Even as the Health Ministry is working on implementing an action plan to contain the rising suicides in the country, mental health experts lament the absence of a comprehensive policy or the will to deal with it.
The action plan, prepared by a panel of mental health experts, to deal with suicides is with the Health Ministry. Among the actionable items suggested are: reducing access to pesticides, reducing access to alcohol and offering supplementary exams at all levels, so that children may be allowed more opportunities to clear their exams. And more importantly, equipping the basic health services to view suicides as a mental health issue. It is not easy to track the exact number of suicides. Very few countries have a proper reporting mechanism.
Although the Mental Health Bill of 2017 says that a person who has attempted suicide must be treated as a person in distress and seen by mental health professionals before any action is taken against them, it did not recommend the removal of Section 309 of the IPC which makes suicide a criminal offence and hence a stigma. Hospitals are confused on the procedure and a suicide survivor may still be arrested after being examined by a mental health professional. As a result, many families do not report attempted suicides.
According to one mental health professional, government agencies are reluctant to reveal the exact number of suicides in the country. Often estimates by private studies or WHO numbers are much higher than the official figures in India.
The last published report by the National Crime Records Bureau (NCRB) pertains to 2015. Figures for all the years from 1967 are available, but there is a sudden absence of numbers after 2015. The State Crime Records Bureau (SCRB), Tamil Nadu, said the last available number is for 2016 for the State. Figures for 2017 and 2018 are unavailable. One SCRB official said the NCRB had changed the norms for reporting and documenting suicides, as a result of which compilation had been delayed.
Responding to a query in the Lok Sabha on July 23, 2019, on the number of farmers’ suicides in the country since 2015, Union Minister of State (Home) G Kishan Reddy said that owing to some discrepancies in the reporting of suicide cases in 2016, the NCRB had asked the States to verify the data and recompile it.
WHO estimates that India has a suicide mortality rate of 16.3, the highest in the South East Asian region. India accounted for about 2.50 lakh suicides out of 8 lakh in the world in 2016.
According to the report released in 2015, there were 1,33,623 suicides in India. Maharashtra had the highest number with 16,970 suicides, followed by 15,777 in Tamil Nadu and 14,602 in West Bengal. These States along with Karnataka and Madhya Pradesh accounted for 51 per cent of suicides in the country. NCRB data is a collection of reported attempts and completed suicides.
Suicides in Tamil Nadu
According to the SCRB, in 2016, Tamil Nadu accounted for 15,182 suicides. Chennai, which reported 2,274 suicides in 2015, was the highest among the metros.
Glorification of suicides in Tamil Nadu for political reasons has contributed to taking one’s life and being made a hero for the action. Many self-immolations have taken place on the streets, whipping up emotions.
Tamil Nadu reported the highest number of deaths on account of family problems and illness. Dr Lakshmi Vijayakumar, psychiatrist and founder of Sneha, a suicide helpline based in Chennai, says the pattern of suicides in India in the last 30 years has been consistent – highest in the Southern states, middle in the middle states and lowest in the Northern states. This pattern seems to continue even today. Experts attribute this to higher education levels and therefore, greater expectations and frustration in the South. In general, the ratio of males to females committing suicides is 2.2:1. This number has increased from 1.41:1 a few years ago.
Tamil Nadu has consistently reported high suicide numbers and prompted by mental health experts, the State government launched the 104 helpline for suicides in 2013. Counsellors who work with 104 are provided training by the Institute of Mental Health (IMH) in talking to the callers and identifying cases that may need immediate help.
The global picture
Globally, it has been found that developed nations have a ratio of 3:1 male - female suicide ratio, while developing and less developed countries record a higher number of female suicides. If loosely associated, it could mean that societies that had a greater degree of women empowerment had lower female suicides.
In the Indian context, the number of female suicides is higher in the below 30 age group, but the number of male suicides is higher in the above 30 age category. Among women in the 18-30 age group, suicides have overtaken maternal mortality rates in India, says Dr Lakshmi.
The sociological aspect
While there are many studies tracking the number of suicides, there appears to be no sociological study, analysing the reasons for the increased vulnerability of some age groups, certain groups of people and some geographical regions.
In general, in Tamil Nadu the number of people who take an impulsive decision to take their own life appears to be very high, followed by alcoholism and substance abuse, mental illness and fear of failure in exams or the fear of failure (stress).
Studies with respect to student suicides show that a majority of suicides occurred either because the students fell short of 100 on 100 marks or because they failed by 1 or 2 marks, says Dr Lakshmi. According to the NCRB report, in 2015, Assam had the highest number of student suicides with 414, Maharashtra with 383, Tamil Nadu with 322 and Karnataka with 282. Sneha facility receives about 60 calls a day from people contemplating suicide. It is difficult to track the callers and see how many may translate into suicide, for one, because the helpline is committed to maintaining confidentiality and tracking would violate that principle, and two, it would be physically impossible to track every caller. At best the volunteer may seek permission to follow up with them a few days later, if he/she senses urgency in the caller.
