Suicide is a scary word, but unfortunately, it is a reality for many families. Surviving family members suffer the trauma of losing a loved one to suicide, and they become vulnerable to suicide and emotional problems. According to World Health Organization, more than 700 000 people in the world die by suicide every year, of which 17% are residents of India. Suicide is the second leading cause of death in the world for those aged 15-24 years. In India, an average of 381 suicides happens daily. In 2019 alone, over 1.39 lakh deaths were due to suicides, and over 90,000 of them were aged between 18 and 45. These young Indians did not die because of infectious disease or chronic lifestyle disease or even by accident. They all died because they felt they had no hope for the future. The numbers quoted here are just completed suicides, but for every suicide, there are many more people who attempt suicide. Further, it is impossible to estimate the number of people who may think of suicide but may not act upon it.
Why people attempt suicide
We need to understand that suicide is a manifestation of complex behaviour and not just a response to one problem that a person is experiencing. For instance, we see an increase in reports of suicide among adolescents when exam results are announced, however, not all children who fail exams commit suicide. It needs to be noted that India has one of the highest rates of suicides among adolescents. The question then arises, what is the cause of suicide? Was it an exam or academic pressure, or was it a lack of emotional support? Or was it some other factor? Generally speaking, there are several reasons why an individual commits suicide, and it is difficult to pinpoint one particular reason why a person may commit suicide. Suicide is multidimensional and could be a compounding result of several factors. Some of the common risk factors for suicidal attempts include anxiety, depression, alcohol use, and other mental disorders. However, mental health issues are not the only prerequisite for suicide. Quite often, persons who have been seemingly doing well may commit suicide. Many a time, suicides happen impulsively in moments of crisis with a breakdown in the ability to cope with life stresses, such as financial problems, relationship break-up or chronic pain and illness. Experiencing conflict, disaster, displacement, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. Vulnerable groups such as refugees and migrants; LGBTI persons; and prisoners also are at high risk for suicide.
Some signs to look out for
Most suicidal individuals give definite warnings of their suicidal intentions, and when they talk about death and suicide, it is not to be taken lightly, especially when they are undergoing a stressor. Some signals to look out for are: talking about wanting to die, feeling hopeless, feeling trapped, being in unbearable pain, and being a burden to others. They may also be looking for a way to kill themselves and google about it. Behaviours such as using alcohol/drugs, acting anxious, agitated, mood swings, anger or rage are a sign that they are not coping well with the stressor. Sleeping too little or too much, socially withdrawing, isolating self, making preparation to die such as writing a letter, Will, etc., saying goodbyes, etc. are all indications that the individual has thoughts of ending their life. This is not a comprehensive list; any other unusual behaviours should also be noted.
What to do?
People who are suicidal may feel trapped or like a burden to their family, friends, and those around them. They may feel like they are alone and have no other options. The Covid-19 Pandemic has contributed to increased feelings of isolation and vulnerability, making the person at risk feel hopeless. Unfortunately, there are no agreed-upon, set procedures for handling a suicidal or a potentially suicidal person. Nevertheless, we can all play a role in supporting those experiencing a suicidal crisis or those bereaved by suicide. Through action, we can all make a difference to someone in their darkest moments. Simply making the time and space to listen to someone about their experiences of distress or suicidal thoughts can help. Small talk can create a sense of connection and hope in somebody who may be struggling. Be calm, non-judgemental, and a good listener. Discuss the problems and solutions, offer support, talk about past achievements and offer hope for the future. Acknowledge suicide as a choice, but do not normalise suicide as a choice. Actively listen to them, show empathy to their distress, and reinforce self-care. At this point avoid asking in-depth questions about deep-rooted problems, which can be done at a later stage when the person is more stable. It is important not to express personal moral, religious or philosophical opinions since it can block communication. Encourage them to seek help from mental health professionals or speak to professionals on helpline numbers.
What are the Immediate actions to take?
Take any expression of suicide seriously. Remove access to lethal means. Do not leave the person alone. Seek professional help immediately. Take the person to the emergency room of a hospital. Suicidal individuals have a range of needs from information to counselling to medication. A combination of brief supportive counselling and medications to treat depression and other behaviours are indicated.
Are you having suicidal thoughts?
If you are having suicidal thoughts, know that there is help available. Reach out and speak to someone. Even if you feel that your pain and unhappiness will never end, whatever you are going through is temporary, it will pass just like every other situation, every problem has a solution. Talk to a friend or family member or a trusted person. Tell them what you are going through. A lot of times, others around us may not be aware of what is going on in our lives. They may have a different perspective on our situation, and may not consider the same problem as hopelessness. When you speak to them, they may offer a solution that had not occurred to you. Call suicide helpline or go to the emergency department of any hospital and tell them you are distressed. Seek help from a counsellor/psychologist. All psychologists, counsellors or mental health professions strictly follow the ethical code of conduct, and whatever information you divulge (exception: intended harm to self or others), no matter how shameful you feel about it will be strictly kept confidential. They will be non-judgemental, empathetic and accepting of you, so do not hesitate to reach out. They will see things in a different light and help you find solutions to your problems and teach you ways to cope with the situation. Your pain may seem overwhelming and permanent at the moment, but there are ways to cope and overcome it. Remember that there are people out there who are willing to help, and you are not alone. Even if you’re in a lot of pain right now, give yourself some distance between thoughts and action, wait for the pain to subside, and give time for things to change. It will all be okay.
Here are some of the helpline numbers if you are distressed and need support. Social Justice and Empowerment Ministry have launched mental health rehabilitation helpline (1800-599-0019). This 24/7 helpline offers early screening, psychological first-aid, psychological support, distress management, mental well-being, psychological crisis management services and referrals to mental health experts. School of Human Ecology, Tata Institute of Social Sciences, offers free telephone and email-based counselling services, to individuals in emotional and psychological distress. Their number is 9152987821, and they are available from Monday to Saturday: 10:00 am to 8:00 pm. AASRA, a Suicide Prevention and Counselling NGO runs a helpline number: 91-9820466726. State-wise helpline numbers are listed on their website. Several such helpline numbers are operating in India that offer free counselling, and any individual in distress must make use of these services.
Suicide can occur across all ages, economic, social, and racial boundaries. Most suicidal people desperately want to live, but they are just unable to see an alternative to their problems. They may lose hope for the future and see no point in living, or it could be an impulsive emotional reaction to a stressor. They attempt suicide because they are in intense pain or distress and see no way forward. What they need is hope for the future, and emotional support to overcome their pain. However, we need not wait until a person reaches the brim of a breakdown. Let us lookout for people around us. We interact with several people daily – our family members, neighbours, friends, colleagues and so on. Let us check on them, especially when we know that they have experienced a loss, trauma or stress recently. Ask them how they are doing, listen, empathise, offer hope, discuss problems and solutions, and let them know you are available. Perhaps our one small gesture can comfort someone. By creating hope through our actions, we can let people experiencing suicidal thoughts know that there is hope for them and that we care for them and want to support them.