Introducing the National Suicide Prevention Policy — ‘Hope through Action’
The recent National Crime Records Bureau (NCRB) report stated that 1.64 lakh people died suicide in 2021. This is 10 per cent higher than the COVID deaths in India 2020, and 6.8 times the maternal death (23800) in 2020. Yet, we have had so much more focus and efforts on COVID protocols and maternal health as compared to suicide prevention. The UN’s Sustainable Development Goal (SDG) 3.4 aims to reduce premature mortality from non-communicable diseases one-third, through prevention and treatment, and promote mental health and well-being. One of the indicators for this is the suicide rate.
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Since the time India became a signatory for The 2030 Agenda for Sustainable Development, in 2015, the suicide rate has increased to 12.0 (in 2021) from 10.6 (in 2015) per lakh population. Given this trend, the government needs to urgently draft the National Suicide Prevention Policy (NSPP) to achieve the target of reducing the suicide rate one-third. A first step in this direction has been the decriminalisation of suicide through the Mental Healthcare Act 2017 (MHCA), which now paves the way for suicide prevention to be a focus area for the Minry of Health and Family Welfare (MoHFW).
Suicide prevention: What the NSPP needs to consider
The NSPP should articulate the need for awareness about suicide as a social issue and reduce the stigma around it. We need more conversations that challenge myths like ‘talking about suicide increases it’, or that it is ‘an individual issue, not linked to the environment the person belongs to’.
Just like the MHCA, the NSPP should also encourage community-based interventions for suicide prevention, meaning services delivered people from the community, who understand the context of the individual and the services are culturally appropriate. Such services should be provided through the Health & Wellness Centres (HWCs) integrated within Ayushman Bharat, as part of mental health services that are offered. Healthcare workers, doctors, police, and the judiciary need to be sensitised, too. This will result in better care and empathetic conversations on suicide. It will help shift the lens from suicide being a medico-legal issue, to one that recognises the social structures (gender, caste, religion, class, or sexuality) that adversely impact certain communities and contribute to suicide.
Marginalised groups in particular are at a higher risk of suicide and self-harm; it is thus important to work on suicide prevention of these groups. This will also underline the fact that suicide is not an individual issue, but a social issue, and requires a psychosocial approach. As the Mariwala Health Initiative’s report Suicide Prevention – Changing the Narrative mentions, suicide prevention needs psychosocial approach where interventions that include both—providing psychological support through counselling and enabling access to social benefits like employment, health services, and education, among other things. For example, to reduce the death among students, while there need to be helplines that can support the needs of the students during crisis/board exams, there will also be need to create awareness about supplementary exams to reduce their anxiety.
Additionally, given that suicide is a complex issue, tackling it will necessarily require inter-sectoral collaboration. The 2021 NCRB data shows that family issues (33.2 per cent), unemployment/indebtedness/career problems (7.7 per cent), health concerns (18.6 per cent) are some of the major causes. To work on prevention, we need the Minry of Women and Child Development, Minry of Commerce & Industry, the MoHFW, among others, to work collaboratively. The national policy must also be designed through a consultative process that has representation from policy makers, psychiatrs, psychologs, NGOs, academicians, survivors of suicide, families of people with suicidal ideation, as well as families who have lost a loved one to suicide. This is not the case currently. Suicide is instead viewed as an individual’s inability to deal with life’s challenges. This is stigmatising and limits an individual in seeking support.
Marginalised groups in particular are at a higher risk of suicide and self-harm; it is thus important to work on suicide prevention of these groups. (Photo: Getty/Thinkstock)
It’s important to look at suicide as a health and wellbeing issue, and adopting a public health approach to suicide prevention will enable us to do so. For this, we first need to understand the issue well, and highlight the responsibility of the healthcare system to provide services for care and recovery. In order to design effective programs, we also need widespread rigorous data, not just on deaths suicide, but also attempted suicides, which will highlight its causes. Building this knowledge on causes and approaches to suicide prevention will ultimately improve the quality of care that people with suicide ideation or survivors of suicide receive. Especially if skills of social workers are also developed to provide adequate support and care. Taking a public health approach will also enable us to look at the accessibility of services, and equity within service delivery.
The government can create hope for suicide prevention introducing a National Suicide Prevention Policy that has a psychosocial, public health and community-based approach that recognises the social determinants to accessing care and support, and centres the lived experiences of survivors of suicide, suicidal ideation or families bereaved suicide.
(Priti Sridhar is the CEO of Mariwala Health Initiative (mhi.org.in), which is a personal philanthropy of Harsh Mariwala, chairman Marico Limited. MHI is a grant making, advocacy and capacity building organization with a focus on the mental well-being of marginalised persons. Read MHI’s report on suicide prevention ‘Changing the Narrative’ here.)
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