Friday, December 1, 2023

First step

According to The Lancet, India reports the highest number of suicide deaths in the world. In a review updated early this year, the publication stated that the suicide rate among Indian girls and women continues to be twice the global rate. Suicide accounts for most deaths in the 15-39 years age group compared with other causes of death. It also revealed that hanging is the most common method of suicide, followed by pesticide poisoning, medicine overdose and self-immolation. In addition to depression and alcohol-use disorders as risk factors, several social and cultural factors appear to increase the risk of suicide, it found. In February, it cited the absence of a National Suicide Prevention Strategy, inappropriate media reporting, legal conflicts in the interpretation of suicide being punishable and inadequate multi-sectoral engagement, as some of the major barriers to effective suicide prevention in the country. “A scaffolding approach is useful to reduce suicide rates, as interventions provided at the right time, intensity and duration can help navigate situations in which a person might be susceptible to and at risk of suicide. In addition to outlining research and data priorities, we provide recommendations that emphasise multilevel action priorities for suicide prevention across various sectors. We call for urgent action in India by integrating suicide prevention measures at every level of public health, with a special focus on the finalisation and implementation of the national suicide prevention strategy”, the review stated. Nine months later, in the final weeks of November, the Centre awoke from its stupor and introduced its attempts to address a problem that has permitted all spheres of the Indian society ~ the Union Ministry of Health and Family Welfare announced a National Suicide Prevention Strategy, the first of its kind in the country. It came with time-bound action plans and multi-sectoral collaborations to achieve a reduction in suicide mortality by 10% by 2030. Finally acknowledging the fact that suicide in the country is a much bigger problem that needs urgent intervention, the report stated that there is a need to establish effective surveillance mechanisms for suicides within three years, to establish psychiatry OPD that provides suicide prevention services in all districts within five years, and to integrate mental well-being curriculum in all educational institutions within the next eight years. It envisages developing guidelines for responsible media reporting of suicides and restricting access to means of suicide. As per the Ministry report, India has a high suicide rate ~ with around 71% male and 29% female accounting for total number of suicide deaths in the country in 2020. On a high youth population base, in the last 3 years, the suicide rate has increased from 10.2 to 11.3 per 1 lakh population. The report stated that economic and professional status of an individual also has a bearing on suicides. The maximum number of suicides accounting for 63.3% occurred among those who earn less than Rs 1 lakh per annum, followed by 32% suicides among those who earned between Rs 1 lakh and Rs 5 lakh per annum. While 3.8% of suicides were by those who earn Rs 5-10 lakh per annum, and 1% of suicides were reported for those earning more than Rs 10 lakh per annum in 2020. Around 65% of suicide cases happened between 18-45 years of age, stated the report. As always, the first step towards addressing a malaise is to recognise that it exists. Experts say that without targeted intervention programmes and stigma reduction strategies, a public health crisis of gargantuan proportions is imminent. Globally, suicide is the second leading cause of death among 15-29-year-olds and also the second leading cause of death for females aged 15-19 years, as per WHO estimates. That’s why emphasis has been given to early identification of psychiatric illness and early treatment. Because the main problem with suicide, experts say, is hidden psychiatric morbidity. We still struggle to identify mental health illness and there is huge stigma associated with it. Addressing issues relevant to India ~ including access to pesticides, and alcoholism ~ has set the Strategy on the path towards the achievement of its goals. It is, however, incumbent on the Government to stay the course until the targets are achieved. And ensure that all aspects of the Strategy are implemented by all the States and Union Territories.