India needs state-specific policies for suicide prevention

mental health problem in india
India needs to break the taboos linked to mental health and remove the stigma around such issues.

On the World Mental Health Day (October 10) it is imperative that India pays attention to suicide prevention, with action being led by states that have suicide mortality rates that are much higher than the national average. Latest data on suicides in India from the National Crime Record Bureau (2020) shows that 1.39 lakh people died by suicide in 2019. Suicide mortality rate was 10.4 per 1 lakh population. Further, for every suicide death in India, there were nearly 210 people who had suicidality (suicidal ideation, plan, intent, preparatory behaviour and attempt) according to the National Mental Health Survey (NMHS) 2015-16. The NMHS also reveals that in 2015-16, nearly 300 lakh Indians (aged 18 years and above) had thought of ending their life and 20.6 lakh had attempted suicide. What do we know about which population groups have higher share of suicides, why people decide to die by suicide and which are the regions that have a high suicide mortality rate in the country?

While the NCRB does not publish data on suicide mortality rate for each sociodemographic category, it does furnish information on the numbers and percentage distribution of suicide victims for each sociodemographic category. In 2019, the age groups 18-30 years (35.1%) and 30-45 years (31.8%) accounted for a larger share of those who died by suicide. Further, majority of them were married (66.7%). The share of suicide victims who had completed secondary schooling (23.3%) and middle schooling (19.6%) was higher than higher categories. Daily wage earners (23.4%), housewives (15.4%), self-employed (11.6%) and unemployed (10.1%) were the occupational groups that accounted for a large share of suicides. A large share of suicide victims belonged to the lowest income category (66.2%).

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Job market insecurities are a reality in India, as Periodic Labour Force Survey 2018-19 shows that only 46.8% of the population aged 15 years and above were in the workforce and 5.8% of the population were unemployed. Unemployment rates were the highest among those who had completed secondary schooling and above. Patriarchal norms that keep women’s work participation low in India at 22% among those aged 15 years and above are also responsible for the disproportionate burden of unpaid housework that falls on women. For instance, the Time Use Survey 2019 reveals that in rural areas participation in unpaid domestic services for household members was 82.1% among women and 27.7% among men. In urban areas this was 79.2% among women and 22.6% among men. Further, in rural areas while women spent 301 minutes in a day on unpaid housework, men spent only 98 minutes. In urban areas this was 293 minutes among women and 94 minutes among men. Clearly, this burden of unpaid work on women coupled with improved educational levels among them could be a factor driving housewife suicides.

Among those who took their own lives, 45,140 were due to family problems and 23,830 were due to illness. Under the category illness, mental illness and other prolonged illness accounted for a large share. While suicide mortality rates were higher among males when compared to females, the NMHS 2015-16 shows that suicidality was higher among females. Detailed findings from the NMHS published in Lancet Psychiatry in 2019 shows that suicidality prevalence was highest in the age group 40-49 years and 50-59 years, among residents in urban metropolitan areas, illiterates, unemployed, widowed/ divorced/ separated and the lowest income quintile. Further, they found that those with alcohol use disorders and depressive disorders had an increased risk for high suicidality.

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The reasons cited in police records for suicide include family problems, illness, drug/alcohol use disorders, marriage-related problems, love affairs, indebtedness, failure in examinations etc. The most common reasons for dying by suicide were family problems (32.4%), illness (17.1%), drug/alcohol use disorders (5.6%), marriage related issues (5.5%), love affairs (4.5%) and indebtedness (4.2%). To design interventions, there needs to be specific information on what these family problems constitute. It has been argued by psychiatrist Dr KS Jacob that there is subtle cultural sanction for suicides in India. Popular discourse, cinema and media romanticise individuals who die by suicide due to adversities in personal life, educational life and occupational life as well as those who take their life for a political cause.

Five states — Maharashtra (13.6%), Tamil Nadu (9.7%), West Bengal (9.1%), Madhya Pradesh (9.0% ) and Karnataka (8.1% ) — accounted for nearly half (49.5%) of the total suicides reported in India according to the NCRB 2019 report. In 2019, suicide mortality rates (per one lakh population) were the highest in Andaman & Nicobar Islands (41) Sikkim (33.1), Puducherry (32.5), Chhattisgarh (26.4), Kerala (24.3), Telangana (20.6), Tripura (18.2) Tamil Nadu (17.8), Dadra & Nagar Haveli (17.1) and Karnataka (17.1). Findings from the NMHS 2015-16 published in Lancet Psychiatry show that suicidality prevalence per 100 population was highest in Kerala (10.4), Manipur (7.3), Rajasthan (7.0), Madhya Pradesh (6.5), Uttar Pradesh (6.1) and Tamil Nadu (6.0).

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Some of the states with high suicide mortality rates, namely, Kerala, Tamil Nadu, Telangana, Karnataka and Sikkim were ranked high on the Sustainable Development Goal Index in 2019. Further, Kerala and Tamil Nadu have one of the lowest poverty ratios in the country and are known as well performing welfare regimes. However, in Kerala, unemployment rate was highest among those who had completed graduation (25.2%) and post-graduation (22.8%). In Telangana (34.1%) and Tamil Nadu (22.3%), unemployment was higher among those who had completed a diploma course. States which had relatively high suicide mortality rates and unemployment rates were Kerala (9%), Tamil Nadu (6.6%) and Telangana (8.3%). However, Chhattisgarh has a high suicide mortality rate and low unemployment rate with research pointing to agrarian distress as an important factor driving suicides. This suggests that regional specificities have a role to play in suicides.

The National Mental Health Policy of India 2014 emphasises suicide prevention with a focus on increased access to mental healthcare services, framing media guidelines on reporting of suicides, addressing substance use disorders, restricting access to means of suicide like pesticides as important areas for intervention. The Mental Healthcare Act 2017 has decriminalised attempted suicide and calls on the government to provide care for those who attempt suicide. While these represent a step forward in preventing death by suicides, it is clear that social and economic insecurities too need to be addressed.

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Clearly, socioeconomic conditions and cultural norms vary across states and each state will have to undertake research into the reasons for suicides and tailor health and social sector interventions accordingly. The central government and state governments have to issue guidelines for media (including social media) reporting on suicides with a bar on mentioning cause and method in the headlines, romanticising suicides and excessive reporting of celebrity suicides, all of which can result in copycat suicides. Finally, the discussion on suicides should not stop with occasions like World Mental Health day, release of annual National Crime Records Bureau Report and celebrity suicides.

For anyone who needs help to overcome suicidal thoughts the following helplines can be contacted: Sneha, Tamil Nadu – 044-24640050; Maithri, Kerala – 0484-2540530; Roshni, Telangana – 040-66202000.

(Dr Gayathri Balagopal is an independent researcher based in Chennai.)