“My friend’s son failed in his 12th standard exams. He took his life that evening” – Shikha*
“I myself had attempted suicide once. I was 23/24 then and straddled with a baby and a mom-in-law with the most acidic tongue, who kept telling me how ugly, dark and unsuitable I was for her dashing, talented son. Little did I know then that she wasn’t able to handle clear thinking, razor sharp minds and smart women. She felt that she could control me better if she put me down every time.” – Prerana*
The above are just two examples of the many cases shared in one of the countless WhatsApp groups across the country, following news of the death by suicide of a talented young actor. In fact, the tragic incident has led to a sudden burst of discussions and analysis around suicide and mental health issues; while many opinions and speculations about the reasons behind the recent death are doing the rounds, the needless jury is still out.
In any discussion or deliberation over a suicide and the circumstances surrounding it, one needs to keep in mind the following points by WHO:
- Health, mental health, stressful life events, social and cultural factors need to be taken into account when trying to understand suicidal behaviour.
- Impulsivity also plays an important role.
- People with mental illness, which may influence a person’s ability to cope with stress factors and interpersonal conflicts, are more likely to be at risk of suicide. However, mental illness alone is insufficient to explain suicide.
- Almost always, it will be misleading to attribute a suicide to one specific event alone, such as failure in an examination or breakdown of a relationship.
This begs the question, who all can attempt suicide? Who are the people at risk?
Reasons behind a suicide attempt
“It is all about the individual, and the stress level a person is facing at that point of time.” says Dr Kalyanasundaram, a Bengaluru based Senior Consultant Psychiatrist. “It could be an economic issue or a social issue – some pressure or a perceived threat of an imminent disaster a person cannot cope with. For example, farmer suicides is a completely different ball game – it is not just a clinical issue but something more than that.”
“Some people have a vulnerability to this (attempting suicide), and when something happens that, from their perspective, they are unable to handle, they think the next best option is to die. If only these people seek help from a mental health professional at the right time, there is always the possibility for treatment and hope for recovery,” he adds.
WHO has observed that:
While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.
In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour.
Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners.
By far the strongest risk factor for suicide is a previous suicide attempt.’ Studies show that, “…for each suicide, there are more than 20 suicide attempts.”
Some other risk factors include family history of suicide, easy access to lethal means, local clusters of suicide, lack of social support and sense of isolation, stigma associated with asking for help, lack of healthcare, cultural and religious beliefs such as the belief that suicide is a noble resolution of a personal dilemma, and exposure to others who have died by suicide (in real life or via the media and internet).
Recognising the health angle
The reason(s) for someone attempting to take one’s own life could be anything, and not limited to mental illness alone. However, that does not take away the need for enabling adequate mental health across the country. Nor does it take away the fact that the person is hurting and needs help at the earliest.
The truth is, suicide is an ever prevalent public health problem. WHO statistics indicate that one person dies by suicide every 40 seconds. This is close to 800,000 people a year globally. Of these, over 100,000 people (12.5%) are from India.
Indeed, the silver lining to this dark cloud is that Suicides are preventable at various levels. At first though one needs to understand why someone would attempt to take one’s own life.
Understanding the thoughts behind a suicide attempt
At an individual level, one can look out for warning signs as a step towards preventing a possible suicide attempt.
“We do not look out for signs of suicide in every single patient who comes to us. We very definitely observe those who have depression – moderate to severe depression. That is simply because many of them may not voice it (their thoughts on suicide)” says Dr. Kalyanasundaram.
Mental health professionals like Dr Kalayanasundaram have to be alert enough to ask patients certain critical questions. It is not polite to bluntly ask, ‘Are you contemplating suicide?’ “We need to understand our patients in detail and ask questions like ‘How has life been treating you?’ or ‘How are you coping with all the stress we have been talking about?’,” says the doctor.
Helplessness and Hopelessness are certainly red flags.
“We then ask questions like ‘Why do you feel so helpless and hopeless?’ or ‘What kind of thoughts come to your mind?’ or, ‘What do you do to get rid of those thoughts?’; If the person says something like ‘I don’t see any way out this’, ‘the thoughts seem to engulf me, overwhelm me,’ more red flags go up. More the red flags, more the concern,” he adds.
