Poverty, debt, addictions, homelessness, abuse, discrimination and social isolation are equal risks
This broader understanding of suicide triggers can help devise better coping strategies in India, where over 170,000 lives are lost annually due to suicide.
At Satara’s legal aid
centre, Varsha Deshpande found a dishevelled woman in her early 30s, who had
been dropped off by her rescuer, an autorickshaw driver. The woman’s husband,
an alcoholic, would sexually abuse her after watching porn. “She was so messed
up she did not know what to do and attempted suicide by jumping from a fort.
The autorickshaw driver saved her and got her to our centre. Now she’s paranoid
that her husband, who has fled with their eight-year-old son and five-year-old
daughter to West Bengal, would abuse them physically as well,” says Deshpande.
It’s
cases like these, of extreme stress, anxiety and depression brought about by
external circumstances, that have been taken note of by The Lancet Public
Health as it fact-checks triggers for self-harm. It calls for changing the
health policy lens on suicide from being just a mental health concern to giving
equal weightage to socio-economic triggers that drive people to desperation.
“We need to move from presenting suicide as a purely mental health issue to
acknowledging the impact of social risk factors like poverty, debt, addictions,
homelessness, abuse, discrimination and social isolation on a person’s decision
to consider suicide,” says one of the series authors Dr Rakhi Dandona,
professor at the Public Health Foundation of India (PHFI).
This broader understanding
of suicide triggers can help devise better coping strategies in India, where
over 170,000 lives are lost annually due to suicide.
Why is this Lancet study
relevant for India?
This is relevant for India
because the National Suicide Prevention Strategy in 2022 had confined most of
the proposed actions within the arc of mental health management despite Indian
police data showing that age, gender, education, employment and stressful life
events had an equally important role in suicides. “We need to work on all
aspects collectively. Social factors must be included in national suicide
prevention strategies in order to prevent people from reaching crisis point”
says Dandona.
The primary challenge in
preventing suicides is considering them as a crime file statistic rather than
seeing them as a public health issue. “If we can profile each case by not just
age, sex and occupation but the context and the socio-economic determinants,
then we can effectively target suicide prevention,” says Dandona.
Pranita Madkaikar of
the Pune-based NGO, Connecting Trust, says she has
been tracking factors other than mental illness that drive a person to the
abyss of absolute hopelessness. “Sexuality, academic stresses, career and job,
family and societal pressures are some of the reasons why a person may feel
absolute helplessness, hopelessness, worthlessness and thus loneliness. Things
may come to such a pass that a person may lose all hope and feel that ending
life is the only option that s/he is left with. Direct/open conversations are
the only hope,” she says.
Can a revised approach work?
The study lists how
economic security in the form of minimum wage legislation and income protection
policies have had a direct effect on suicide prevention. In Brazil, for
instance, the Bolsa Familia conditional cash transfer programme was introduced
in 2004 to relieve poverty and provide access to various services (eg, health
services and job skills training). The effect of the programme on suicide was
examined in a study that followed beneficiaries for 12 years and compared them
with non-beneficiaries with similar profiles; the suicide rate for
beneficiaries was 5.4 per 100,000 population, whereas the suicide rate for
non-beneficiaries was 10.7 per 100000, providing strong evidence that the
programme was protective against suicide.
Policies that limit
alcohol consumption and regulate social media platforms improve mental health
profiles too, says the study.
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