World Suicide Prevention Day: A look at where India stands in suicide intervention vis-a-vis the world

When it began raining he hoped his bajra crop will help him repay debts built up over the last three crop failures, but little did Rajendra Singh of Bakara village in Rajasthan's Jhunjhunu district know that deficient rains in his region will lead to the withering of this year's crop too. Unable to face local money lenders he had borrowed from, he committed suicide by hanging himself from a tree on the bund outlining his dried up field on August 27. 

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Nearly 1,100 km south-west, Vapi resident Vallabh Patel is still numbed by his 29-year-old son Rajesh's suicide on August 31. "He was driven to it," weeps the septuagenarian. His newly married daughter-in-law Roopal wanted Rajesh to move to her hometown Daman without his parents. When he refused she left with all her jewelry and clothes. The Patels were then charged domestic violence and harassment for dowry based on her complaint. "I told him we'll fight this false case. But he was shattered when police began harassing us, not sparing even my old wheelchair-bound wife," reminisces the senior Patel, "He couldn't take it and consumed insecticide. By the time we took him to the hospital it was too late."

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Two days later, 160 km away, death came calling on nursery teacher Shraddha Lad. This 40-year-old mother of three and psychology major who ran a pre-school and day care centre in the far northern Mumbai suburb of Thane hung herself to death from the ceiling fan at home with her dupatta late last Saturday. The suicide baffled both family and neighbours who insist there were no apparent triggers or signs of depression. "Always jovial, she enjoyed spending time with kids," an immediate neighbour in her building in the tony Panchpakhdi neighbourhood told this writer. "Her husband Dilip who was away working in Moscow had resigned and returned six months ago. Shraddha seemed excited he'd found a better position in the United Arab Emirates he was taking up next month."

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On the same day that the last suicide was creating shock waves in Thane city, this writer was at the Institute for Psychological Health (IPH), Thane, working in the area of mental healthcare for 27 years. At their helpline Maitra (02225385447) where people "seek emotional first-aid," the counsellor was busy calming a young man standing on the ledge of his building terrace. Despite his emotional outburst and anger, the counsellor kept a calm, soft tone. It took her almost 30 minutes but she was able to finally dissuade him from taking the extreme step. She also convinced him to come personally for a follow-up.

Being heard

Senior mental health professional Sulabha Subramaniam of IPH (We have pic by Hemant) says, "Sometimes all a person needs is to be heard and understood. At Maitra, we try to listen without getting judgemental about the circumstances. Which is why it takes us a four months to screen, select and train counsellors." She further underlines: "Very rarely does anyone commit suicide overnight. It is something an individual grapples with for quite some time, hedging, working out methodology and logistics, even sending out distress signals," and adds, "The fact that s/he has reached out and called a helpline means there is a sense, however feeble, of a ray of hope. Our counsellors on the phone are trained to latch on to that without getting too aggressive. We take things at their pace, keep them talking gently nudging them away from the negativity even if they transfer-project anger and hostility about their situation, on to the counsellor."

(Sulabha Subramaniam at the Maitra helpline- Hemant Padalkar/DNA)

Reachable from 9 am to 9 pm on through the week and from 9 am to 1 pm on Sundays, Maitra has received about 22,000 calls till now, of which approximately over 8,000 calls from those in suicidal distress. Detailed notes are made after each call and all that data is statistically analysed. A look at the analyses findings shows how 40% callers are females, 60% men. While most callers are between 18-55 years of age Maitra has received calls from individuals as young as 13 and sometimes from those in the late 70s too. "Largest number of calls are from urban middle class in Thane and Mumbai but we also get calls from across rural interiors across Maharashtra and even neighbouring states. The latter is largely migrants from Thane and Mumbai, or those who find us on the internet," explains Subramaniam.

As the day pans out we realise that some callers come from poorer sections of society. "They might not articulate their thoughts exactly but when they reach out one senses their awareness of both the problem and the redressal," explains Subramaniam. "With the upper middle and rich class, a lot more stigma is attached to feeling suicidal or attempts. Despite accessibility and awareness being high they hence don't reach out to actual caregivers.

Someone on the phone becomes convenient. Also, let's not forget that this class often wants everything now. A counsellor might not be available on such short notice. Helplines then become the easier first line to reach out."

Johnson Thomas who runs the Aasra helpline (27546667/9) across the Thane creek in Koparkhairane agrees with Subramaniam. "We are a 24x7 service and get calls from people largely between 18-45 years of age and we can sense that they often want the resolution to their problems on phone itself," he said and added, "We are seeing more youth reach out in distress particularly students." He admits that with merely two lines the intervention his organisation is providing is mere drop in the ocean. Like Subramaniam, he highlights the need for more such services given the acute need among people. "But we have limited resources and have to make do with what we have."

iCall the psycho-social helpline run by the Tata Institute of Social Sciences has been providing both email/phone counselling for five years has recieved over 50,000 calls and 3,000 emails. Dean of the School for Human Ecology which runs the helpline Sujata Sriram says the helpline gets equal number of calls from men and women. "In 2012 when we began actual suicide intervention cases would be once a week, now we have 2-3 cases every single day," she remarks and points out how the helpline has 14 counsellors on call from 8 am to 10 pm daily. "Most callers are between 18-30 and our data shows as many as 40% are repeat callers. It helps that we're located at TISS with its wide social work network so we can quickly suggest effective and reliable referrals."

