‘Creating Hope Through Action’ is the triennial theme for the years 2021- 23 for the World Suicide Prevention Day observed every year on 10 September. This is to draw societal attention to the important issue. A few days back, the National Crime Records Bureau (NCRB), released data for 2021, and reported 1,64,033 suicides in India, with a rate of 12 per 1,00,000 population, an increase by about 7 per cent compared to 2020.

These figures miss out those unnatural deaths which are still under investigation, or inconclusive. The NCRB report finds that five states put together – namely Maharashtra, Tamil Nadu, Madhya Pradesh, West Bengal, and Karnataka – accounted for over 50 per cent of the suicides in India. On the other hand, the most populous Uttar Pradesh reported a lower percentage. Furthermore, analysis by the NCRB mentions causes such as family problems/ personal issues, illness, love affairs, abuse, violence, isolation, and alcohol/drug use.

The age group 18- 45 is the most vulnerable as around 66 per cent of suicides are reported in this age range. Let us try and understand the impact of suicides on those kith and kin who are left behind. Any kind of death affects families resulting in a process called grief. It takes at least a year before it starts to subside. But in case of death by suicide, the grief process becomes more complex, as it is traumatic and violent. Talking about suicide, especially the mode of death, can cause lot of distress in anyone, including the person reporting it. The immediate family members and close friends may develop guilt, start to question themselves with many ‘what ifs’ and whether they could have saved the person. Close ones may also have to face police investigation and media scrutiny. There is a need to support suicide survivors; especially some family members such as mother, father, sister and even spouse may get affected deeply and can show signs of mental breakdown. Trauma can haunt some mothers or spouses for many years.

The health care system and community need to support them as mass/family suicides are slowly on the rise. The theme ‘Creating hope through action’ is a reminder that there is an alternative to ending life by suicide and the objective is to inspire and instil confidence.

Through their actions, no matter how big or small, everyone can create hope for those who are struggling. Some people thinking of suicide have said they wish someone had at least asked them once. Warning bells should ring if you see a recent change in behaviour – a gloomy appearance, mood swings, frequent expression of death or dying, talking about going far away, expressing hopelessness, unusual fear, not making eye contact, not being open, appearing depressed, not engaging, unable to resolve a problem and experiencing chronic stress.

Along with trying to engage the person, leaving work aside, it is recommended that one should ask directly if she or he is having suicidal thoughts or plans, or if the person is thinking about dying. Many people have the notion that by enquiring directly about suicide, they could increase the risk by instilling the idea into the person’s mind. But it is the other way around. Asking directly about suicide gives a good chance to save them. The person may actually feel better after this socalled emotional ventilation.

If still in crisis, it is best to take them to the nearest Emergency room or if during the day to a psychiatrist. Suicidal thoughts are complex and vary across individuals. Sometimes it can be impulsive. However, many actions are planned, with elaborate preparations made before the final act including the date and mode of death. Some may even say their goodbyes indirectly.

These should be seen as hints. Many would have visited their doctors, friends or even been hospitalised before the act. For every suicide reported, there are at least 25 suicide attempts. Attempts increase risk of suicide. Many suicide attempts may go unrecorded, and some may not get assessed, though many hospitals insist on the person seeing a psychiatrist.

The individual may not have disclosed previous attempts, leaving many around unaware. Individuals are different, so the same approach may not work for all. Persons with suicidal thoughts may feel trapped, and that they have no other option.

There is a quote by Magic Johnson, ‘all the kids need is just a little help, a little hope and somebody (who) believes in them’. Many may not need advice, but just need some time where they can be heard without being judged. Such small talk can create a sense of connectedness and thus some hope. It can actually save lives. While many can cope with the adversities in life, a few are vulnerable.

There are many factors like family problems, personality style, environmental factors, traumatic childhood events, and mental health conditions that contribute to the vulnerability. At the same time, protective factors like support from family and friends, problem-solving skills, decision making skills, rational and critical thinking and resilience would help the person to overcome suicidal thoughts. Suicide is a complex interaction between these triggering factors, vulnerabilities and protective factors. Focus should be on enhancing the protective factors and minimising the vulnerability factors. Stigma or a belief that they can get discriminated against, and being labelled as a weak-minded person may act as a barrier to seeking help.

Listening to those sharing their experience of having overcome the problems, and how they changed their approach is one way to educate the public. These narratives can help others understand what it means to feel suicidal and how they can help themselves as well as others. One of the most successful Olympic swimmers ever has spoken about having had suicidal thoughts. In a media interview, famous English cricketer Jonny Bairstow has spoken out about his late father, again a wellknown cricketer, who died by suicide, and how he was affected by his mum’s cancer. He has talked about the challenges he faced, while trying to focus on playing in India and the Ashes series.

Impact of his dad’s death by suicide and building his career in the cricket community, where many knew his dad, and eventually managing to carry on his dad’s legacy, have lessons to offer to the many families going through the loss of loved ones through suicide. A few Indian cricketers also have expressed in the media that they had these thoughts intruding their minds. It was painful to learn of the death of a successful entrepreneur, whose business slogan itself was ‘a lot can happen over coffee’ and made one wonder if he had followed the slogan. The message here is that there are many options to be tried before concluding that no help is available.

Depression can make someone feel lonely, hopeless, and so make it hard to trust anyone. But this illness is treatable. Anyone feeling blue, doomed, hopeless or worthless, should take a step back and examine ambitions and goals, and look at changing career paths if required. Make changes to the lifestyle. Nurture old hobbies or cultivate new ones that give pleasure. Try learning new skills. Spend time with friends and family. If work is causing stress, discuss this with colleagues, and ask for a break. Get involved in social and community activities, including volunteering.

Try spending time with nature, visit places and spend time in a calm environment. Spirituality and meditation, including practising mindfulness techniques, are to be tried. Take out time to exercise and meet friends in the park or at the jogging track. One must try and attend family functions, marriages and events to meet friends, even when not feeling like it. Mass media, playwrights and authors must depict suicide with responsibility.

There was a novel called ‘Sorrows of Young Werther’ written in the 18th century that led to many copycat suicides, as it was shown that Werther did not have a way out other than suicide. On the other hand, in an opera called “The Magic Flute”, a suicidal character named Papageno is reminded by some boys of alternative ways to resolve the problem. Such is the influence of the media on people who are in crisis.

If a person searches for ‘ways to commit suicide’ on search engines, the first few hits will now show ‘crisis helpline’ or ‘help is available’. Responsible reporting by the media is important and the World Health Organisation have issued guidelines on dos and don’ts. Ultimately the decision to choose life or death rests with the individual.

The message to anyone who might be thinking of ending life is to hold on and give your friends and family a fair chance. The person must meet and discuss problems with a nearby psychiatrist. They may try to remove your pain or support you and so it is important to work with them. Suicide is not at a solution to any problem.