Suicide and suicide attempt was considered a CRIM till last year. The stigma attached to mental disorders and suicide makes many people fail to seek help. To create awareness about the suicide , ATHMA – Suicide Prevention Centre was started in 2000. We believe that suicide is a preventable and curable disease and that suicide prevention works.
A public Mental Health Model was adopted to raise awareness through education and a campaign to dispel the myths about suicide.We reaffirm that mental health is the Birthright of every citizen of our country.
Suicide Prevention cell is a 24 x 7 service that saving suicidal victim’s lives. We can achieve this through our HOTLINE 98424 22121. The individual suicidal contact well-trained counsellors, vent their emotions, express their problem, get psychological support, and crisis intervention is done. The most important aspect of the S.P.C. (Suicidal Prevention Centre) is that the clients are accepted as a human on the whole with their virtues and defects, and they can be confident that they have a friend to confide.
They feel more relaxed, start reasoning and are given guidance to solve their problems. We periodically connect with them and enquire about their well-being and continue support.
The important feature of this program is that clients can be completely anonymous, and the final decision and responsibility on their lives lie with them. However, most of the clients identify themselves. They contact us and get counselling. Severely depressed clients are referred to the doctors for Medical Management.
So far, more than 19000 such clients have been benefited. Many of the disasters were prevented through our counselling.
Functions of Suicide Prevention Centre
ATHMA centre organizes suicide prevention and awareness programs in various villages, schools, colleges, teacher training institutions, and the general public.
Every September 10th world suicide prevention day program is organizing to raise a voice for suicide prevention.
Training programs and conferences have been conducted along with other institutions on suicide prevention.
We have established contact with Medical stores and fertilizer shops and created awareness about not dispensing sedatives and tranquillizers refusing to sell pesticides that look strange.
Know About Suicide
Everyone struggles and undergo hardship only to have a good quality of life and taking care of family, delay (if possible – prevent) death. But this is not universally true as an average of 8,00,000 people dies of suicide across the world. India dubiously ranks 1stin the number of suicides. The subject of suicidology is a complex one. It’s not an individual issue; it is a national & global issue. Behavioural scientists, psychiatrists, psychologists, and sociologists are working hard to create a universal strategy to prevent this malady. Still, due to the psycho-socioeconomic and cultural factors, this becomes very difficult.
According to National Crime Record Bureau (NCRB), an average of 1,70,000 people commit suicide in India every year. Every hour, four people die of suicide in India. More than 20 times, the attempters survive at a substantial medical cost. Many of the suicides are not reported in our country.
Close to 800 000 people die due to suicide every year, which is one person every 40 seconds- WHO
The other alarming facts include the male: female suicide ratio being 1:2. 80% of them Are literates, 70% of them are between 15-35years. Puducherry (35.5 suicides / Lakh population), Tamil Nadu leads the list among Indian states. Chennai, the capital of Tamilnadu, tops the cities with 1750 suicide deaths/year. The statistics about farmer suicide is far negligible than the other reasons.
The rate of suicide is much higher than death due to accidents. Among the literate, it’s a very sorry fact to state that professionals – Doctors (Anesthetists, Neurosurgeons, oncologists, and Psychiatrists) top the list. The above statistics are mentioned not to threaten anyone but to convey the facts and provide awareness about the magnitude of loss due to suicide, which could be very well prevented. The loss of productive life could be minimized.
Suicide is the act of deliberately killing oneself.
A suicide attempt is a non-fatal, self-directive potentiality injurious behaviour with an intent to die due to the response but does not result in death.
Though suicide & suicidal attempts (Deliberate Self Harm) are different about the intent, they represent the two ends of a thread. We, medical professionals, are in such a critical position that while treating suicide attempts and saving lives, we also have the compulsory duty to prevent repeated attempts.
According to statistics, 70% of first-time attempters repeat the act within one year, and the attempt is more lethal than the previous attempts.
Psychopathology of Suicide
According to Freudian Psychoanalytic Theory – Suicide is due to a harsh superego (high morality), which makes a person feel extremely guilt even for a minor mistake. Suicide is murder at 180’ (Aggression turned inwards).
