Suicide is a serious global public health issue. Close to 8,00,000 people commit suicide every year. It is one among the top twenty causes of death worldwide and the third leading cause of death in 15-19-year-olds.
About 79 per cent of global suicides occur in low- and middle-income countries. Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally.
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Suicides are preventable with timely, evidence-based and often low-cost interventions. The World Suicide Prevention Day (WSPD) is organized every year on the 10th of September by the International Association for Suicide Prevention (IASP) and WHO has been the co-sponsor of the day.
WSPD is observed to raise the awareness among public that suicide is a preventable phenomena. In past years, over 300 activities in around 70 countries were reported to IASP, including educational and commemorative events, press briefings and conferences, as well as Facebook and Twitter coverage.
This is the second year that the WSPD theme is “Working Together to Prevent Suicide”.
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Definition:
Suicide means the intentional taking of one’s own life. According to world health organization (WHO) suicide is the act of deliberately killing oneself.
Risk factors:
Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. The main risk factors for suicide are:
• A prior suicide attempt
• Depression and other mental health disorders
• Substance abuse disorder
• Family history of a mental health or substance abuse disorder
• Family history of suicide
• Family violence, including physical or sexual abuse
• Having guns or other firearms in the home
• Being in prison or jail
• Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
• Medical illness
• Being between the ages of 15 and 24 years or over age 60
Warning signs:
The behaviors listed below may be the signs that someone is thinking about suicide.
• Talking about wanting to die or wanting to kill themselves
• Talking about feeling empty, hopeless, or having no reason to live
• Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
• Talking about great guilt or shame
• Talking about feeling trapped or feeling that there are no solutions
• Feeling unbearable pain, both physical or emotional
• Talking about being a burden to others
• Using alcohol or drugs more often
• Acting anxious or agitated
• Withdrawing from family and friends
• Changing eating and/or sleeping habits
• Showing rage or talking about seeking revenge
• Taking risks that could lead to death, such as reckless driving
• Talking or thinking about death often
• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
• Giving away important possessions
• Saying goodbye to friends and family
• Putting affairs in order, making a will
Treatment:
Effective suicide intervention practices are based on research findings and tested to see how various programs benefit various specific groups of people. Few of the treatment modalities include the following
• Psychotherapy. In psychotherapy, also called psychological counseling or talk therapy, the issues that make someone feel suicidal are explored and taught skills to help manage emotions more effectively. The client and the therapist works together to develop a treatment plan and goals.
• Medications. Antidepressants, antipsychotic medications, anti-anxiety medications and other medications for mental illness can help reduce symptoms, which can help the client feel less suicidal.
• Addiction treatment. Treatment for drug or alcohol addiction can include detoxification, addiction treatment programs and self-help group meetings.
• Family support and education. The loved ones of a client can be both a source of support and conflict. Involving them in treatment can help them understand what the client is going through, give them better coping skills, and improve family communication and relationships.
Prevention:
Suicides are preventable. There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. In the United States, the 2012 National Strategy for Suicide Prevention promotes various specific suicide prevention efforts including:
• Developing groups led by professionally trained individuals for broad-based support for suicide prevention.
• Promoting community-based suicide prevention programs.
• Screening and reducing at-risk behavior through psychological resilience programs that promote optimism and connectedness.
• Education about suicide, including risk factors, warning signs, stigma related issues and the availability of help through social campaigns.
• Increasing the proficiency of health and welfare services at responding to people in need. e.g., Sponsored training for helping professionals, Increased access to community linkages, employing crisis counseling organizations.
• Reducing domestic violence and substance abuse through legal and empowerment means are long-term strategies.
• Reducing access to convenient means of suicide and methods of self-harm. e.g., toxic substances, poisons, handguns.
• Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g., aspirin.
• School-based competency promoting and skill-enhancing programs.
• Interventions and usage of ethical surveillance systems targeted at high-risk groups.
• Improving reporting and portrayals of negative behavior, suicidal behavior, mental illness and substance abuse in the entertainment and news media.
• Research on protective factors & development of effective clinical and professional practices.
Role of health care providers in suicide prevention:
Health care providers can help prevent suicide when they understand the risk factors and use evidence-based treatments and therapies. In addition, The Joint Commission recommends screening all patients in all medical settings for suicide risk using validated, population and setting-specific tools.
Clinicians should be advised that it is no longer acceptable to “contract for safety” with patients. Safety planning for managing future suicidal thoughts and means restriction (removing or ensuring safe storage of potentially lethal items) have been proven to be effective ways of preventing suicide.
Health care providers can initiate awareness programs. They can also refer the at risk people to proper suicide prevention organization or NGOs.
Role of Media:
Media plays an important role in prevention of suicide. Recommendations around media reporting of suicide include not sensationalizing the event or attributing it to a single cause.
It is also recommended that media messages include suicide prevention messages such as stories of hope and links to further resources. Particular care is recommended when the person who died is famous. Specific details of the method or the location are not recommended.
There, however, is little evidence regarding the benefit of providing resources for those looking for help and the evidence for media guidelines generally is mixed at best.
TV shows and news media may also be able to help prevent suicide by linking suicide with negative outcomes such as pain for the person who has attempted suicide and their survivors, conveying that the majority of people choose something other than suicide in order to solve their problems, avoiding mentioning suicide epidemics, and avoiding presenting authorities or sympathetic, ordinary people as spokespersons for the reasonableness of suicide.
Specific strategies:
Suicide prevention strategies focus on reducing the risk factors and intervening strategically to reduce the level of risk. Risk and protective factors, unique to the individual can be assessed by a qualified mental health professional.
Some of the specific strategies used to address are:
• Crisis intervention.
• Structured counseling and psychotherapy.
• Hospitalization for those with low adherence to collaboration for help and those who require monitoring & secondary symptom treatment.
• Supportive therapy like substance abuse treatment, Psychotropic medication, Family psycho education and Access to emergency phone call care with emergency rooms, suicide prevention hotlines, etc.
• Restricting access to lethality of suicide means through policies and laws.
• Creating & using crisis cards, an uncluttered card formatted readably that describes a list of activities one should follow in crisis until the positive behavior responses settle in the personality.
• Person-centered life skills training. e.g., Problem solving.
• Registering with support groups like Alcoholics Anonymous, Suicide Bereavement Support Group, a religious group with flow rituals, etc.
• Therapeutic recreational therapy that improves mood.
• Motivating self-care activities like physical exercises and meditative relaxation.
Support organizations:
Many non-profit organizations exist, such as the American Foundation for Suicide Prevention in the United States, which serve as crisis hotlines; it has benefited from at least one crowd-sourced campaign.
The first documented program aimed at preventing suicide was initiated in 1906 in both New York, the National Save-A-Life League and in London, the Suicide Prevention Department of the Salvation Army.
Suicide prevention interventions fall into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of the population.
In India, there are many nongovernmental organizations (NGO) which are working for suicide prevention among the general public. Few of them are: Jeevan Aastha, AARRA, COOJ Mental Health Foundation, Fortis Helpline, ASHA Helpline, Suicide Prevention India Foundation, Sneh Foundation, Befriends India, etc.
Conclusion:
Suicide is a serious public health issue and a leading cause of death globally. With timely intervention suicides are preventable. Much can be done to prevent suicide at individual, community and national levels.
Since suicide is a complex issue, it’s prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defense, politics, and the media.
At an individual level and as a responsible citizen of the country it is our responsibility to extend a helping hand to those who are in crisis so that the burden of suicide can be lowered.
(The author is Professor-cum-Principal, NEMCARE Group of Institutions, Mirza in Assam. She can be reached at papori78@gmail.com)