According to a World Health Organisation (WHO) report, India belongs to the category of nations in which suicide rates are more than 21.1 per 100,000 of population – a definite red zone as far as the global statistics are concerned. This means that 1,34,799 people have already taken the extreme step in the country in 2013, according to the National Crime Records Bureau (NCRB) – that’s 15 suicides per hour.
If you consider those individuals who are contemplating taking the extreme step or just harming themselves with no intention of dying – a condition that is called deliberate self-harm (DSH) – then this figure may just be the tip of the iceberg, as these individuals often go undetected.
A 10-year-old girl in Bangalore allegedly committed suicide by setting herself on fire on Monday, when she was alone at home. The girl, who was in Class 4, left a suicide note in which she said, “Amma, I didn’t go to school for over a week. Please forgive me. Wherever I go, I am with you. I love you very much.” She was admitted to hospital last night and died today. Her mother, a garment factory worker, was reportedly not at home when the child used kerosene and set herself on fire.
Recently, Bangalore – the IT capital of India – gained the dubious distinction of becoming the unofficial suicide capital. Even though it was second behind Chennai in 2013, it would not be too long before it overtook Chennai in the suicide statistics table. The harrowing real life story of the 10-year-old girl reported recently in the media may strike one as an exceptional case, but figures reveal that there are still two children per one lakh population of the country who actually commit suicide.
The youth of the country also seem to be an unhappy lot, and are taking the extreme step, or at least thinking about taking it. The suicide rate shoots up to 35.5 when the age group of 15 to 29 years is considered, with women overtaking the men – perhaps owing to the pressures and demands of a married life and a new family environment that they have to get adjusted to in that stage of their life.
In the next age decade – 30 to 49 years – the men outnumber the women considerably, as they struggle to acclimatize to the pressures of a competitive life, difficult inter-personal relationships, and substance abuse.
Worryingly, the rate of suicide is as high as 20.9 in the above 70-year-old category: is this the result of broken families, with children abandoning their elderly parents to a life of solitude and neglect?
There are two niche groups that are historically associated with a high suicide risk, although for different reasons: recently married housewives and farmers. In the former group, the pressure of adjusting to an alien and potentially hostile family environment, as the newly wed woman moves to her husband’s house; dowry-related harassment; and an overall loss of a sense of identity may be the possible factors at play. Whereas in the latter group, socio-economic issues predominate as debt-ridden farmers, abandoned by society and the State, take the extreme step.
RC, a software professional, jumped to his death from a building in south-east Bengaluru. Quoting relatives, police said RC was depressed and had shown suicidal tendencies. Ninety minutes of drama preceded the jump as RC ignored appeals not to do anything drastic. In the morning, RC reportedly met a few relatives … and told them he wanted to jump under the wheels of a speeding truck or train. Angered by their plea not to do so, he walked out in a huff. On his way home, RC entered the under-construction building and went to the fourth floor. Labourers at the site noticed him and realized he was out to do something desperate. They gathered below and pleaded with him not to jump. RC reportedly yelled he would jump if anyone went near him. Summoned to the spot, police alerted the fire brigade. “Two fire brigade personnel entered the building from the rear and ran up the stairs. But by the time they reached the top, he had jumped,” a senior police officer said. He was rushed to hospital in an ambulance. Doctors declared him brought dead. RC’s parents said he was under depression for two years (sic), but refused to undergo treatment.
There are other professions that are associated with a high suicide risk: police, army, doctors, software industry and commercial sex workers. It is noteworthy, that apart from the pressures associated with these professions, the access to harmful and lethal means of committing suicide is present. Firearms, lethal drugs, high-rise buildings and easy availability of over-the-counter drugs make it particularly easy for any of these professionals – indeed for anybody to commit suicide.
Mental health services
Contrast this scenario with the reality of the professional mental health services on the ground level. The WHO estimates that 76 to 85% of people with severe mental illnesses do not receive treatment in the low and middle income countries group, which includes India. This is hardly surprising, as there are only 40-50 mental health hospitals all across India. There are only 0.3-0.4 per one lakh population of doctors trained in psychiatry; 0.16-0.2 nurses trained in mental health; 0.05 psychologists; and 0.03 mental health social workers.
Appalling as these figures are, also consider what the medical professionals encounter during their academic and professional pursuits. There is hardly any emphasis on communication, empathy and mental health in the undergraduate medical or nursing curriculum. Even those professionals contemplating taking up mental health as a career after graduation are discouraged by the condescending attitude of their colleagues and the stigma associated with the profession as a whole. In fact, you are likely to be considered a failure if you opt for a postgraduate seat in psychiatry as opposed to more ‘glamorous’ seats such as orthopaedics, paediatrics or radiology.
