Context:
It is hard to believe when we lose someone to suicide, especially when it is a successful and popular public figure.
It does not just affect the family and friends of the person who dies, but in the case of popular figures, it brings a sense of loss to the community.
Every death by suicide leaves behind a trail of questions and a deep sense of helplessness.
In the context of the ongoing and unpredictable COVID-19 pandemic, the helplessness is exacerbated.
What is in our control, however, is to do more to identify the crisis building within ourselves and others, and to learn how to avert it.
Suicide is considered a preventable cause of death:
Close to 800 000 people die by suicide every year. Furthermore, for each suicide, there are more than 20 suicide attempts.
Suicides and suicide attempts have a ripple effect that impacts on families, friends, colleagues, communities and societies.
Suicides are preventable. Much can be done to prevent suicide at individual, community and national levels.
Suicide is considered a preventable cause of death and does not always involve a history of mental illness.
Societal and global issues can wear down on us and affect our mental and physical health.
Suicide rates in India and around World:
- Recent data from the Global Burden of Disease project by the World Health Organisation shows that the suicide rates for Indian men and women are 5 and 2 times the global suicide rate respectively.
- Further, in India, suicide is the number one cause of death for both sexes between the age of 15 and 39, probably pointing to the significant developments related to career and family typically experienced during these ages.
- Across the globe, suicide rates among the elderly are falling, but in India there is a trend for sharp increase in suicide rates in old age (70 and above).
- These trends point to some socio-cultural issues related to age and gender that may affect suicide rates.
- Indeed, a recent review of suicide data in India found some factors that put an individual more at-risk male unemployment, married female, physical illnesses and social isolation among the elderly, rate of agricultural employment in the state, minority community status, domestic violence, family problems, and alcoholism.
Who is at risk?
While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.
In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour.
Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners.
By far the strongest risk factor for suicide is a previous suicide attempt.
Why and When Suicide thoughts used to come:
This just goes to show that the broader political, economic, and socio-cultural factors play a very important role in our mental well-being and we must not blame every case on mental illness.
Of course, when one is in a suicidal state, there is intense emotional turmoil.
These environmental and personal stressors can add up and create a sense of a “life not worth living”.
Many of us have thoughts about death at some point in life, such as “death would be easier”, or, “I cannot go on, I want to get away”.
However, it is important to recognise when this changes to active desire for killing oneself such as “I want to hurt or kill myself”.
The risk for suicide is higher when these thoughts become intentions and there is a specific plan (time, place, method) that comes to mind.
Criminalisation of mental health issues also adds to this stigma. Suicide attempts are also no longer considered a criminal act in India under the Mental Healthcare Act passed in 2017.
Therefore, let that not stop you from accurately reporting a suicide attempt or seeking help.
Do not blame or shame someone for thinking of suicide, or call it a selfish act. It undermines the struggle the person is going through, further stigmatises the thoughts, and prevents them from opening up.
How to overcome Suicide thoughts and become strong:
- The first step here should be to get away from any lethal means of hurting yourself. Poisonous substances, medicines, equipment like weapons or rope need to be thrown away or removed.
- Discussing the problem with someone who can help you keep safe is also important. Lock the medicines and give the key to someone else. Give your wallet and car keys to others for safekeeping.
- Get away from any location where these thoughts are more intense or places your mind had chosen to carry out the plan.
- Get to a place of safety or distraction, such as a park or café. Stay away from drugs and alcohol when you are feeling low, because they affect emotions negatively and lead to more impulsivity and reduced problem-solving.
- Reasoning and problem-solving capacity greatly reduces during a suicidal crisis, making situations seem more dire and hopeless. In these moments, you may feel intense agitation, self-hatred, hopelessness, and mental anguish.
- However, it is important to realise that suicidal thoughts come and go, and that if you make it through the most difficult moments, you have a chance at feeling better.
- It is not a battle to be fought alone however, and we need an army of support including personal and professional support, and therapy and pharmacological treatment. You shouldn’t delay getting professional help at this juncture.
- Stigma related to mental health issues prevents help-seeking by persons who are suffering.
- For instance, non-suicidal self-injury includes acts committed intentionally to hurt oneself but not to kill oneself, such as cutting, scratching, hitting, or burning oneself.
- These acts are related to higher likelihood of suicide attempts in the future and therefore can be seen as a gateway to suicide attempts. However, such behaviour is often looked down upon and dismissed as attention-seeking.
- On the contrary, research has consistently shown that people engage in these behaviours to regulate their negative emotions and not to seek attention from others.
Therefore, we must not let our assumptions get in the way of providing support and attempts of the patient to reach out to others.
Listen to the person, support them without judging their struggle, get them professional help and resources, and keep reaching out to them even after they are connected to treatment.
Social support is a known protective factor against suicide, meaning that it reduces the likelihood that a person will attempt suicide.
Therefore, reaching out to others even when they are not obviously struggling is very important.
Conclusion:
We need to reach out to others when we are struggling. Often, we assume that others are too busy or don’t care, or won’t understand us. However, we have to take the crucial step to let others know how we feel clearly.
This can be hard when we feel like we don’t belong, or are a burden on others, or are not amongst well-wishers.
In these instances, we need to try harder to find at least one person who may be supportive and helpful.
Also, they may not be able to solve our problems, but having emotional support can help us feel less alone.
It also doesn’t make us emotionally weak to need others, because we all go through emotionally overwhelming times when objective and rational perspective of others can help us see through our emotions.
You can also start by contacting your local crisis or mental health helpline to get professional help. A list of helplines in India is available here: http://www.suicide.org/hotlines/international/indiasuicide-hotlines.html.
It may also help to use the app Stay Alive, which is a UK-based app that follows all recommended guidelines for suicide prevention and provides information and resources to cope with suicidal thoughts.
The app is meant as a self-help tool but cannot be a replacement for professional help. Remember, when in doubt whether anything can make you feel better, start by simply reaching out.
