Action on national suicide prevention policy is need of the hour

India needs a strong campaign for suicide prevention, as 2023 data reveals it's the leading cause of death for 15-29-year-olds.

In 2020 The National TB Elimination Program emphasised the aim of the Government of India to eliminate tuberculosis in India by 2025, five years ahead of the global target of 2030. While that may not have happened, the country did show the will and direction to eliminate TB. We need a similar campaign for suicide prevention. If anything, the 2023 National Crime Records Bureau data out this week should jog us into action.

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Suicide has emerged as the most common cause of death among 15-29-year-olds in India. One can think of several interventions but periodic voluntary screening for emotional disability should become the norm at every educational institution. If the IITs in the country can spend lakhs of rupees on tech fests, why not encourage mental health fests?

In my experience with educational institutions-- in private as well as municipal schools-- the simple exercise of giving blank chits to every student to write anonymously on how they feel at the at the end of our conversations, have yielded surprising results. At least one to three students will write that they want to die. When this happens, we try and trace the students who have expressed a death wish through their handwriting and counsel them. With the handwriting the students are traced and assisted.

Twenty years ago, during a workshop with about 500 school teachers, I asked the question if any of them had ever attempted self-harm and saw several hands go up. That’s when I first realised that people want to talk about their despair but don’t know whom to turn to.

While heath is a state subject, during the pandemic, the central government ran an effective campaign with a door-to-door screening. We need a similar resolve with curing mental health issues. What is the use of being the fourth-largest economy in the world while the country struggles? It’s not rocket science to decipher mental health red flags. Community and aanganwadi and aasha workers can be trained to screen.

In the 2023 NCRB report one stark fact was that one in four who died by suicide were daily wage labourers. This fact has not caught the attention of either the media or the policy makers. All-pervasive globalization destroys safety nets for the poor, especially in health and education. Who are these poor who vanish by self-harm? Is there no way by which the government can reach out to this hapless population and prevent them from killing themselves?

A proper mapping of migrant workers or those who have become invisible on the margins is now a necessity. Lawmakers should encourage these conversations on mental health and chalk out programs for the same. We need rural and urban data along with gender differences, caste, religion across the country to better understand this phenomenon of self-harm. Marriage too is no longer a protective factor in preventing suicide. According to NCRB data 67% of suicide victims were married while 26.1% were unmarried

Poorly-addressed interpersonal issues, family quarrels, financial issues, depression and violence are common causes for suicide but the World Health Organisation has found that often causes attributed to suicides to be unscientific as they are largely reported by the cops, family and neighbours. Mental health professionals rarely involved, and a psychological autopsy is almost never conducted.

Psychological autopsies map a person’s life backwards, checks the deceased’s social media feed, looks at their medical reports, past history and it involves detailed interviews with close friends, teachers, neighbours and significant others. This is a standard procedure in the armed forces for instance. We need this with civilian suicides too to map a larger suicide prevention policy.

When the 2024 NCRB data releases, it should have details of suicides across every taluka with a break up of gender, caste and religion so that the dataset actually becomes meaningful and not just a report to keep on library shelves. As one of my mentors, the late professor NN Wig used to say, mental health revolution is too important to be left to mental health professionals alone! We need more hands on the deck to prevent a suicide epidemic.

The author is a Mumbai-based psychiatrist who has been working extensively in the field of suicide prevention.