Let us work together to prevent suicide

Dr T R John
Senior Consultant Psychiatry,
Aster Medcity, Kochi

Since 2003, September 10 is observed as World Suicide Prevention Day (WSPD). It is organized by the International Association for Suicide Prevention (IASP) and co-sponsored by WHO, to promote awareness and worldwide action to prevent deaths due to suicide, which has become a major public health issue. Every year a topic is chosen and theme activities are conducted to sensitise, educate and empower the global population in order to reduce the number of deaths due to suicide. This year the theme is 'Work together to prevent suicide'.,

Suicide prevention had become a global challenge. Suicide is among the top 20 leading causes of death globally for people of all ages. WHO statistics reveal that It is responsible for over 800,000 deaths every year, which equates to one suicide every 40 seconds. For every successful suicide, about 25 persons attempt suicide that does not end in death. Put in other words, almost every second, somewhere in this world someone kills himself or attempts to kill himself.

Every life lost, represents someone’s partner, child, parent, friend or colleague. It is estimated that each suicide has an impact on approximately 135 people who suffer intense grief or are otherwise affected. This amounts to more than ten crore people per year who are profoundly impacted by suicidal behaviour. When viewed like that, suicide is a major social problem, a problem that can affect the future of human society, a problem for which solutions need to be discovered at the earliest. World Suicide Prevention Day is about that. It is about our global community, encouraging us to engage with each other and joining together to spread awareness of suicide prevention.

In Kerala, a comparatively small state in the south of India, as per estimates, approximately 8000 persons commit suicide in an year. It means 25 persons per day or one person per hour. About 25 times that, or one person per two minutes, makes a serious suicide attempt. What is worrisome is that, 60 percent of these belong to most productive and otherwise most healthy 30-59 year old.

Suicide is one of the commonest cause of death among the 15-40 year old group. Well publicised road traffic accidental death rate is nothing considered to this huge human tragedy. As per police statistics 4300 persons died in RTA in Kerala in 2018.

However the response of the Kerala society is widely different for the two social tragedies. The government approached the increasing traffic deaths with great seriousness. It created a detailed road traffic security plan, launched well publicised awareness activities and organized effective emergency medical care across Kerala for the accident victims. Because of these activities, in the past decade, despite huge increase in vehicle numbers, road traffic agents and deaths have relatively decreased significantly.

Unfortunately such a clear plan is visibly absent for suicide prevention. Till today, there is no clear suicide prevention program in India. We have still not acknowledged these high suicide numbers as a problem that needs to be addressed. In fact we do not even have reliable statistics about suicide. The widely quoted crime bureau statistics are estimated to be at least 30 percent less than the actual suicide rate. Indian per capita expenditure for mental health is just 4 rupees, just 0.01 percent of our annual budget.

The fear, stigma and misinformation about suicide and mental disorders in general, prevents the society from addressing the issues effectively. The pessimistic belief that suicides cannot be prevented, stops us from taking effective steps that will reduce suicides. Because of the lack of effort, those at risk of suicide remains unidentified and are unable to get effective medical help that could have prevented suicide.

But the truth is not that. Suicides can be prevented. Early identification and effective treatment of mental disorders especially depressive disorders and drug abuse will reduce the risk of suicide in these vulnerable population. A significant number of suicides occur as a result of impulsive response to inability to deal with a difficult development in life situations like a failure in exam or a breakup in relationships. Easy availability and access to lethal means increases the risks of suicide. World over, 20 percent of suicides, especially in the rural populations occur using cheap, insecticides. Laws for restrictions of such insecticides has been successfully enacted by various countries with evident decrease in the suicide rate. School based social skill development activities are also simple and effective methods of reduction in future suicide rates.

For the suicide rate to decrease four things should happen. Firstly the awareness that suicide is a major social problem should develop among the public. Secondly even the lay person should have the basic knowledge about how to prevent suicides. For example everyone should be able to recognize the symptoms of depression in self or a friend. Thirdly the stigma surrounding mental disorders and suicide will have to reduce. Finally those suffering from mental distress or mental disorders should get an assurance that they are not alone, that help is available. For these to happen, there should be a policy based National Suicide Prevention Program.

Till that happens what can we, as individuals, do?.
That's what this Suicide Prevention Day tells us. We can work together to prevent suicide. It encourages us to take a minute to help someone around in distress. Take a minute to notice what is going on with you, your family, your friends and your colleagues.

Taking a minute to reach out to someone in your community – a family member, friend, colleague or even a stranger – could change the course of another’s life. Testimonies of individuals who have survived a suicide attempt teaches us how the words and actions of others can be important in increasing or decreasing the risk of suicide. This one minute is your chance to show your empathy to those people around you who are in distress.

In this one minute, you can start a conversation to show that you care. You can give a ray of hope to someone who is feeling hopeless. If you are in distress, in this one minute, start discussing your problem with someone whom you trust. Gently encourage a person, who lost a dear one to suicide, to talk about it.

If you have media skills, take a minute and do something to increase the public awareness about suicide. It can be an article, a snippet even a WhatsApp message will do. If you are a manager write a message of hope, a positive communication to the team members. Give them information about the resources available in and around the company or the community which they can approach when they are in distress. In this one minute give message to your leaders, encouraging them to take lead in making a plan for suicide prevention in the society. If you are a leader give a good message about mental illness and suicide prevention to your followers. If nothing else, take a minute to light a candle , near a window at 8 PM on 10th September in support of World Suicide Prevention Day for the survivors of suicide and for the memory of loved lost ones and to spread awareness about suicide prevention.

We need to identify those who are not coping. Warning signs of suicide include: hopelessness, frequent vocalisations of wish to die, rage, uncontrolled anger, seeking revenge, acting reckless or engaging in risky activities – seemingly without thinking, feeling trapped like there’s no way out, increased alcohol or drug use and final acts like writing a will or giving away previous things.

People are often reluctant to intervene, for many reasons, including a fear of not knowing what to say. It is important to remember, there is no specific formula. Empathy, compassion, genuine concern, knowledge of resources and a desire to help are key to preventing a tragedy. Some are worried that talking about suicide can plant the idea in a vulnerable person's mind. Evidence clearly shows that this is not the case. The listening ear of someone with compassion and empathy without a judgemental attitude will reduce distress and can help restore hope in them. Encourage them gently, to get qualified help and direct them to the right resources.

Finally each one of our us needs to realize that only combined activities can remove social ills like suicide. Let us all come together and work together to prevent suicide. Remember that each suicide is preventable. Understand that suicide is not a failure of an individual, it is the failure of the society around that individual. No man is an island. Every suicide diminishes us, kills a little part of our life. When the bell tolls for a suicide victim remember that it tolls for the society.