Mere drop in ocean

At all three helplines, a majority of problems arose from the caller's primary support, immediate family, best friend, romantic relationships. The problems were either pre-marital, marital or in some cases extra marital. Problems related to parents, in-laws, siblings came a close second. Most problems arose from not being able to to get along with each other, feelings of being neglected/misunderstood or having done something wrong and fighting guilt/ fear of repercussions. Personality differences or differences of opinion over core issues to do with families, jealousy, aggression dissatisfaction and abuse also seemed to be the subject of most calls. The second category was student related. Exam phobia, inability to decide on a stream/career, inability to cope with a subject/course and pressure from teachers, peers, and parents. The third category was of calls was related to mental health problems with stress, anxiety, phobias, personality disorders, psychosis, neurosis including schizophrenia, OCD, substance abuse or psychosexual and gender identity problems.

And yet, with a population of over 1.2 crores Mumbai even the 12 helplines listed on the internet, to offer assistance to suicidal persons, seem insufficient. What's worse, when this writer called up the dozen helplines most were not working and some were working only for two hours a day. We could get through to the counsellor only on the three mentioned here.

"If this is the case in the country's financial capital, imagine what happens in interior India," laments Delhi-based psychologist Dr Prakash Swain. He recounted how a suicide helpline ( 0712-8888817666) was launched with much fanfare in Nagpur one of the main big cities in the farmer suicide country of Vidarbha. Given the spate of farmer suicides, this should have been a much patronised service but this writer found that here too even locals in the Somalwada neighbourhood (where it is located) did not even know of the helpline. It ran for eight months after its launch in March 2012 and then shut shop after those running it found it unsustainable!

India vis-a-vis the world

Though it is globally only 24th for its suicide rates, among all its South Asian neighbours India (15.7) is second only to Sri Lanka (which at 35.3 has the world's fourth highest number of suicides) in the suicide mortality rate (suicides per 100,000), whereas the figures for Bangladesh (5.5), Nepal (6), Bhutan (11.7) and Pakistan (12.7) are smaller. "Many of these are poorer countries with smaller GDPs. What are they doing right, that Indian isn't?" wonders Dr Swain.

Subramaniam tries to explain this in context with the changing nature of the Indian society. "Though we had nuclear families earlier too, people didn't feel so isolated. Now though there are one-child families each member is busy in their own world. Thanks to the internet, people can come home at midnight and get sucked back into work. Our society still wants to reinforce its community character while we are becoming individualistic."

While she thinks the internet making more information than we can process is also part of the problem. "When people see the world outside, they resent why others have so much when they don't even have enough for two meals a day. This is fuelling aspiration without actually providing any means to fulfill it in sight or even the awareness of how to calibrate that space and grow."

According to the World Health Organisation (WHO), nearly 8,00,000 commit suicide every year. That means every 40 seconds someone in the world is killing her/himself. And yet the global health body admits this is a conservative statistic since suicide figures from some countries may be underreported by between 20% and 100% because of the extent of the stigma associated with it and the actual death toll could well be much higher.

Worldwide, suicide rates have increased by 60% over the last 50 years, and the increase has been particularly marked in developing countries (SEE BOX).

"The WHO also estimates globally there are at least 20 suicide attempts for every successful one, meaning a whopping 20 million attempted suicides every year - and rising!" avers Swain who adds, "Suicides occur throughout the lifespan and is the second leading cause of death among 15-29-year-olds globally. This is a global phenomenon. Latest figures available for 2015 point how 78% of suicides occurred in poor and middle-income countries and that suicides account for 1.4% of all deaths worldwide, making them the 17th leading cause of death."

According to Dr Swain, effective interventions at community levels can help bring the numbers down. "Not everyone who attempts suicide really wants to die," he explains. "Studies by the UK's National Health Services looking at the rating of suicidal intent found those with very high intent to be as few as 4.2%. This goes up for those with high intent (25%), moderate intent (33.9%) and low intent (36.9%). So a number of deaths are preventable."

He goes on to quote well known American author Richard Bach: "Anyone desperate enough for suicide should be desperate enough to go to creative extremes to solve problems: elope at midnight, stow away on the boat to New Zealand and start over, do what they always wanted to do but were afraid to try."

It his final lament though that key to this problem becomes at once visible and yet seems unattainable. "But we live in times when ruling dispensations are not moved even by people killing themselves," he sighs.
Will those in power heed that lament?

Every 40 seconds someone in the world is killing her/himself

According to the World Health Organisation (WHO), nearly 8,00,000 people commit suicide every year. And yet, WHO admits this is conservative since suicides are under-reported in many countries because of the social stigma attached 

Worldwide, suicides have increased by 60 per cent over the last 50 years, mostly in developing countries. WHO also estimates at least 20 suicide attempts for every successful one, which is a whopping 20 million attempted suicides every year 

Though suicides occur throughout the lifespan, it is the second leading cause of death among 15 to 29-year-olds globally. Figures available for 2015 point how 78 per cent of suicides occurred in poor and middle-income groups of developing countries