In November 2022, the Ministry of Health and Family Welfare announced the National Suicide Prevention Strategy for India, a long-awaited strategy document. Suicide is one of the most rapidly growing public health crises in the country as seen through the rising number of deaths by suicide, especially among younger age groups. While suicide prevention efforts have been ongoing across the world, we are living in an exceptionally critical time when the need to build a collective understanding of the complex phenomenon that is India's suicide crisis is all the more pressing.
During the peak of the COVID-19 pandemic in 2021, India's suicide rate jumped to 12 per 1,00,000 population, a significant increase in a short time period, when compared to previous years. The pandemic and the disruptions it caused to lives and livelihoods has had a severe psychological impact on individuals. The repercussions of the pandemic are likely to continue to be experienced in varied ways over the next few years.
Every year, September 10th is marked as a day to acknowledge the lives lost to suicide and bring attention to suicide prevention efforts. However, beyond a brief period when social media and news reports are aglow with sensitive discussions, the conversation on suicide quickly dies down. Similarly, apart from commentary from a few dedicated stakeholders, the recent National Suicide Prevention Strategy has not captured the desired public attention, despite being a significant milestone in advancing suicide prevention in the country. However, the announcement of the strategy is just one piece of the puzzle; holding the government accountable for the implementation of the actions detailed in the strategy document going forward is the larger priority.
Why should we care about suicide?
Across the globe, over 8 lakh individuals die by suicide every year. In 2021, 1,64,033 suicide deaths were recorded by the National Crime Records Bureau in India. However, this is a known underestimate where researchers estimate the deaths could be upward of an additional 1lakh deaths per year.
A recent analysis suggests that every suicide death has an impact on a large number of people exposed to the death, including a profound, or lifetime impact, on nearly 15 people, particularly close family or friends. The sobering data on deaths by suicide indicate that every individual life, over the course of a lifetime, will be touched or impacted by suicide. The rising numbers show the crisis is too grave to dismiss. Mental health professionals, researchers, and other stakeholders argue that it is important to factor suicide prevention in as many aspects of everyday life as possible.
Seemingly, misconceptions about suicide are widespread. Contrary to the popular belief that suicide is solely a mental health concern, mental illness accounts only for approximately half of the suicides in India. Suicide is strongly influenced by life stressors and structural determinants. Structural determinants are systemic factors that lie beyond an individual's control, deeming groups of people highly vulnerable to a multitude of stressors. Stressors could include unemployment or financial distress, homelessness, marginalisation, familial or social pressures and experiences of violence, trauma, abuse, and exclusion. These are also known as 'manufactured vulnerabilities', where those who are deemed as vulnerable groups, are created or manufactured by levels of inequality and apathy, perpetuated by societal structures.
A common misunderstanding is suicide is the wish to die, however, conversations with those who overcame suicidal ideation clarify that suicide instead comes from a wish to no longer live or a wish to end suffering. Beyond being an issue of semantics, understanding nuanced reasons for suicide is in fact a key consideration that can provide insight and redefine effective interventions for suicide prevention. Further, stigma around poor mental health, self-harm and suicide ideation means these are seen as signs of weakness or a personal failing, making it difficult for many to discuss their struggles openly or seek help. On the other hand, sensationalism around suicide involves a hyper-focus on suicide, often rife with misconceptions, leading to unhealthy discourse on suicide. Both are counterproductive to having a meaningful conversation on how suicides can be prevented. Ultimately, there is no single explanation for suicide and no single solution to prevent suicide loss.
If suicides are caused by multiple factors, how can they be prevented?
While it is widely believed suicidal ideation is a finality and suicides are not preventable, suicides are indeed preventable with timely action to identify and support individuals in distress and address the root cause of distress. Suicide is a complex sociological issue that needs to be addressed using a multifaceted approach. An immediate action is to build the capacity of individuals to better understand the multifactorial nature of suicide, but also train first-line respondents (ie. gatekeepers such as parents, schoolteachers, employers, or anyone in frequent contact with a large group of people) to recognise and respond to changing behaviour and signs of suicide ideation. For suicide prevention to be effective in the long term, efforts must include concerted multisectoral action tailored to address different contexts and dimensions of vulnerability in a multitude of settings. This will require sustained collaboration between different sectors of society, including government, civil society, and the private sector.
Along these lines, the National Suicide Prevention Strategy, 2022 aims to integrate suicide prevention interventions into several intersectoral government programmes and initiatives. The strategy aims to reduce suicide mortality by 10% by 2030, an ambitious goal within a short time period. To make a difference to this growing crisis, regional and targeted strategies are required, focused on reducing stressors and improving the quality and aspects of daily life for individuals.
The Centre for Mental Health Law & Policy, Indian Law Society, Pune has developed a series of articles to discuss in-depth, over the next few weeks, the multitude of factors that contribute to India's suicide crisis and how suicide prevention efforts can be aided. The series will discuss dimensions of vulnerability including crisis in employment and financial insecurity, stressors specific to youth, women, gender minorities and tribal populations, as well as discuss existing data patterns in suicide deaths and the policy landscape in India. The series is envisioned to enable meaningful conversations on suicide while detailing nuances in strategies for prevention. Through the series, we hope our readers will appreciate the intersectoral nature of suicide that encompasses all facets of life and recognise that with timely, targeted and relevant intersectoral action, suicides are indeed preventable.
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Amiti Varma and Isha Lohumi are research associates; Soumitra Pathare is a consultant psychiatrist and director; all at the Centre for Mental Health Law & Policy, Indian Law Society, Pune.
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Note: "Discussing suicides can be triggering for some. However, suicides are preventable. In case you feel distressed by the content or know someone in distress, call these numbers of local helpline services."