Building a community-based approach for sustained suicide prevention in India

India accounts for 17.5 per cent of the world’s population and yet sees more than 25 per cent of global suicide deaths. Such reportage is frequently accompanied discussions around suicide helplines or crisis-lines, as well as expert opinions from psychiatrs or psychologs. This is a dangerous over-simplification that narrowly focuses on the individual, one factor (mental illness) and one point in a trajectory (acute crisis).
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To illustrate, suicide helplines tend to be designed for those who may be in acute dress or at risk of attempting suicide. While such services are critical, they are not the panacea for suicide prevention. The same applies to looking toward psychotherapy or psychiatry as a one-size-fits-all approach to suicide prevention — especially if such services are de-contextualised and expert-led. This is because suicide is a complex problem that cannot be separated from social, cultural, economic, political and horical contexts.
In the last few days, reported suicides and suicide attempts have included six farmers dying in Vidarbha, Maharashtra due to crop failure and inability to access loans, to seven factory workers attempting suicide in Bhopal, Madhya Pradesh over non-payment of wages for months on end. These examples are indicative of the larger picture — the National Crime Records Bureau (NCRB) reports showed that in 2021, Maharashtra had the highest number of deaths suicide of persons working in agriculture. The same report showed that 25.6 per cent of suicide deaths in India were daily wage earners. That is one in every four deaths suicide in india in 2021.

Dress, crisis and suicidal ideation arising from challenging life circumstances such as poverty, systemic social exclusion, structural violence, and discrimination, cannot be addressed solely through medical diagnoses and interventions. Thus, suicide prevention necessarily requires an intersectoral, multifactorial and decentralised, community-based approach. Community-based care involves individuals from communities or local organisations providing support and services to those in need of care.
If India is to undertake comprehensive suicide prevention efforts we must look beyond acute crisis services. (Photo: Getty/Thinkstock)
A community-led approach to suicide prevention would include both — providing psychological support through counselling, and enabling access to social benefits like employment, health services, and education, among other things. One such program run Shivar Foundation follows such an approach to work with farming communities in Osmanabad, Maharashtra. Funded and supported Mariwala Health Initiative (MHI), Shivar trains local, community volunteers to create awareness about suicide, talking about common stressors that farmers experience, providing psychosocial first-aid; sharing details on government schemes; enabling access to cash support, credit, and farming equipment. Apart from this in-person outreach, they also run a psychosocial helpline for farmers as well as Farmers’ Friends Centres for people to drop-in. With over 550 local, community volunteers addressing dress, through counselling, advocacy, links to markets, debt relief and even seeds over the last 2 years, 4670 farming families have accessed these supports.

Such an approach enables services and support to be available where people already are, making such programmes accessible during times of crisis. Not only does this reduce the need for costly, expert-led interventions, but also reduces the cost of accessing care for individuals — both of which are important in low-resource settings. This way of working leverages the exing expertise of communities to create a collective effort to address not only crisis situations, but also to provide support to prevent crises from arising in the first place.
This is also the rationale behind the Suicide Prevention & Implementation Research Initiative (SPIRIT) program Centre for Mental Health Law and Policy which runs in 116 villages in Mehsana, Gujarat. One important facet of SPIRIT is a school-based suicide prevention program among students who are 14-16 years of age. The ‘Youth Aware of Mental Health Program’ training focuses on this age group because trends in South Asia show that from the age of 15 onwards, suicide rates begin to increase.

Delivered school teachers who are trained master trainers, this intervention involves workshops, active roleplay and educational posters related to mental health and suicide, in local languages. This training enables youth to understand their mental health, ways to reach out for help, and also, how to talk to a peer who may be in dress. The examples of community-based work shared above can be very effective at encouraging public conversation, helping combat stigma, and providing culturally-appropriate support.
Community-led models may also be appropriate in supporting people bereaved suicide. Research has shown that family and friends are at an increased risk of suicide themselves. A suicide death can affect those beyond immediate friends and family to others and even an entire community. Tamil Nadu, one of the top three states contributing to suicide deaths in India is the location of a Project SPEAK — a community-based program to support those bereaved suicide –a ‘postvention’ M.S. Chellamuthu Trust and Research Foundation.

This MHI-funded program aims to provide both short-term and long-term support to the bereaved, which includes both psychological support and psychosocial referrals for their various needs in the aftermath of a suicide (including financial, legal, educational support, funeral expenses, etc.). Alongside these services, 20 community stakeholders are sensitised on suicide prevention and can hold community awareness meetings on suicide prevention, as well as support groups for those affected.
The above community-based examples illustrate that local and contextual knowledge and empowerment are key to addressing multiple factors that lead to suicide and its trajectories — whether prevention, intervention, crisis response or postvention. If India is to undertake comprehensive suicide prevention efforts we must look beyond acute crisis services and biomedical, expert approaches to community led work that is contextual and based on lived experience.
(The writer is the director of Mariwala Health Initiative (MHI.org.in), which is a personal philanthropy of Harsh Mariwala, chairman, Marico Limited. MHI is a grantmaking, advocacy and capacity building organisation with a focus on the mental well-being of marginalised persons. Read MHI’s report on Suicide Prevention: Changing the Narrative – here)
If you are feeling suicidal or have suicidal thoughts, help is at hand — please contact Sneha Suicide Prevention helpline – 044 -2464000 (24 hours)

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