A recent report on student suicides presented at the IC3 conference has set alarm bells ringing yet again. The question is for how long these bells will ring this time. Going by experience, one can anticipate they will recede into our collective unconscious after the initial media hype and academic mention in a few conferences.
That the suicide rate among the youth of India is one of the highest in the world is a fact we have known for a few years. Suicide is the number one cause of death for young Indians in the age group of 15 to 29. The National Crime Records Bureau reported that in 2020, 34 students ended their lives every day. What ought to make us take a more lasting notice is the sharp increase in student suicides over the last decade—male student suicides rose 99 percent and female suicides by 92 percent. As part of an organisation that works with thousands of young people in a clinical setting as well as with community-based organisations, I have had to confront the heartbreaking reality of witnessing more suicides in the last 2 years than we had seen in the previous 20.
Ever so often, when the background stories of people dying by suicide come to the fore, there is bewilderment about how it could have happened. As if they happen out of the blue, without any antecedents or warnings. Nothing can be farther from the truth in the large majority of cases. Usually, a suicidal attempt is a culmination of a series of jarring external and internal experiences, an act of desperation by a young person who has gone through months or years of emotional turmoil that has, in most instances, gone unnoticed and unattended. The fact that we can’t pick up the early signs of the evolution of suicidal behaviours is a disturbing reflection of our lack of awareness and sensitivity towards the emotional life of young people.
The dean of a reputed institute of higher education was recently quoted as saying, “Increasing suicide rates is a major concern for us. Building tolerance, early identification of symptoms, early diagnosis, and early intervention among students are the main pillars to tackle the issue.” Such a resource-heavy, expert-led biomedical approach that focuses on diagnosis and intervention has limited vision and value. Borrowed from the West, it fails to address the complex multicultural and sociopolitical influences of our diverse country.
Despite having one of the largest spends on mental health, the rates of depression and suicide in the US have risen in the last five years. Dr Shekhar Saxena, a former director of mental health at WHO, summed it up: “When it comes to mental health, all countries are developing countries.” Adopting such a broken and ineffective model is bemusing, to say the least. We require a radical shift in our understanding and approach towards mental health and suicidal behaviours if we hope to make a dent in this growing epidemic.
Suicidal behaviours are a complex set of phenomenons that are influenced by a range of biological, sociocultural, economic, relational and political issues. The lens of intersectionality with factors such as race, class, caste, religion, education, disability and social justice could add more depth to our understanding. Some recent suicides in institutions of higher learning were precipitated by caste issues that led to the othering and isolation of the students who eventually took the extreme step. Likewise, ever so often, we hear stories of young women whose lives, smothered by oppressive patriarchal structures, have come to a tragic end.
Mental illness, as is commonly believed, is not essential for suicidal tendencies to manifest. Farmer suicides are yet another example where financial crises and hopelessness surrounding it are often the main drivers. Similarly, among students, academic pressure, perceived failure in exams, breakdown in relationships and cyber bullying have been found to be major determinants of suicidal behaviours. Such experiences can contribute to the development of mental illnesses too; and while the relationship between the two is complex, it would be reductionist and narrow if we attempted to understand suicide purely from the mental health perspective.
The pandemic opened up the floodgates of mental health problems across all communities and turned the spotlight on this vastly neglected space of human suffering. While statistics of depression being the number one cause of disability in the world were doing the rounds even before Covid, there was abject apathy towards mental health conditions in India. The annual budget of the national mental health programme was a mere Rs 40 crore before Covid struck, which has increased by more than three folds to Rs 134 crore for 2023-24. And yet, this is no more than a drop in the ocean of mental health needs of our county, where conservative estimates project a figure of more than 200 million people needing some form of help at any given point in time.
The biomedical model to address suicide and/or mental health has been an abysmal failure in more ways than one way. It is clear by now that we have to think out of the box to make a substantial difference. Promising models that approach it differently have been emerging from various parts of the world in the last decade or more. Many of these are rooted in the community, are preventative in nature and their line of action could include social justice, public health, economic and political systems. They target the stigma experienced by the affected people, are aimed at building awareness and safe spaces for the young, are committed to giving shape to more inclusive and accepting communities, and are determined to create alternative pathways of learning in this diverse and ever-changing world around us.
For any sustainable change to occur, what is required is a much deeper engagement with all stakeholders including parents, educators, pivotal institutions, policy makers, professionals, and young people with lived experiences who have faced the brunt and survived. As adults, we have to listen to our children and students, understand their challenges and aspirations, have faith in their abilities and insights, and include them in our efforts to build a safer world for them and all of us.
(Views are personal)
Dr Amit Sen | Child and adolescent psychiatrist; Co-founder, Children First