Some other red flags or warning signs include one or more of the following:
- (Increased) thoughts, experiences and expressions of:
- Feeling trapped as if there is no way out of the problems one is dealing with
- Rage or anger
- Excessive shame or guilt
- Actions and words:
- The person being depressed or sad for a prolonged period of time
- Conversations or writings about death or suicide like ‘you won’t have to worry about me for much longer’
- Withdrawing from family and friends
- Substance abuse
- Personality change
- Impulsive and / or reckless actions
- Poor performance at home, work or school
- Sudden writing of a Will or getting personal affairs in order
- Voluntary distribution or giving away of prized possessions
- Calling or visiting loved ones
However, none of the above signs may be displayed by the person attempting suicide.
How is prevention of suicide possible?
In this regard, WHO has stated that ‘Much can be done to prevent suicide at individual, community and national levels.’
“Education about mental health should not start at a point of time when a person is going through depression. It should start much, much earlier – as kind of a preventive learning so that one can build a resilient personality. In education, we only talk about marks, grades etc. We never talk about a person’s holistic development – a child’s social abilities or a child’s attitude, perception, hardiness, etc. This is where one should start giving the child life skills – very early in life, say at around 6 to 7 years of age. This would help a child manoeuvre the way through the challenges of life,” says Dr Manika Ghosh, Secretary, Association of Health Psychologists, and President, Bangalore Psychology Forum..
How the person perceives the whole thing too matters, says Dr Ghosh. Where a person is going through depression, it is very essential for the person to identify that and realise that this is something he needs help with. The help need not necessarily be a psychiatrist right away… it could just mean talking or reaching out to anyone that he feels would listen without judgement – a family member, a confidant, a friend or a counsellor. “It is very essential for people to know that there are people who can help – please reach out, don’t bottle it up. Depression is not the end of the tunnel.” she continues.
At an individual / family level, one can watch out for the warning signs mentioned earlier. If some such changes are observed in a loved one, one can then gently get the latter to talk about what is bothering them.
Encouraging the person to seek help from a qualified mental health professional may also help in ailments like depression, since such health challenges need medical diagnosis and management. One needs to break the stigma of talking about and / or seeking treatment for an ailment of the brain. The role of gatekeepers is important here.
A gatekeeper is someone who believes that suicide can be prevented, and is willing to give time and energy for this cause. Anyone can be a ‘gatekeeper’ – be it a teacher, hostel warden, parent, neighbor, employer, watchman, bus conductor, shopkeeper or a community leader. More information on how one can attempt to prevent suicide is available in articles by White Swan Foundation on this topic.
Community would include your neighbourhood, schools, colleges, work places, places of worship, etc. where a lot of people gather or get together frequently. Dr Ghosh feels that the influencers in these spheres should make opportunities to talk about mental health and well-being. She is of the opinion that there should be many more mental health awareness camps, and interactions with the various communities about mental health.
State / National level
“Insurance should also cover mental illness and therapy. It does not at this point of time. Mental illness is as real as any physical ailment,” says Dr Ghosh while talking about what can be done at a national level to reduce the incidence of suicide. “There should be some policy to teach mental hygiene in schools and colleges. Very often, we do not empathise with any mental health issue. That is a very important thing. We need to talk more often about mental hygiene,” she adds.
Role of media
Celebrity deaths have a kind of spiralling / cascading effect on so many people who are already going through some level of depression. One suicide can trigger another one. In fact, during a workshop held by NIMHANS some years ago, the media was told to not give graphic descriptions about the place and method of suicide. The reason for this was, if a person is already contemplating suicide and details of the celebrity suicide were broadcast or published, they may use it as inputs for their own suicide attempt, and try to emulate it.
It is not a very happy moment that we are currently living in,” cautions Dr Ghosh. “This suicide could trigger a call of gloom, aggravate things.” She stresses that the media has an important role to play (in preventing suicide). Graphic descriptions of such suicides, sensationalism of such news are to be strictly and completely avoided.
Many helplines are offering telephonic support to people struggling with issues like anxiety, depression, COVID related worries, and the like. “Our team of volunteers at Swasti – Covid Tele-Counselling Centre (080 47186060) are all trained psychologists based in Bengaluru. We provide counselling in Kannada, Hindi, English, Tamil and Urdu.” says Dr. Ghosh.
Some other helplines include:
Roshni Helpline: +91 4066202000
Sneha Foundation India: +91 4424640050
Sumaitri Helpline: 011-23389090
The Samaritans Mumbai: 8422984528/29/30
Connecting India: +91 9922001122
Cooj: +91 8322252525
Vandrevala Foundation: +91 1860-2662-345, 1800-2333-330
Saath: 079-2630-5544, 079-2630-0222
Lifeline Foundation: 033-2463-7401, 033-2463-7432
Aasra Suicide Prevention Hotline: (022)27546669.