Creating Hope through Action

According to the World Health Organization (WHO), 700,000 people die due to suicide every year. Suicide is the second leading cause of death among people aged 15-29 worldwide. There are 40 attempts for every suicide that results in death. It is one of the preventable serious public health problems. Untreated and undiagnosed mental illnesses are the provocation for a suicide. Hence, it is considered as one of the silent or hidden epidemics.

The ongoing pandemic, the uncertainty of one’s life, the pain of bereaved families due to COVID 19 have a huge impact on our mental health. The loss of family members and friends, fear of getting infected with the ghastly virus, incurred loss in business, the prolonged lockdown, jobs at stake, deprivation of meeting loved ones have spiked mental health issues. Mental health disorders like depression, anxiety, phobia, post-traumatic stress disorders (PTSD), psychotic disorders, mood disorders are on the rise due to the pandemic. Thye pandemic has played a crucial role in affecting the rates of suicide. Higher suicide is seen among the women and younger age group, migrant workers, marginalized and disaster-affected population. Along with the COVID -19 pandemic, a global mental health problems outbreak has soared up way high.

Stigma and discrimination of people towards mental illness are one of the major reasons this disease is being hidden. Where people are ready to sacrifice their entire savings for physical illness, mental illness is perceived as a “weak mind” or “spiritual dysfunction.” Knowledge and awareness about mental health among the people is very crucial to save them from the internal struggle.

The International Association for Suicide Prevention with the motto of saving lives celebrates September 10 every year as the World Suicide Prevention day. With the theme this year, “Creating hope through action”, this day is being celebrated by lighting a candle in the memory of everyone who lost their life. The main motive of celebrating this day is to research suicidal behavior, diagnose the cause and develop sound policies and actions for the prevention of suicide. WHO Mental Health Action Plan 2013-2020 has the global target of reducing the suicide rates in countries by one-third by 2030.

According to a study conducted by Nepal Health Research Council, before the lockdown, the prevalence of suicides, lifetime suicidal attempts, and future likelihood of suicidal thoughts was found to be 7.2 percent population in Nepal.

Nepal lacks reliable data on the deaths due to suicide. The data are based on the police reports and many cases are left unreported due to which there is the possibility of gross underestimation.

To plan the specific prevention strategies, it is very important to follow the pattern of risk factors and try to eliminate them. Some of the strategies implemented in Nepal are immediate clinical interventions for the suicidal survivors within 24-hour vigilance, restriction of import of toxic pesticides like Organophosphates (common means for suicide), attempts to reduce the harmful use of alcohol by increasing taxation and controlling the illegal production. Since young children are the most vulnerable groups, preventive measures like accessibility to information, including mental health in school curriculum, and mental health awareness programs should be conducted at the schools and colleges.

Proper surveillance and intervention of suicide prevention strategies should be implemented at the local, provincial and national levels. Creating awareness among people about the prevention of self-harm with appropriate help and counseling should be widened in communities. Community-based health programs should be scaled up. Promotion of help-seeking behavior should be done by training Female Health Care Volunteers, maternal and child health workers, primary care providers on high-risk suicidal behaviors, and basic psychosocial support. Mental health care should be made approachable by the people. So, hotline numbers that have been available in certain districts should be made available nationwide 24 hours a day which can play a huge impact in saving the attempts. The policy formulated by the government should be enacted.

The Ministry of Health and Population (MoHP) developed the Community Health Care Package Nepal, 2074 which is guided by the principles of mental health into primary care and the WHO Mental Health Gap Action Programme (mhGAP). The MoHP has been scaling up nationwide community mental health programs based on this package. To ensure the availability and accessibility of mental health services for all of the population of Nepal, and in particular, for the underprivileged and vulnerable groups, mental health services have to be integrated into the general health services system of the country.

Seeking proper help in time can save lives. With proper treatment and counseling, one can lead a normal life. Identification and treatment of mental disorders at the right time should be the core strategy to prevent suicide. So, strategies with concrete plans should be implemented by the government with the participation of the community. An integrated approach like psychosocial and economical interventions, community participation, formulation of plans and policies are needed to be implemented at the national level to save the lives of people from self-harm.

American Psychologist Marsha M. Linehan has said, “Responding to a suicide attempt by insisting that it must stop, and devoting the full resources of therapy to preventing it, is a communication with compassion and care at its very core.”

(The author is a final year resident at the College of Medical Sciences, Bharatpur)