Suicide Deaths in India

In News

According to a report by Lancet, India reported highest number of suicide deaths in the world.

• The paper is titled: ‘The national suicide prevention strategy in India: Context and considerations for urgent action’.

About

• The Lancet has published a broad and comprehensive policy paper offering a range of evidence-based solutions across sectors.
• The paper hopes to propel India’s efforts to evolve a suicide prevention strategy as a rounded policy involving multiple sectors and implementation.

Image Courtesy: Lancet 

Key Data

• Suicide rate: 
  • The suicide rate among Indian girls and women continues to be twice the global rate, though it has dropped in the last decade or so. 
• Youngsters:
  • Large number of young lives are being lost to suicide, which accounts for most deaths in the 15-39 years age group.
• Most common way: 
  • Hanging is the most common method of suicide, followed by pesticides poisoning, medicine overdose, and self-immolation. 
• Other factors:
  • Depression and alcohol use disorders, and social and cultural factors, appear to increase the risk of suicide. 
• Suicide v/s attempt:
  • According to the Centers for Disease Control and Prevention (CDC), women are more likely to attempt suicide than men, but men are more likely to die by suicide than women.
• India reports the highest number of suicide deaths in the world. 
  • India lumbers on with the formulation of its national suicide prevention strategy which is in preparation for some years now. 

What is Suicide?

• Suicide is when people harm themselves with the goal of ending their life, and they die as a result.
• A suicide attempt is when people harm themselves with the goal of ending their life, but they do not die.
• Treatments and Therapies:
  • Brief Interventions
    • Safety Planning: 
      • Personalized safety planning has been shown to help reduce suicidal thoughts and actions. 

• Follow-up phone calls: 

• Research has shown that when at-risk patients receive further screening, a Safety Plan intervention, and a series of supportive phone calls, their risk of suicide goes down.

• Psychotherapies:
  • Cognitive Behavioral Therapy (CBT) can help people learn new ways of dealing with stressful experiences. 
    • CBT helps individuals recognize their thought patterns and consider alternative actions when thoughts of suicide arise.
  • Dialectical Behavior Therapy (DBT) has been shown to reduce suicidal behavior in adolescents. 

Legal status of Suicide in India

• Section 309:
  • History: The law, brought in by the British in the 19th century, reflected the thinking of the time, when killing or attempting to kill oneself was considered a crime against the state, as well as against religion.
  • Anyone who survives an attempted suicide can be booked under Section 309 IPC, which deals with “Attempt to commit suicide”. 
    • The section reads: “Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year (or with fine, or with both)”.
• Status of Section 309:
  • Unlike people’s perception, the section continues to remain in the IPC and is more misused.
  • However, the Mental Healthcare Act (MHCA), 2017, which came into force in July 2018, has significantly reduced the scope for the use of Section 309 IPC and made the attempt to commit suicide punishable only as an exception.
  • The restrictions put on the use of this section under the provisions of the MHCA, as opposed to it being removed from the statute all together, do not seem to be enough simply because of continued reports of its use by police forces across the country.

Government of India Initiatives 

• National Mental Health Programme (NMHP) in 1982
  • To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population.
• Mental Healthcare Act, 2017
  • It was passed in 2017, came into effect in May 2018 and replaced the Mental Health Act of 1987. 
  • To the joy of most Indian medical practitioners and advocates of mental health, the act decriminalised suicide attempts in India. 
  • It also included WHO guidelines in the categorisation of mental illnesses. 
  • The most significant provision in the act was “advanced directives”, which allowed individuals with mental illnesses to decide the course of their treatment and also appoint someone to be their representative. 
  • It also restricted the use of electro-convulsive therapy (ECT), and banned its use on minors, finally introducing measures to tackle stigma in Indian society.
• Rights of Persons with Disabilities Act, 2017
  • The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide effective mechanism for ensuring their empowerment and inclusion in the society
• Manodarpan Initiative
  • An initiative under Atmanirbhar Bharat Abhiyan, aims to provide psycho-social support to students for their mental health and well-being.
• Kiran Helpline
  • The helpline is a giant step towards suicide prevention, and can help with support and crisis management.
  • The helpline aims to provide early screening, first-aid, psychological support, distress management, mental well-being, and psychological crisis management and will be managed by the Department of Empowerment of Persons with Disabilities (DEPwD).
• GateKeeper Model
  • Gatekeepers:
    • Gatekeepers are existing people who are in close contact with the prisoners and can provide help for the prisoners. 
    • They could be other convicted prisoners, prison staff who will be able to identify and support prisoners needing psychological help. 
    • People having a psychological problem or at risk of suicide can access the gatekeeper, who can bridge the gap between them and the professional services. This is of particular benefit in at-risk suicidal prisoners.
  • Objective:
    • In this model, selected inmates, trained to identify prisoners at risk of suicide, would refer them to treatment or supportive services. 
  • Case Study:
    • Referring to the Bangalore Prison Mental Health Study, the advisory pointed to the prevalence of mental illness and substance use disorder in about 80% of the prison population.
• Buddy system:
  • The concept of a ‘Buddy System’ — social support through trained prisoners called “buddies” or “listeners” — was found to have a good impact on the well-being of suicidal prisoners. 
  • Periodic telephone conversations with friends and family would also foster support
• e-Mulakat:
  • It is an online platform enabling relatives/friends/ advocates of prisoners to book prior appointments for interviewing prisoners through the National Prisons Information Portal. 

Way Ahead

• A scaffolding approach across all domains that is available and accessible during vulnerable points over the life course could help individuals who might not be able to cope without help.
• The paper calls for the constitution of a task force for suicide prevention research to create a road map. 
• There is also a need for more robust, relevant and real-time data on suicides and attempted suicides.
• A reconciliation of the various contradictions on the ‘attempt to suicide’ clause in the law. 
• It also lists interventions that have reduced the suicide rate in various sections in the country, including among students and rural groups, by limiting the availability of pesticides.
• It is also essential to launch a programme in mission mode, a strategy that has served multiple nationwide health interventions in the country well. 
• A national policy which gives overall guidance must be tailored to the needs of States. A huge number of deaths by suicide is seen in the country. Even a 5% reduction in the rate will result in a good number of lives saved

Image Courtesy: NIMH 

Sources: TH