In advance of the World Suicide Day on September 10th, Dr Lavina M. Noronha laments the growing incidence of youth suicide in India and suggests ways to stem the crisis of confidence in our youth.
“No man is an island, entire of itself;
Every man is a piece of the continent, a part of the main...
Any man’s death diminishes me, because I am involved in mankind.
And therefore, never send to know for whom the bell tolls, it tolls for thee.”
John Donne seems to gently awaken us from our slumber and outright apathy towards this public health crisis of suicide and reminds us of our responsibility towards humanity.
India loses one student to suicide every 55 minutes (National Crime Records Bureau, 2015). NCRB also reported that 8,934 students killed themselves in the year 2015 of whom 1,230 (14%) were from Maharashtra. Tamil Nadu stood second in student suicides with 955 deaths. According to Lancet 2012, India has the world’s highest suicide rates for youth aged 15-29. It is not an understatement to say that our collective silence and inaction have resulted in astronomically high suicide rates in our country. Suicide attempts are likely to be much higher as many go unreported or are simply listed as accidents. Sikkim topped the country in suicides in the year 2016 among 21-30 year-olds out of which 27% were attributed to unemployment. Approximately half of India’s population is under the age of 26 and by 2020 India has been projected to be the youngest country in the world. The question is, are we ready to handle the challenges that accompany this projection?
In general, today’s youth are ailing from a low frustration tolerance and find it hard to cope with failure and rejection. We do not have systems in place to offer sufficient support when our youngsters experience desolation. In the constant struggle for economic advancement, families too are under a lot of stress making it next to impossible for being emotionally available to their children. Extended family structure that was historically providing a safety net for its members has been replaced by nuclear units. Technological advancement, digital and social media have also infiltrated the families rendering them vulnerable. It was her Husband’s addiction to social media that led to Sandhya’s suicide attempt just six months into her marriage. The death note clearly indicated that she was disillusioned and had nowhere to turn for help.
Academic pressures and failure in exams have been cited by professionals as primary reasons for a hike in student suicides. To add to this, commercial coaching centres have also mushroomed in most cities that prepare students to ace a wide array of entrance tests. In 2016, Huffington Post reported that a majority of student suicides in Kota, Rajasthan were ascribed to the pressure generating by these coaching centres on the students. Not being able to cope with the pressures of medical school, Gana had slit her wrist in the hostel room. Her roommate who walked in late at night found her in a pool of blood and she was rushed to the hospital on time. Gana was in the third year of MBBS, had 2 papers pending from the 2nd year. Her parents had borrowed huge sums of money to fund her education and she felt she had let them down and saw death as the only solution.
Access to mental health services and availability of mental health professionals has been implicated as one of the reasons why suicides are sky-rocketing in India. According to one of the reports by IndiaSpend, India spends less than Bangladesh on mental health. World Health Organization report (2011) also reiterated the fact that India spends a shameful 0.06% of its total health care budget on mental health and Bangladesh spends 0.44%. Most developed nations allocate more than 4% of their budgets for mental health services which includes prevention of mental illness and research. In the year 2015, there were only 3,800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses nationwide according to the ministry of health and family welfare which amounts to an 87% shortage of mental health professionals in our country!
Dependence on substances in an attempt to self-medicate is not too uncommon among the youth who often use alcohol to drown their sorrow.
According to the National Mental Health Survey (2015-2016) conducted in 12 states, more than 22% of Indian youth above 18 years suffered from a substance disorder, including alcoholism, nicotine abuse or illegal as well as prescription drug abuse. Youngsters addicted to such substances are found to be at a higher risk for suicide and therefore, addressing issues related to substance abuse is bound to cut down the suicide rates. Depression and substance dependence combined have been found to have an inverse relationship with suicidal behaviours.
It has been established that previous suicide attempts put people at risk for future suicide. As every suicide attempt is a ‘cry for help’, overlooking it could be disastrous.
Shiny admits that her decision to die was an impulsive one. She was registered at the local hospital with 60% burns. Yet, she survived because she had a will to live. It is imperative therefore that those who attempt suicide receive professional attention and/or medical intervention. The stigma attached to suicide or terming of suicide as a ‘cowardly act’ makes it difficult for those who are suicidal to seek help.
While it is true that not all suicide attempters are mentally ill, being diagnosed with mental disorders like depression or schizophrenia increases one’s risk for suicide. Additionally, those suffering from anxiety spectrum disorders- phobia, anxiety, obsessive compulsive disorder or post-traumatic stress disorder are highly susceptible to suicide compared to those without psychopathology. Chronic medical conditions like cancer, renal failure, HIV and so on are also to those suffering vulnerable to suicide.
It has been stated that a spectrum of behaviours that come under the rubric of ‘deliberate self harm’ like non-adherence to medical advice in diabetes mellitus, cardio-vascular diseases; involvement in high-risk sports like wrestling, boxing, scuba diving, racing are partial suicides. In recent years, sexual harassment and workplace violence have also sent some over the edge. Many youngsters are struggling to cope with the emotional consequences of sexual abuse and incest.
