Each suicide is a personal tragedy that prematurely claims the life of an individual and has a continuing ripple effect, affecting the lives of families, friends and communities.
Every year, more than one lakh deaths by suicide are recorded in India. A total of 1,64,033 suicides were recorded in 2021 alone. The recent data released by the National Crime Records Bureau (NCRB) highlights that Chennai stands second among the metropolitan cities in the country with an alarmingly high number of suicides in 2021.
According to the NCRB data, Delhi City stands first among the mega cities of India by recording 2,760 suicides, followed by Chennai with 2,699 suicides, Bengaluru with 2,292 suicides and Mumbai with 1,436 suicides. These four cities together have reported almost 35.5% of the total suicides reported from 53 mega cities in India.
Notably, Chennai has shown an increase of 11.1% in cases of suicide, going from 2,430 suicides in 2020 to 2,699 suicides in 2021. Similarly, Tamil Nadu also ranks second among the states with highest number of suicides by recording 18,925 suicides in 2021. This accounted for 11.5% of total suicides in India.
Given the figures showing increasing suicides, the World Health Organisation has zeroed in “Creating hope through action” as the triennial theme from 2021 – 2023 for the World Suicide Prevention Day observed on September 10 every year.
The theme suggests that our actions, no matter how big or small, may provide hope to those who are struggling. It also highlights the importance of setting suicide prevention as a priority public health agenda by countries, particularly in places where access to mental health services and availability of evidence-based interventions are low.
We all have a role to play in supporting those experiencing a suicidal crisis or those bereaved by suicide whether as a member of society, as a child, as a parent, as a friend, as a colleague or as a person with lived experience.
We interviewed a team of experts from the Banyan Academy of Leadership in Mental Health (BALM) to understand the crisis of suicides in Chennai and spotlight how community efforts can help in suicide prevention.
The team of experts from BALM who have shared their insights includes Dr Lakshmi Sankaran, Deputy Director; Dr Lakshmi Ravikant, Dean); Aishwariya Ramesh, Mental Health Associate; Namrata Rao, Lead, Centre for Trauma Studies and Innovation; Mrinalini Ravi, Co-Lead, Sundram Fasteners Centre for Social Action and Research and Ramesh K.S. Deputy, Director.
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Causes and stigma around suicide
There is a lot of stigma around suicide. What are the most common misconception about suicide? What can someone going through suicidal thoughts do to prevent acting on such urges?
The common misconceptions about suicide include the following
- Suicide cannot be prevented and occurs without warning
- Once a person has a suicidal thought it will keep occurring
- Talking about suicide can have an adverse impact on the audience
- Suicide is something that only depressed people do; or cowards
- Suicide is a criminal act and the person needs to be punished
- Talk therapy or seeing a counsellor or medication does not work
- People who talk about suicide are not serious; they only want attention
Someone going through suicidal thoughts can talk about the suicidal ideation with close friends/ family/ teachers/ school counsellors or seek helplines and hotlines dedicated to this immediately. You can offer support or ask the person about their feelings if you are concerned about the person showing signs. Take what the person has to say seriously and listen. Build consistent and trustworthy support systems in advance.
The recent NCRB data shows that Chennai stands second among the metro cities with the highest number of suicides. What do you think are the reasons behind such a high number of suicides?
Suicide has been culturally appropriated in incidents where the person is subjected to shame and guilt. India also has a long history of altruistic suicide, with various practices such as Jauhar and Sati leading up to recent times. The idea of self-sacrifice for the greater good, and incidentally glorifying suicide is well embedded in the culture.
