The 2015 World Suicide Prevention Day is today and with this year’s theme Preventing Suicide – Reaching Out and Saving Lives the aim is to encourage everyone to consider how offering support to someone vulnerable may help combat suicide. And it is an important cause. The World Health Organization estimates that more than 800,000 individuals die of suicide globally each year, and for each of these, as many as 20 others attempt. Suicide is the second leading cause of death among 15-29 year olds, and such incidences obviously leave individuals, families, and societies deeply affected.
While we tend to think that suicide is mainly a problem in Western countries, the highest burden of suicide is actually found in low- and middle-income countries with 75% of suicides occurring there. In rural households in Asia and Latin America pesticides are used extensively in agriculture. Take the case of Sri Lanka. After the Green Revolution in the 1960’s, pesticides became easily available across the farming community in the country. This availability has made pesticides the most widely used mean of suicide in Sri Lanka and through-out Asia.
Most cases of suicide and suicide attempts are not associated with mental illness in Sri Lanka. Here the individuals at stake live under immense pressure linked to socio-economic and health issues, many times exacerbated by problematic alcohol use and social conflicts as a result of this– but rarely with mental illnesses. The suicide attempt is oftentimes a way of responding to these stressors and communicating distress to close relations and local communities. It is rarely done with a wish to die. To an outsider, suicide attempts may seem like an extreme reaction to seemingly trivial social conflicts such as marital disputes or failed love affairs. However these individuals are often caught in a great web of social, financial and emotional problems that cannot be said in words and seem too overwhelming to cope with. Suicide then becomes a solution.
I am part of an international team of researchers who explores this topic to better understand and intervene. For this year’s suicide prevention day we teamed up with NCDFREE and created a film showcasing some of the issues at stake in a rural Sri Lankan setting. With the film we have two main aims: First, to showcase how the social determinants of mental health are extremely important when we talk about severe self-harm and suicide – and when interventions and policies are made. You will see how the family we follow is battling a number of difficult issues; chronic diseases, heavy alcohol use, a difficult financial situation and more.
Second, though such situations are complex, solutions do exist. In the film we introduce one of our interventions exploring how storing pesticides in locked boxes, with only one key per family, may deter and prevent the most impulsive suicide attempts and thus deaths. We know that other types of means restriction have proved effective in other settings, for instance with firearms and medicine. This specific type of pesticide intervention has been promoted by the industry and organizations as a solution, and we are with this research testing whether such an approach will prove feasible in this context.
The film further shows the commitment and hard work carried out by local staff members and students at the medical faculty of Rajarata University in the North Central Province of Sri Lanka. By linking medical students with specific families for up to a year, mutual benefits arise. The students are able to build relationships and understand the issues at stake in the family as well as provide mental support and assist the family members to identify solutions. The families we talked to felt acknowledged and many of them improved their life situation, if only just a little bit. At the same time, the medical students get a deep understanding of rural family life conditions and the social determinants of mental health. This equips them with important skills for their future careers as health professionals, showing them how such situations are usually not medical issues, and how crucial it is to keep the social context in mind.
I hope that this film will provide insight into the complexities of mental health in this specific setting, and inspire to action. On this year’s world suicide prevention day I urge you to think about what you can do, wherever in the world you are. Reach out, check in on someone you are concerned about, listen and show kindness and support. It does help!
And then let’s call on our political leaders to get global mental health on the agenda. Suicide and mental health must be prioritized as serious public health problems. And this is not only the health sector’s responsibility to deal with. A multi-sectoral approach is needed and a focus on poverty and equality, to name a few areas, is evident. With mental health now being a suggested topic of the new historic United Nations Sustainable Development Goals, we are at a crucial landmark with the foundation to act and make mental health a priority.
Jane Brandt Sørensen is a PhD Fellow at the Department of Public Health’s Global Health Section, University of Copenhagen, Denmark. She has studied trauma psychology and international development and has previously worked and studied in Sri Lanka, Ghana, South Africa, and New York. Through assignments with the UN (UNICEF, UNDP and WFP), NGOs and Copenhagen University, her focus is on health and development, especially NCDs and mental and social well-being. In her current research she explores alcohol’s role in self-harm and suicide in rural Sri Lanka.
Recently she co-directed a film in rural Sri Lanka for NCDFREE, focussing on the troubling relationship between chronic kidney disease, alcoholism and suicide. Coinciding with World Suicide Prevention Day she shares key learnings about the growing burden of suicide in low and middle-income settings.