Further, for those doctors who have finished their training in psychiatry in other countries and wish to return to India, the situation is hardly encouraging. On the one hand, the Health Ministry decries the ‘brain-drain’ and says that it wants to increase the number of mental health professionals to meet the huge demand. In reality, the Medical Council of India is still holding on to the short-sighted policy of not recognising foreign postgraduate degrees, thus making it very difficult for interested doctors to work in Government or teaching hospitals.
Apart from this, there are several social causes for the current state of mental health care and suicide prevention in the country. Stigma is a prickly problem which is very resistant to correction. It prevents individuals from seeking timely help due to the fear of being labelled as a ‘mental patient’, which has social and occupational ramifications.
Unfortunately, the condescending attitude towards mental health is pervasive and even medical professionals look down upon mental health services. Popular perception is often shaped by the media, and the situation is equally grim in this domain too. Mentally ill characters in films and TV are often portrayed negatively, worthy of ridicule and ostracism. All these factors have resulted in the festering of mental health services in general and the suicide prevention strategies in particular.
The commonest method of committing suicide in an agrarian country like India is pesticide consumption. Whereas the commonest reason for people committing suicide is ‘family problems’. Family appears to be a double-edged sword as far as mental health is concerned, as on one hand it provides a protective environment for an individual to stay in and to communicate with family members and, on the other, misunderstanding, gargantuan parental expectations, pressure to conform to norms and family strife put untold pressure on the individual.
Factors indicating high suicide risk
Some of these are:
- Being male: as men are more likely to go for dangerous methods of suicide which are often lethal
- Being single or separated or divorced
- Bereavement and loss: death of a close relative or loss of a valued object
- Financial burden: this includes debts, bankruptcy or job loss
- Homelessness and incarceration: suicide rates are high among the destitute and prison population
- Previous history of suicide attempt
- A history of repeated deliberate self-harm: DSH tends to have a cumulative effect and increases the risk of completed suicide
- Presence of mental illnesses: this significantly increases the suicide risk. In particular, depression and schizophrenia are associated with a high suicide risk.
- Drug and alcohol: drinking and taking drugs are definite risk factors for suicide, as they cause a sense of disinhibition and loss of self control , which in turn increases impulsivity and irresponsible actions, be it drunk-driving, homicide, sexual assaults or suicide.
- Presence of medical illnesses: especially those that are chronic, painful, or end-stage conditions such as AIDS or cancer.
- A family history of suicide: studies have shown that having a first-degree relative who has committed suicide increases the risk of suicide in the individual.
What can be done?
The State policies and implementation of national strategies at the grass-roots level should be taken up all across the country. One hopes that the recent launch of the National Mental Health Policy by the Ministry of Health would be a new beginning in achieving this. Quite apart from all this, at the individual level, there are several things that one can do or watch out for, to help those with suicidal ideas.
- Watch out for the warning signs: withdrawal, isolation, communicating less, not eating, being evasive in replies, losing interest in hobbies; making last minute preparations such as settling finances, distributing wealth or personal possessions and finalising wills are some of the things that a person contemplating suicide might do
- Communicate: it is always better to open up channels of communication with a person who has expressed a suicidal wish; face-to-face talk is better, but electronic media can also be made use of to help the person
- DSH: remember that repeated DSH is a risk factor for suicide; encourage the person to seek professional help
- Treat other conditions: it is a well-recognised medical truism that in any complex condition, one should ‘treat the underlying cause’. So it is with suicide; the underlying mental and medical conditions should be adequately treated and the person regularly followed up.
- Reduce access: keep medication, drugs, pesticides, inflammable liquids locked, build barriers in high-rise buildings, erect fences near railway platforms, restrict access to water bodies, etc.
- Encourage the person to keep away from drugs and alcohol. If necessary seek professional help to stop drug dependence.
- Pick up the cause: there are a number of voluntary and Government organizations working to reduce suicide rates. NIMHANS, the premier mental health institute in the country, which is based in Bangalore, has launched a website for this purpose: gatekeepersindia.org
- Encourage: educate and motivate those around you to pick up the cause. Reducing stigma associated with mental disorders and suicide is very important in breaking barriers and for encouraging and improving access to services.
- Helplines: there are a number of suicide specific helplines manned by trained professionals who could help the person who is on the verge of committing suicide. Here are a few:
|Samaritans||Mumbai||022-64643267; 022-65653267; 022-32473267||—|
|Sumaitri||New Delhi||011-23389090||[email protected]|
|Lifeline Foundation||Kolkata||033-24637401; 033-24637432||[email protected]|
|SAHAI c/o Medico Pastoral Association||Bangalore||080-25497777||—|
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