More than 11,000 Germans take their own lives annually, though more people are deciding to seek help. But for the majority, suicide still remains a subject they would rather not talk about.
People considering suicide want to be taken seriously
While some 6,600 Germans died in automobile accidents in 2003 -- the last year for which official figures have been compiled -- 11,150 took their own lives in the same year, according to Germany's Federal Statistics Office.
"When you realize that more people commit suicide than die in traffic accidents and then look at the attention given to automobile accidents, it is clear that suicide is still a taboo subject and not taken as seriously as it should be," said Elmar Etzersdorfer of the Clinic for Psychiatry and Psychotherapy at Stuttgart's Furtbach Hospital.
The number of suicides yearly has remained fairly constant in recent years, after dropping steadily in the 1980s and 1990s, according to Georg Fiedler of the Therapy Center for Suicidal Persons (TZS) in Hamburg and secretary of the National Suicide Prevention Initiative.
The initiative works to raise awareness and break taboos by providing positive examples of people who have successfully sought and received help.
"Help used to be centered on large state hospitals where it was hard for many people to get to," Fiedler said of the changes that account for more people seeking help before it's too late. "Now people have more options closer to home in the normal health system."
Help can now be found outside of clinics
Since people considering taking their own lives nearly always suffer from feelings of guilt and shame, an increase in outpatient therapy means more of them can choose to get help without the stigma of checking into a clinic, Fiedler added.
Suicide can affect anyone
There's no definition of the "typical" suicidal person; it is a problem that can neither be attributed solely to social or economic conditions nor localized by geographic region.
People considering suicide often remove themselves from society
"A person's social situation is one of many factors in suicide," Etzersdorfer said. "You can't say that the unemployed are generally at a higher risk -- though that could be one of many factors that play a role -- or that cities or rural areas are worse off."
Men die more often than women
However, there are some demographic conclusions that can be made about who is at risk.
Statistics show German men are nearly three times more likely to die from suicide, while twice as many women attempt to take their own lives. Women also tend to use techniques, such as drug overdoses, that leave a window for rescue by medical personnel, while men choose methods with a smaller chance of getting outside help, such as hanging and jumping from tall buildings.
"Women seem to come in earlier when they are experiencing a crisis," said Angela Hofmeister of the Berlin Crisis Service, which has nine centers dotted around the German capital. "Men make up about one-third of the visitors to our crisis centers, and by the time they come, the situation is usually already very serious."
The feelings of shame, guilt and helplessness make it especially hard for men to look for help due to entrenched gender roles telling them not to show weakness, Fiedler said.
Seniors often feel suicide is their only option
Older people also at risk
The elderly are another group with an especially high rate of death by suicide, and as the German population continues aging, there is also a likelihood that the number of suicides will increase, Fiedler said.
"Many older people considering suicide are afraid of what will happen to them," Etzersdorfer said. "They don't want to die in a hospital, they want to be able to die in dignity and are not aware of options other than taking their own lives.
"Most of these people, when they receive proper care, decide not to commit suicide," he added.
But it's not just the elderly that need to be made more sensitive to suicide and suicide prevention treatments. Fiedler said that awareness of suicide's warning signals plays too small a role in the education of those most often confronted with suicidal people: medical personnel, psychologists, police, social workers, and teachers.
Some people prefer to seek help anonymously
Talking about suicide doesn't cause it
Often friends and family are afraid of mentioning the topic to someone who may be in danger for fear that it could be enough for the person to take their own life. But studies show people considering suicide often want to talk about their problems and concerns.
"People want to see that they are being taken seriously, not just hear, 'Hey, look how great life is'," Fiedler said.
"It makes sense to talk about it and try and influence the person to seek professional help."