Imagine dialling a number in a distressed, suicidal state, and no one answers. What kind of an effect will that have on a fragile mind that’s functioning on dearth of hope, making a last-ditch effort, and taking one last leap of faith in humanity?
It happens in India more often than not. Suicide prevention helplines go unanswered. Most helplines are also functional for only a few hours in a day. And the coronavirus pandemic has made India’s mental health crisis even worse.
But the Narendra Modi government seems to have finally woken up to the need of a reliable, 24×7 suicide prevention helpline and has launched KIRAN — a 24×7 mental rehabilitation helpline in 13 languages. However, it’s difficult to call it anything more than a baby step. While a mere Rs 40 crore (Rs 10 crore less than the previous year) was allotted to mental health in the fiscal year 2019 under the National Mental Health Programme, even more shocking is the fact that only Rs 5 crore of the allocated funds was actually used in fiscal years 2018 and 2019.
To put just how bad these budgets are in perspective, a study by the Indian Journal of Psychiatry estimated the cost to implement the Mental Healthcare Act 2017 to be Rs 94,073 crore.
How helpful are helplines
Shagun Gupta, who is pursuing an MA in Clinical Psychology from Tata Institute of Social Sciences, says that the helpline iCALL (by TISS) helped her get through a particularly distressing year, but it was a bittersweet experience for her.
“Three out of five times, I used to feel like the person on the other end is not listening to me. Two out of five times, the other person would jump on to conclusions about my state of affairs, passing judgements like telling me I am stuck in an abusive cycle, which really weighed me down,” Shagun says.
The experience can be disheartening. When I dialled a number in a highly anguished situation, the call didn’t go through. I ended up dialling five times, and eventually was distracted from whatever toxic concoction was brewing in my mind. Instead, I was, all of a sudden, angry about the state of affairs in this country.
This is because a lot of these organisations are short-staffed with only about 2-3 people answering calls coming in from all over the country. Most helplines also do not have trained counsellors. Generally, young, college-going volunteers and psychology students take up the responsibility of handling the helplines after undergoing a short training, and might be short of experience and expertise when faced with clients in highly distressing situations.
It’s not easy on the volunteers either — listening to people in distress day-in and day-out can weigh you down, and proper training is required to process such information.
Under-trained personnel can seem patronising too. I took a text counselling session once, and the person on the other end kept on responding with an ‘I can see you…’ for anything and everything I shared with them. They followed up with the kind of advice (counsellors shouldn’t really give so much advice) that friends who don’t know you well offer, often putting the burden of my problems on my shoulders, and my shoulders only.
As the last suicide intervention point, this can be rather dangerous. Government helpline KIRAN seems to have taken this into consideration because it says only 650 trained and qualified counsellors from all over the country will answer the helpline. Another reason why it looks promising.
Dr Hamid Dabholkar, a psychiatrist in Pune and head of the Parivartan Trust, says government focus also needs to shift exclusively from tertiary health care (medical colleges, centres for excellence, mental health institutions, hospitals) to primary health care (identifying problems, early intervention). “Current mental health plans talk about community mental health services, but there’s hardly anything on paper,” he says.
One of the primary ways of offering mental health service delivery, Dabholkar says, is to train ASHA and Anganwadi workers to identify certain symptoms and offer aid, this is also called gatekeeper training. “By making them aware of the signs of psychological distress, we can teach them how to facilitate appropriate mental health first aid. Countries with effective mental health systems as well as suicide prevention systems invest in gatekeepers who give you first aid,” he says.
Dabholkar also feels awareness generation is the need of the hour, but the current situation in the country, and the reporting on the alleged suicide of Sushant Singh Rajput is abysmal. It is triggering and throws out of the window any guidelines provided by the World Health Organization (WHO) on suicide reporting.
“It’s been noted that ‘copycat suicides’ start happening when suicide is reported from a particular area. Even after Sushant Singh Rajput’s death and the continuously crass reporting, I have noticed 2-3 cases of suicides that studied SSR’ case. There must obviously be many more,” he says.
Some of the WHO guidelines include not providing details of the site where the suicide happened, not providing explicit details of the methods used, and following up every news about suicide with helpline numbers.
On the contrary, news channels are busy flashing which side of the bed Sushant Singh Rajput was found on, what cloth the actor used to hang himself, the angle of the fan, what kind of marks were found on his neck. All these are highly triggering and extremely irresponsible ways of reporting. Don’t know if I’d be wrong in saying that the burden of copycat suicides emerging out of this case should be borne by these channels too.
Helplines are just a beginning — a step in the right direction in mental health service delivery. But the process of healing, checking, being aware is lifelong. Sadly, India is still called the ‘suicide capital of the world’.
Views are personal.
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