Sunday, September 10 marked World Suicide Prevention Day 2017. In Sri Lanka, it was observed with many events. The main programme sponsored by Sumithrayo was held at Independence Square to motivate the nation to ‘Take a minute – Change a life.’ Activities included dramatic presentation, video cuts from survivors, panel discussion by an eminent team and an art competition for youth.
There was also public awareness walk in memory of loved ones and those that struggle every day. In addition, a number of excellent articles appeared in the national newspapers related to this issue.
Suicide has stolen thousands of lives in our country during the last one and half decades. Most of them were young lives. Reasons attributed to suicide and opinions of what to do have been discussed in many forums at great length during those years. Yet, suicide is still continuing to demand a relentless toll. There are thousands of people who are being touched by the tragedy of suicide. When a family loses one of its members as a result of suicide, the traumatic experience will remain in their hearts for many years to come.
High rate
For the last two decades, suicide remained an important issue in the Sri Lankan context. In 1995, Sri Lanka had the highest rate of suicides in the world. Forty seven people out of 100,000 committed suicide that year. A Presidential Task Force was set up to mitigate this dismal statistic and subsequent action helped to reduce the number significantly to 16 per 100,000 by 2014.
However, our suicide rate remains high with an average of 58 persons taking their lives weekly but experts say that the rate would be 15 - 20 times higher if all suicide attempts succeeded. The welcome news is that the rate has been dropping, with around 10 per cent each year during the last few years.
There is a wide variation in the suicide rates within the country. A study investigating variation in suicide rates across Sri Lanka’s 25 districts revealed that changes in the incidence of suicide would be most marked in rural areas due to the availability of toxic pesticides in these locations. This mode of suicide comes next to strangling.
Another study exposed that the civil disturbances which spanned over 25 years (1983-2009) left the country in social disintegration and suicide rates were highest during that period. A significant reduction was established in post-conflict Sri Lanka. Yet, financial hardship and loss of livelihoods had repeatedly affected families especially in the East and Northern provinces and numerous individuals suffered from depression and posttraumatic stress disorder (PTSD) and many resorted to suicide.
Statistics
If we analyse the Police Records of suicide statistics for 2016, we note that 25 % of the total suicides of the year belong to the youth. (Following the Indian example, we have categorised youth as a person between 16 and 30 years). Fifty five percent of the youth suicides had happened due to three reasons: (1) harassment from family members -19%, (2) disappointment and frustration due out-of-family reasons – 28%, (3) Certified mental disorder -7%. All three reasons point up to mental depression.
Youth issues
Some time ago, a national pilot survey was conducted to find out the predominant issues faced by the modern Sri Lankan youth. Among the issues were (1) The belief that their parents were not “synchronised” with the “modern” thinking and therefore not supportive to them, (2) They were under too stressful academic and social pressure, (3) They lacked the required life skills to face the calamity of their youth lives, (4) They lacked the vocational or technical skills to secure a decent career and to lead comfortable life in the society. The survey also showed that approximately 10% had seriously considered attempting suicide at least once during their youth period.
This generation of modern youth is changing, becoming increasingly diverse from a socio-cultural perspective. The global evidence shows that prevalence of mental disorders among youth ranges between 10-20%. The situation of Sri Lanka is also similar.
Stresses
Consultant psychiatrist at the Mental Health Institute, Dr. Neil Fernando once said at an interview, “Worries about school performance, pressure from parents to achieve academic excellence, economic and other losses affecting the family, bereavement, being accused of wrongdoing by school authorities or law enforcement agents were some of the situations rated as highly stressful by adolescents.”
Consultant Community Physician in Family Health Bureau, Dr. Kapila Jayaratne commented, “Youths experiencing multiple and ongoing stresses of this nature should be considered as having a potential for suicide. Teenagers and young adults are impressionable and sensitive, and especially vulnerable to social and peer pressure.”
According to Dr. Jayaratne, social and peer pressure are the most common causes for teenager suicide. They are going through dramatic biological and psychological changes and it can be a very difficult time for them. Teenagers are often extra-defensive or aggressive, and quick to react. Adults and teachers should understand this.”
Mental depression
Many studies have revealed that most of those who die by suicide have a mental depression. Most young people commit suicide because of their depression due to difficulty of tolerating distress associated with an interpersonal conflict. Therefore, rapid interventions addressing central causes of suicidal behaviour are essential.
In Sri Lanka, the high rate of suicide among young adults is also associated with greater socio-economic stressors that have followed the rapidly changing market economy and huge disparities in incomes and the inability to meet role obligations in the new socially changed environment. Research has proven that prolonged unemployment has always been a huge burden to the youth is also a considerable suicide factor. Education system in Sri Lanka is highly competitive and is overly academic orientated. In the recent tines, some efforts have been made to modernize the programme by introducing apprenticeships and certain career opportunities. Yet, significant portion of youth remains unemployed.
In addition to the education problem, the breakdown of the joint family system and the desire to prove one’s self-worthiness has proven to be detrimental on the mental health of the youth. Therefore, psycho-social support and services focusing these matters are essential in tackling youth suicide rates.
Rapid urbanization, industrialization and changing family systems are resulting in social upheaval and distress. The diminishing traditional support systems leave people vulnerable to suicidal behaviour. Hence, there is an emerging need for external emotional support.
It is obvious that the state-sponsored psychiatric modalities and facilities are insufficient to meet the increasing suicidal challenges. Rehabilitation activities still need to be developed and spread island-wide.
The enormity of the problem combined with the inadequate state mental health service has led to the emergence of a number of NGOs in the field of suicide prevention. With the support of these NGOs, the Government should attempt to improve the community-based services throughout the country to address this issue.
Training
Years ago, mental health patients had to come to the hospital to get treatment. Modern thinking is that health professionals should go to them. When they do so, in addition to treating to the disease, the professionals should be able to help patients change other environmental factors that contribute to the illness as well.
The primary aim of these NGOs should be to provide support to suicidal individuals by befriending them. Often, they function as an entry point for those needing professional services. Of course, they are doing a great service.
Apart from obtaining services from NGOs, the Government should also undertake education of “gatekeepers”, raising awareness in the public and media and some intervention programmes.
Gatekeeper-training programmes (GKTs) are an increasingly popular approach in western countries to addressing access to mental health care in adolescent and youth population. GKTs target individuals (“gatekeepers”) who are in frequent contact with others in their communities. The trainings equip non-professionals with the skills and knowledge to recognize, intervene with, and link distressed individuals to appropriate mental health resources.
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