The loss of hope

Despite a mountain of evidence testifying to the huge toll of suicide in our youth and the knowledge of effective interventions to prevent suicide, there remains no coordinated effort to address suicide as a public health issue in India.

March 03, 2016 12:19 am | Updated 12:19 am IST

The recent > suicides of three young women students in a medical college in Tamil Nadu citing the appalling conditions in their institution add to the mounting toll of suicides among young Indians in the past year. Consider just a few examples that have hit our headlines: the suicide attempts > by four female athletes in a sports facility in Kerala; the 29 suicides of youth preparing for national entrance exams in > coaching institutions in Kota ; > the suicide of Rohith Vemula in Hyderabad; and the most recent > loss of Saira Sirohi , a national-level swimmer, in Ghaziabad.

Each of these events has been extensively dissected as discrete events, with commentators emphasising the relationship of the deaths of these young people to the particular social problems they found themselves struggling with, from caste-based oppression and gender discrimination to the pressures of academic performance and the abject failure of the systems intended to hold private institutions accountable for the quality of their education. In the din that has surrounded each of these tragedies, with the predictable hysteria in TV news debates and the slugfest between rival ideological camps, one common thread running through all of these suicides has escaped our collective attention: the loss of hope in the young educated victims trapped in a system that had failed them.

The vulnerability of youth There is little mystery about the burden of suicides of young people in India. We now have numerous reports, from the National Crime Records Bureau as well as independent investigations of mortality, which show that suicide is a >leading cause of death in young people . The scale of the carnage is immense. The latest government data suggest about 60,000 deaths of youth each year; with independent studies showing that these data underestimate up to a third of youth suicides by misclassifying them as accidents — the true figure may even approach 1,00,000 a year.

To be sure, suicide is also a leading cause of death among young people in other countries. The reason why youth is a vulnerable period for suicide globally is because this is the phase of life which is characterised by impulsive behaviours, is associated with dramatic changes in one’s self-image and aspirations, and is when some of the most important life decisions related to education and relationships are made. This is why suicide attempts in youth, unlike suicide in older adults, are often impulsive — triggered by acute disappointments such as a poor examination result or the loss of a romantic relationship. In some instances, there is a history of a longer-term period of social problems precipitating a clinical depression. A convincing body of research has shown that the epicentres of youth suicide are in the most developed States of India, for example in the south of the country. One may speculate that a key reason for this is the growing gap between the aspirations of educated youth, for example to freely choose their life partner or live a life free of social prejudices, and the reality of a harsh, inflexible, and uncertain society in which they find themselves trying to find a foot.

Suicide is preventable No matter whether the suicide was impulsive or well planned, one thing is for certain: no one attempts to end their lives unless they have lost hope for their future. Other countries have implemented a range of interventions which target not only the social circumstances that trigger the hopelessness that leads to suicidal acts, but also the more immediate individual interventions to help young people recover their hope to live. These countries have shown that though the feelings of hopelessness are universal, suicide is also preventable.

Despite this mountain of evidence testifying to the huge toll of suicide in our youth and the knowledge of effective interventions to prevent suicide, there remains no coordinated effort to address suicide as a public health issue in India. Thus it comes as no surprise that the suicide rates in young people in India are among the highest in the world. In this regard, our response to these tragedies is similar to that of suicides in other groups in our society. This is no better illustrated than by the discourse on farmer suicides being viewed almost entirely through a socio-political lens. Similarly, the response to the tragic suicides of the parents of a young child who had died of dengue in New Delhi in September 2015 focussed on the actions of the hospitals which denied admission to the dying child; there was no attention to the fact that the suicide of the parents might have been prevented with appropriate counselling. It seems that our gut response to each suicide tragedy, not least in our news media, is to hold someone responsible for the social factors that trigger the loss of hope. Sadly, we never question whether the suicide might have been prevented had there been enabling circumstances for the recovery of hope and what lessons we may learn to prevent further suicides.

One may question that if social factors play such a significant role in understanding suicidal behaviour, why should we focus on interventions targeting individuals? Some argue that this may even divert attention from the social forces that must ultimately be held responsible for all suicides. The reason is that most young people who are exposed to the same social factors do not lose hope and, if they do, they do not attempt to end their lives. The vast majority of young people in the same tuition factories of Kota or in the decrepit medical college in Tamil Nadu survive their ordeal and move on. Self-harm behaviour is a relatively rare outcome of a unique confluence of factors in a particular individual, both social and related to psychological well-being, and we must target both of these if we are to prevent suicides.

Strategies to stem suicides We know what these strategies should be: an open dialogue to challenge the stigma surrounding mental health; the building of life skills in schools to strengthen emotional regulation, which can help build resilience to cope with the periods of loss of hope that are inevitable in the transition from childhood to adulthood; parenting interventions to reduce the pressures on young people to perform academically and to choose their intimate partner; ensuring freedom from violence, gender discrimination, and social exclusion of youth, not least in campuses; a campaign to ensure the safe storage of pesticides, the most commonly used method for suicide; and easy access to trained personnel to deliver psychological treatments in educational institutions and health-care facilities.

Last week, at a function celebrating the 30th anniversary of SNEHA, the pioneering Chennai-based suicide prevention NGO, R. Seshasayee, chairman of the Board of Directors, Infosys, commented that the spate of suicides in youth was the collective responsibility of society. Indeed, we need to fix many aspects of our system if we are to stem this tragic tide. Not least, I hope some of the passionate debate about suicides might be diverted to fix the health-care system which fails our youth, the future of our nation, when they lose hope. While creating a socially inclusive and just society must remain our ultimate vision, a life saved today is just as important as the many we seek to save in the future.

(Professor Vikram Patel is a psychiatrist at the Public Health Foundation of India and the London School of Hygiene & Tropical Medicine and is co-founder of Sangath, a Goa-based mental health research NGO.)

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