Tackling the problem
Mental health experts suggest a three-pronged strategy: At the healthcare level, societal level and policy level. At the healthcare level, the doctors, nurses and support staff must be trained in identifying a vulnerable person and provide counselling support. At the societal level, there must be gatekeepers identified such as school teachers, prominent members of the community and families of vulnerable people. At the policy level, there must be an action plan to pre-empt conducive conditions and prevent them. Suicide is often an impulsive reaction to express unhappiness or anger. About 80 per cent of the people who attempt suicide are not sure that they want to die, says Dr Lakshmi.
What makes a victim so vulnerable to an impulse? Dr Poornchandrika, Director of the Institute of Mental Health, Chennai, says, “There is a predisposition to suicide (genetic), perpetuation through socio-economic conditions or stressful conditions and a precipitating factor which causes the final act.” If these can be handled and the means to give in to the impulse, such as pills or pesticides, removed from the scene, a number of suicides can be immediately prevented.
The break-up of the joint family and the relative isolation of people plus the desire to win appreciation all the time, fuelled by social media have added to the pressure, she added. She recommends that counsellors be appointed at every school, trained to identify suicidal tendencies early on and treat them. Typically, the victim expresses the desire to die before which often is ignored. There are over 300 attempts daily, she stated.
10.6% adults suffer mental disorder
Responding to a query on suicides in Lok Sabha,Union Minister of State for Health and Family Welfare, Ashwini Kumar Choubey said:
- The prevalence of mental disorders including common mental disorders, severe mental disorders, and alcohol and substance use disorders (excluding tobacco) in adults over the age of 18 years is about 10.6 per cent The prevalence of mental morbidity is high in urban metropolitan areas
- Mental disorders are closely linked to both causation and consequences of several non-communicable disorders (NCD).
- Nearly 1 in 40 and 1 in 20 persons suffer from past and current depression, respectively
- Neurosis and stress related disorders affect 3.5 per cent of the population and was reported to be
- higher among females (nearly twice as much in males)
- Data indicate that 0.9 per cent of the survey population were at high risk of suicide
- Nearly 50 per cent of persons with major depressive disorders reported difficulties in carrying out their daily activities.
Treating the symptoms
Dr Manjula of SCARF says, “Families can help in early identification of symptoms. Being non judgemental and supportive will help them cope better. Persons with mental illnesses are more likely to attempt suicide. Depression is the common cause. Women are more likely to attempt while men are more successful in their attempts. Behaviour addictions like social media and online games are also potential risk factors.” “With students, life skills training will go a long way in helping them deal with failure,” says a psychiatrist at the IMH, Kilpauk. The WHO will observe World Suicide Prevention Day on October 10 this year.
TN Study proved that prevention better than cure
A third of all suicides globally are committed by ingesting pesticide. A study done during 2013 at Kattumannarkoil near Cuddalore in Tamil Nadu, proved that storing pesticides in individual lockers did not reduce access to it but only limited it.
Four villages were identified in one Taluk – two were intervention villages and two were control villages. The process was done to see how the members reacted when the pesticide was placed in two centralized storage facilities rather than being readily available.
Each family in the village had its own locker. In the initial stage of the study, about 4,446 individuals (1,097 households) from the intervention village and 3,307 individuals (782 households) from the control village were recruited. About 16 attempted pesticide suicides in the intervention and 5 in control during the initial process.
When the study progressed, there were 4,308 individuals (1,063 households) in the intervention and 2,673 individuals (632 households) in the control sites who attempted suicide. Overall, there had been 10 cases of completed suicide whereas none at control villages.
The results revealed that most participants found the storage facility to be both useful and acceptable. In addition to protecting against wastage, they felt that it helped prevent pesticide suicides as the pesticides stored here were not readily accessible.
The primary analyses were done on an intention to treat basis. This simple and cost-effective community intervention has the potential to reduce pesticide suicides.
The Werther phenomenon
The term was coined by sociologist David Phillips in 1974 to refer to the tendency to copy a suicide. The name comes from the book ‘Sorrows of Young Werther’ by Wolfgang Goethe, in which the hero, Werther kills himself for love. The book described in detail the suicide and the method adopted.
In 1774, the year of its publication, 40 youngsters took their own lives like Werther.
Very often, vulnerable people take a tip or two from detailed news reports and try to copy the same method. Prompted by this finding, the WHO has issued a set of guidelines for media reporting on suicides.