Abstract
The suicide rate in India is 10.3. In the last three decades, the suicide rate has increased by
43% but the male female ratio has been stable at 1.4 : 1. Majority (71%) of suicide in India
are by persons below the age of 44 years which imposes a huge social, emotional and
economic burden. Fifty four articles on suicides have been published in IJP. Several studies
reveal that suicidal behaviours are much more prevalent than what is officially reported.
Poisoning, hanging and self immolation (particularly women) were the methods to commit
suicide. Physical and mental illness, disturbed interpersonal relationships and economic
difficulties were the major reasons for suicide. The vulnerable population was found to be
women, students, farmers etc. A social and public health response in addition to a mental
health response is crucial to prevent suicidal behaviour in India.It is hard to believe when
we lose someone to suicide, especially when it is a successful and popular public figure. It
does not just affect the family and friends of the person who dies, but in the case of popular
figures, it brings a sense of loss to the community.
Every death by suicide leaves behind a trail of questions and a deep sense of helplessness.
In the context of the ongoing and unpredictable COVID-19 pandemic, the helplessness is
exacerbated. What is in our control, however, is to do more to identify the crisis building
within ourselves and others, and to learn how to avert it.
Suicide is considered a preventable cause of death and does not always involve a history of
mental illness. Societal and global issues can wear down on us and affect our mental and
physical health. Recent data from the Global Burden of Disease project by the World Health
Organisation shows that the suicide rates for Indian men and women are 1.5 and 2 times the
global suicide rate respectively. Further, in India, suicide is the number one cause of death
for both sexes between the age of 15 and 39, probably pointing to the significant
developments related to career and family typically experienced during these ages.
Across the globe, suicide rates among the elderly are falling, but in India there is a trend for
sharp increase in suicide rates in old age (70 and above). These trends point to some sociocultural issues related to age and gender that may affect suicide rates. Indeed, a recent
review of suicide data in India found some factors that put an individual more at risk —
male unemployment, married female, physical illnesses and social isolation among the
elderly, rate of agricultural employment in the state, minority community status, domestic
violence, family problems, and alcoholism.
This just goes to show that the broader political, economic, and socio-cultural factors play a
very important role in our mental well-being and we must not blame every case on mental
illness. Of course, when one is in a suicidal state, there is intense emotional turmoil. These
environmental and personal stressors can add up and create a sense of a “life not worth
living”. Many of us have thoughts about death at some point in life, such as “death would be
easier”, or, “I cannot go on, I want to get away”. However, it is important to recognise when
this changes to active desire for killing oneself such as “I want to hurt or kill myself”. The
risk for suicide is higher when these thoughts become intentions and there is a specific plan
(time, place, method) that comes to mind.
The first step here should be to get away from any lethal means of hurting yourself.
Poisonous substances, medicines, equipment like weapons or rope need to be thrown away
or removed. Discussing the problem with someone who can help you keep safe is also
important. Lock the medicines and give the key to someone else. Give your wallet and car
keys to others for safekeeping. Get away from any location where these thoughts are more
intense or places your mind had chosen to carry out the plan. Get to a place of safety or
distraction, such as a park or café. Stay away from drugs and alcohol when you are feeling
low, because they affect emotions negatively and lead to more impulsivity and reduced
problem-solving. Reasoning and problem-solving capacity greatly reduces during a suicidal
crisis, making situations seem more dire and hopeless. In these moments, you may feel
intense agitation, self-hatred, hopelessness, and mental anguish.
However, it is important to realise that suicidal thoughts come and go, and that if you make
it through the most difficult moments, you have a chance at feeling better. It is not a battle to
be fought alone however, and we need an army of support including personal and
professional support, and therapy and pharmacological treatment. You shouldn’t delay
getting professional help at this juncture.
Stigma related to mental health issues prevents help-seeking by persons who are suffering.
For instance, non-suicidal self-injury includes acts committed intentionally to hurt oneself
but not to kill oneself, such as cutting, scratching, hitting, or burning oneself. These acts are
related to higher likelihood of suicide attempts in the future and therefore can be seen as a
gateway to suicide attempts . However, such behaviour is often looked down upon and
dismissed as attention-seeking. On the contrary, research has consistently shown that people
engage in these behaviour to regulate their negative emotions and not to seek attention from
others.
Therefore, we must not let our assumptions get in the way of providing support and attempts
of the patient to reach out to others. Criminalisation of mental health issues also adds to this
stigma. Suicide attempts are also no longer considered a criminal act in India under the
Mental Healthcare Act passed in 2017. Therefore, let that not stop you from accurately
reporting a suicide attempt or seeking help. The biggest myth I want to dispel is that asking
or talking about suicide does not plant ideas or increase the risk of suicide in someone else.
If you suspect someone is going through a tough time, ask them whether they are having
thoughts about death or suicide. Do not blame or shame someone for thinking of suicide, or
call it a selfish act. It undermines the struggle the person is going through, further
stigmatises the thoughts, and prevents them from opening up.
Listen to the person, support them without judging their struggle, get them professional help
and resources, and keep reaching out to them even after they are connected to treatment.
Social support is a known protective factor against suicide, meaning that it reduces the
likelihood that a person will attempt suicide. Therefore, reaching out to others even when
they are not obviously struggling is very important.
Similarly, we need to reach out to others when we are struggling. Often, we assume that
others are too busy or don’t care, or won’t understand us. However, we have to take the
crucial step to let others know how we feel clearly. This can be hard when we feel like we
don’t belong, or are a burden on others, or are not amongst well-wishers.
In these instances, we need to try harder to find at least one person who may be supportive
and helpful. Also, they may not be able to solve our problems, but having emotional support
can help us feel less alone. It also doesn’t make us emotionally weak to need others, because
we all go through emotionally overwhelming times when objective and rational perspective
of others can help us see through our emotions.
You can also start by contacting your local crisis or mental health helpline to get
professional help. A list of helplines in India is available here: http://www.suicide.org/
hotlines/international/indiasuicide-hotlines.html.
It may also help to use the app Stay Alive, which is a UK-based app that follows all
recommended guidelines for suicide prevention and provides information and resources to
cope with suicidal thoughts. The app is meant as a self-help tool but cannot be a
replacement for professional help. Remember, when in doubt whether anything can make
you feel better, start by simply reaching out.
A social and public health response to suicide is crucial in India, and should
complement a mental health response. Mental illness is a risk factor for suicide, in India,
as it is in developed countries.
However, additional risk factors are prominent in India. These tend to relate to societal
structures and specific stressors. A social and public health approach acknowledges that
suicide is preventable, and promotes a framework in integrated system of interventions
across multiple levels within society including the individual, the family, the community,
and the health care system. A key step in such an approach involves modifying
attitudes toward suicide via educational efforts and legal levers (e.g. decriminalizing
suicide)