For a city with one of the highest suicide rates in the country, one would assume that options for immediate help would be many. Far from it, the options here have fixed timings of operations, forcing those in crisis to look for helplines — if at all they do — that work at the national-level.
The State-run Arogya Sahayavani (104), which provides counselling for a wide range of medical issues, also receives calls related to suicide, and is among the few options available 24x7. Those who manage the helplines cite resource availability as a major constraint to expand operation timings.
Akku Pahlajani, coordinator for the Sahai helpline (080-25497777), which functions between 10 a.m. and 8 p.m. from Monday to Saturday, said though there were not many calls during the night time, he admitted that it was a disadvantage to not be available to those in need of help all the time, but they had neither logistics nor resources.
“The helpline started in October 2002. We get seven to eight calls a day from across the country and the world. Earlier, we got only seven calls a week. The number of calls has increased dramatically because of awareness. Most calls of late are relationship issues. The call can last for five minutes or an hour-and-a-half to successfully prevent self harm,” he said.
They are 22 volunteers who work in shifts for three to four hours a day, and operate out of the premises of the Medico Pastoral Association.
For those who call the helpline beyond the work hours, Sahai has positioned ‘helpful artificial intelligent based chatbots’. However, it comes with a rider: “Please note that these chatbots are not affiliated to us in any manner and we do not attest their capabilities.”
Are they really of help? To an extent, said Dr. Mahesh Gowda, Director, Spandana Healthcare, which had started a 24x7 helpline in 2010. “It can be an alternative, but a comforting human voice is better than a mechanised one,” he said.
“We get five to six calls every day for general counselling, though we started it as a suicide prevention helpline. At night, it is around one or two calls per week. We do see a spike in calls around exams or results. Otherwise, the reasons vary from illness to family issues. It is also related to the pressure cooker like chaotic lifestyle in Bengaluru. Even children are left frustrated due to the travel in traffic. For some, it is difficult to accept that their achievements are fewer than their ambition and cannot adapt to failure. Addictions are also a cause,” explained Dr. Gowda.
Maintaining the helpline, especially manpower, is a big challenge, he said. “Seven to eight counsellors, who are taking care of patients, manage the helpline during off-duty hours. They are paid ₹1,500 as extra allowance for this. Helplines should be available round-the-clock as loneliness is common during night time, and those requiring help need a shoulder to lean on. There have been instances where they call us the next day and come for consultation,” he said.
V. Senthilkumar Reddi, Additional Professor of psychiatry and coordinator of the Emergency Psychiatry and Acute Care Services, National Institute of Mental Health and Neurosciences (NIMHANS), said most helplines are NGO-based, while there was nothing at the State or central level specifically for suicide prevention.
“The only State-based helpline is in Kerala, but that is also only accessible to people staying Kerala. The number will not connect for others. NIMHANS does not have a helpline for various reasons. Those who are successfully running 24x7 helplines also say training and retaining manpower is the main challenge,” he said.
Dr. Reddi also explained why employing someone poses its own challenges: “Not just in India, everywhere, the front end staff often experience fatigue and burnout. The strategy adopted in developed parts is an internal debriefing supervised by a mental health professional, where individual counsellors discuss calls in a group with peers. The idea is to brainstorm.”
The fact that many of them do not hear back from those who they have counselled (as identities are not revealed), which leaves them in the dark about whether their counselling bore the desired result, is also stress inducing in crisis intervention, he said.
Creating suicide gatekeepers
Help for suicide prevention could be easily at hand, with the National Institute of Mental Health and Neurosciences’ (NIMHANS) Gatekeepers’ Training for Suicide Prevention.
V. Senthilkumar Reddi, Additional Professor of psychiatry and coordinator of the Emergency Psychiatry and Acute Care Services, NIMHANS, said a couple of thousand people ranging from lay people to teachers, principals, student peer support groups, managers in private companies and government organisations had been trained so far.
“The training is to create gatekeepers within their network because accessibility matters. For example, managers can notice a deviation in behaviour or in the work pattern if an employee takes a lot of days off, and engage with them,” he said.
The half-day to one-day programme is in a workshop format and is multi-modal and interactive, he said. For instance, a mock video of how to interact with a person, identify risk associated with suicide and react appropriately is part of the curriculum.
“In India, a large number of cases are often contextual to the pressure in the environment and poor coping mechanism, as well as maladaptive behaviour, such as alcohol. The intensity of suicidality varies too. So, we help provide skills to gatekeepers to identify the strength of the individual to defer the thought. The community is being empowered and this also reduces the stigma attached to it,” said Dr. Reddi.
The programme is free and the intake for each programme is 20. Interested people can contact the NIMHANS Centre for Well-being.