(If you feel suicidal or know someone in distress, please reach out to them with kindness and call these numbers of local emergency services, helplines, and mental health NGOs)
1 in 3 suicides that happen in the world, happen in our country.
Suicide is thorny, uncomfortable and awkward to talk about, and though it’s slowly seeing the light of conversation, it is not seen as what it is - one of India’s biggest silent killers.
According to this Lancet report by Dr Rakhi Dandona on the gender and state differentials for suicide deaths in India, that terrifying statistic means that in 2019 India, 250,000 will kill themselves in one year out of 800,000 people in the world.
FIT spoke to Dr Soumitra Pathare, a consultant psychiatrist and Director of Centre for Mental Health Law and Policy at ILS, and someone who helped draft India’s new mental health law.
"“Did you know that almost half of the people who die from suicide in India do not have any diagnosable mental health illnesses?”" - Dr Soumitra Pathare
So then why are so many people dying from suicide? And can investigating the reasons help stop these preventable deaths?
That’s where Dr Pathare and his team started work on SPIRIT (Suicide Prevention & Implementation Research Initiative) to curb suicide deaths in rural India.
Here’s another fact for you:
"“Half of the suicides in India tend to be impulsive. Research showed that most suicide attempts are without the intent of killing themselves, but because they are distressed.”" - Dr Soumitra Pathare
So a fight with your husband or boss can trigger intense emotions, and because we don't know how to, or have a space to deal with these valid, real, human emotions constructively we may take a drastic step. Suicide is a desperate cry for help.
It’s the last, littlest voice that wants us to listen and if we do, it lives and most suicide survivors are happy to be alive.
1/4th of Indians who attempt or die from suicide do so by the use of a common pesticide.
Could this mean then, that controlling access to pesticides can have an effect on suicide incidences?
This was one of three of the simple hypothesis a group of researchers set out to test to regulate India’s alarming suicide rate.
In a country of a billion-plus, we’ve become immune to shocking statistics, almost resigned to accept that there are some things too big to fix. We read about student suicides or farmer suicides and feel a pang but often think it is inevitable and move on.
But the silver lining from these facts is that it could mean suicide is preventable and not an inevitable, assumed reality.
So what if we could curb deaths from suicide and systematically save lives through research-backed, tested, data?
"“We are looking at suicide in a very simplistic way currently. It’s great that we are talking about mental health, but suicide is an issue that is multi-sectoral. By this I mean that the causes and solutions for suicide go beyond just the healthcare industry.”" - Dr Soumitra Pathare
In other words, Dr Pathare tells FIT, suicide is not just a health or mental health issue.
"“For example, WHO has also said that countries could proactively reduce the means to suicide to reduce numbers, so this is a very fixable, preventable issue. We wanted to test this out in India with SPIRIT as well.”" - Dr Pathare
Getting village panchayat’s to centrally store pesticides and reduce easy access has already happened in four villages in Tamil Nadu and has resulted in reduced suicide attempts and rates.
Fixing Our Brokenness: How to Stop Suicides?
The intervention is targetted at rural India, specifically in 55 villages in Gujarat with a population of over 300,000 people so that it is “statistically relevant and can be taken to other regions, districts and then at a state-level, if the outcome is positive,” says Dr Pathare.
The three components of SPIRIT are:
YAM and the first intervention of restricting access (by way of getting the Panchayat involved and creating storage rooms for pesticides that disallow easy access) have been tried successfully before.
The second intervention of gate-keeper training to community workers has been adapted from a WHO mental health gap program aimed at medical doctors.
But now, for the first time ever, all three interventions are being used together in the hopes of amplifying their individual impact.
Speaking more on the interventions, Dr Pathare added that is was imperative to the success of the program that the community members get involved and feel like they “have some skin in the game.”
He added, “In India, suicide is typically a straight line till you’re about 15/16 and then there's a dramatic rise. So we focus on building young people's resilience to mental health issues and encourage talking about these common problems through YAM, it will help.”
Dr Pathare tells me a fascinating case study about youth suicides and education interventions.
" “In Tamil Nadu, after the board exams, supplementary exams were implemented that can be taken a week after the board results and count as part of your final grade. This move reduced youth suicides by more than 70%”"
Not Just Mental Health: Why Else Do People Kill Themselves?
Another major problem with our understanding of suicide is that it is still very euro-centric and so we have blindly believed that suicide is primarily a mental illness issue.
In India, suicide is a complicated story where the motivations differ depending on your age, region, gender and more. For example, we have more youth suicides, unlike the West which has more older victims. Then, while the West sees a 4:1 ratio of male: female suicide victims, it is 1.5:1 here. This means we see a lot more women die from suicide. According to this article in The Guardian, nearly 2 in every 5 women who kill themselves in the world are Indian.
The tightly wound, rigid and often unforgiving social norms in our community-based hierarchical society are a huge contributing factor to our sense of self and problems in this can be a trigger for suicide.
“ Between ages 19-39, societal hierarchies are so tight,” explains Dr Pathare. From patriarchy, casteism, classism (social norms) to age-specific reasons (board exams for example), the reasons for suicide and distress are myriad.
We know that a lot of suicides in India are because of economic and societal reasons like those post board exam failure or due to the agrarian crisis.
Mental health issues are then the final straw, the stress and ensuing depression become the final pathway.
So what do we do? We need to ask tougher, deeper questions about suicide prevention:
- What are the policy interventions?
- What are the interventions across different sectors?
- Are the voices of suicide survivors, caregivers and mental health professionals centered?
What we do know now is that suicide is not an individual problem, and we need to hold governments to account and demand more research and policy advocacy.
We need specific solutions in different parts of the country, populations, age groups. We need a national suicide prevention strategy that involves diverse sectors (not just the health sector) for a multi-pronged approach. Because suicide is preventable and demystifying the topic is just step one.
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