The will to live

The world is celebrating mental health awareness week by putting a voice to a topic often shrouded in silence. In Sri Lanka mental health problems are extremely hard to track but one indication could be suicide rates, usually preceded by depression.

Sri Lanka’s consistently high suicide rates have long been a problem without a solution. Last September the country was ranked fourth among 172 countries in suicides by a report released by the World Health Organization (WHO), throwing a disturbing light on a massively complicated issue.

Sri Lanka had a shocking 28.8 suicides for every 100,000 people. The most suicide-prone countries were Guyana (44.2 per 100,000), followed by North and South Korea (38.5 and 28.9 respectively). Sri Lanka narrowly avoided becoming the third highest country by the thinnest of margins, highlighting the urgent necessity of bringing this massive social problem onto the discussion platform.

The report said a person commits suicide every 40 seconds somewhere in the world, an avoidable tragedy that fails to grab attention because of taboos and stigma. The same reasons are found in Sri Lanka, where suicide and contributory factors such as depression and poverty are not brought under the microscope. The absence of positive publicity and empathy along with an inclusive, well-funded and long-term assistance program is also worsening the situation.

In the South-East Asia region, the estimated suicide rate is the highest compared to other regions. Suicide rates show a peak among the young and elderly. Most suicides in the world occur in the South-East Asia region (39% of those in low- and middle-income countries in South-East Asia alone) with India accounting for the highest estimated number of suicides overall in 2012. Suicide by intentional pesticide ingestion is among the most common methods of suicide globally, and is of particular concern in rural agricultural areas in the South-East Asia region.

Such a trend was also observed in Sri Lanka several years ago, resulting in stronger regulation and monitoring of pesticide distribution. However, reducing access to the means of suicide is only one way to reduce deaths. Other effective measures include responsible reporting of suicide in the media, such as avoiding language that sensationalises suicide, avoiding explicit description of methods used, and early identification and management of mental and substance use disorders in communities and by health workers in particular. This is lacking in Sri Lanka, with the majority of health workers having little or no training to indentify and treat such issues.

Follow-up care by health workers through regular contact, including by phone or home visits, for people who have attempted suicide, together with the provision of community support are essential because people who have already attempted suicide are at the greatest risk of trying again. In such a scenario, reducing stigma and providing the environment for these people to lead normal lives is essential.

WHO recommends that countries involve a range of government departments in developing a comprehensive coordinated response. High-level commitment is needed not just within the health sector but also within education, employment, social welfare and judicial departments. Sri Lanka as a WHO member State has committed to work towards the global target of reducing the suicide rate in countries by 10% by 2020. Now that the former Health Minister is president this should be a policy that transcends 100 days.