Mental Health in India: Need for a National Suicide Prevention Strategy that targets the youth

According to the National Crime Records Bureau (NCRB), India recorded over 1.53 lakh suicides, an estimated 418 daily suicides in 2020. This amounts to a suicide mortality rate (per lakh population) of 11.3 in 2020, as compared to 10.4 in 2019. This is the highest number of suicides in the country in a decade and is the highest in the world. Among those who died by suicide, students saw the greatest increase of 21.2% in 2020, compared to a 7 to 8% increase in the past few years. For every death by suicide in India, there are more than 200 people with suicidal thoughts and behaviour, and more than 15 suicide attempts. Keeping in mind that these numbers are only those of reported suicides and that there is no definite data on the number of suicide attempts, the burden of suicides in India may be altogether much graver. The numbers may further be compromised by the rampant stigma attached to mental health and legal complications of suicide reporting that lead to massive underreporting of suicides.

The drastic increase in suicides in 2020 also indicates the adverse impact of the pandemic on mental health. Joblessness, inability to access opportunities, social isolation, among other factors, have led to an increase in stress and anxiety. The situation is worsened by the discrimination associated with mental illnesses that negatively affects help-seeking behaviour, and the lack of information about whom to contact for help.

In terms of gender variance, the suicide rate among Indian girls and women continues to be twice the global rate despite a 40.7% reduction from 1990 to 2019 in India. These deaths are often due to marriage-related issues like dowry harassment, early marriage, forced marriage, arranged marriage, domestic violence and widowhood, thereby highlighting the requirement for gender-friendly mental health services to be urgently scaled up.

For the youth of the country (15-29 years), among whom 1/3rd of all suicides take place, data suggests that one student dies by suicide every 55 minutes, and 1,129 suicides among children below 18 years of age in 2020 were due to failure in examinations. Suicides also account for most deaths in the 15–39 years age group compared to other causes. Increased pressure and anxiety about performing well in examinations and fear of failure among students can translate into increased suicides. The highest political offices in the country must deliberate on introducing context-specific interventions and outline multi-level action priorities for suicide prevention across various sectors. India must also integrate suicide prevention at every level of public health in the form of a national suicide prevention policy at the macro-level. Apart from peer support through parents, families and communities at the individual level need to offer empathetic, non-judgmental listening.

According to the Central Board of Secondary Examination, close to 1.59 lakh students failed in class Xth and 1.34 lakh students failed in class XIIth examinations in 2020. With board examinations approaching, there is a need for setting up systems for universally conducting supplementary examinations that would allow students to re-appear for examinations. Starting helplines that are functional before, during and after examinations can also reduce anxiety among students. Further, initiating conversations about mental health issues in schools and colleges to guide students in dealing with mental health challenges, and creating safe spaces for them to share their problems can also reduce stress, and improve their ability to perform well.

Another challenge is that most research on suicide prevention is undertaken in high-income countries that may have limited applicability in a developing country like India. Promoting national and sectoral research into the reasons for suicide mortality and its rise, and making culturally and economically appropriate suggestions to help mitigate the problem is critical. There also needs to be enhanced emphasis on collating real-time numbers of suicides to understand the severity of the crisis and ensure timely and planned interventions.

Additionally, media reporting can play a significant role in shaping people’s understanding of suicide. During times of distress, media must promote health-seeking behaviour, correct information and counter the possible myths related to suicide. Inappropriate reporting that sensationalizes suicide details, shares the identity of the person who died by suicide and their methods, can lead to higher stigma around suicides and mental health. It can be potentially be harmful to vulnerable populations and cause a 1 to 2% variance in suicides. The reporting guidelines issued by the World Health Organization, and those by the Press Council of India must be followed to ensure responsible reporting norms and proper journalistic conduct.

Despite being entirely preventable, India has been increasingly losing individuals to suicide. The severity of the crisis worsened by the COVID-19 pandemic must be addressed by building a holistic environment for mental health. Undertaking evidence-based interventions that keep in mind the needs of the most vulnerable and marginalized populations, like women and young individuals, providing the required support systems can reduce the number of lives lost and build a healthier response system.

(Dr Virander Singh Chauhan, Distinguished Visiting Professor, Institutions of Eminence, University of Delhi, and Founder ETI; Dr Lakshmi Vijayakumar, Founder SNEHA)

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