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Timely Interventions

Timely Interventions

Latest statistics released by the National Crime Records Bureau indicates that overall, 1,34,516 suicides were reported in the country during 2018, showing an increase of 3.6% in comparison to 2017. The suicide rate, which means deaths per one lakh population, also increased by 0.3% during 2018 over 2017. Notably, on an average 35 unemployed and 36 self-employed people committed suicide every day in 2018, with the two categories together accounting for 26,085 suicides during the year. The number of unemployed people committing suicide (12,936) was slightly less than self-employed people (13,149), while both categories outnumbered those working in the farming sector - 10,349 - in 2018, data showed. Housewives accounted for 54.1% of women who committed suicide (22,937 out of 42,391) and constitute nearly 17.1% of suicides during 2018. A total of 10,349 persons involved in farming sector (consisting of 5,763 farmers and cultivators and 4,586 agricultural labourers) have committed suicide during 2018, accounting for 7.7% of total suicides victims (1,34,516).

The World Health Organisation’s warning is that suicide, which is a major public health problem and one of the leading causes of death in the Western world, will be responsible for the death of approximately 1.53 million people in the year 2020 and 10 to 20 times more will attempt to take their own lives. It is a growing public health problem in the United States where it has seen a whopping 30% increase over the years.

Looking at suicide, the pain left behind is harrowing. It is also rather nauseating that the number of persons ending their lives prematurely different reasons is increasing. The cause for concern is that for every death by suicide in India, there are more than 200 people with ‘suicidality’ and more than 15 suicide attempts.

Sample this. According to the suicide note left behind by a 57-year-old bank manager in Bengaluru, who had been overlooked for promotion despite good performance,  due to harassment by his superiors he hanged himself to death. In Ghaziabad a businessman killed his wife with a hammer, poisoned his three daughters, including a three-year-old to death before ending his life. Another Gurugram resident slit the throat of his wife, young daughter and minor son while they were asleep and killed himself leaving a suicide note which read, “I am completely failed. Taking my family along with me.” 45-year-old Angad Paul, son of billionaire steel magnate Swraj Paul, jumped to death from the balcony of his luxury penthouse apartment in London in 2016 following collapse of family business. Failing to obtain a licence from the local authorities for his newly built auditorium, 48-year-old Sajan Parayil ended his life in Kerala.

Although the growing incidence of depression, caused by financial constraints, professional and relationship discords including marital seem to trigger a horrific spree of suicides, studies have shown that 95 % suicides are closely tied to mental illness.

Debates on the suicide menace never seem to end. Many health professionals are of the view that suicides cannot be prevented as it is a personal matter that should be left to the individual to decide. It is also believed by others that suicides cannot be prevented because its major determinants are social and environmental factors such as unemployment over which an individual has relatively little control.

o, is suicide is often a permanent solution to a temporary problem? Who are the people more vulnerable to mental disorders that by and large lead to suicides?

Latest National Mental Health Survey data shows that mental disorders are significantly higher in households with lesser income, low levels of education, or limited employment.

Common mental disorders including depression, anxiety disorders, severe mental disorders, and substance use disorders are a huge burden affecting 11% of the population anytime.

Mental illness means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by sub normality of intelligence.

The Mental Healthcare Act, 2017 which has come into force from 7 July 2018 provides for medical insurance. Clause 21(4) of the Act states that “every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness”. But how many people are aware of this?

Several studies have concluded that most who commit suicide explicitly, and often repeatedly, communicate their intentions to kill themselves to others. It could be their doctors, family, or friends - before doing so. Also many who seem to act on impulse or cloak their plans never give a warning or clue thus give no chance to themselves or others. But for those who do make clear their desire to die, such lives can be saved with the intervention of trained professionals. In many of our societies, because suicide is usually seen by others as a preventable or avoidable death, spouses often bear the brunt of community gossip and family blame.

According to Kay Redfield Jamison, renowned psychiatrist at the Johns Hopkins School of Medicine and author of the best-selling memoir “An Unquiet Mind”, Suicide is a particularly awful way to die: the mental suffering leading up to it is usually prolonged, intense, and unpalliated… The suffering of the suicidal is private and inexpressible, leaving family members, friends, and colleagues to deal with an almost unfathomable kind of loss, as well as guilt. Suicide carries in its aftermath a level of confusion and devastation that is, for the most part, beyond description. For those who have had unsuccessful suicide attempts, returning to their previous lives might prove to be challenging. Chances are, they’ll go back to the same mental health challenges and stressful life situations. As such, it’s important for them to find professional help that can guide them on their new paths.

As each suicide is a personal tragedy that predominantly and prematurely takes the life of an individual which has a continuing ripple effect affecting the lives of families, friends and communities, it is important to prevent people from taking their own lives. In China efforts are aimed at identifying and treating depression besides curtailing access to pesticides, initiation of suicide prevention programmes and reportedly young girls are being taught better ways to handle the stresses they encounter.

Awareness generation can help the public at large to overcome mental illness in the initial stages itself. But it poses several challenges, primarily due to non-availability of qualified psychiatrists. The country needs around 13,000 psychiatrists. We have one psychiatrist for over 2 lakh people. So, what is the take-home message? Yes, suicide is a growing problem today but with support from the family and small steps/prevention interventions by the community at the household level can go a long way to help people who consider suicide to feel more positive and optimistic about their lives.

(Published on 27th January 2020, Volume XXXII, Issue 05)