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27 August 2024 – The Hindu

Enhancing Suicide Prevention Measures in India

Why in News?

A recent publication in The Lancethas spotlighted the urgent need for intensified political efforts to tackle the grave public health crisis of suicide in India, where more than 100,000 lives are lost to suicide each year. The article also critiques the slow progress of the National Suicide Prevention Strategy (NSPS), introduced in 2022, which was designed to combat this issue.

Understanding the National Suicide Prevention Strategy:

The National Suicide Prevention Strategy (NSPS) was established with the ambitious goal of reducing suicide mortality in India by 10% by 2030. The strategy emphasizes the importance of a collaborative, multi-sectoral approach, inclusiveness, and innovation to achieve this goal.
Vision: The strategy envisions a society where individuals are empowered to value their lives and receive the necessary support during critical times.

Objectives:

The NSPS plans to set up psychiatric outpatient departments across all districts within five years, leveraging the District Mental Health Programmes.
Another key objective is to integrate mental well-being curricula into educational institutions within eight years.
The strategy also aims to develop guidelines for responsible media reporting on suicides and to restrict access to means of suicide.

The Suicide Landscape in India:

Annual Deaths: According to the 2022 report from the National Crime Records Bureau (NCRB), India witnessed over 170,000 suicides in that year alone. Alarmingly, nearly one-third of these cases involved daily wage earners, agricultural laborers, and farmers. The suicide rate has risen from 10.2 per 100,000 in 2019 to 11.3 per 100,000 in 2022.

Primary Affected Groups:

6% of suicides involved self-employed or salaried professionals.
2% of suicides were among unemployed individuals.
Over 12,000 students succumbed to suicide.
Among the approximately 48,000 women who died by suicide, over 52% were homemakers, making up about 14% of all suicides.

Regional Distribution:

Maharashtra reported the highest number of suicides (22,746), followed by Tamil Nadu (19,834), Madhya Pradesh (15,386), Karnataka (13,606), Kerala (10,162), and Telangana (9,980).

Causes of Suicides:

Common causes include family problems, unemployment, financial difficulties, and illness, accounting for almost half of all suicides.
Other contributing factors include drug abuse, alcohol addiction, and marriage-related issues. A significant number of women cited dowry-related problems as a reason for suicide.
The rising suicide rate among young women is driven by factors such as the conflict between modern education and rigid societal norms, leading to feelings of deprivation. The shift towards modern relationships, such as love and inter-caste marriages, fosters individualism but also loneliness.
Persistent patriarchy, gender discrimination, and high rates of domestic violence further exacerbate these challenges.
Academic Pressures: Academic performance pressures are a leading cause of student suicides, particularly linked to exam failures in the 18-30 age group. The Supreme Court has noted that intense competition and parental pressure contribute significantly to the rising suicide rates, emphasizing the need for balanced expectations from children.

The Imperative for Suicide Prevention in India:

Impact on Individuals and Society: The death of an individual by suicide deeply affects family members and friends, leading to widespread social and emotional consequences.
Mental Health Stigma: Cultural and social stigma around mental health issues often prevent individuals from discussing their challenges openly or seeking help. Suicide is frequently misinterpreted as an act of cowardice or sin rather than a manifestation of deep psychological distress, which hinders preventive measures.
Societal Norms: Societal expectations related to academic achievements, gender roles, and marital responsibilities create immense pressure, making it difficult for individuals to seek help.
Economic Burden: The economic cost of suicide is significant, including healthcare expenses and loss of productivity, which affects the national economy.

Challenges in Suicide Prevention in India:

Resource Constraints: The Indian healthcare system often lacks the resources necessary to provide adequate mental health support. Despite recent improvements, there remains a shortage of mental health professionals and limited access to affordable mental healthcare, especially in rural areas.
Insufficient Data: The lack of comprehensive studies and under-reporting of suicide attempts hampers understanding of the crisis’s true extent, making it difficult to design effective interventions.
Political Commitment: There is a lack of sufficient political will to tackle suicide prevention comprehensively. While the Mental Healthcare Act, 2017, and the NSPS have been introduced, significant gaps remain in policy implementation.
Media Involvement: The media often lacks the initiative to educate itself on responsible suicide reporting. Developing and adhering to guidelines for reporting suicides is crucial.

Initiatives Related to Suicide Prevention in India:

National Mental Health Programme (NMHP):

The District Mental Health Programme (DMHP) is implemented in 738 districts, offering outpatient services, counseling, ongoing care, and a 10-bed inpatient facility at the district level.

National Tele Mental Health Programme:

Launched in 2022, this program aims to improve access to quality mental health counseling and care services across the country. As of December 2023, 34 States/UTs have established 46 Tele MANAS Cells, handling over 500,000 calls.

KIRAN Helpline:

The Ministry of Social Justice and Empowerment has launched a 24/7 toll-free helpline, “KIRAN,” to provide mental health support.

Ayushman Arogya Mandirs:

More than 160,000 Sub-Health Centres (SHCs), Primary Health Centres (PHCs), Urban Primary Health Centres (UPHCs), and Urban Health and Wellness Centres (UHWCs) have been upgraded to Ayushman Arogya Mandirs. Mental health services are included in the Comprehensive Primary Health Care package at these centers.

Manodarpan Initiative:

The Ministry of Education launched this initiative under Atmanirbhar Bharat Abhiyan to provide psychosocial support for mental health and well-being during the Covid-19 pandemic.

Legal Framework and Judicial Perspectives:

Section 309 of IPC: This section deals with the attempt to commit suicide, punishable with simple imprisonment of up to one year, a fine, or both. While some courts have condemned this provision as unconstitutional, the Supreme Court has upheld its validity.

Bharatiya Nyaya Sanhita, 2023:

The new legal framework removes the section on attempting suicide but retains punishment for those who attempt suicide to compel or restrain a public servant from performing their duties. This aligns the law with the Mental Healthcare Act, 2017.

Way Forward:

Workplace Wellness: Mandate mental health support in workplaces, particularly in high-stress sectors. Public health strategies, such as gatekeeper training and awareness programs, are essential.

Strengthening Mental Health Infrastructure:

Expand access to mental health services, especially in rural and underserved areas.
Increase the number of trained mental health professionals.
Develop targeted interventions for high-risk groups like farmers, students, women, and the elderly.
Establish support networks specifically for these groups.
A 20% reduction in suicides could save 40,000 lives annually.

Addressing Root Causes:

Create job opportunities, reduce inequality and poverty, and strengthen social safety nets.
Promote gender equality, address domestic violence, and curb dowry harassment.
Enforce guidelines to prevent suicide imitation, and promote mental health awareness.
Implement comprehensive mental health education programs, foster open dialogue, and promote stress management techniques.

Leveraging Technology: