World Suicide Prevention Day: ‘The first step in suicide prevention is empathetic, non-judgmental listening; there’s always a cry for help before it happens’ – The Economic Times

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SynopsisDr Lakshmi Vijayakumar, founder of SNEHA, says the myth that suicidal people won’t talk needs to be busted.

Over 7,00,000 people around the world died by suicide in 2019, according to the World Health Organization (WHO). In India, that number was 1,39,123, according to the National Crime Records Bureau (NCRB).

Over a decade ago, when the first World Suicide Prevention Day was observed in 2003, the number in India was 1,10,851.

Dr Lakshmi Vijayakumar, the then-Vice President of the International Association of Suicide Prevention (IASP), was among the three people who spearheaded the initiative to earmark a day towards the cause. Working closely with professor Diego De Leo, the IASP President, and Dr Jose Bertolote from WHO, Vijayakumar spent two years, buried under voluminous paperwork, trying to get various global organisations on board and to set aside a date as World Suicide Prevention Day (WSPD). They were finally given a date on August 27 in 2003.

The announcement came a mere two weeks before the date and De Leo wrote the brochure for the very first WSPD in a week. Recounting those days over a video call, Vijayakumar says they didn’t have access to stock images for the brochure. So she dialled a local newspaper vendor and asked for all the glossies that were available. They cut out the faces of people belonging to various ethnicities from these papers and put those together as the graphic design.

Vijayakumar, who has founded SNEHA, a suicide prevention centre in Chennai, took 200 copies of this very brochure to a suicide prevention conference in Stockholm.

Little did the 15 people in that room that day realise what a global movement this would become.

They were so enthused by the conference and its purpose that they forgot to save even one brochure for themselves.

“Every year, the brochure and theme of the day is present on the WHO and IASP websites. All the archived brochures are there except the first year’s. Because we didn’t have it,” she says.

But years later, Vijayakumar would find a silver lining in the 2015 Chennai floods, when she was evacuated from her home on a boat. While reassembling the house, she came across a trunk with two copies of that special brochure.

“My first call was to WHO!”

But she sent them only one copy, preserving the other for herself.

AgenciesA copy of the first-ever World Suicide Prevention Day brochure.
Now known for her pioneering work in the field, Vijayakumar was once a young, determined student at Madras Medical College who once didn’t give up on a patient with cyanide in his stomach and managed to save his life. It was a chance encounter with the same man six months later — he ran up to her while she was visiting the city’s Marina Beach and thanked her for saving his life — that got her thinking about suicides and how they can be prevented.

“The man was happy and married and on the beach. It just showed that even those without a will to live could find it, if only suicides were prevented.”

A psychiatry student, Vijayakumar realised that while not much could be done about conditions such as schizophrenia, suicide could be prevented.

Having noticed a gap in the field of psychiatry, she presented a paper at an IASP conference in Vienna in 1983 about how suicide was affecting young people in India and not just the “elderly white lonely male dying by sucide” examples she read about in textbooks.

“Indian textbooks on the subject weren’t available at the time.”

This was followed by a visit to a UK branch of Befrienders International, a volunteer-led suicide helpline. By the time Vijayakumar returned to India, she had decided to set up SNEHA, a volunteer-based suicide prevention network.

AgenciesDr Lakshmi Vijayakumar started SNEHA on April 13, 1986.
Lack of phone penetration in India was the smallest of her hurdles. The idea itself faced criticism, with many raising questions over a volunteer model, and others saying a suicidal person won’t come forward to talk. It wasn’t limited to verbal criticism alone either.

“Initially, we had difficulties in finding a place to rent to run the service, because nobody wanted to give a place where all kinds of people may walk in. So it was a difficult start,” she says.

But 35 years on, SNEHA, which offers complete confidentiality to every caller, is still run solely by volunteers. Their advertisement reads: “Are you ordinary enough to be a volunteer?”

However, out of the 200 yearly applications, only 10 get selected to be volunteers. They are often the last link between a caller living or dying, Vijayakumar says, explaining why they need to have a stringent selection process. The volunteers go through extensive training and a probation period.

The team fields 60-70 calls daily, some that go on for hours, in addition to emails.

But every call means a chance to save a life.

“So, see, people will talk,” she says with a smile.

In a video interview from Chennai, Vijayakumar talks about the importance of empathy in preventing suicides, why the myth that suicidal people won’t talk needs to be busted and how to change the discourse around the topic.

Edited excerpts:

How can suicides be prevented?
There are three characteristics that make it possible to prevent suicides.

The first is that it is an impulse phenomenon. So, if at that moment of impulse, if support is available, suicides are averted.

The second thing is that the majority of people who die by suicide have communicated their suicidal thoughts to somebody. 60 to 70 per cent suicides are not surprises. But when somebody shares a suicidal thought, the response they receive is often not helpful. They are told to look at people who are worse than them and be happy. Or, at the most, if someone is very empathetic, they will ask that person to take a break and maybe go somewhere.

So no one is willing to listen to the psychological pain of the suicidal person. It is a cry for help. And if you hear that cry for help, suicides can be prevented.

The third point is that 80 per cent of the cases are ambivalent about wanting to die. The wish to live and the wish to die is like a see-saw battle for them. Sometimes the want to live is greater, and at other times the need to die increases. If you were to talk to them, most of them would say that it is not that I really want to die, but I cannot go on living like this. If you are able to increase their wish to live, then suicides can be prevented.

People do talk, people do reach out. We have this myth that people who really want to die will not talk about it to anybody. Rather, they are struggling, and don’t know what else to do and how to cope with the situation.

My belief has always been that suicide prevention is everyone’s responsibility. All we need is a person who understands. The final feelings of the person who is suicidal is a sense of loneliness, craving belongingness. It is also a feeling of being some kind of a burden.

