The World Health Organisation (WHO) estimates around 726,000 suicides per year worldwide. The National Crime Records Bureau (NCRB) in India, in its latest report finds the total number of recorded suicides in India was 171,000 in 2022, compared to 135,000 in 2018. The triennial theme for World Suicide Prevention Day is “Changing the narrative on suicide,” emphasising the need to support by initiating a conversation.
The areas of focus are:
• Talk about thoughts surrounding suicide ideations to reduce stigma, which can prevent suicides.
• Engage the persons in a dialogue, respect their dignity, acknowledge their agony, identify the problems, and support them to find alternative solutions. This is done not only by family members, friends, colleagues, or supervisors at work but by anyone, anytime, anywhere, with good faith. There are options for individuals to see a nearby psychiatrist or other mental health professionals. Also, now there is Tele-manas, a national tele-mental health programme from the Government of India, a project led by the NIMHANS that offers tele-counseling services.
At the Tele-manas cell, the call is redirected to the appropriate cell based on the language preferred, and answered by counselors trained in clinical psychology or psychiatric social work. Most of the time, talking about their distress and problems to the counselor may suffice. If it is felt that the distress is severe, it is referred to a qualified psychiatrist. If need be, they will convince the caller and inform the local psychiatry service provider, such as the District Mental Health Team, who may see the person the next day.
If it is felt that the person is in imminent danger of doing something to themselves, the caller will be asked to attend the emergency department at the nearest hospital or psychiatric centre. There are several examples where a person with suicidal ideations has been well supported and managed. Unfortunately, the data on how many were saved is hard to get. Based on the research available and expert consensus, Tele-manas are likely to be a lifeline. The National Suicide Prevention Strategy of 2022 also talks about better accessibility to mental health care to reduce suicides.
Research has shown that most suicides are associated with depression, psychosis, alcohol, or drug use. Therefore, the services are offered by around 10,000 psychiatrists in private, as well as through Staterun District mental health programmes or in Government-run hospitals. People can also be reached by tele-support. Training of general doctors is also possible via tele-support by specialists. Suicide attempts must not be ignored. All persons attempting suicide must be screened for mental illness and advised. Suicide attempts create a lasting impact on family members. The parents or family members must not hesitate to talk, whatever the issue may be. In the case of children, make the child talk. Parents need not worry about directly enquiring about feelings of dying, death, or suicide.
If they don’t ask, they will not know. Parents need to talk with an open mind, a non-judgmental approach, active listening and be prepared to acknowledge the issue the child brings up. Some children may be stuck between parental expectations and academic performance, similar to what is already depicted in the movie Taare Zameen Par. Parents must know their children’s capabilities, strengths and weaknesses. If parents have marital conflicts, they need to sort these out. They need to modify the nurturing style based on the environmental situations.
Spend time talking one-on-one, maybe in the name of some activity. Despite having many friends in digital media, children may still feel socially isolated. Bullying, including in social media, needs to be identified early, and professional help may be needed. In the case of teenagers, many feel shy about opening up to their parents but may be close to their peers, where they are ready to discuss their difficulties. Teens have the curiosity to experiment with new ventures, many don’t mind risk-taking, suffer from mood swings, and swing between childhood and adulthood depending on the situation. They are trying to establish their identity in society.
The developing front part of their brain, which is like the brakes of a bike, is still weak, with a highly accelerating amygdala charged with emotions. This may explain their controlling ability, and therefore, they require guidance. Teenagers with high energy may channelise it in sports. Other talents that involve creativity may help. The life skills training from NIMHANS experiences has created a module that includes specific areas to work, to enhance critical thinking, creativity, decision-making, problem-solving, communications, relationships, stress, emotional control and selfawareness. Students spend a substantial amount of time in school.
Teachers can identify subtle changes in behaviors, and they are key partners in the mental health care support system. Student counseling in schools and institutes has helped and must be regularised. It is best to train the teachers, who may help identify early, help resolve problems, and promote better mental health, which is likely to reduce the chances of suicides. The spouse, friends, or employers may not be aware of how to communicate with someone who has attempted suicide. There is a need to start the conversation with confident, open, trusted communication, offering support with a problem-solving approach. There may be mental health issues in the person, spouse, or both, which a psychiatrist can identify. Friends can build confidence, reduce pessimism, help a person to be resilient, and inspire to have optimistic thought patterns.
Some employers offer counseling services, but the employees must be assured of confidentiality regarding their issues. This highlights the trust issues, a gap they must bridge as a first step. Suicide is one type of death that leaves a lasting impact due to adverse emotional responses on kith or kin or anyone getting this news. Media must understand the sensitivity of the issue, and responsibly report suicides following the WHO guidelines. One must provide helpline numbers before reporting. Any glorified authored books, plays, or information may need to be removed or banned because publicising suicides can increase incidence, which is known as the ‘Werther effect’. Similarly, problem-solving approaches highlighted in plays or books with an alternative solution have been known to reduce suicides, called the ‘Papageno effect’.
Suicide gatekeeper training for a large number of people may help. This is similar to someone administering resuscitation in cardiac arrest. The community collectively realizes this, and this kind of multi-modal approach in different kinds of age groups is likely to prevent suicides. The key message to the person with suicidal thoughts is ‘stop, take a step back, think of alternative positive solutions, and if you cannot, just talk to the Professional or call Tele-manas’.
Tele-Manas, offers counselling and mental health care and is available toll-free at 14416 or 1800 8914416.
(The writers are psychiatrists at Bowring & Lady Curzon Hospital, and NIMHANS, Bangalore respectively.)