World Mental Health Day, 2019
Mental health promotion and suicide prevention

Dr Athokpam Ranita Devi *

World Mental Health Day (10th October) is a day for global mental health education, awareness and advocacy against social stigma. It was first celebrated in 1992 at the initiative of the World Federation for Mental Health.

This year, the World Federation for Mental Health (WFMH) has decided to make “suicide prevention” the main theme of World Mental Health Day. The object of making suicide prevention the theme of World Mental Health Day in 2019 is to attract the attention of governments and different stakeholders so that the issue might be given priority in public health agendas around the world.

Suicide and non-fatal suicidal behavior (suicide attempts/selfharm) are major, global public health challenges. Currently, suicide is the second leading cause of death among young people aged 15-29 years at global level (WHO, 2018b). It is often believed that it is only adults who exhibit suicidal behaviors, but it should be made known that many children and young people engage in this kind of behavior as a result of violence, sexual abuse, bullying and cyber bullying.

An estimated one million people per year die by suicide or about one person in 10,000 (1.4% of all deaths), or “a death every 40 seconds or about 3,000 every day”. As of 2004 the number of people who die by suicide is expected to reach 1.5 million per year by 2020. On average, three male suicides are reported for every female one, consistently across different age groups and in almost every country in the world. More people die from suicide than from murder and war; it is the 13th leading cause of death worldwide.

According to WHO there are twenty people who have a suicide attempt for every one that is fatal, at a rate approximately one every three seconds.

Risk and Protective Factors

A combination of individual, relationship, community, and societal factors contribute to the risk of suicide. Some of the risk factors for suicide are:
Previous suicide attempt(s),
History of alcohol abuse and substance abuse,
mental health conditions - depression (80%),
alcohol abuse,
psychosis,
anxiety disorder etc.

Relationship problems - conflict with parents and/or romantic partners,
Family history of child maltreatment,
Legal or disciplinary problems,
Access to harmful means such as medication or weapons,
Recent death of a family member or a close friend,
Ongoing exposure to bullying behavior such as cyber bullying,
Loss (relational, social, work, or financial),
Chronic Physical illness or disability,
Impulsive or aggressive tendencies,
Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma),
Barriers to accessing mental health treatment,
Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thought

Protective Factors for Suicide

Protective factors buffer individuals from suicidal thoughts and behavior. Identifying and understanding protective factors are, however, equally as important as knowing risk factors.

The protective factors are:
effective clinical care for mental, physical, and substance abuse disorders,
Easy access to a variety of clinical interventions and support for help seeking,
Family and community support (connectedness),
Support from ongoing medical and mental health care relationships,
Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes,
Cultural and religious beliefs that discourage suicide and support instincts for self-preservation.

SUICIDE PREVENTION The overwhelming majority of people who die by suicide do not want to die, nor do they kill themselves on a whim. Suicide is rarely an act of impulsivity: rather, it has been mulled over for a long time. People considering suicide are in extreme psychological pain and they want that pain to end. This pain causes their vision to become so narrow that the only way out of it they can see is killing themselves.

Suicide prevention is a collection of efforts to reduce the risk of suicide. Beyond direct interventions to stop an impending suicide, methods may include:

o treating mental illness
o improving coping strategies of people who might consider suicide
o reducing risk factors for suicide, such as poverty
o giving people hope for a better life after current problems are resolved

Many methods have been developed in an effort to prevent suicide. The general methods include: direct talks, screening for risks, lethal means reduction and social intervention.

Direct talks

An effective way to assess suicidal thoughts is to talk with the person directly, to ask about depression, and assess suicide plans as to how and when it might be attempted. Contrary to popular misconceptions, talking with people about suicide does not plant the idea in their heads. The WHO advises to not say everything will be all right nor make the problem seem trivial, nor give false assurances about serious issues. Remove all the dangerous weapons , items medicines from the surrounding .

If your friend/ family members talks about committing suicide, don’t keep to yourself, inform others and seek help from experts .

