Saillant S, Michaud L, Besson J, Dorogi Y
Département de psychiatrie générale et liaison, Centre Neuchâtelois de psychiatrie, Maladière 45, 2000 Neuchâtel, Suisse.
Service de psychiatrie de liaison, département de psychiatrie, CHUV, Les Allières, Av. De Beaumont 23, 1011 Lausanne, Suisse.
Encephale. 2020 Aug;46(4):258-263. doi: 10.1016/j.encep.2019.10.008. Epub 2020 Jan 31.
In the field of suicide prevention, the identification of risk groups is important, as is the training of front-line workers, to raise awareness of suicide issues. Agricultural workers represent a group at high risk of suicidal behavior due to various factors (low income of farmers, work related to climatic conditions, social isolation, poor access to primary care). The main objective of this article is to present the implementation of prevention training in suicide prevention for a population of agricultural workers in two cantons of French-speaking Switzerland (Vaud and Neuchâtel) which represent a population of about 980,000 inhabitants. The second objective is to identify the experiences of the participants in this training and their expectations.
Suicide prevention training sessions are organized in collaboration with public health departments, agriculture departments and suicide prevention professionals. Each session is led by four trainers experienced in suicide prevention and belonging to the "Groupement Romand Prévention du Suicide" (GRPS) which manages the training and other training modules on this topic in French-speaking Switzerland. The GRPS guarantees the content of the training as well as the updating of scientific knowledge. The training model is based on a concept that alternates between brief theoretical contributions, exchanges between participants in plenary sessions and role playing in small groups. The training has two main objectives: on the one hand to work on the participants' representations of suicide and to modify their posture by training "sentinels", i.e. "peers" who can establish a link between suffering individuals and the available support resources. On the other hand, to give key messages: dare to talk about the suicidal question and to not remain alone with this.
Between December 2016 and May 2018, nine sessions were held in the two cantons of Vaud and Neuchâtel with a total of 220 participants. The sessions took place in agricultural schools or buildings related to agriculture. Invited to express themselves on the theme of suicide as well as on the concept of training, agricultural workers all verbalized the importance of this issue and were often very moved when the subject was discussed. The topics addressed by the participants were the taboo aspect of the subject, the difficulty of talking about it and the need to be able to address the subject (breaking the isolation). Participants also highlighted the need for peers to act as relays for help.
The sessions were highly appreciated by the organizers concerned, particularly by the public health and agricultural departments. Participants expressed their satisfaction at the opportunity to express their views on this subject, regretting that such initiatives are all too rare. Although studies highlight the difficulty of emotional expression in the agricultural field, we observed on the contrary a great facility of the participants to express their emotions in relation to the suicidal theme. We have highlighted that the issue of suicide in this population is linked to several causal factors, as is the suicidal issue more broadly. Factors specific to this population emerged from the sessions, including working conditions and difficulties related to the family environment of farmers. There is a need to strengthen suicide prevention with training programs among the agricultural population. We also note the major importance of improving access to mental health care which is often very deficient in rural areas.
在自杀预防领域，识别风险群体很重要，对一线工作者进行培训以提高对自杀问题的认识也很重要。由于多种因素（农民收入低、与气候条件相关的工作、社会孤立、获得初级医疗服务的机会有限），农业工作者是自杀行为的高危群体。本文的主要目的是介绍在瑞士法语区的两个州（沃州和纳沙泰尔）针对农业工作者群体开展自杀预防培训的情况，这两个州约有98万居民。第二个目的是了解培训参与者的经历及其期望。
自杀预防培训课程由公共卫生部门、农业部门和自杀预防专业人员合作组织。每次课程由四名在自杀预防方面有经验的培训师主持，他们隶属于“罗曼德自杀预防小组”（GRPS），该小组在瑞士法语区管理这一主题的培训及其他培训模块。GRPS确保培训内容以及科学知识的更新。培训模式基于一种理念，即简短的理论讲解、全体会议参与者之间的交流以及小组角色扮演交替进行。培训有两个主要目标：一方面，处理参与者对自杀的认知，并通过培训“哨兵”来改变他们的态度，即那些能够在痛苦个体与可用支持资源之间建立联系的“同伴”。另一方面，传达关键信息：敢于谈论自杀问题，不要独自面对。
2016年12月至2018年5月期间，在沃州和纳沙泰尔两个州共举办了九场培训课程，共有220名参与者。培训课程在农业学校或与农业相关的场所举行。在被邀请就自杀主题以及培训理念发表看法时，农业工作者都表达了这个问题的重要性，并且在讨论这个话题时常常深受触动。参与者提到的话题包括该主题的禁忌方面、谈论它的困难以及能够探讨这个主题的必要性（打破孤立）。参与者还强调了同伴作为求助传递者的必要性。
相关组织者，特别是公共卫生和农业部门，对这些培训课程给予了高度评价。参与者对有机会就这个主题表达自己的观点表示满意，遗憾的是这样的举措太少了。尽管研究强调在农业领域情感表达存在困难，但相反，我们观察到参与者在与自杀主题相关的情感表达上非常顺畅。我们强调，这个群体中的自杀问题与几个因果因素相关，更广泛地说，自杀问题也是如此。从培训课程中出现了这个群体特有的因素，包括工作条件以及与农民家庭环境相关的困难。需要通过针对农业人口的培训项目加强自杀预防。我们还注意到改善获得心理健康护理的机会非常重要，而在农村地区，心理健康护理往往非常匮乏。