So, all they need is someone to be there for them.

“Majority of people who die by suicide have communicated their suicidal thoughts to somebody.”

— Dr Lakshmi Vijayakumar
The theme for this Suicide Prevention Day is ‘creating hope through action’. What action can be taken at a policy as well as individual level to save lives?
LV: India, unfortunately, has the dubious distinction of having the highest number of suicides in the world. According to NCRB data, the figure stood at 1.35 lakh in 2019, but the WHO estimates it at 1.80 lakh, and if we look at the global health estimate, it was around 1.90 lakh. While the suicide rate has come down in the last 10 years, it is still unacceptably high.

Can you think of a condition where you lose 1.35 lakh people every year and the government doesn’t do anything about it? After a lot of effort, they initiated a strategy, which we wrote, but it is still not announced, published or implemented. It is just lying there, which is really a sad state of affairs.

The idea is to approach suicide prevention from three angles.

One is to adopt strategies that will be useful to reduce suicides across all populations. One of the most effective prevention strategies is reducing access to the methods. For example, banning guns in the UK, or reducing the pack sizes of paracetamol. In South Asian countries, it is banning some class-one pesticides. This easy access is a huge problem in rural areas, as people impulsively consume it.

As a test run, we did a central storage system for pesticides in two villages in Tamil Nadu’s Cuddalore district. We built lockers for farming households to store their pesticides. This made access to it difficult when one was impulsive. In the past 10 years, those two villages have reported zero suicides. This was supported by the WHO, which recommended it as one of the very effective interventions, following which we got funding from the National Institute of Mental Health (NIMH). We are now doing this in about 50 villages in Gujarat.

The other thing is reducing alcohol availability and consumption.

Another very important aspect is creating awareness by the media. Sensitive portrayal of suicides can reduce them, but sensational reporting can increase the cases.

These are universal methods. Then there are selective interventions – for people who are at higher risk. For example, people with psychological disorders, people facing domestic violence, or exam failures. For such people, you have to hire and train gatekeepers like school teachers, nurses and police people among others, on how to identify and support a person who is suicidal.

Then there is indicated intervention — for people who are already suicidal. Something as simple as checking up on them to see if they are feeling lonely can help. If you’re able to provide contact, repeat suicides and attempted suicides come down drastically.

In Australia, professor Gregory Carter of the University of Newcastle sent postcards to people who had earlier attempted suicide asking if they were okay. This helped to reduce the number of reattempts. Most people are lonely. The feeling that somebody remembers them, somebody is willing to be there for them is important.

The final feelings of a person who is suicidal is a sense of loneliness, craving belongingness. So, all they need is someone to be there for them.​

iStockThe final feelings of a person who is suicidal is a sense of loneliness, craving belongingness. So, all they need is someone to be there for them.
What are some of the signs that point towards suicidal thoughts?
If you see a person whose sleep is suddenly completely disturbed, or whose behaviour has changed, somebody who withdraws from a group or becomes very angry and gets frustrated, a person who loses interest in anything, or somebody who says or posts messages like ‘nobody loves me, I don’t want to live’. These are the kind of things to look out for.

Often we assume it is just an emotional outburst. Maybe, but it is always worth checking out if there is anything more.

Sometimes young people have emotional outbursts on social media, but then retract their statements saying, ‘I’m fine now’. So people forget it and assume that person is fine. But many times that’s not true, and normalcy is an act.

Feeling hopeless and helpless are signs to watch out for.

“Don’t try to provide solutions to the problem. Nobody can solve other people’s problems. But you can try to understand what they’re going through.”

— Dr Lakshmi Vijayakumar
What do you say to someone who may be battling suicidal thoughts?
First, you have to create time for them. Most of us are busy and we don’t find the time. Also avoid asking them anything in public. Find a private moment to express your concern, and ask them if there is anything they would like to talk about.

The first step in suicide prevention is empathetic, non-judgmental listening.

If a person says “someone broke up with me, I’m feeling terrible, I feel worthless”, you don’t say “forget about it, there are other people around.” The person is not looking for solutions. They are looking for your understanding. So don’t try to provide solutions to the problem. Nobody can solve other people’s problems. But you can try to understand what they’re going through.

Once they talk it out, and someone listens with empathy and understanding, the pressure is slowly released. Only then will they be able to see for themselves what they’re going through.

So, all you need to do is spare time, reach out, tell them you care, listen to them without judgment, offer them your support and be available for them.

What is the one thing someone battling such thoughts should tell themself?
The one thing you need to tell yourself, is, “Okay, I made this decision that I’m going to die. Can I postpone it by two hours? Think about it in the evening? Can I postpone it by one day?”

Because when you buy time, things change.

The pandemic added to the mental health burden. Has your organisation noticed any stark causes that have been triggers?
About 50 to 60 per cent of people who die by suicide in India have a mental health disorder — depression, anxiety, schizophrenia. But the majority of causes are interpersonal problems. That is a major chunk of our calls.

Even if we look at the NCRB statistics, family problems are the number one cause.

We always look towards the family for emotional support. But when there is a problem within the family, the family members are not able to provide support. They become the stressor. So you don’t know how to go outside and ask for help.

The younger generation often finds a generation gap when attempting to speak to their families about mental health struggles. How can this conversation change? How do we bridge that gap?
Bridging the gap is possible only in two ways. One is awareness and the other is spreading the knowledge that there are effective treatments for mental health problems, that mental health issues are like physical health issues and can be handled with proper treatment.

It’s not some jadugari (magic). It’s a science. And there are scientific methods of treating such issues. Anybody can get depressed at any point of time. It’s all about awareness.

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