Mental Health and rising number of suicide cases: Lack of help and hope

Tamil Nadu had the second highest number of suicide cases in 2020

By Anoushka Sawhney and Sushmita Dey

Trigger Warning: In March 2022, a 21-year-old woman committed suicide after a man started to blackmail her with her bathing videos in Cuddalore district, Tamil Nadu.

In another incident that took place in February 2022, T Kumar, a senior photojournalist at the news agency United News of India (UNI), committed suicide in his office in Chennai. The state was in shock.

The reason was that the media organisation had not paid Kumar's salary for 60 months, wrote Vishwaa Viswanaath, a senior journalist in his tweet.

Tweet link: https://twitter.com/V_Vishwaa/status/1493099920319860738?t=7B-Vv9DgofnWoHDpS-bu6g&s=19

A class 9 student committed suicide in September 2020 due to the fear of online exams, as he was not prepared for the exam that particular day, alleged by the parents.

The above-mentioned incidents have one thing in common, that is, help did not reach them on time, or there was not an intervention at the necessary time.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association (APA), defines suicide as “the act of intentionally causing one’s own death”.

In 2020, according to the National Crime Records Bureau data (NCRB), India reported 1,53,052 suicides, which is an increase of 10.0% from 2019.

The budget for the financial year 2022-23 allocated Rs 670 crores to mental health, which is 0.77 per cent of the health budget.

However, 94 per cent of these funds are for two government-funded organisations, that is, Rs 560 crores for the National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, and Rs 70 crores for Lokpriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur.

Tamil Nadu reported 16,883 suicides in 2020 and is at the second position after Maharashtra for four years.

In 2019, Tamil Nadu had 9.7 per cent of suicides, and in 2020, the state had 11.0 per cent of suicides. A minimum of 36 people commit suicide every day in Tamil Nadu.

The NCRB defines suicide rate as the “number of suicides per one lakh population”. In 2020, the suicide rate for the state was 22.2 per cent.

As per the NCRB data 2020, Tamil Nadu is in the first position in the country regarding family suicides.

As per the data, of all the cities in Tamil Nadu, Chennai has more number of suicide cases, that is, 2,430.

The NCRB data mentions various causes behind suicide, such as indebtedness, marriage-related issues, family problems etc.

Dr. Poorna Chandrika, Director at the Institute of Mental Health (IMH), Chennai, said, “In Tamil Nadu, the culture of suicide is entirely different. There is a temple where they say ‘vadakkai noki’ ,that is, a person will look towards the north, not eat, and lose their life. They also self-immolate themselves and that is considered as a form of martyrdom.”

The method of suicide followed in the state, most of the time, is self-immolation, she added.

Dr. Chandrika said that when Indira Gandhi, former Prime Minister of India, was assassinated, 24 suicide cases were reported.

“They self-immolated themselves, 23 of them were from Tamil Nadu, and one was from North India.”

Everyone was shocked to know that someone from North India self-immolated himself, and later it was found that the person was from TN who went there and started a tea stall.

“So, it forms part of our cultural milieu,” Dr. Chandrika said.

Institute of Mental Health in Kilpauk, Chennai.

According to the World Health Organization (WHO), “for each suicide, there are more than 20 suicide attempts”.

Dr. Chandrika said, “There are certain cases about which we will never know, like drowning. We never know whether those people went in with intent to drown themselves or they accidentally drowned. There are certain grey areas like falling off the top floor; whether a person went to sit there or they fell intentionally.”

In 2014, Chennai was called the suicide capital of India.

The chief of the psychiatry department in the Rajiv Gandhi Government General Hospital (RGGH) in Chennai said that there are many reasons for committing suicide. “Sometimes, suicide runs in the family.” Other reasons include biological reasons, genetic reasons, childhood experiences, social factors, etc., he added.

Rajiv Gandhi Government General Hospital in Park Town, Chennai.

According to NCRB data 2020, out of all the cities, Chennai had the highest number of suicide deaths due to bankruptcy or indebtedness.

Anand Srikanth, Director of Sneha, a suicide prevention organisation in Chennai, quoted Dr. Lakshmi Vijayakumar, psychiatrist and founder of Sneha, and said, “suicide is a very complex human behavior. So many things and so many factors have to go wrong at the same point of time for anybody to contemplate the idea of suicide.”

He added that it is not just one reason, but a lot of other factors or elements involved in that suicide. “What we come to know of is only one reason, but we don't know the mind of the suicider.”

Srikanth said that around 15-20 per cent of the overall calls are by the people in the age group of 11-17. “Around 50 per cent of our calls will be only for inter-personal relationship issues.”

He added that 10-20 per cent of calls will be by people who are going through financial distress and mentally ill people who are suffering from bipolar disorder or schizophrenia.

“Most of the doctors or qualified psychologists don't have the time to spend with the patients or callers. It may hardly be about five-ten minutes, which is why people reach out to Sneha,” Srikanth said. (The people who call Sneha are called callers.)

A doctor at RGGH said, “according to statistics, once you attempt suicide, you have a chance to attempt again.”

She said that according to the suicidal intent scale, a suicide attempt is termed as mild, moderate, or severe.

