-related crisis, CVT Ethiopia engages in practices that center the wellness of both the clients and the colleagues that are aiding in the response. 

This means both ensuring that staff are well-trained and up to a task emotionally before engaging, as well as offering ample space to process tough situations after they occur. 

“We have protocols where we debrief after every response. We all come together and revisit some of the strategies we’ve done, our emotional capacity after the incident, and if they need any kind of support.”

Medhanye also highlighted that many CVT colleagues on location are from their work areas. This means that any intra-country conflict inherently affects them, and that is taken into account when protocols are created and carried out.

“Our colleagues themselves have also been impacted by and have lived through the conflict. In one way or the other, either their family members or themselves are the survivors of war trauma,” he said. 

Restoring hope in hopeless situations

CVT understands and acknowledges that much of what contributes to these high-risk situations are external circumstances. Because of this, there isn’t an expectation for our services to eradicate all instances of depression or suicidal ideation.

However, Medhanye shared that even with the ongoing intra-country conflict, their assessments show that engaging in CVT services have proven positive for clients.

We have seen a significant improvement in their hope for the future, the situation they’re in, their daily functioning; their ability to form social networks and connections and to be able to socialize with others.”

“Yes, many in the region have been impacted and still require massive interventions… but for the ones that CVT has reached, I can confidently say that we have brought change in their lives. We’ve brought change to the way they see life and the way they perceive themselves.”