Tuesday, February 27, 2024

IN FOCUS : HANG ON, DON’T HANG! You are not alone, and there is always help

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Like in many parts of the globe, suicide is becoming a major public health problem in India. More people die by suicide than due to road traffic accidents and homicide put together. While a lot of initiatives have been taken to prevent deaths from traffic accidents such as building better roads and mandating safer vehicles, society has not yet mounted organized efforts to curb death by suicide.

On the contrary, glorification and normalisation of suicide by the media, including cinema and the internet, has reduced the threshold for adolescents and youth, who tend to use suicide as a way out of this world at the slightest difficulty or indication of stress.In the light of World Suicide Prevention Day, Tanisha Saxena looks closely at the factors leading to suicide and how we can prevent people from taking the extreme step.

With an estimated 2,50,000 suicides each year, India has the highest suicide rate in the world.The causes of this are numerous and complex, though the frequently mentioned ones are social stigma, gender inequity, access to mental health treatments, and poverty.

Also prevalent in India is substance misuse, which raises the risk of depression and suicidal ideation. Last but not least, mental health issues are taboo in India, where people are dissuaded from seeking help.

Suicide is significantly influenced by mental health. Suicidal thoughts and actions can result from mental health conditions such depression, anxiety, and substance misuse. People who are dealing with mental health problems may feel hopeless, overwhelmed, and helpless, which makes them think that suicide is their only option.

Suicidal thoughts and behaviours can also be influenced by other elements such a lack of social support, financial stress, and traumatic life events. It is critical to identify the warning symptoms of mental health problems and to take immediate action to address them.

The GBD (Global Burden of Disease) Study estimate of 13,9,123 suicide fatalities in 2019 was 40% lower than the figure provided by the administrative data source for suicide deaths in India, which is based on police reports. Since correct documentation of suicide fatalities is affected by societal shame, legal repercussions, and the quality of data acquired by local police stations, the National Crime Records Bureau (NCRB) is infamous for undercounting suicide deaths and differentially reporting deaths by sex, age, and geographic area.

Housewives make for the largest percentage of reported suicide fatalities, with little change over time, compared to other occupations, according to NCRB’s documentation relating to occupation of the deceased. In India, there are more than 200 people with non-fatal suicidal thoughts and behaviours (referred to as suicidality here) and more for every suicide fatality.

According to a research paper titled The National Suicide Prevention Strategy in India: Context and Considerations for Urgent Action, “The most frequent methods of suicide, according to the NCRB, include hanging, ingestion of pesticides, excessive medicine use, and burning oneself on fire. Hanging is the method used in about half of all suicide deaths, and between 2010 and 2019 it was utilised far more frequently than it had been.

Pesticide poisoning is the cause of 20% of all suicide deaths, and these deaths are far more frequent in regions where agriculture is the primary business since pesticides are more easily accessible there. Despite a decline in the use of this strategy between 2010 and 2015, a systematic analysis indicates that there may be up to 50 000 or more pesticide-related suicide fatalities per year, which is more than what was shown in the NCRB data.”

Mental health factors

Dr Sujatha Rajamani, Consultant Psychiatrist at KIMS Hospitals, Secunderabad, shares, “Because they are intrusive, persistent, and negative, anxious thoughts might cause you to feel fearful, worried, or uneasy. They could be more general and pervasive or connected to a specific instance or event. A few instances of anxious thoughts include worrying about the future, reflecting on the past, dreading rejection or judgement, worrying about making mistakes, and worrying about not being able to handle a situation.”

Similarly, a serious mental illness like depression can cause suicidal thoughts and actions. If anyone is experiencing depression, it is critical to recognise the symptoms and get treatment. Talking about wanting to die, feeling hopeless or unworthy, withdrawing from friends and family, and participating in risky behaviour are all warning indicators of suicide. It is crucial to get help from a mental health professional if an individual is displaying any of these symptoms.

“Suicide can result from a variety of drug-related causes. Abuse of drugs or alcohol can cause depression, which increases the risk of suicide. Drug users may also be more likely to engage in unsafe activities like drunk driving, which can result in tragic accidents.

Drug users may also be more likely to distance themselves from friends and family, which can result in emotions of helplessness and despair. Last but not the least, drug users may be more inclined to attempt suicide,” says Doctor Sujatha.

Individual experience is important to note. Not everything that works for one person can also work for the other. It depends on an individual’s lifestyle and coping mechanisms. Arouba Kabir, mental health professional and founder of Enso Wellness, says: “Suicide is a complicated, multi-faceted problem that is greatly affected by a variety of variables.

It is like a puzzle with many components, including family problems, emotional suffering, mental health troubles, and other hurdles. Additionally, because every person’s puzzle is different based on their culture, upbringing, age, gender, etc., it is difficult to identify a single explanation.

Since I have been working with people from all walks of life for almost 10 years, I have gained insights into the top three causes of suicide attempts and deaths by suicide: relationship with self (where a person has low self-esteem, many unresolved emotional traumas, has experienced abuse (emotional, physical, or sexual), or has lost trust and belief in themselves);  relationship with family (where individuals have experienced some form of abuse); and relationship with environment.”

