Suicide prevention and role of community

KATHMANDU, SEPTEMBER 10

Suicide is among the top three causes of death among youth worldwide. According to the WHO, every year, almost one million people die from suicide and 20 times more people attempt suicide; a global mortality rate of 16 per 100,000, or one death every 40 seconds and one attempt every 3 seconds, on average.

Around 800,000 people die by suicide every year. 15 men and 8 women in every 100,000 persons die due to the cause. Behind every suicide, there are 25 related attempts. The number of deaths due to suicide in men is three times higher than that of women, while the number of attempted suicide is two or three times higher among women than that of men.

In Nepal, over 20 people die of suicide every day. It is the seventh highest rate in the world and in South Asian countries, Nepal comes second after Sri Lanka.

In the fiscal year 2075/76, 5754 deaths were reported as per Nepal Police’s data. The ongoing fiscal year 2076/77 has already witnessed 4586 death reports due to suicide.

During lock-down, the suicide rate has increased rapidly in the country. There have been more than two thousand suicides of which around 200 were children and adolescents.

Let me remind a case of a villager who had contracted the coronavirus infection but his village his co-vllagers refused to accept him due to the lack of knowledge about the disease. He unfortunately resorted to suicide. This is to say that community members and the community as a whole can play a huge role in prevention of suicides while it can also at times be a hurdle in prevention of the same.

If there are trained people in a community who can identify persons that are at risk of suicide and refer them to treatment or provide supporting services as appropriate, it can lead to saving of a lot of lives.

There are many factors that often play a vital role for prevention of suicide. Let’s discuss few of them here:

Knowledge about Suicide

Knowledge about suicide includes declarative and perceived knowledge about suicide, depression, and resources available for at-risk persons. If the community is unaware about suicide, they cannot help their members. It always helps for community members to have knowledge about such vital life threatening illness and reasons behind the same.

Beliefs and Attitudes

Beliefs and attitudes about suicide prevention can be understood in a larger sense but it primarily focuses on whether or not suicide is considered preventable, if it is appropriate to intervene with at-risk individuals, and whether seeking help for mental illness is a viewed as a form of self-care. Changes can happen if we incorporate changes in our attitudes and beliefs which can lead to reaching out to someone in need. Rather than merely talking and negating others’ understandings, one can always listen to people around them.

Reluctance to Intervention, and Stigmatisation

Since people may deem it inappropriate, they may be reluctant to intervene with an at-risk individual. The stigmas attached to mental health is another reason why community members are reluctant to approach at-risk individuals.

Stigma basically means negative stereotypes and discriminatory behaviours against those that have or are perceived to have mental health issues. The most common form of discriminatory action is the social-avoidance an individial who is thought to have mental illness. Potential gatekeepers may not feel comfortable interacting with individuals in distress and may avoid them. Furthermore, gatekeepers may ignore the topic of depression and suicide altogether in a bid to avoid attributing the label of mental illness to another individual, which they fear could cause further distress.

How can one help or prevent suicide?

1. Monitoring and controlling access to lethal means

The first and foremost means of preventing suicides is to prevent the at-risk person’s accessibility to lethal means such as sharp objects, pesticides, harmful chemical, kerosene, etc. There are many studies which support the fact that such vigilance yields positive results.

(Similar interventions were used like limitation of the access to specific means such as firearms, notably in Canada at the end of the 1970s and in Austria at the end of the 1990s)

2. Preservation of contact with patients at risk for recurrence

If we are able to continuously follow up with high risk clients or individuals in the long term, than we have higher success in prevention of the issue.

A randomised controlled trial (RCT) conducted in five countries (Brazil, India, Sri Lanka, Iran, China) on a total of eight hospitals evaluated the impact of a program including an information session through different means were beneficial.

3. Call lines and help centers

Helplines are easily accessible for help and give immediate relief for the high risk behaviours. There are a lot of toll free numbers available in our country. One of them is 16600122223 ran by Mental health promotion and suicide prevention center. According to their report, they were able to save 45 lives in a year. Such baby steps can help prevent suicides.

4. Training general practitioners

Studies have shown that training of general practitioners and medical officers to identify and intervene in cases pertaining to depression can reduce corresponding risks.

5. Programs in schools

School children are the most vulnerable groups and as such hence awareness, prevention measures and accessibility to information should be made available right from early ages. One has to take the lead to form small groups to identify and intervene at the right time

6. Reorganisation of care

Interventions aimed at the continuity of therapeutic management by specialists upon discharge from the hospital is also one of the vital mechanism to manage related risks.

7. Public information campaigns

Public awareness definitely has a positive impact on reducing suicide rates. If the campaign is run by the following groups, then the success rates are higher:

• A communication campaign arm (website, posters, brochures, etc.) aimed at the general public;
• An information and training arm for professionals (general practitioners, religious leaders, police officers, teachers, and journalists);
• An arm devoted to supporting patients and their families.

Rampukar Sah is a Clinical Psychologist and trained in child and adolescent psychiatry. He is currently a consultant at Kanti Childrens Hospital.

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