Suicide accounts for one out of every 100 fatalities globally. It has the potential to influence each and every one of us. Every suicide is heartbreaking and has a lasting impact on those who are left behind. We can, however, reduce suicides throughout the world by raising awareness, lowering the stigma associated with suicide, and promoting well-informed action. World Suicide Prevention Day is an opportunity to increase suicide awareness and encourage action via proven methods to reduce the number of suicides and suicide attempts throughout the world.
According to WHO, more than 700 000 people die by suicide every year. Furthermore, for each suicide, there are more than 20 suicide attempts. Suicides and suicide attempts have a ripple effect that impacts on families, friends, colleagues, communities and societies.
Medically Speaking spoke with a team of experts to examine this significant, yet often overlooked subject, the mental health concerns that contribute to it, as well as the probable early indicators and its treatment.
Here are a few snippets from the interview:
Why is mental health becoming a cause of concern?
Dr Sandeep Vohra: Mental health has long been neglected, but since the pandemic, it has risen to the forefront, and everyone must pay attention to it since it is clear from all aspects that people are stressed. According to an Indian government study, we lost a person to suicide every 4 minutes in 2019, and we lost 1,40,000 individuals in total. If these are pre-pandemic statistics, you may guess what the post-pandemic figures would be. Suicide is a widely underreported issue, owing mostly to the societal taboo of revealing the suicide death of a cousin or family member. Mental health problems are growing as a silent epidemic and must be addressed once the Covid-19 pandemic is cured. We need to understand that unless there is brief emphasis on Mental Health and the fact that Suicide is preventable, these figures will continue to rise.
Would you agree that loss of near and dear ones to Covid is adding to the anxiety and depression of people, thus making them susceptible to take such steps?
Dr. Akansha Batra: I agree that Covid has cost us jobs and businesses, and there have been reports of domestic violence and parenting issues, as a result of which many individuals have begun to have health worries. A lot of the time, we’d have patients who were just talking about small symptoms that they’d observed, and they’d get all worked up in their heads, causing them a lot of anxiety. There was also a great deal of anguish at the loss of those who were close to them. As a result of all of these factors, as well as a lack of support, individuals are taking such severe measures. Suicide and depression warning signals are not being recognised.
When does the situation, their mental health started deteriorating, how significant is it to catch the early signs and to provide the support to those who are vulnerable?
Dr Harpreet Kaur Bhan: It is critical to detect the early indications of depression, which can progress to more serious actions such as suicide. Because of the taboo, many individuals in our environment avoid discussing it.
Sadness, weeping, lack of interest, and energy are early indications, and the individual will seek treatment or tell friends or family that “I don’t want to live” or “I’m worthless.” Symptoms such as hopelessness, helplessness, not eating, sleeping well, not attempting to talk to anybody, or trying to be alone might help you recognise that there is a problem and that the individual requires professional assistance. It is critical that you make time for that individual.
It is a widespread myth that depression and mental health disorders are disease for the rich and the privileged because they have nothing better to do. How would you like to debunk this myth considering it is such an important day
Dr. Jyoti Kapoor: People have so many myths and misconceptions around mental health issues that they are still questioning themselves. People have this notion that our feelings and emotions should be in our control. Like if someone is feeling sad, then people will say things like “you can’t be sad,” “get yourself out of this,” etc. There are many parents who come to us with their kids and say that they always keep thinking negatively and being sad, to which we, as doctors, have to say, “Who wants to feel sad? No one does.” We have to understand that the brain and our nervous system are a part of our body and they contribute a lot to how we feel. That is the function of it. If we are not able to feel good and think positively, it can be a neurochemical disorder because that’s what it is. This is just like when we go to the doctor for stomach problems or other problems, we need to go to the doctor for brain problems as well.
Have you noticed apprehension amid the patients that they could probably be suffering from depression?
