Understanding and preventing suicides

One in every 100 deaths globally is the result of suicide. Every year, in order to prevent this global epidemic, the International Association for Suicide Prevention (IASP) marks September 10 as World Suicide Prevention Day. This year's theme, ‘Creating hope through action’, is focused on collective action and collaboration to prevent suicides worldwide. 

According to the World Health Organization, suicide claims over 700,000 lives annually; the number of people who attempt suicide is even higher. A vast majority of these deaths — 77 percent in 2019 — occur in low- and middle-income countries. It is the fourth leading cause of death among the 15-19 age group. These are not only substantial numbers but also unique stories and experiences linked to culture and context. 

There is evidence that countries in Asia have higher suicide rates than the global average with a huge gap between the magnitude of the problem and the means to address them effectively. Thirty-nine percent of global deaths from suicide occur in the South East Asian region. The absence of national-level data on the prevalence of suicide in Asian, primarily South Asian countries, only makes it more challenging to understand the issues and take appropriate action. Many Asian countries, including Nepal, face multiple challenges when confronting suicide, ranging from a lack of adequate medical facilities and accessible preventative measures to social stigma against mental health problems. As a result, mental health issues remain hidden and suicide is unreported or underreported. 

Different disciplines explain suicide differently. These include from the clinical, pathological, individual action to a social and global health perspective. An early attempt to study suicide from a social science perspective came in 1897 when Emile Durkheim first published his book Suicide: A Study on Sociology. The book illustrates the vital role of social factors in triggering suicides. Durkheim explains, “Suicide rates vary inversely with the degree of integration of the social groups to which the individual belongs”. 

Although suicide has long been a subject of sociological inquiry, the effort to better understand suicide from a sociological perspective has been inconsistent. This has resulted in a weak response from sociologists in particular and anthropologists and other social scientists in general, to engage in designing policy and the national research agenda to reduce suicide by identifying key sociopolitical. In addition to individual-level mental health issues such as depression and anxiety, a wide range of social factors play a crucial role in shaping the risk for suicide. WHO, thus, suggests an integrated effort, as well as a multi-sectoral commitment to combat the rising rate of suicide. 

In Nepal, the number of annual suicides has been steadily increasing over the years. But this has not been met with a corresponding increase in services, facilities, and support systems such as awareness programs. 

In 2012, Nepal was placed seventh in the world with an over 24 percent suicide rate in the country, second in South Asia after Sri Lanka. According to the 2018 National Mental Health Survey, approximately 20 to 30 percent of Nepalis are at risk of one or more mental health problems, which in turn places them at risk of suicide. The prevalence of suicide is reported to be over 8 and 10 percent among adolescents and adults, respectively. 

Evidence suggests a range of risk factors leading to suicidal ideation, including family disputes, academic failure, financial hardship, and low coping skills. There is thus a demand for a holistic understanding of the etiology and social epidemiology of suicide within the wider socio-political context of the community and the country at large.

In more recent times, COVID-19 has only exacerbated the situation. The pandemic not only put a strain on our public health system but also disrupted the everyday lives of millions of people living across the country. As a result, many lost their jobs and livelihoods, leading to much uncertainty and triggering mental health issues such as anxiety and depression. For a substantial population, the pandemic and the lockdowns exacerbated the condition of those who were already suffering from mental illnesses. 

According to data from the Nepal Police, at least 20 people died by suicide every day during the lockdown imposed by the government in 2020 to control the spread of COVID-19. Even before the lockdown, the figure was at 15 per day. This alarming situation not only indicates the burden on our health system but also calls for a concrete effort to associated services to prevent deaths by suicide. 

But neither mental health issues nor suicide has received the necessary attention, both from the health system and society at large. Consequently, they have neither become social issues nor have our health systems attempted to deal with mental health problems. The unavailability of specific national-level data is itself evidence of the serious lack of research and scholarship in the area of mental health and suicide in Nepal. Social stigma continues to lead to under-reporting when it comes to suicide. 

Further, the social determinants of mental health issues have not received adequate attention, resulting in inadequate and ineffective awareness-raising programs and interventions. While awareness through public outreach programs and a few pieces of research have emerged in recent times, they are inadequate, compared to the complexity and magnitude of the problem.

Despite the restructuring of health systems, quality services to prevent, control, and treat mental health illnesses in the community are still lacking. The majority of people living across the country do not have easy access to mental health services. This is equally true in the case of counseling and preventative measures needed to control thoughts of self-harm and suicide. Available services are only limited to urban areas. 

Suicide is not only a medical issue but a major public health concern with deep socio-economic and psychological implications. Thus, it calls for a collective effort from concerned authorities, including the media, civil society organizations, and professionals from different sectors. WHO’s Mental Health Action Plan 2013-2020 aims to reduce suicide rates by one-third by 2030.

The social determinants of health also demand equal effort and attention. Thus, efforts should be made to strengthen the health system and service delivery, including preventive, promotive, curative, and other aspects—with adequate focus on the local health system. 

Finally, an interdisciplinary perspective should be adopted to develop and implement appropriate surveillance mechanisms and suicide prevention strategies at all tiers of government, with concurrent efforts to research mental health issues. This would not only contribute to understanding the issue in-depth but would also help to promote appropriate solutions in a historically neglected sector. 

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If you or anyone you know is considering suicide or having mental health issues, it is important to reach out to health care professionals. The following hotlines can help:

National Suicide Prevention Hotline: 1166

Tribhuvan University Teaching Hospital suicide hotline: 9840021600 

Patan Hospital crisis helpline for suicide prevention: 9813476123 

The Transcultural Psychosocial Organization: 1660010200