Existing literature points to the following reasons for suicide all across the country:
- Family conflicts and domestic violence; having inadequate role models
- Imitation suicide – exposure to suicide in their neighbourhood or area may trigger copycat suicides
- Socioeconomic Status: linkages in vulnerability and risk to mental health issues due to low income, no income, poverty; debt trap
- Unemployment; loss of jobs
- Academic pressure and high expectations due to high literacy rates in Tamil Nadu
- Increased migration from rural areas to the metros and suddenly dealing with stress
- Alcohol abuse / early use and easy access to alcohol; pressure from peers and social media and films
- Loneliness among elders and medical issues and chronic ill health; small or nuclear families, leading to less support from immediate members
Common causes of suicide
The Integrated Motivational Violitional model (IMV), which has recently gained a lot of consensus in the academic community, talks about causes in three different stages.
● Stage 1: Pre-motivational phase – Environmental, biological, and life event factors such as
minority status, chronic illness in a family member(s), adverse childhood experiences, socioeconomic status, chronic illness in self or family member, etc. all contribute as predisposing factors
● Stage 2: Motivational phase – The phase at which suicidal ideation formation happens. When an unfavourable event occurs, such as the loss of a job or failing an exam, it can cause a sense of defeat/humiliation. Due to poor coping skills, and rumination, they start feeling entrapped. With a lack of perceived support, feelings of alienation, and their own attitude they start having thoughts pertaining to suicide. Significant factors in this stage are traumatic experiences, academic pressure, loan, and substance abuse.
● Stage 3: Volitional phase – Factors such as access to means, desensitisation (exposure to suicide), and hopelessness may lead to the progress of suicide ideation to attempt.
Signs to look out for
What are the signs and symptoms of suicide that loved ones could look for? How could they help? Especially, what should we never say to someone going through hard times?
A combination of the following signs may indicate a greater risk of suicide. Different stages may elicit a different combination of signs
- Talking about wanting to die or wanting to kill themselves; feeling empty or hopeless or having no reason to live; feeling trapped or that there are no solutions.
- Feeling unbearable emotional or physical pain; talking about being a burden to others.
- Physiological symptoms such as lack of sleep, lack of hunger and exhaustion, and changes in mood.
- Mental health issues that precipitate – depression, anxiety, loss of interest; irritability; humiliation/shame, agitation/anger; alcohol use disorders
- Sense of entrapment and hopelessness – negative expectations of the future
- Perceived lack of support – alienated, or cut off from others; isolated. May be due to structural barriers such as caste, stigma, and marginalisation.
- Lack of motivation in their usual areas of interest- they no longer want to engage in activities that used to interest them. Or find it meaningless
- Giving away prized possessions
- Poor coping mechanisms – they are engaged in substance use or deliberate self-harm
How can loved ones help?
Family and friends can help those struggling with developing their protective/resilience factors.
They can
- Help them to meet professionals so that they can develop appropriate coping behaviours (healthy coping). As a family member, you can act as the bridge between the service provider and the individual with suicidal ideation and can assume responsibility for seeking help.
- Offer them support – spending more time with them, talking to them more frequently
- Help them engage in volunteering/ activities that benefit the community, and develop a sense of
- belonging
- Help them to help others – taking care of pets, gardening
- Help find purpose and meaning in life
- Help them connect with their potential and be creative
- Build a support system.
Techniques and tips for those looking to help loved ones under duress
QPR method (Like CPR for suicide)
- Question – Initiate a conversation with them about suicide, ask them if they have such ideations
- Persuade – Persuade them to seek help
- Refer – Refer them to appropriate services
What should we never say to someone going through hard times?
We should never minimise the complexity of their issues. We must acknowledge the realities of people’s
hard times without devaluing their experiences or statements. We must take care to not be disrespectful or make derogatory statements. Another important consideration to extend is to not label them – e.g., calling them cowards or saying they’re weak. Finally, we should never compare their problems with that of others.
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Role of the community in suicide prevention
How could the community as a whole play a role in suicide prevention at large? How could the community be equipped for the larger mission?
We can create safe community spaces where people can get together, engage in recreational activities together, build belongingness, and encourage more social mixing such as festivals/celebrations. Building awareness and selective interventions for information about suicide such as signs and ways to
seek help among high-risk groups such as youth and women.