Dr Sandeep Vohra: Some of them may be hesitant because, in a depressed state of mind, the brain is difficult to make a choice due to feelings of pessimism. Suicidal ideation, like diabetes and hypertension, is curable and preventive. Just as blood sugar and blood pressure are examined, a mental figure examination can detect depression, for which we have medicines and treatment. Many people can be prevented from taking this step if they are intervened on time. Where people are hesitant to share their issues for fear of being criticised, the element of treatability must be examined. If you have a depressed family member, it is advisable to start a polite dialogue and urge that individual to speak out. Even if suicide is spoken casually, it should be taken seriously and professional aid should be sought.
Do you face resistance when it comes to prescribing medication and following through?
Dr. Akanksha Batra: We would frequently advise patients to begin taking medication or send them to a psychiatrist during counselling sessions. So they have a lot of doubts, such as if these drugs will be addictive because they would be used for the rest of their lives. Would I be taking it for the rest of my life? Are they going to call me insane? Will I be sleeping the entire day away? What good will it do me? Resistance to medicine is common, but we’ve also seen resistance to counselling. The psychiatry department is not a place where people desire to be seen. There is also the taboo of secrecy or not visiting a psychologist or psychiatrist. So we need to do a lot of counselling for the care givers and the patient themselves regarding the medication as well as the treatment of the disorder.
Dr Sandeep Vohra: If someone says that mental health medicines are addictive, ask them if people who take diabetes or blood pressure medications are also addicted to them. Long-term medications can save lives in some situations if the disease is severe. Fortunately, the government has begun tele-consultation as a result of the Covid epidemic, which can tackle social taboo component as well as anonymity. For those who are hesitant to talk about their problems, digital mental health is the way to go, and these services are available across the country. Keep in mind that life is really valuable.
What are the early signs which one needs to watch out for? Depression and anxiety are a few symptoms, but there are many who are suffering silently because of the social stigma and taboo around mental health issues. The second is also because of the stigma and the resistance in the minds of those who are around the patient to begin with.
Dr Jyoti Kapoor: Yes, we all know that 90 percent of the people who commit suicide have mental health issues, so this is a significant thing, plus, according to statistics, most of the suicide cases are happening in the age group of 15–39 years, which is a very young age. So when young people come to us, they don’t only have depression or anxiety, but a number of issues that can cause suicidal tendencies. Coming to the signs of suicide, one is that someone is talking about suicide. Things like “life is not worth living” and “what’s the point of living?” have to be taken seriously. Second, behavioral changes, such as someone who used to be a talkative and funny extrovert who has started withdrawing and trying to be alone; another sign can be that a person starts talking about death more often, someone who starts reading literature about death and all; and the third important sign is that someone starts taking drugs, liquor, or other things more frequently and believes that we have seen the signs, then there are many suicide screening tools that are available which have very simple questions with which you can know that a person is having suicidal tendencies.
Once you have been able to detect that a person indeed has you suicidal tendencies, what would be the first immediate step which should be taken? What would be your advice to their family and friends?
Dr Harpreet Kaur Bhan: It is important to send a person with suicidal inclinations to a psychiatrist. We also recommend that they be admitted to a hospital since such patients require special attention. We can’t leave the patient alone, even if it’s in the restroom or sleeping. Sharp items, cables, and even medications should not be near them.
If someone does have suicidal tendencies, what is the diagnosis for it and how are they treated?
Dr Sandeep Vohra: Suicidal ideation, Suicidal Attempt, and Suicidal Gesture are the three elements of this. Suicidal ideation may be a temporary setback in one’s life that may be resolved with a dialogue with someone. Suicidal Gesture is when someone tries to call for aid by slashing their wrists or injuring themselves in some way, but the injury is not significant. Suicidal attempt occurs when a person attempts to hang themselves or takes an overdose. The intensity of the symptoms determines the treatment for each of them.
Suicide attempt with a suicide note is a highly serious disorder that should be treated in a psychiatric facility. There, we begin pharmacotherapy and psychotherapy, which is beneficial not only to the patient, but also to the patient’s family members. If a patient’s life has challenges, we strive to address them through counselling. Suicidal ideation or suicidal gestures can be treated on the OPD basis or with medicines and combinations, depending on the patient’s and psychiatrist’s preferences. The greatest thing is that these levels of severity can be treated, but therapy must be taken seriously.
