World Mental Health Awareness Week 2019: Working together to prevent suicide

I begin with a confession today. I am a suicide survivor. This deadly modern pandemic has taken over our homes, our families, work-places......... the young, the aged, the naive, the seasoned.............. Nobody seems to be spared.  In a fashion similar to how many epidemics have been tackled in the past, let’s begin our battle against this modern-day plaque by educating ourselves and the society at large. Medically Suicide (kill oneself- Latin) is defined as the act of taking one’s own life voluntarily and intentionally. The keywords here are: lethal and intention. These two can be used as criteria to grade the type of suicidal behaviour and also help us provide timely, appropriate help to the individuals in need. About 8 lakh persons die due to suicide every year, which is one person every 40 seconds. Now the question of the hour is: why do people commit suicide?
Psychiatric causes: many psychiatric conditions have a very risk of suicide, especially mood disorders, schizophrenia, substance abuse and post-traumatic stress disorders.  The strongest risk factor for suicide is a previous suicide attempt.
Medical causes: many medical conditions especially with chronic illnesses and poor outcome like cancer, heart diseases, HIV/AIDS, Diabetes, Parkinson’s disease, chronic pain conditions have all been associated with a high risk for suicide.
Impulsive attempts: the causes are innumerable. Failed relationships, unsuccessful career, fights with family or with friends, peer pressure, finances, shame, guilt, humiliation, regret.... the list just goes on.  Are we becoming emotionally weaker, complacent, needy adults in contrast to our mighty ancestors? If they are to be believed, each of them swam rivers and walked several kilometres in rain or shine to reach their respective educational institutes. Impulsivity is definitely on a rise but so are stress, easy access and loneliness as side-effects to modernisation.
Para-suicidal behaviour: The other day, a frantic educator wanted to know why her students would resort to drinking a capful of disinfectant that wouldn’t cause much damage in any case. Many of our patients assure us that they vomited out immediately after ingestion of the poison. Why do it in the first place? Or the superficial barely-there cuts on the forearm; what are they meant to be? Are these just attention-seeking gimmicks that should be ignored? Deliberate self-harm also known as para-suicidal behaviour is a cry for help and has been linked with a very high incidence of suicides. We need to reach out in time and help them find the courage to live before they pick up the courage to quit instead.
The figures definitely are scary, 8 lakhs deaths due to suicide annually, one life every 40 seconds and for every suicide, about 20 attempted suicides. Suicide is one of the leading causes of death in the youth. The good news is that it is preventable. However the figures are just too large for us to wait for “someone” or “some agency” to take care. Everyone has to be a stakeholder. Everyone needs to pick a role. It is in our homes, work places, schools, colleges; students, doctors, businessmen, daily-wage workers, the rich and the poor alike, nobody seems to be spared. We can no longer sweep things under the carpet or wish it away.
Every year, the 10th of October is celebrated as World Mental Health Day and the entire week as Mental health Awareness Week to raise mental health awareness and promote mental well-being world-wide. For the past 15 years, the 10th of September every year is being celebrated as Suicide Prevention Day. Recognising the pressing need to combat this deadly pandemic, the theme selected for this year’s World Mental Health Day is also to raise awareness for suicide prevention. In this era of instant gratification where pizza comes in 30 minutes or free, time constraint plays a huge factor. Keeping this in mind, the experts have come up with a strategy to take “40 seconds of action”.
#40seconds aims at:
1.    Making suicide prevention a global public health concern
2.    Improve knowledge of what can be done to prevent suicide
3.    Reduce the stigma associated with suicide
4.    Let people who are struggling know that they are not alone
It invites everyone to take just 40 seconds of the day to show they care, in whatever little way they can. For instance:
-40 seconds to chat with someone in distress
- 40 seconds to share a message on suicide prevention on social media
- 40 seconds to generate awareness at one’s workplace
-40 seconds to share an awareness message at a public gathering
-40 seconds to grief with a family who lost a dear one
Let’s be very clear. Suicide is not bravery and it is definitely not the end. The problems that we are trying to escape don’t cease even if we quit and leave. We would just leave behind a legacy of unanswered questions, guilt, self blame and pain for our nearest and dearest ones.  A suicide survivor is one of the family and friends of someone who has died by suicide. Statistics reveal that for every suicide, there are seven to ten people intimately affected. Losing someone dear is never easy and maybe reducing the stigma associated with suicide can ease up the healing process, though nothing would completely take away the pain.
WHO’s approach to suicide prevention is known as LIVE LIFE:
Leadership                                             , Interventions,                                            Vision                                                      Evaluation                                              
It recommends four key interventions:
Restricting access to means- this includes strictly regulating the sales of firearms, commonly abused poisons, medications without prescriptions, keeping a close watch on persons with high risk, removal of all sharp objects from their vicinity, etc.
Helping young people develop skills to cope with life’s pressures- several schools, colleges and workplaces have counsellors stationed in the campuses for the distressed persons to reach out. Life is definitely tougher for our youth, academics excellence is no longer an option and competition is massive. Social media adds on to the pressure, making youngsters even more vulnerable.
Early identification and management of people who are at a risk or who have made a suicide attempt, with regular follow-up: suicide help-lines, mental health professionals, friends, family, co-workers all can contribute their bit.
Working with the media to ensure responsible reporting of suicide: the aim should be to create awareness and alertness only. Care should be taken to avoid gory details that would add to the pain of the survivors. Glorification of the act in any form can yield deadly results in the form of copycat suicides.
We all have to die someday. The goal is not to live forever but to create something that will. Each day presents us an opportunity to do just that. Life is beautiful and very precious. Let us all become stakeholders and prevent this merciless cruel self-destruction. #40seconds at a time, let us each do our bit. Prevention is the only cure!
The author is a Consultant Psychiatrist, Shija Hospitals and Research Institute, Imphal, Manipur and Member, Indian Psychiatric Society- Manipur State Branchcan and be reached at: [email protected]