Let's talk about India's invisible emergency – suicide

India has the highest number of suicides for any country in the world. In spite of the numbers, it is a crisis no one talks about...

Published: 06th December 2022 10:18 PM  |   Last Updated: 06th December 2022 10:26 PM   |  A+A-


Image used for representational purpose only.

India is beating most other economies; we are self-sufficient in food; and our post-Covid economy is showing greater resilience than even China's.

Here is the sobering statistic, though: we have the highest number of suicides for any country in the world.

According to the World Health Organisation (WHO), there were approximately eight lakh deaths by suicide globally in 2021, up from a little over seven lakh deaths the previous year. India accounted for over 20% per cent of those deaths -- 164,033 -- up by over 7% from the previous year. India's suicide rate per one lakh population is 12, ranking it 41 in the list of countries with the highest such statistic.

India's suicide crisis, therefore, is immediate and requires a long-term, intersectoral approach.

In spite of the numbers, it is a crisis no one talks about. There is hardly any media or political discourse about suicide in India (except when people like actors Sushant Singh Rajput or Vaishali Takkar die), and, in most cases such as farmers' suicides, the emergency is often politicised or it remains a bleak statistic in government files.

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Pune-based psychiatric healthcare expert Soumitra Pathare says the situation in India is, "Bad, very bad." When I asked him what is the crux of India's suicide problem, he said, "The utter lack of policy action. In most instances, it is policy action that is needed, especially intersectoral policy action. The default mode of reducing it down to mental health is extremely naive and simplistic."

Pathare knows a thing or two about both mental health advocacy and suicide prevention. He was the co-author of India's landmark Mental Healthcare Act of 2017 which, among other important policy advancements, decriminalised attempted suicide under Section 309 of the Indian Penal Code, a long-standing demand of mental health professionals.

It is in this context -- India's invisible suicide emergency, the lack of political discourse or media coverage, and the overall indifference towards the socioeconomic impact of suicide -- that the newly-formulated National Suicide Prevention Strategy (NSPS) document assumes significance.

In November, the Ministry of Health and Family Welfare (MOHFW) issued the NSPS detailing not only India's suicide emergency, but has created a broad framework to include inter-sector stakeholders, given time frames for  implementation and detailed every aspect of suicide prevention over a 10-year period.

It is, like the Mental Healthcare Act, a landmark policy document. You can access it here.

While it is broad in its scope and detailed in its approach, there are a few highlights we must take a look at.

1.    It’s primary goal is to reduce suicide mortality by 10% by 2030

2.    It wants to establish nationwide suicide surveillance mechanisms by 2026

3.    It aims to establish psychiatric OPDs in all districts by 2028

4.    There will be a mental well-being curriculum in educational institutes by 2031

5.    Using national, state and district level resources, it looks to strengthen suicide surveillance and generate evidence through evaluation, to ensure improvement in the programme quality

It has not just outlined specific objectives, it has detailed the list of stakeholders at every level and created a responsibility and implementation matrix for them to follow.

"Implementation is key," says Dr Pathare, who is the founder and director of the Centre for Mental Heath Law and Policy in Pune. "While the National Mental Health Policy 2014 has a section on suicide prevention and identifies areas of strategic action, a detailed suicide prevention strategy is really necessary given the scale of the suicides in our country. The Mental Healthcare Act 2017 also addresses suicide issue, by effectively decriminalizing attempted suicide. We thus have the entire set in place: legal provisions, policy guidance and now a strategy."

To help matters, the technical committee was led by Dr Lakshmi Vijaykumar, a world-renowned expert in suicide prevention and the founder of Sneha in Chennai, an organisation that focuses on suicide prevention.

Dr Pathare feels the strategy sets out a broad framework, and that it is now up to states to develop specific state suicide prevention strategies using this template, depending on their specific priorities and demographics. "Let's get on and implement it," he says. "If we even did 70-80% of the planned activities, we will have achieved a lot."

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States are really the key. While the national policy will be formulated by Delhi, the responsibility of implementing it will lie with the states. Also, some states are more important than the others. Maharashtra, Tamil Nadu, West Bengal, Madhya Pradesh and Karnataka -- just five of India's 29 states -- account for over 50% of the country's suicides.

"There is a naïve misunderstanding amongst Indian middle class, that a 'czar' like figure can drive through implementation," says Dr Pathare. "This may work for limited conditions which are primarily intra-sectoral. For something like suicides, the need is for different sectors to interact. The health ministries in the states will have to take a lead in bringing other sectors to the table and co-ordinating actions. This is happening at the state government level – in many states, for example, health departments are co-ordinating their actions with education and agriculture sector."

Suicides are not just a rural problem, though; more than 25,000 of India's 1.64 lakh suicidal deaths in 2021 were from 53 top cities. Delhi, Chennai, Bengaluru and Mumbai recorded the most, and accounted for more than 35% of India's urban suicides.

An inter-sectoral approach is also important because of the diverse factors responsible for suicides in India.

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According to the MOHFW, bio-psychosocial factors (psychiatric illness, substance abuse, family history of abuse or suicide), Environmental factors (job loss, relationships, exam failure, domestic violence, child abuse, etc) and sociocultural factors (stigma surrounding mental health, healthcare access barriers, religious or cultural beliefs, media coverage of suicide) are the main umbrella factors, but each of them is so diverse in its roots and impact that, without an intersectoral approach, success will always elude us.

Therefore, the implementation matrix developed by the suicide prevention technical committee will be key, and even if each aspect has been provided with a stakeholder, a strategy, indicators, action points and a time frame,
the most significant part will how each state actions it, regardless of the target.

As Dr Pathare puts it, "In the mental health sector, I have realised that realistic or unrealistic targets are of little consequence. Even if we set the bar low, governments manage to miss targets and goals. I would rather focus our attention on implementation – if we implement it, we will get results."

Sachin Kalbag, a former newspaper editor, is Senior Fellow, Takshashila Institution



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