Because it is a taboo, they do not talk about it and suffer in silence. Even when they muster courage to share their experience, they are asked to hush up in order to protect the family’s honour. We need to empower our children to talk about abuse and also educate them about what constitutes abuse.
What can be done?
• Every so often we hear about students resorting to suicide following on-campus ragging. Ragging is just another name for derogatory, humiliating behaviour with a potential for an emotional breakdown in psychologically vulnerable students. Psychotic breakdowns and depression have ruined the careers of several students nationwide. A zero tolerance policy implemented by educational institutions will stop this victimization on the pretext of socialization. Likewise, students who take vicarious pleasure in hurting and deriding others have to be tackled appropriately. These students should be held accountable for creating a hostile environment on campus.
• Attributing teenage emotionality to hormones and trivializing their anguish could be baffling for the young ones. While some ‘act out’ in violent ways others ‘act in’ by engaging in self-injurious behaviours. Calling a teenager a ‘bully’ or a ‘drama queen’ is not going to solve the problem. We have to acknowledge that being a teenager is not easy. While it does not validate either bullying or suicide, it certainly explains why so many young people act the way they do. Bullying also takes the form of shaming and threatening in the classrooms, the hallways and on playground. It is understandable that those who are bullied as well as those who bully need professional help.
• Suicides are not always impulsive or spur-of-the-moment acts but gradual, well-planned, seasoned efforts. Consequently, it is possible to identify the distress before it culminates in lethality. Sudden changes in mood, behaviour, crying spells, disturbed sleep, appetite, neglect of personal hygiene, serious or casual expression of a desire to die are some of the overt signs of distress to watch out for. Awareness about the warning signs will help in reaching out to those in distress in a timely manner. “Do you have thoughts of harming yourself?” is the only question a parent or a teacher needs to ask someone who is in obvious emotional turmoil.
• Parents should encourage the teenagers to openly discuss their feelings and provide a platform to ventilate their frustrations. Comments like ‘grow up’, ‘don’t be a sissy’, ‘just be brave’ should be avoided if you want your children to open up. Ridiculing or shaming them will not make them brave, they will withdraw further and ‘bottle up’ their emotions and feelings.
Youngsters contemplate suicide because they do not see a light at the end of the tunnel. By active listening and empathy, you can relate to the angst they are in. Just by being there and caring, you can help someone who is feeling helpless and hopeless see alternatives to killing themselves.
• Whenever we hear about a young suicide, our immediate response as a society is to look for someone to blame. Calling them ‘self-centred’ or ‘blaming the victim’ is a common reaction and we do not hesitate to point fingers at the parents and loved ones left behind. We fail to see how hard it is for the parents to grapple with the trauma of losing their child on the one hand and on the other deal with the guilt trying to figure out where they went wrong.
• Thinking about killing oneself is not very easy, it’s not just a fad or a phase which youngsters go through. We need to fathom the intensity of the despondency behind such acts and ponder about what drives them to take this extreme measure of self-destruction. Compassion is what is needed to reach out and touch these young minds in order to help them make better choices for their lives.
• In India, we have a number of suicide prevention hot-lines and crisis lines for handling suicidal emergencies. Most hot-lines in metropolitan cities operate 24X7 and are available for assistance to those in distress. We have lost many lives to suicide and cannot risk losing more! We have to take the bull by its horns and stand up, speak up and mobilize.
• Mental health and wellness has to be part of the school curriculum. Life skills education should be a priority in the school in an attempt to equip students to deal with a myriad challenges that come their way- be it academic stress, exam failure or relationship issues. We don’t have an option other than incorporating promotion of mental health and coping skills into the curriculum. There is a need to overhaul the educational system and change the curriculum so that we don’t just teach students how to make a living but also teach them how to live. A three-pronged approach involving parents, teachers and students working hand-in-hand is essential to promote mental health and to prevent suicide.
• Mental health awareness cannot be limited to a handful of celebrity campaigners highlighting the issues in the media and a few policy makers pretending to address the same. Present day youth are battling depression and anxiety than ever before. We as a society have swept this issue under the rug for way too long. Addressing mental health issues before at the onset of symptoms and offering timely interventions is the need of the hour.
• Every educational institution- school, college, university should have a counselling unit to address mental health issues. Appointment of professionally trained school and college counsellors will go a long way in helping students handle emotional distress much before it culminates in suicidal crises.
• Easy access to means of self destruction is a risk factor for suicides in India. Pesticides, medications, insecticides, prescription drugs, over-the-counter medications need proper control and regulation.
• The policy makers should take this public health crisis seriously and implement immediate measures for the promotion of mental health and prevention of suicide. Increasing budget allocation for mental health is imperative so that NGOs can join hands in this war against suicide.
• Finally, in lieu of media glorification of suicide, focus on awareness and prevention will certainly help save lives.
(The names and identifying information of the persons mentioned in the article have been changed to protect their privacy)
Dr Lavina M. Noronha is the Director Ave Maria Palliative Care centre Mangaluru, and a Member of the Core Committee, Suicide LifeLine, Mangaluru (A unit of Susheg Charitable Trust)