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World Suicide Prevention Day: In India, multiple challenges persist despite efforts

Sometime in August 2003, the United Nations decided to anoint 10 September as World Suicide Prevention Day. Recognising particular days or weeks based around themes proposed by organisations is a preserve of the UN, and a powerful lobbying and awareness tool.

This was great news for Dr Lakshmi Vijayakumar, then the vice-president at the International Association for Suicide Prevention. The team had been working to get a special day for the preceding two years. But there was one problem.

“We didn’t want 10 September because 11 September (9/11) was still very fresh in everybody’s mind at the time,” she said, during a recent chat. “So we asked them whether they can change the date. They said no, either you take it or leave it. We said fine, we will take it.”

That first time in 2003 was a low key affair, where at a hastily organised press meet to which no more than 15 people showed up, World Suicide Prevention Day was kicked off. The sticky association with 9/11 has over the years receded. Now more than 130 countries recognise the day with dozens of awareness-building events pushed around it.

 World Suicide Prevention Day: In India, multiple challenges persist despite efforts

Representational image. Reuters/Arko Datta

“What it has captured is the imagination of people,” said Vijayakumar. “Now it has snowballed into a major, major event. Many countries have started initiating national suicide prevention strategies because they see the public involved. There has been a huge momentum.”

Vijayakumar is the country’s foremost suicide expert, a member of the World Health Organization’s network on suicide research and a member of the International Academy of Suicide Research. A practicing psychiatrist, researcher, and founder of Sneha, one of India’s first suicide prevention helplines, Vijayakumar is also the only Indian fellow to be nominated to both the Royal College of Psychiatrists and the Royal College of Physicians. The latter was an honour bestowed last year. Since it began in 1986, Sneha, a volunteer-driven effort based in Chennai has fielded more than seven lakh calls, saving countless lives in the process.

It all started from an incipient interest Vijayakumar had as a psychiatry student: why was suicide, an obviously preventable problem receiving such little attention? Further, the textbooks had hardly prepared Vijayakumar for the kind of patients she was seeing: not elderly white males living alone as conventional wisdom described, but young married women.

Following a paper presentation in Vienna on this seeming incongruity, Vijayakumar and her husband travelled for two weeks through Europe, sightseeing tourist spots and then visiting suicide prevention centres. She came back with something resembling a plan. Why not try to work along the lines of the Samaritans in London, where ordinary people manned a phone line and talked to people having emotional or mental health trouble?

In the early days, people were skeptical: would people even want to talk about such things in a city like Madras? Was suicide preventable simply through conversation? Would volunteers suffice?

It has been more than two decades since, and Sneha gets on average 40 calls a day, having never shut its line in all these years except for a single day during the 2015 Chennai floods. “Can we have zero suicides? I doubt it. But we can prevent so many. It is like can we have zero malaria? But we have been able to curtail it to a large extent.”

Still, in India, suicide statistics have been growing at an alarming rate. In 1978 for instance, the suicide rate (counted as deaths per one lakh people) was 6.3, now it is 10.6. Conservative estimates suggest at least 1,00,000 people die by suicide annually, and still it remains to be seriously tackled.

“Take HIV, the amount of money spent, the amount of public awareness. And how many people die of HIV in India?,” Vijayakumar explains, “Twenty-five thousand. Suicide deaths are 10 times more than this. And still, we don’t have a national plan for suicide prevention. It is a growing public health problem.”

It is hard to narrow down why this is the case, why the numbers have been going up. “If I’m able to answer that perfectly, then I’ll probably get the Nobel,” said Vijayakumar, smiling. “We don’t know. There are many things possible. One is the fact that when a country is in a developing stage, the rate goes [up] until the country reaches a certain stability. We found in China the rate growing and now it is stable.”

Sociologically speaking, suicides are broadly categorised as four kinds: egoistic suicides, or those triggered when a person isn’t well integrated into society. Anomic suicides are those where a person takes their own life following a sudden or traumatic change: a loss of limb or loved one or crop or money. Then there is fatalistic suicide where a person is stifled by society’s overregulation. And finally, there is altruistic suicide, where the individual life is taken for the sake of a group – for instance, terrorist suicides or ritual suicides like seppuku. In India, a combination of shame, honour, social pressures, failed romances and economic frustrations mean suicides usually fall in the first two categories, said Vijayakumar.

Sometimes there is a spike in calls Sneha receives, around exam time for instance, or in the weeks following a natural disaster or catastrophe. “We say suicide is a permanent solution for a temporary problem,” said Vijayakumar. “So if you tide over that phase people can come out.”

Multiple challenges remain for tackling suicide in India, despite the decriminalising of suicide attempts in the new Mental Health Law, which was one of the things Vijayakumar worked on.

She is now focused on lobbying the government to bring in a comprehensive suicide strategy, as well as, media guidelines for suicide reporting. Studies show that how news about suicide is written can have an impact on suicide attempts and ideation. She gave the example of Hong Kong and Taiwan, for instance, where following the reporting around one case of suicide through charcoal burning [by creating a noxious carbon monoxide chamber], the use of the method spiked by 20 percent over a five-year period. “Be responsible about it,” she said. “Don’t show gruesome pictures. Don’t write the method in detail. I’m not saying don’t report at all.”

Vijayakumar isn’t sure how many lives Sneha volunteers have helped save over the years, and it doesn’t matter. “I don’t think we should count,” she said. “Even one life saved is one life saved.” The work is its own reward. “When a person is absolutely depressed, and feels nobody understands or cares for them and suddenly realises you do care for them and you make that connection in their depth of despair, that connection is the rope with which they climb back,” she said. “That’s a moment of satisfaction.”

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Updated Date: Sep 12, 2018 15:14:04 IST