Every Life Matters: Changing the Narrative on Suicide

Introduction

Every year more than 7,00,000 individuals commit suicide, that translates to 1 person dying every 40 seconds.  To create awareness around this serious issue, World Suicide Prevention Day is observed on 10 September across the globe. Every suicide impacts not just a single person but the whole family and community at large. It raises a lot of questions, many remain unanswered. The family members often find themselves at loss, sometimes blaming themselves, but mostly clueless about where they missed the red flags. Suicide is not an isolated incident but a culmination of multiple factors- emotional, psychological, personal, social, and economical- which eventually leads an individual choose death over life. For every suicidal death, there are many who will attempt, putting a large number of people at risk.

What does Statistics say?

As per the National Crime Records Bureau, 1,64,033 suicides were reported in 2021, which is an increase of 7.2% as compared to 2020. The states of Maharashtra, followed by Tamil Nadu, Madhya Pradesh, West Bengal and Karnataka accounted for 50% of the reported suicides.
The rate of Suicide is 12 per lakh population, which is the highest ever since NCRB started suicide reporting in 1967.

The age groups 18-30 years (34.5%) and 30-45 years (31.7%) have the highest rate and together account for 2/3rd of reported cases. Among these, a total of 13039 students died of suicide which translates to 35 students dying by suicide each day.

Although males (72.5%) outnumbered females (27.4%) across age groups, housewives contributed more than half (51.5%) of the cases in female suicide highlighting another area of concern.

These figures are not just startling, but saddening as well because for others, these are just numbers, but for family and friends, each of them was an individual related to them, a part of their lives.

Mental illnesses such as depression, bipolar disorder, substance use disorder (alcohol, drugs) and psychosis have strong association with suicidal tendencies. The National Mental Health Survey (NMHS) 2015–16 found that almost 80% of those suffering from mental illnesses did not receive treatment for more than a year. Hence, early referral and treatment of mental health issues are of utmost importance for prevent potential suicides.

Causes of Suicide

Family problems followed by illness were cited the two major causes of Suicide, accounting for more than 50% of the cases. Other causes include drug abuse/alcohol addiction, marital problems, romantic relationships, debts, unemployment, failure in examination, career related issues.

A rising trend is that of children and adolescents committing suicide due to issues around examination like fear of failure or not getting good marks. The recent suicide of two NEET aspirants in Kota on the same day brought back the spotlight on coaching centers but things are not so rosy in other educational institutions as well.

Identifying High –Risk signs

There are multiple factors which may increase a person’s emotional vulnerability and consequently increase their suicide risk. Very often, a person who is having suicidal ideation gives plenty of indications. Identifying those risk factors is an essential step in preventing future attempts. Some of these signs are:

o   Expressing thoughts of suicide (ideas or plans) o   Multiple past attempts o   Psychiatric diagnosis (depression, bipolar disorder, substance use disorder, schizophrenia, personality disorder etc) o   Physical illness o   Unemployment/recent job loss or drop in socioeconomic status o   Recent stressful life event (loss of spouse) o   Social withdrawal o   Family conflicts (familial discord, domestic violence, stress) o   Aggressive, impulsive behaviours, agitation o   Expressing hopelessness, shame or humiliation, low self- esteem. o   Cognitive features – Tunnel vision (thinking death is the only way out), close-mindedness, polarized thinking (If one option does not work then I don’t have any other choice except death) o   Making end-of-life plans like making wills, giving away belongings, saying goodbye. o   Drop in academic performance, Loss of interest in activities o   Increased use of drugs/alcohol o   History of childhood sexual abuse/childhood trauma

This not a comprehensive list and there are many more factors that needs to be considered while assessing suicide risk.

Protective Factors

These act as buffers against stresses and improvising them builds the safety net around people.

Effective coping and problem solving skills   Reduced access to lethal means.  Good family support   Peer support   Feeling connected to others   Availability and accessibility to healthcare

What to do in a crisis

If you ever find yourself facing someone who expresses suicidal ideation, it's essential to listen to them with calmness, compassion and and attention. We must understand that the person is in deep pain to contemplate suicide.  It is essential that we don't ignore or trivialize the matter or express shame or shock.  Inform family members or college authorities and do not leave the person alone. Ask the person who else may help. Inform any in house counselor if available. Refer to mental health professionals for further evaluation and management.

Prevention Strategies

WHO suggests various measures as preventive strategies:

Restrict access to means of suicide (pesticides, firearms, and certain medications); Early identification and effective management of psychiatric disorders, substance use disorders (alcohol etc) Awareness campaigns for mental health disorders and their treatment Educational approaches in schools Provide social support for vulnerable individuals in communities. Crisis management groups and helpline numbers. Provide support to those affected by suicide. Appropriate portrayal of suicide in media,  especially of celebrities and popular public figures.

Gatekeeper Training : It is a WHO recommended evidence - and community -based training programme which aims to train people with skills to identify individuals who show signs of emotional distress and prevent potential suicides. This can be tailored to meet specific groups like adolescents. A gatekeeper can be anyone- teachers, parents, friends, coaches, wardens- who is willing to act as a first responder in case someone displays warning signs and can refer to a mental health professional for proper assessment and necessary management.

The Government of India has launched Tele-MANAS program across India with the aim of providing mental health services across India, especially in rural and poorly accessible locations. There are trained counselors and mental health professionals who provide comprehensive and free of cost services round the clock.

Helpline Numbers

KIRAN	1800-599-0019
Tele MANAS	14416 OR 1800-89-14416
AASRA	+91-9820466726/ www.aasra.info
iCALL Psychosocial Helpline, TISS	9152987821/ icall@tiss.edu
Vandrevala Foundation	9999666555/ help@vandrevalafoundation.com
For more details, visit	https://www.patientsengage.com/resources/suicide-prevention-helplines-india

Despite contrary belief, most suicides are preventable if given early and proper intervention. Saving one individual may go a long way in saving an entire family.

References:

National Crime Records Bureau, Accidental Deaths and Suicides in India (2021). Government of India. 

National Mental Health Survey of India (2015-2016): Prevalence, Patterns and Outcomes, Supported by Ministry of Health and Family Welfare, Government of India, and Implemented by National institute of Mental Health and Neurosciences (NIMHANS) Bengaluru: In Collaboration with Partner Institutions.

Geddes JR, Andreason NC, Goodwin GM. New Oxford Textbook of Psychiatry. 3^rd Edition. Oxford University Press, 2020.