Prevention as cure

With NCRB reporting an increase in number of suicides yet another year, experts talk about the mportance of early intervention and engaging the community in the process
Prevention as cure

CHENNAI: The pandemic, in all its devastating glory, has woken people up to what health professionals have always warned about — many of us are just one crisis away from emotional bankruptcy. With mental healthcare only gaining the attention of the masses as a foreign concept, instead of lived-in conditions in their community, it’s safe to say there’s little support readily at offer. The virus-riddled world managed to effect some change to this laidback negligence.

Governments stepped in to set up helplines, workplaces started looking at virtual well-being workshops, and even educational institutions tried to make counselling services available for the students. On the heels of such reckoning came the annual National Crime Records Bureau report, establishing that the number of suicides had increased in the year 2019. While Tamil Nadu reported the second highest number of deaths by suicide, Chennai too was among the four metropolitan cities to register an increase.

While we are far from hosting a robust healthcare system in the country, there’s no denying the immense need for early intervention; especially at a time like this when uncertainty, fear and neglect seem to be the only constant. And this begins with the knowledge that depression is not the only cause for suicides, suggests Dr Vivian Kapil, a psychiatrist who recently moved to the United Kingdom to work for its National Health Service. “People think that only those with depression are prone to suicide. While depression can certainly be one of the reasons, there are many other things that can push a person to the decision. Some may have a difficult family background; substance abuse could lead to self-harm,” he points out.

Given that these causes (and triggers) are omnipresent, one of the most effective strategies pertaining to suicide prevention is not exclusively looking at it from a health perspective, but to consider it from a broad standpoint of what are the various components that influence or contribute to the vulnerability of suicide, says Dr V Senthil Kumar Reddi, additional professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru. “What’s proposed and recommended, and is probably ideal in any country, is an inter-sectoral approach. It’s not just the health system working towards suicide prevention; or the law enforcement or judiciary that contribute in terms of changing the laws; it’s not exclusively the Ministry of Human Resouces and Development; it’s not about social welfare and empowerment, but all working jointly to address the challenge,” he explains.

When it comes down to intervention in everyday terms, it is about buying time and helping the person find the right healthcare resources, offers Vivian. “This is when there’s the need to engage the community in offering immediate help. That’s precisely what NIMHANS’ Gatekeeper Training in Suicide Prevention does. It engages the key stakeholders — parents, teachers, peer leaders, etc. — and trains them to identify signs of distress,” he notes.

“One prevention strategy that is effective is to use the existing resources — what do we have available and who are the people that can be trained to possibly be involved in this area of gatekeeping. It has a twin-pronged approach — it helps bust the myths and take away the stigma pertaining to mental healthcare. More importantly, it creates a human resource base within a society that can identify potentially vulnerable people in their near and dear ones, in their peer groups, social network and even workplace. If they are aware of what the warning signs of suicide are, they can approach those people and try and demarcate what the level of risk is, and encourage them to seek help. This training can be provided to healthcare providers as well ,” narrates Senthil. He is quick to mention that the gatekeeper’s job is in no way to provide mental healthcare; it is only to identify and link the person with the necessary help they may need.

And there has been great success, he notes. While their Gatekeeper programme is completely for volunteers, there has been an increase in demand to train people over time, he reports. “Most people who have received the training have given us positive feedback that they feel a lot more confident to be able to help someone in need. By way of that, we have received training requests from large organisations, educational institutions and universities. In an integrated programme, the training that was delivered for the Tamil Nadu Police Department, benefitted all. That has received positive feedback as well to the point that Karnataka state government has requested the same. We’ve also trained Air Force personnel and the Border Security Force,” he details.

While NIMHANS’ programme covers schools and colleges too, the need for engaging this community becomes all the more pertinent with the advent of online classes and the distinct lack of adequate resources. PRAGYATA, the Central government’s guidelines for digital education assigns the teachers as first-level counsellors. It suggests that parents and teachers may be vigilant enough to pick up on changes in behaviour. Yet, the reality is far from being that simple. Sandhya Shivakumar, a clinical psychologist who has helped train school teachers, says that funding is the need of the hour. “Schools are keen on employing counselling psychologists — be it part-time or full-time. But the teachers have not been fully trained in handling students, in terms of identifying or screening them.

The students feel judged. Considering the pandemic, we’ve come across situations where the teachers are highly frustrated. So I understand that schools are requesting packages in terms of delivering mental health services, working on parent-child relationship or parent-teacher relationship. There is quite a bit of effort going in but the government should also look into funding this. It’s a problem with every other school. So, mental health services take a backseat,” she explains. Colleges, on the other hand, fare better as many of them have courses on psychology and have trained personnel on their staff already.

A well-equipped community would also help in the early diagnosis of learning disabilities, keep track of absenteeism and, in specific cases, look for the effects of a family member’s suicide on the child. All this will take them one step closer to connecting the student to the mental health care he/she needs, adds Sandhya.

Given that India is a developing country, it’s healthcare systems are also evolving and developing, notes Senthil. The COVID push may just take it over the next bump on the road. 

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