“I am constantly torn between killing myself And killing everyone around me.” – David Levithan
Other Theories say that suicide is due to one’s helplessness. A Suicide attempt is nothing but a cry for help; Emil Durhiem tried to explain suicide based on socio dynamic model
- Anomic suicide: lack of integration with the society.
- Egoistic suicide: Too much integration with the community makes the person vulnerable
- Fatalistic suicide: where death is the ultimate end to misery-eg cancer patients,
- Altruistic suicide: for the sake of society, e.g., freedom fighters, political suicides.
Risk factors of suicide
- Maladaptive Temperament
- Poor parenting
- Childhood psychological trauma
- Substance abuse
- Family history of suicide/mental illness.
Reasons for suicide
Our life nowadays, from children to elders, are full of stress. Ultimately the stress coping skill differentiates whether the person is going to face life or seek death. The inability to overcome impulse is the main reason for suicide attempts (or) deliberate self-harm (D.S.H.). Sometimes the mere gesture or attempt may turn out to be dangerous and end in death.
The rate of suicide is more in men, whereas suicidal attempts are more in women. Relationship failures, broken love affairs, divorce, marital mismatch, educational pressure, high expectation from parents, financial crisis, attrition, effects of social media are some of the significant reasons for attempts. Celebrity suicide portrayed heavily in media leads to suicide by copying. Of the total suicide attempts, people under alcohol intoxication account for 21%, whereas major depression is the main factor for completed suicides.
In severe depression, people try extended suicide, i.e., trying to poison children before they attempt to make sure their children and spouse do not suffer.
Both the lover and partner agree to commit suicide since their chance of marrying is remote. Most of the time, they die together, and methods are so lethal that the possibility of saving them is very slight. Sometimes our partner service.
(Term coined by our teacher Late PROF. Dr A. VENGOBA RAO)
Example: Married person, having children, being a breadwinner are some of the reasons for some trying hard to control their suicidal impulses. Ex. : “Had I not had a girl to be married, I would have committed by now.”
Biological causes for suicide
Though the exact site of mind, its function, neurobiochemical action of the reason is still a mystery, many research on Neurotransmitters like neuroimaging, Spectroscopy, fMRI, etc., have revolutionized Psychopharmacology.
In patients with suicide attempts, researchers have identified with Brain study (Post mortem studies) and CSF analysis indicate a Serotonergic dysfunction system.
In depressive suicide patients, low CSF – 5HIAA and low dopaminergic metabolic H.V.A. were found.
The management depends upon the clinical diagnosis
- Depressive Disorder / Bipolar Disorder
- Adjustment disorder with suicide attempt/ PTSD
- Acute Stress Reaction
- Personality Disorder
If depression is severe, an Antidepressant with E.C.T. may be needed.
Counselling, family therapy, marital therapy, problem-solving techniques, cognitive behavior therapy, and interpersonal therapy, depending upon the need will be sufficient for other disorders.
Besides, we cannot undervalue the biological vulnerability of the individual.
So, an antidepressant with the least side effects like SSRI, SNRI is preferred. A good therapeutic relationship, mutual trust, regular follow-ups are essential.
Prevention of Suicide
We have to understand that mental health is an essential component of health. We disseminate knowledge about physical disorders like stroke, heart attack, diabetes, hypertension, etc., but we miserably fail to acknowledge mental health. The main reason is the stigma.
Since time immemorial, all works of literature saints hard understood the power of the mind, “Control your mind,” “Desire is the root cause of evil” – Buddha.
We have to incorporate mental health into general in the mainstream. “Talking Mental Health is everybody’s business.” If we can identify depression and start treatment, most of the suicide can be prevented.
Talk about mental health itself is enough to promote awareness. In addition to posters about physical illness, a poster about yoga, meditation, exercises, and one with the symptom of depression will create awareness.
Educating the public about good parenting, stress-free education, the impact of social media are needed. Promoting positive mental health with yoga, meditation, sports, arts, healthy relationships, healthy lifestyle, the ill effect of stress is the duty of every physician.
We can work together to bring up a good community.
It is the duty of a nation not only to add years to life but life to years – J.F.K.