A significant barrier to suicide prevention is perpetuated by us directly: stigma. There are widespread beliefs that someone at risk and their desire to die cannot be stopped, that it is inevitable. Or some feel that they have no business interfering in the choices that people make, including the decision to die.

Our attitudes toward suicide and our personal feelings toward it are influenced by stigma. It can prevent our being of any help to someone on the verge of killing.

WARNING SIGNS OF SUICIDE:

Warning signs of suicide can allow individuals to direct people who may be considering suicide to get help.There are two types of warning signs as follows:

o Verbal Warning Signs:-
”I wish I could disappear forever”,
“Nobody cares, I may as well be dead”,
“I want to go to sleep forever”,
“I just can’t take it anymore”.

o Non verbal warning signs :-
Symptoms of depression,
Withdrawal Isolation from family and friends ,
reckless behaviorincreased alcohol or drug use,
dropping out of sports, hobbies,
work or school,
making a will,
visiting relatives ,
buying of dangerous weapons,
Settling outstanding affairs,
giving away prized or valuable possessions,
or making amends when they are otherwise not expected to die
(as an example, this behavior would be typical in a terminal cancer patient but not a healthy young adult) etc.

Why It Is Important to Prevent Suicide ?

Suicides are preventable. Comprehensive multi-sectoral strategies for the prevention of suicide are essential to achieving suicide reduction worldwide, and community-level approaches should be employed as part of an effective strategy.

The prevention of suicide is not only important for individuals and families but also benefits the well-being of communities, the health-care system and society at large. Governments need to take a lead in suicide prevention in order to develop and implement comprehensive multisectoral national suicide prevention strategies.

In some countries, multilevel community suicide prevention programmes are being implemented and it has been noted that synergistic effects can arise when different activities and measures are implemented simultaneously. However, variations in the suicide rates within countries (e.g. by geographical regions) suggest that top-down suicide prevention must go hand-in-hand with local bottom-up processes.

Hence, communities play an essential role in suicide prevention when they provide bridges between community needs, national policies and evidence-based interventions that are adapted to local circumstances.

Role of Media in suicide prevention :

The media in all its forms is extremely influential. Numerous studies conducted from the 1960s onwards have shown that when stories about suicide appear in the news, there are ‘spikes’ in suicide rates, particularly the case when media reports on suicide are prominent or repetitious, uses dramatic or glamorizes a death or describe ethods of suicide in explicit detail.

Fortunately, there are also certain types of reports that are associated with drops in suicide rates as well and help people seek help. The International Association for Suicide Prevention and the World Health Organization have produced and updated guidelines for journalists and editors.

Evaluations of these guidelines have shown that they can have a positive impact on journalistic practices.

Social intervention

Some of the social intervention for suicide prevention are developing groups led by professionally trained individuals for broad-based support for suicide prevention,
Promoting community-based suicide prevention programs,
Screening and reducing at-risk behavior through psychological resilience programs that promotes optimism and connectedness,
Education about suicide, including risk factors, warning signs, stigma related issues and
the availability of help through social campaigns, gatekeepers training
Increasing the proficiency of health and welfare services at responding to people in need.
e.g., Sponsored training for helping professionals,
Increased access to community linkages, employing crisis counseling organizations,
Reducing domestic violence and substance abuse through legal and empowerment means are long-term strategies,
Reducing access to convenient means of suicide and methods of self-harm. e.g., toxic substances, poisons, handguns.
School-based competency promoting and skill enhancing programs,
Improving reporting and portrayals of negative behavior, suicidal behavior, mental illness and substance abuse in the entertainment and news media,
Research on protective factors & development of effective clinical and professional practices

We need everyone’s help, which is why we hope to receive contributions not only from the community but also from various stakeholders organizations so that we can share our experience of and knowledge about an issue as important and painful as suicide with each other.

We invite you to join the campaign for Mental Health Day 2019 and, to make a big difference all over the world to this very important issue.