Developing non-stigmatising attitudes through media and discussions with empathy and understanding towards those at risk. Building awareness of life skills to promote mental health at educational institutions, workplaces, social gatherings, and communities for target groups is crucial. Sharing information about helplines and other resources among the members of the community is vital.
Suicide prevention resources available for people in Chennai and how to access them
If you or any persons you know are in distress, or have suicidal thoughts, please reach out to any of the following:
- SNEHA 044- 24640050
- Institute of Mental Health Chennai: 044-26425585
- Government of Tamil Nadu – 104
- Kiran, Government of India – 1800-599-0019
- Other tele-helplines: The Samaritans Mumbai is a helpline providing emotional support for those who are stressed, distressed, depressed, or suicidal; iCALL responds in 24 hours as a psychological helpline that aims to provide high-quality telephone counselling and internet-based support
- Counselling services through government hospitals and private hospitals
What kind of community mental health programmes is being run in Chennai, particularly for those hailing from low-income communities?
The Banyan works for ultra-poor and vulnerable communities in the mental health sector. Several community programs and services such as Home Again, a rehabilitation program where individuals with no exit pathways from institutions are offered supported housing/supported living services, NALAM, a community mental health care workers actively engage in promotional, preventional, curative, and rehabilitative activities in specific locations and Aftercare services such as follow-up services post-discharge to ensure continuity in care.
Schizophrenia Research Foundation (SCARF) has a similar community mental health program run by grassroots-level workers in Tamil Nadu. The TTK foundation has de-addiction programmes. The Institute of Mental Health, Kilpauk, Madras Medical College, and Stanley Medical College have free out-patient and in-patient clinics for those experiencing difficulties.
Women Self-Help Groups (SHG) in the city have regular discussions on socioeconomic distress. They also have frequent sessions with experts, persons with lived experiences & professionals on important topics such as parenting, domestic violence, money management and health.
The South India AIDS Action Programme engage with the community on issues pertaining to adolescent children, providing them training on important topics and using sports as a medium for engagement.
Organisations such as Nalandaway provide well-being and arts-based interventions for children from disadvantaged backgrounds. One All works towards empowering marginalised youth from urban-slum areas in Chennai. The organisation Sumunum promotes the well-being of youth through art-based interventions such as theatre.
Can policy or governance changes enable better implementation of suicide prevention programmes at a city level?
Yes, they can. Decriminalisation of suicide through the enactment of Mental Healthcare Act 2017, and striking down other discriminatory provisions such as Section 377 was a progressive step forward in destigmatising mental health and suicide.
Policies can definitely help structure the implementation of suicide prevention activities and act as guides. There still exists implementational gaps from existing policies that need to be filled.
Incorporating mental health literacy at a school level to build awareness amongst students, and teachers to identify signs of suicide. Training gatekeepers to identify signs of distress, particularly at a young age, and running de-addiction programmes for substance use disorders also influence suicidal thoughts/behaviour.
Implementation of allied Acts can also significantly help reduce distress such as the Protection Of Children from Sexual Offenses Act and Dowry Prohibition Act.
How can the community support someone who has lost their loved one to suicide?
We must refrain from making assumptions or judgments regarding the victim or the family. The family
may be overwhelmed with regret, shame, and grief. Active listening and genuine communication can offer comfort without minimising the loss. Showing empathy and being present for the individual, even if it means sitting in silence can help them tide over their grief.
As a community, we can educate ourselves to identify signs of distress, and also not stigmatise and judge the individual for what they’ve gone through. Community integration by engaging them in multiple local activities can play a role in prevention. Parents, teachers and other gatekeepers can be more supportive toward children and help identify signs of distress, particularly amongst children and act.
The close family members and friends of the person who died by suicide are also at risk of attempting suicide. Supporting them is also another form of prevention. Support groups run by organisations such as Caregiver Saathi can provide a safe space for them to grieve and seek assistance.