The history of suicides is nearly as old as that of human society. Surprisingly, despite innumerable threats to human survival, suicides rank among the top 13 causes of death in all ages worldwide and continues to present significant challenges to our society’s collective wisdom.
Suicides represent a desperate attempt to escape suffering that has become unbearable, blinded by feelings of self-loathing, hopelessness and isolation. Often, a suicidal person is unable to see the path towards relief, except through death. But despite a desire for the pain to stop, most suicidal individuals are deeply conflicted about ending their own lives – while they seek an alternative to committing suicide, they aren’talways able to see one.
Statistically, suicides have a higher prevalence among males than females, and the commonest means resorted to are poisoning, hanging or burning.In what is a matter of concern in recent times, suicides have emerged as a cruicial public health issue in the Indian context.
WHO estimates that nearly onr million people die every year due to suicides.Statistics specific to India are alarming – over 2 lakh lives are lost every year to suicides – 37.8% of which are by those below 30 years of age, and 71% by those below 44 years of age. These represent an overwhelming number of preventable deaths; lives which may have been saved if help was available in time. In any case, from some studies we already know that 9 out of 10 people in India are unlikely to receive the mental healthcare that they may require.”
The government’s recent decision to decriminalize attempted suicide created a stir and revived a debate on the merits and demerits of this bold step.
For every suicide related death, it is estimated that 20 other individuals attempt it. Given that we’ve seen cases where patients and their family members have suffered immensely, we’ve engaged with MPs and policy makers for over two decades to sensitize them to repeal Section 309 of the IPC and to consider its impact on the broader public health policy. It is cruel to punish a vulnerable person in the midst of emotional chaos, creating a wedge between them and the help they require – while in fact what works is affection and understanding.
Small step may go a long way in terms of the level of care which is available to suicidal individuals. Repealing of this law will certainly contribute to timely help being available to a person contemplating such an extreme step, and hopefully raise the bar in terms of better treatment, therapy and rehabilitation options available – as opposed to being labeled criminals.
When suicide is treated as a criminal offence, it fails to take into account the realities of the conflicts that the individual may be undergoing. Further, as the offence was one of ‘attempted’ suicide, it has the potential of either motivating a vulnerable individual to go one step further, or for the incident to not be reported at all.
In a country like India, which faces an acute shortage of qualified mental health professionals, the evidence of increasing suicides and mental health issues poses great challenges to psychiatrists, psychologists, social workers, and public health personnel to identify underlying factors promoting such tendencies and devise strategies to improve the general mental health of the society.Often, those at the risk of committing suicide may be suffering from diagnosed or,possibly in a large proportion of the cases, undiagnosed psychiatric illnesses like alcoholism, or drug abuse, or bipolar disorders, etc.
In practice, we also see a growing number of depression cases which are aggravated due to social problems including unemployment, dowry disputes, personal conflicts, financial burdens, etc also seem to have a role to play.
While most suicidal individuals may not verbalize it, they seek alternatives to suicide and are in need of help as suicide does not present as a solution to the problems they face, but only an escape. Talking about suicide or death, saying goodbyes, self-destructive behaviour, sudden calmness in behaviour, etc may be signs which could indicate suicidal tendencies and must be taken seriously, and professional help and care must be sought. Identifying signs of suicidal behaviour by being aware, and facilitating professional health care is the most important step towards prevention.
Dr. Sunil Mittal is Director of Cosmos Institute of Mental Health & Behavioural Sciences (CIMBS), New Delhi , CIMBS at East Delhi and CIMBS – Delhi Psychiatry Centre, 35 Defence Enclave, Vikas Marg, Delhi 110 092, India