“I felt very lost and alone for many months. I was not able to communicate my feelings to my family. I felt very pressurised to finish my course requirements in college, and it overwhelmed me into thinking about suicide”, says Ram*, a final year engineering student at a reputed college in Chennai.

Before Ram could take the drastic step, he turned to online resources hoping for help. “I don’t know what I was looking for. I Googled how I felt, and found the contact number of a suicide prevention helpline. I figured I would just make that call. I did not expect much, but I think the decision saved my life,” he says.

Tamil Nadu’s suicide rate is three times India’s national average, as per World Health Organisation (WHO) reports. In 2015, the state had the second highest number of suicides in the country, at 14,602, as per National Crime Records Bureau (NCRB) data. Students and housewives are particularly vulnerable, with the 2015 NCRB data showing 916 and 2673 suicides among these groups respectively.

Chennai accounts for a significant proportion of the state’s suicides. Over 2270 suicides occurred in the city in 2015, accounting for more than 15 percent of the state figures. Self-harm is now a leading cause of death in the city.

Help on call

For those battling depression, anxiety and other mental health issues, daily life can be fraught with struggles. The stigma associated with mental illness and the lack of general awareness also makes it difficult to share feelings and seek help. There is a big gap in intervention, which suicide prevention helplines are trying to bridge.

The 24-hour ‘104’ helpline was launched by the state government in December 2013, with clinical psychologists on call to counsel those contemplating suicide. Set up in the PPP model, this helpline is operated by the private company GVK EMRI. The helpline offers support in English, Tamil, Hindi and other Indian languages. The professionals who attend calls have expertise in counselling people with depression, stress, anxiety and suicidal ideation.

“The main challenge is to recognise psychological needs as an emergency that requires professional help, without isolating individuals who seek assistance” says an official with the helpline, on condition of anonymity.

When a person in distress calls the helpline, he is connected to a psychologist who talks to him through his crisis and helps him understand his symptoms. If the caller shows symptoms of chronic suicidal ideation, he is guided to seek medical help. He is provided resources including the location of the nearest hospital or clinic offering mental health services.

“These days all medical college hospitals, taluk hospitals and primary health centers are equipped to deal with mental health issues. The person who mans the helpline guides the caller to seek further help, based on an assessment of the caller’s issue and its severity,” says the official.

The helpline also follows up with the callers in need until the professional attending to them is satisfied of their progress. A tracker is maintained for those who call the helpline, and callers receive periodic check-ins from the counselors on a need basis.

The official gives the example of a young mother who suffered from postpartum depression. She was unable to recognise her symptoms for what they were, and was afraid of not feeling affectionate towards her child. She came across the helpline and was counselled. She was made aware of her condition and symptoms, and provided reassurance and guidance until she recovered.

Calls spike during exam season, and also as a result of new online phenomena like the Blue Whale Challenge. Technology-savvy youth are the ones who mostly take to such trends out of curiosity, says the official. An offshoot of the 104 helpline is the dedicated education services helpline 14417 that guides students on career options and also offers counseling to cope with exam stress.

Helplines around since the 80s

Predating the 104 helpline is the Sneha Suicide Prevention Helpline that has been offering 24-hour on-call support, with a team of volunteers since 1986. Being one of the earliest helplines, Sneha has been critical in suicide prevention in the city.

“I had called Sneha as I was suffering from severe depression. I did not have a diagnosis then, but felt very distressed and agitated due to some personal issues. I found it hard to open up to friends,” says Athira*, a researcher at a city-based NGO.

Athira had heard about Sneha helpline during an awareness drive, and decided to make the call. “The person at the other end was very supportive and heard me out. They guided me by helping remove my fear of getting treatment. I have since been going to a therapist regularly, and feel much better now,” says Athira.

The effort is driven completely by volunteers who handle the lines on a shift. Two volunteers are on call at the helpline anytime. Volunteers have to undergo a rigorous 40-hour training programme before they start handling calls. If required, they refer callers to a professional mental healthcare service, the way 104 helpline does.

The nature of helplines are changing, says Dr Lakshmi Vijayakumar, Founder of the helpline. “When we started the helpline in 1986, phone penetration was very poor, so people used to visit us directly. Now more people call in. Since the last 4-5 years, people prefer to communicate through email as it grants them anonymity, and they can respond in their own time.”

Citizens are also becoming aware of these helplines through different channels now. Dr Lakshmi points out that the helpline received many calls after being featured at the end of the popular Netflix show ‘13 Reasons Why’ which dealt with themes of bullying and suicide.

While helplines have been offering crucial support to those in distress, these services are yet to match the scale of the city’s mental health crisis. With the state helpline getting as many as 2000 calls a day, the chances of a person in distress being put on hold is high. Those who run the helpline encourage persons seeking help to not be disheartened in such instances, but to call back after a while.

Sneha helpline gets 40-50 calls a day. “Close to 40 percent of the calls we receive are from people who are acutely suicidal. Sometimes the 104 helpline also directs people to us. These calls take a long time as we try to help them,” says Dr Lakshmi.

A call may last just 10-15 minutes or go on for 45 minutes, depending on the person’s state of mind. The helpline does not follow up on callers, but callers can revert for support as many times as they like.

“We maintain a directory of helplines and mental health professionals in other states as well, for when we receive calls from out of state,” says Dr Lakshmi. The 104 helpline also collaborates with Sneha Foundation Trust, the NGO that operates Sneha helpline, for training and awareness programmes.

With the unabatingly high suicide rates in the state, the yeoman service of helplines cannot be overstated. The continued operation of the helplines, and collaboration between the state and non-profit organisations like Sneha Trust, remain crucial.

* Names have been changed to protect identities