On October 10, World Mental Health Day, the WHO’s focus will be on preventing suicides
Every year close to eight lakh people take their own lives and there are many more people who attempt suicide globally. Suicide is a serious public health problem; however, suicides are preventable with timely intervention and counselling.
According to the WHO (World Health Organisation), one of the major actions is to increase the awareness of suicides and suicide attempts as a public health crisis and has given a goal to nations to reduce death by suicide to 10% by 2030. This October 10, World Mental Health Day, WHO has decided to address the issue of suicides globally with a focus on suicide prevention strategies.
To deal with this crisis, governments need to develop or strengthen comprehensive suicide prevention strategies in a multi-sectoral public health approach.
According to the NCRB (National Crime Research Bureau) 2015, the most common issues of suicides in India are family problems (28%), illness (16%), marital conflicts (5%), love affairs (3%), indebtedness (3%), substance use (3%), unemployment (2%), failure in examinations (2%), other causes (26%) and causes unknown (12%). These are the latest figures available.
Suicide was the leading cause of death in India in 2016 for those aged 15-39 years, out of which, 71% of women and 58% of men were in this age group.
India has taken the first step towards addressing the crisis of suicides by decriminalisation of Section 309 of the Indian Penal which had originally criminalised attempt to suicide.
More, however, needs to be done. The most important step is to address the underlying causes of suicide and develop action plans.
The first step is to identify vulnerable sections of society - farmers, students, women and the elderly – who are prone to suicide for a variety of reasons.
Apart from these communities, there are others who are more at risk of attempting or committing suicide.
Substance abuse: Alcohol use disorder is one of the major reasons for male suicides which is often due to lack of judgement and impulsive actions. Wives of such men are also driven to suicide due to consequent abuse and debt related suffering.
Previous attempters: There is a higher risk of death by suicide by someone who has already attempted suicide or self-harm. Patients like these should be red flagged by the healthcare system and proper counselling should be provided.
People with major physical illness (eg HIV) or mental disorders (mainly depression and schizophrenia): Treatment and rehabilitation at health establishments should be provided.
Family history: Someone in the family who has already committed suicide.
Victims of trauma or abuse
Loss of a dear one: Counselling to cope with a loss of a family member or loved ones should be provided.
Failures or hopelessness: Students being bullied, abused or failing examinations; recently unemployed or unemployed for a long time; loss of business.
Veterans and Armed Forces: Tough working conditions and long working hours without basic amenities could pose as stressors.
Recognising and targeting such specific sections of people at risk, would make it easier to provide help and save lives.
To envisage a country where suicide is preventable, where help and support is provided to anyone who is contemplating suicide and to those who have lost a loved one to suicide, government bodies need to collaborate and ensure effective implementation of strategy.
Under-reporting of suicides makes the database unreliable in monitoring previous attempters and in documenting causes and triggers for suicides.
Suicide prevention needs more fund allocation towards research, medical support and counselling. Social health workers and village level health units need to be trained to create awareness in removing stigma surrounding suicide and seeking help.
The most common methods of suicides are self-poisoning, hanging, self-immolation, drowning and jumping from heights.
According to a nationally represented study in India, suicides in 49% men and 44% women were primarily through pesticide poisoning. Suicide is by and large an impulsive act. Reducing access to the most common means of suicides and effective strategies around it would subsequently reduce the number of deaths.
The astounding success of a study in 2010 illustrates how removing access to pesticides can bring down suicides drastically.
Founder of suicide helpline SNEHA and eminent psychiatrist Dr Lakshmi Vijayakumar conducted a study for WHO in 2010, collaborating with the panchayats of two villages in Kattumannarkoil in Cuddalore district.
Setting up a bank locker system to store pesticides – in which one key was with the farmer and the other with the manager of the lockers - made its access a little tougher for farmers, resulting to a drop of 78% in suicide rates in a period of one and a half year. The farmers had to use both keys in order to access the pesticide, thereby delaying the act of consuming it and allowing the impulse to subside.
The government needs to allocate funds for such research and in training of health care workers in identifying suicidal tendencies in people. Post identification of suicidal inclinations, professional counselling and support should be provided.
Easier access to seek help and an increase in the number of practicing professional counsellors is also required. Awareness should be created for the removal of stigma around reportage of suicide attempts and seeking help.
Easy availability to excess amount of alcohol should also be reduced as alcoholism and substance abuse are major reasons for impulsive decisions, according to various reports.
Crimes against women should be addressed more sensitively and counselling and support should be provided to victims of abuse, in a more effective manner than is currently available.
Prevention of suicide can be only done with timely intervention. By working together across sectors, organisation and communities, people in distress can be identified and millions of lives can be saved.
For every 40 seconds, we lose a life to suicide. From the time you starting reading this more than 10 people have died. We need a working strategy for national suicide prevention and the clock is ticking.