If the doctor advises, medicines should be followed up and treatment should not be left in between because it is seen that patients tend to become non-compliant towards the treatment.
If someone is on the path to recovery, what should they do to ensure the relapse and what should be the way forward?
Dr. Akanksha Batra: Regular counselling, psychoeducation of caregivers, parents, and family members, keeping yourself occupied with things that interest you and being more optimistic about the future, talking it out and taking your life seriously, talking with your counsellor, and adhering to and complying with the treatment, as Dr. Vohra stated, should be the steps to recovery.
Looking at the statistics, we know that suicide is very common among children between the ages of 15 and 29. This is a time period when children are very vulnerable and very emotional, so what will you advise parents who have younger children and who don’t seem to behave normally the way they used to?
Dr Jyoti Kapoor: I am glad that we are talking about this today because education and awareness are the first steps. We accept this fact that suicide is a reality. It doesn’t happen to our neighbor, it doesn’t happen to people in another city, but it happens to everyone and we understand that suicide is not because of certain thoughts or ideations. According to the suicide theory, there are two ideas. First is the thought and the feeling of anxiety, sadness, depression, etc., and second is the availability of opportunities, like the availability of some accessories like blades, ropes, fire arms, etc. And talking about suicide in a very sensational tone also triggers the person who is suffering to end up committing suicide. So people should be sensitive towards each other and parents and teachers should keep a check on the kids. We should keep this in mind that this is a treatable condition rather than thinking about it as I am a weak person and I am good for nothing. Parents should understand that saying things like, “How can you think like this?” etc. So we should talk about it in a very neutral manner, in a very non-judgmental manner, so that the person who is going through this can think about it. And third, the reason behind committing suicide is not just about being depressed or anxious. There are people who have certain disorders and conditions in which people don’t want to commit suicide but they keep getting these thoughts and hallucinations about committing suicide. So awareness, education, and reaching out for help are the things that I want to convey to the people out there. The final thing that I want to convey to the people out there is that just talking to a phycologist or a psychiatrist won’t put any label on your head, so please go and talk as it can help you to a large extent and can give you relief.
How do you deal with someone who is influenced by entertainment industry or media claims? How significant do you think it is to not talk about the mental health issues frivolously?
Dr Hapreet Kaur Bhan: Some people are born with suicidal inclinations, while others develop them as a result of a traumatic incident in their lives. When it comes to younger individuals, they pick up on what other people are doing by watching them. So, depending on the situation and age of the individual, we strive to assist and treat them. The basic goal is to confront your negative ideas, since people who are depressed have a lot of bad views about themselves and the environment around them. As a result, dealing with negative ideas, returning to reality, and thinking properly is a problem. When someone has a metal health problem, they are almost always having trouble with their cognitive processes and perception.
What should a person whose mental health has not deteriorated to anxiety and depression, do to channelize their energy positively?
Dr. Akanksha Batra: Identify the sources of stress in their environment. When we work with someone who is depressed or anxious, they often have negative, illogical thoughts. Try to get them to think rationally about it, to be sensible in their thinking. In general, counselling includes not only patients, but also family members, and instructs them on how to assist the patient in dealing with bad ideas.
Theme for the World Suicide Prevention Day is “Creating Hope Through Action” this year. What action is necessary to create this hope?
Dr Sandeep Vohra: The severity of depression influences whether someone is willing to seek counselling or need medication and treatment, which should be determined by the doctor. Second, impulsive suicides are common among teenagers, as well as individuals who are drug addicts or alcoholics. I appreciate NewsX bringing this out, but sadly, media statements have a negative impact on many people’s mental health. The World Health Organization has released a recommendation on this, and just as your channel is delicately treating this topic, other media outlets should do the same and encourage people to get treatment.