Access to Mental Health Resources: Stigma, Prevention, Lack of resources & Psychiatrists

Due to prevailing stigma in society, mental health and other related disorders are often hidden by people, and consequently, leads to poor quality of a person’s life.

As per the National Mental Health Survey 2016, over 13.7 per cent of Indian adults from 150 million people live with mental health issues and are in dire need of support services. However, the salient point of the survey estimates that 70 per cent to 92 per cent of people need mental healthcare but are unable to access quality services.

According to the Chief Officer of RGGH, psychiatry department there is a lack of awareness of mental health in the state. It is a public health crisis that needs to be recognised as an issue of human rights.

“People are hesitant to reach out for resources.”

Dr. Chandrika said that both proximity and distil factors led to suicide. Sometimes, if someone is feeling lonely, depressed, or has financial debts and other personality disorders, putting all of these factors together leads to suicide. Apart from that, there’s also an aspect of society playing a big role in taking this step.

When asked, what is the foremost preventive measure to reduce the risk, she explained that when a person who communicates well and takes care of himself, suddenly does not communicate, does not sleep well, and talks to the family in the way by putting him/her out of the picture. If anyone feels there is something wrong, the first step is to talk to them and tell them you need not visit a therapist.

“Just talk to someone about how you are feeling or what you are thinking. Then, the buzziness in the brain will reduce, and they will think that this is not the only way. There are ways in which we can continue living and facing all the problems.”

Dr. Chandrika points out that there are three kinds of prevention strategies - universal, individual, and selective prevention. In the universal aspect, they try to bring more awareness and knowledge about it and reduce access to pesticides.

“Especially in a state like Tamil Nadu, where most of the cases are related to alcohol, the government tries to increase the rates and rations it.”

Under individual and community level prevention categories, the authorities try to teach and provide training to spread awareness among the local bodies of various sectors – to remove the word ‘suicide’ from being known as a taboo.

According to the NCRB data 2020, more students committed suicide in 2020 to a new high of 12,526 than in 2019.

The severity of the crisis in mental health and suicide cases has especially increased in children from the age group of 11 to 23 years. Increased pressure and anxiety about performing well in examinations and fear of failing can translate into increased suicides among students.

On being asked what the school can do to prevent the students from taking this step, Dr. Nandini Raman, Counsellor, Trainer, and columnist at The Hindu, said, “In CBSE, it is mandated that there should be a school counsellor. And every counsellor should enforce their skills and talk to the parents about how they can deal with such conditions, discipline them, and what the procedure could be.”

She added that there should be mandatory parenting sessions at the school with the counsellor. However, Raman pointed out how over the years, while working as a counsellor in various schools and every parenting session, majorly the mothers have shown up.

“But isn’t parenting a shared responsibility?” she said.

“We should have mental health as a topic in our school textbooks, parents should also be sensitised and not put pressure on their children,” Dr Chandrika said.

Suicide Prevention and Mental Health

A city like Chennai, which accounts significant proportion of the state suicide cases, lacks the information on whom to contact when people are in dire need of help. The situation worsened because of the stigma associated with mental illness, which makes it difficult for an individual to seek help.

Post Covid-19 pandemic, everybody has been talking about emotional health and the importance of mental health.

“However, there has to be more awareness or acceptance, and people should be non-judgmental, which is very important. This is generally what I am saying not related to suicide and mental health,” Srikanth said.

He explained how every year, on September 10, World Suicide Prevention Day, Sneha Foundation put stalls to create awareness in suburban railway stations and distribute pamphlets and special training for the railway police personnel to curb the number of cases and save lives.

Srikanth added, “Things have changed in the past few decades, but there is still a long way to go for people to acknowledge or accept the idea of somebody taking psychiatric help or somebody even reaching out for emotional support.”

In a session on ‘Let’s Destigmatize Mental Health’on April 2, 2022, Dr. Murli Krishnana, Occupational Therapist, discussed the measures that should be taken to improve the system, and said, “We should build a supporting system in every sector. Be it a school or a society, as professionals, we work separately, and being caregivers we work separately, so we should work together to build a supporting society for the clients who need our help.”

He added, if someday a professional or an organisation is not available, then, this support system, which will be well-equipped will help those who need it at that moment.

Dr. Thomas P. Ninan, Clinical Psychologist (left) and Dr. Anbudorai, Psychiatrist (right) in conversation on suicide and mental health.

During the same session, Dr. Anbudorai, Psychiatrist said, “As we know, there is a dearth of awareness and mental health professionals, but there are also lots of possibilities to ensure that people should not commit suicide; they should keep living and enjoy life.”

“We should put stalls in malls, create flash mobs, conversations, share movies, songs from YouTube, or have small get-together sessions,” he added.

Dr. Devi, Medical Officer at IMH, said that we should start by improving our existing mental health infrastructure while focusing on training primary health centre physicians to ensure effective integration of service during emergencies to save a life.

“Efforts should be directed towards creating awareness in villages and small cities about recognition of signs of distress, and availability of mental health services,” she said.

If you or the people around are feeling distressed, reach out to the following helplines:

Tamil Nadu state health department helpline: 104

Sneha suicide prevention centre, Chennai: +91 4424640050, +91 4424640060, help@snehaindia.org (10 am - 10 pm)

Other helpline numbers in India: https://snehaindia.org/new/index.php/other-helplines/