Suicide is preventable

Every 40 seconds, one person is ending his or her life globally. Unfortunately, a study ‘Preventing Suicide: A Global Imperative’ by the World Health Organisation (WHO) says, suicide all too often fails to be prioritised as a major public health problem. The report points out that for each adult who died of suicide, there may have been more than 20 others attempting suicide. It believes mental disorders and harmful use of alcohol contribute to many suicides around the world. Early identification and effective management are key to ensuring that people receive the care they need. It also believes that restriction of access to means plays an important role in suicide prevention, particularly in the case of suicides that are impulsive.

September 10 is observed as ‘World Suicide Prevention Day’, a concept by the International Association for Suicide Prevention (ISAP), an NGO working with WHO on suicide prevention. Dr Shekhar Saxena, Director of Department of Mental Health and Substance Abuse of WHO, spoke to me over email about a series of issues related to suicide and its prevention.

WHO has set a target of 10 per cent reduction in suicides globally by 2020. Is it achievable?

WHO member states (including India) have set a target of 10 per cent reduction of suicide rate by 2020. WHO believes that this target is achievable but will need concerted and sustained action at government and civil society levels. The WHO Report is precisely to suggest those actions that will effective in achieving the target in the Mental Health Action Plan.

India has the highest number of suicides. Do you think India has taken enough measures to handle the issue?

India has taken a number of measures to prevent suicides. However, in view of the large number of suicides in the country, this issue needs to be put higher on public health and public agenda. Given the federal structure of governance in the country, the necessary actions will need to be taken by the Central as well as by State governments. These actions may include among others, safer access to pesticides especially in rural areas, strengthening health care system especially primary care, on identification and treatment of mental and substance abuse disorders, increasing community awareness on suicide and developing a multisectoral suicide prevention strategy. In addition, civil society efforts to increase information and awareness and decrease stigma against suicide can help.

Are suicides preventable?

One of the most important key messages of the Report is that suicides are preventable.

How will steps like access control to means of suicides help? Can you briefly explain the rationale behind this?

There is enough evidence to say that decreasing access to means to commit suicide is effective in decreasing suicides. In India, since the majority of suicides are committed using pesticides, safer access to pesticides like the use of locked boxes with two keys or community storage of pesticides could be effective.

Accepting Law Commission recommendations, India’s Home Ministry has announced has plans to decriminalise attempt to suicides. Do you think such measures would help in creating awareness and removing stigma?

While fully recognising the right of each country to frame their laws, WHO Report suggests that all countries should review their legal provisions in relation to suicide to ensure that they do not deter people from seeking help. The Report brings out the evidence that decriminalization does not increase suicides. Certainly, such measures will lead to decreased stigma, more help-seeking and more accurate reporting of suicides.

Another problem highlighted by the WHO report was the high rate of suicides among youth globally. Why countries, including India, failed in addressing this segment?

The Report presents data that suicides are a leading cause of death among the youth globally as well as in India. This is a matter of serious concern and specific strategies to respond to this problem are necessary. Involving communities and providing help to vulnerable young persons (including those with mental and substance abuse problems) should be part of effective strategies.

There is a belief that most suicides happen suddenly without warning. If it is so, will it be difficult to tackle the problem?

There is evidence that most persons who attempt or commit suicide have sought help before the act. More often than not, effective help has not been forthcoming. This needs to change. First responders need to be better informed and more skilled in providing help and also in referring to more specialised services as needed.

Experts have complained about inappropriate coverage by media about suicides like the excessive coverage of celebrity suicides. Also, now there is social media. What is the role media expected to play when there are chances of misuse of media?

Responsible reporting of suicide in the media has been shown to decrease suicide rates. Important aspects of responsible reporting include avoiding detailed descriptions of suicidal acts, avoiding sensationalism and glamorization, using responsible language, minimizing the prominence of suicide reports, avoiding oversimplifications, educating the public about suicide and available treatments, and providing information on where to seek help. Media collaboration and participation in the development, dissemination and training of responsible reporting practices are also essential for successfully improving the reporting of suicide and reducing suicide imitation. Similar caution is necessary on suicide in suicide media, though more difficult to implement. Social media sites may provide information on where help could be obtained.

(An edited version appeared in Panorama section of Deccan Herald on Sep 10, 2014)

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