(CS Monitor 11/30/15) VILNIUS– 21st century Lithuania has a number of distinctions of which its three million people are proud.

It was the first of the former Soviet socialist republics to break its shackles to the Kremlin, declaring its independence in March, 1990.

It “grows” basketball players: Lithuania is home to no less than ten American Basketball Associaiton players.

It boasts, in Vilnius, with its winding Old Town, one of the most beautiful capitals of Northern Europe

At the same time, however, the otherwise upbeat modern Lithuanian narrative has acquired another darker strand–that of Europe’s suicide leader. A look at the most recent available statistics provided by the Lithuanian government illustrates the country’s dilemma: in 2013, there were 36 suicides per 100,000 people, and in 2014, there were 31 per 100,000, the fourth highest rate in the world and the highest in Europe. The next most suicidal European country, according to the World Health Organization, is Hungary with a rate of 19.l/100,000, and ranking 16th.

In numerical terms, this means that at current rates, approximately one thousand Lithuanians, or about one out of every two thousand citizens, kill themselves every year.

By contrast, the suicide rate in the two other Baltic republics of Latvia and Estonia, according to the WHO, is considerably lower with neighboring Latvia, with a rate of 16.2, for a ranking of 27, and Estonia with a rate of 13.2, making it 38th on the list.

“Somehow suicide has become part of the modern Lithuanian story,” says Vaiva Klimaite, a clinical psychologist and one of a small group of intensely committed Lithuanian suicidologists who are studying the situation.

To be sure, and to be fair to Lithuania, suicide has not always been part of the Lithuania story. During the so-called “golden years” of the first Lithuanian republic, from 1918 to 1940, after the Lithuanian nation first disengaged itself from Mother Russia, the suicide rate was a low 8.1/100,000.

Then in 1944, the light of freedom was blotted out yet again when the country was re-occupied by the Kremlin for a soul-killing half century, and the rate went up again, reaching a high of 36/100,000 in 1984, just as the fissures in the Soviet empire were beginning to show. “Suicide did not exist during the Soviet time because it did not fit the idea of a nation living happily under socialism,” according to Danute Gailene, a professor at Vilnius University and author of the 2015 book, “Lithuanian faces after the transition,” which delves into the suicide issue and its background. “The word “suicide” did not even appear in Soviet encyclopedias.”

In a strange way, this denying attitude conflated with the Catholic Church’s view of suicide, which is that suicide is a sin: unlike Estonia and Latvia, Lithuania is overwhelmingly Catholic.

Then, in 1990, Lithuania re-emerged into the sunlight of freedom, scruffy but proud, and the suicide rate continued to climb, reaching epidemic proportions during the difficult transitional years, hitting 45.6/100,000 in 1995 and 44.1/ in 2000. Since then the rate has declined, but not nearly enough to “endanger” the country’s dubious new crown as Europe’s suicide leader.

By contrast, the suicide rates of neighboring Estonia and Latvia have gone down. “Estonia and Latvia have coped with this better because both the government and society acknowledged it and developed a suicide prevention strategy,” says Dr. Klimaite. “We didn’t and to a great degree still don’t.”

“Suicide is still taboo here,” says Said Dadasev, a postgraduate student in organizational and clinical psychology at Vilnius University. “People think that that if they have thoughts of suicide that they are deficient in some way and are afraid of the reactions of other people. Consequently they don’t seek the help they need.” Mr. Dadasev also believes that the government is still somewhat in denial about the problem. “The fact that our country still does not have a national suicide prevention program shows that there is still much work to do.”

Antanas Grizas, one of the founders of Youthline, a psychological outreach program for young Lithuanians in distress, also thinks that the government could do more. “I think the problem is not so much of resources,” says Grizas, who currently works at the Vilnius center as an emotional support volunteer, “but one of strategy and priorities.” He believes that the approach to suicide, with its focus on medicalization and hospitalization, is, to a great degree, a carryover from the Soviet era.

“In Lithuanian politics and mental health professional circles, the biomedical approach to mental health problems still dominates,” Mr. Grizas asserts. “Some even say—and I agree with them—that mental health care hasn’t really changed since Soviet times. We lack community-based approaches, social integration, as well as accessibility to psychological treatment.”

Lithuania needs “a radical reform of its mental health program,” says Paulius Skruibis, who helped found Youthline in 1996. “We need a well-funded long-term suicide prevention program.”

While the government debates—and some say, dithers—about how to deal with the problem, voluntary agencies and organizations like Youthline are struggling to fill the breach. Another one of these is Café Mano Guru, a sprawling café-restaurant in Vilnius Old Town which sponsors something called The Social Integration Project for People at Social Risk, a program for people with drug and other psychological problems. “The ghost of the Soviet time is still too much with us,” says Sima Vaskelyte, the managing director. “People who need help are still too afraid to reach out. And when they do, the kind of help they need is not there. We are doing our best, but we are still losing too many people, especially in the small villages.”

Dr. Klimaite concurs. “The suicide rate is particularly high in rural villages, where alcoholism is also a problem,” she says. “The situation is slowly changing. People are talking about suicide a little more, and there is more awareness, including in the media.” However, she says, a major problem continues to be one of attitude, including a perverse pride in Lithuania’s status as a suicide “leader,” which leads to a feeling of “hopelessness.”

Mr. Grizas agrees. “I am very concerned about the fact that we are calling ourselves ‘a nation of suiciders,” he says. Too often, the attitude seems to be ‘This is who we are, there is nothing we can do about it. At least we are famous for it. This is the danger.”

Or, as Dr. Klimaite puts it, “I believe we have to start telling a different story about ourselves. Until we do Lithuania will remain a society at risk.”

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