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Many suicides can be prevented, if India breaks silence on mental health

A recent report by the WHO said India had the highest rate of suicide in Southeast Asia in 2016.

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Trigger warning: Contains graphic details of suicide and attempts to suicide.

New Delhi: When Nyana Sabharwal was 10 years old, her mother began talking about the desire to kill herself. Then she saw her mother attempt suicide twice — once by hanging, and then again by jumping out of the window. By the time she was 13, she spent every hour away from home wondering if she would come back to find her mother dead or alive, until one night, she and her brother found their mother’s body hanging from the ceiling.

“We were the ones who brought her body down. There’s no other way to describe how I felt, except for shock and trauma,” Sabharwal tells ThePrint. “It’s not like we didn’t know – she was always talking about it — but no one felt like she would actually do it.”

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The latest data on suicide, released by the World Health Organisation, says India had the highest rate of suicide in all of Southeast Asia in 2016, even though it is among the most preventable causes of death, with timely intervention.

The crisis, experts say, is worsened by how individuals and policymakers treat suicide in India. On the one hand, the belief that those who talk about killing themselves won’t actually commit to their word runs so deep that WHO had to dispel it for the myth that it is. On the other, silence on the topic is so pervasive due to stigma that we don’t ask friends and family at risk if they’re suicidal, for fear that it will be mistaken for encouragement.

In truth, talking about suicide helps, and is the most cost-effective way to initiate prevention. Evidence-based research from the Brown University found that engaging in suicide related content can significantly reduce risk.

Sabharwal now runs two suicide-related platforms — We Hear You, a support group for families who are survived by victims of suicide, and Safe Space, which works on active intervention and prevention when someone reports feeling suicidal.

“You would think that people are firm in their resolve when they say they want to die. But actually asking someone — upfront and directly — what is bothering them, and offering to break down the problem so they can see how it can be moved passed, actually works,” she says.

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What the numbers tell us

No one knows just how pervasive suicide is in India — not since 2015. The latest data presented by the WHO, which says there are 16.5 suicides per 100,000 people, is an estimate. An earlier report, called the Global Disease Burden Report, puts the estimate even higher, at 17.9 deaths by suicide per 100,000 people in 2016.

For perspective, this is radically different from the number furnished by the National Crime Record Bureau for the year 2015, which is the last year suicide and accident data was released by the bureau. It pegged suicides at 10.6 suicides per 100,000 people.

“This large discrepancy exists because of how under-reported suicide is. Families are hesitant to record the cause of death as suicide because of how heavily stigmatised it is, so the death is attributed to something else,” explains Sabharwal.

A report released by the Cosmos Institute of Mental Health & Behavioural Sciences in New Delhi found that out of 10,233 participants, 55 per cent felt those with mental illness were dangerous. The taboo  manifests in small ways, too. Sabharwal says its a common practice for families to hide deaths by suicide by not talking about the victim, or putting away their photographs.

In 2017, things started to look up when India decriminalised attempts to suicide by passing the Mental Healthcare Act. Experts say it’s the beginning of a very long journey, but one that is fast losing momentum unless the government steps in to push for a national suicide prevention strategy.

The most elemental requirement for this is data. India hasn’t released its Accident and Suicide Deaths in India (ASDI) report since 2015, making it impossible to gauge the impact of decriminalisation, for one.

“There is no data, but going by anecdotal observations, I can state that there is reduced interference from the police when there’s an attempt and the medical fraternity feel more comfortable handling emergencies,” says Nelson Vinod Moses, founder of Suicide Prevention Foundation India.

“But, the stigma, the taboo, shame, guilt hasn’t reduced. There is a complete lack of support for suicide survivors, and this is tragic because they are at the highest risk of suicide, so the section of the population that most needs help doesn’t get it,” he adds.

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A national prevention strategy — how can it be done?

A lack of data makes vetting evidence-based approaches to prevention even harder. Dr Soumitra Pathare, a psychiatrist with the Suicide Prevention and Implementation Research Initiative (SPIRIT), says that without numbers, India’s suicide prevention efforts will all be shots in the dark.

The first step to implementing a national strategy is knowing the affected demographics, he says. “In the west, 80-90 per cent of people who die by suicide are depressed or mentally ill. But that doesn’t necessarily hold true for India, where it cannot be said that a majority of deaths by suicide are due to mental illness. Impulsiveness plays a big role in attempting suicide.”

Some of the most common methods of suicide include consuming pesticide, hanging, and self-immolation. An effective way to reduce rates of suicide is to reduce access to these substances and means. A second requirement is a more genuine political will and interest to address the prevalence of suicide. Farmer suicides have been politicised and used as rhetoric to display concerns for mental health, but Pathare says it has been mostly superficial.

“Ironically, the politicisation of farmer suicides has led to a glazing over of all the other demographies, like women, who committed more suicide than farmers. It hasn’t led to any policy intervention, and that goes back to the problem of not having enough research or information about why particular demographies show higher tendencies for suicide,” he says.

Suicides are highest among 15 to 39-year-olds, in India, with the proportion of women committing suicide on the rise. One in three women committing suicide worldwide is Indian. Studies suggest the most common reasons for this are family disputes, breakups and educational pressure. A third of women who commit suicide have histories of domestic abuse.

To tackle suicide, Nelson says, India needs a host of things: “We need a 24/7 suicide crisis helpline that supports all major languages, a crisis text line (SMS/WhatsApp), non-judgmental mental health professionals trained in the problems that are faced by young people and psycho-social education from a young age.”

SPIRIT is working on a pilot project in Mehsana, Gujarat, that trains children in the 9th grade in emotional resilience, as well as ASHA and Anganwadi workers to identify people at risk of suicide, so that these groups can engage in suicide prevention in a sustainable way that can eventually scale up.

“Everyone thinks lack of awareness is a problem,” observes Pathare. “Actually, there’s no denial of the problem — there’s just no communication about it because it seems like there’s no solution when someone says they’re suicidal. The minute you offer a solution, it’s surprising how many people are willing to come forward and co-operate.”

The Fortis Stress Helpline (8376804102) is a 24×7 helpline run by a multilingual team of mental health professionals in order to support individuals experiencing emotional distress.

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