Additionally, the stigma associated with it acts as a heavy fog that frequently precludes honest and caring dialogues about this important topic. Being brave or cowardly has nothing to do with committing suicide. It is oversimplified to characterise suicide as a cowardly act in this day and age.

We are all aware that we only have one life, and if we murder ourselves or attempt to kill someone else, we may not have another chance to make things right or accomplish our goals. It is not always clear-cut and definite. Suicide results from intense, frequently overpowering emotional suffering and despair. People who consider it may have been trapped for a prolonged period of time without being able to see any other way out.

Inability to seek help

About 30 million people require mental health support in India. And shockingly not even half of this population is able to seek professional help. As per the data from the National Institute of Mental Health and Neurosciences (NIMHANS), 10% people fall prey to drugs consumption.

Shruti Jha, a student of physics honours, is battling anxiety disorder. Agreeing to speak on the issue, she begins: “I started feeling worried a bit too much in the second year of my college. I did not take it seriously at that point as the symptoms would go quickly. However, in the third year the situation was worrisome. I don’t know why but I started feeling so tensed and worried about things that are illogical. I would just overthink all the time. Attending classes was becoming difficult as my focus would fade away in minutes.

Gradually, it all affected my physical health too. I would get panic attacks in the night, followed by excessive sweating and breathlessness. I would feel choked and always hungry for air. My hands would tremble, and the brain muscles would become tense creating a pressure. I was stuck in the tunnel and one day I broke down in front of my family. They took me to our family doctor, and I was diagnosed with generalised anxiety disorder. I was feeling so overwhelmed at one point that I literally took a compass and tried to harm myself. It was for the first time that I realised that suicidal thoughts are simply a result of a chain of unwanted thoughts I was trapped in.”

Jha is taking treatment for anxiety disorder in Secunderabad. She feels better now but at times those overwhelming thoughts keep troubling her. However, she has realised that people don’t share their problems and that’s where it all begins. When an individual suppresses his or her emotions then everything that is bottled up explodes at different times.  Moreover, there’s stigma attached to the mental health issues. Say depression and people would assume that the person is mentally retarded or crazy.

Unfortunately, health insurance policies do not cover mental health therapies in most cases, and many people are unable to pay for them out of their pocket. In addition, there is a dearth of knowledge regarding mental health problems and the resources that are available, which can make it challenging for people to get the assistance they require. Moreover, the stigma attached to mental health problems often discourage people from asking for help or even opening up to near ones.

Sociologist Kamal Uddin, says, “Poverty is a major obstacle to receiving competent mental health care. People living in poverty do not have access to mental health services because they lack transportation, insurance, or understanding of their alternatives.

Furthermore, even if such services are provided, people who are poor might not have the resources to pay for them. People may face a cycle of poverty and mental health issues if they can’t get the help they need to improve their mental health.”

Policies and practices

Prior to the passage of The Mental Healthcare Act of 2017, attempts at suicide in India were regarded as crimes. Now, however, the act states “Not withstanding anything contained in section 309 of the Indian Penal Code, any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said Code.”

The Act requires the government to provide therapy, counselling, and rehabilitation to anyone who makes a suicide attempt in order to lessen the likelihood that it will happen again. But it is important to resolve the inconsistency with Section 309 of the Indian Penal Code, which defines suicide attempt as a crime.

“India’s National Mental Health Policy, which was introduced in 2014, aimed to reduce suicide deaths and suicide attempts by implementing a number of strategies, such as suicide prevention programmes, restricting access to lethal substances (particularly pesticides), establishing guidelines for responsible media coverage, training community leaders to recognise suicide risk, improving data on suicide deaths and attempted suicides, and addressing alcohol abuse and depression as major risk factors.

The District Mental Health Programme, which is administered by the Union Ministry of Health and Family Welfare and currently runs in 500 of the nation’s 725 districts and involves a psychiatrist as a member of a multidisciplinary team, is a significant component of this programme,” says Doctor T R John, Senior Consultant Psychiatry, Aster Medcity, Kochi.

Role of education

A comprehensive strategy that incorporates teaching, awareness, and assistance can address suicide prevention in schools.

l Education: Schools should give all pupils age-appropriate information about preventing suicide. Information about the warning signs of suicide, how to approach someone who may be contemplating suicide, and how to get help should be included in this.

lAwareness: Schools should foster a culture that values candid conversation about preventing suicide. This may entail offering tools and assistance to pupils.

lCreate a school-wide suicide prevention programme that instructs staff and students on how to spot warning signs of potential suicide and what to do about them.l Establish a welcoming atmosphere where kids feel comfortable discussing their mental health.

In sum, suicide is not a solution to problems that life throws up, period. Plenty of help is available for any victim with suicidal thoughts who hangs on and seeks help from mental health professionals or counselling centres, instead of reaching for the rope to hang himself or herself.

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