Changing the narrative on suicide
Today 10th of September 2024 the whole world is observing Suicide Prevention Day .
Suicide, ‘the silent epidemic’, is among the leading causes of death globally. Behind each instance of this tragedy lies insurmountable pain. This pain is often neither visible nor audible, until it suddenly is, then the pain is resounding. Those left behind are faced with grief, confusion, anger, and guilt. Yet it is shrouded in misconceptions and disclosed in muffled whispers, which prompts a cycle of pain becoming neither visible nor audible.
Suicide affects people of all ages, genders, ethnicities, locations, education levels and economic backgrounds. The World Health Organization (WHO) reported that globally over 700000 people die by suicide every year, which makes up 1.3 in every 100 deaths.1 There are many more suicide attempts, many of which go unnoticed and unreported due to stigma, misclassification, and limited surveillance systems. The suicide rate is 2.3 times higher in males than in females, but suicide attempts are more frequent in females.1 Although there has been a significant decrease in suicide at a global level over the past two decades, high suicide rates persist, especially in developing countries. Three quarters of all suicides occur in low- and middle-income countries, where most of the global population live1.
Nepal is one such country, where suicide has increased by 72% over the last 10 years.2 Here, around 20 people die by suicide each day, with a total of 7,223 suicides recorded in the fiscal year 2023-2024.3 Suicide is a complex matter that rarely has a single causal factor. Rather, there may be multiple factors that build up and compound vulnerability to suicide. While it is estimated that 90% of those who die by suicide experience some form of mental illness, other factors such as acute stress, socio-economic problems, and cultural issues are strongly associated with suicide in Asian contexts.4 In recent decades, Nepal has been in a constate state of political instability and crises such as natural disasters and the Covid-19 pandemic. In the three months following the devastating 2015 earthquake, there was a 41% increase in suicides compared to the previous 3 months.5 There was also significant increases in self-harm behavior and suicide rates in the several months following the Covid-19 outbreak in March 2020, with highest increases in Sudurpaschim and Karnali provinces.6,7 Upon lockdown, these provinces likely faced higher levels of suicide risk factors such as unemployment and poverty, especially among migrant workers.
Poor economic conditions are linked with suicide in many regions, but countries like South Korea, Japan and Hungary have some of the highest suicide rates despite their high GDPs. In fact, when countries are categorized by income level, high-income countries have the highest suicide rate, particularly for men.1 Research suggests that if economic growth is not accompanied by adequate infrastructures for mental health services, suicide rates may become higher.8; Those from lower income regions within South Korea, those who engaged in excessive drinking, and those who were of age 65 and above were more vulnerable to taking their own life.9
A country with disproportionally high suicide is Lesotho, Africa with 72.4 crude deaths per 100000 population, which is double of any other country.1 Lesotho faces various socio-economic, cultural and health issues.10 There is a high prevalence of HIV AIDS, exacerbated by sexual violence against women and sexual minorities. While the health care system is strained with inadequate mental health services, people are also reluctance to seek professional help due to deep-rooted stigma of mental health issues. Additionally, Lesotho faces significant unemployment and economic instability. These factors, which lead to feelings of hopelessness and isolation, along with grief from the suicide deaths of loved ones, are attributed to the devastating suicide rate.
Regardless of financial security, there are several psychological and social vulnerabilities to suicide, with many suicides occurring impulsively in moments of crisis. The psychological disorders highly associated with suicide are psychotic disorders (e.g. schizophrenia), mood disorders (e.g. depression and bipolar disorder), personality disorders, anxiety disorders, substance abuse disorders (e.g. alcohol), and comorbidity of illnesses.11,12 However, most people with psychological disorders do not die by suicide; risk of suicide has been estimated to be 5–8% for several mental disorders.12 Previous suicide attempts, access to harmful substances or weapons, recent suicide/death of loved ones, conflict with family or partners, experiencing abuse, and discrimination are further risk factors.13
The tragic loss of life due to suicide emphasizes the critical need for a multi-faceted approach to prevention and intervention. This must involve reducing stigma, improving mental health literacy, enhancing access to quality care. Along with this, it is crucial to address other risk factors heighten that vulnerability, including financial insecurity, marginalization, and access to harmful substances or weapons. By working collectively at individual, community, and policy levels, we can change the narrative and turn the tides of this silent epidemic.
The March and The Rally
On the day of world suicide prevention day, the 10th of September, 2004 a march was held at Mental Hospital Lagankhel which went through the inner streets of Lalitpur such as Mangal Bazaar, Labim Mall, Pulchowk, and then assembling at Jawalakhel area. CMC Nepal, Interns from CMCS Nepal, TPO Nepal, Central Department of Psychology, TU, Nepalese Association of Clinical Psychologists (NACP), St. Xavier’s College and other Government and Non-government instituations and organizations took part in the rally. Nepal Police led and managed the rally. All organizations carried their emblems and slogans with the theme of “Changing the narrative on suicide” / “आत्महत्या रोकथाम बारे संवाद सुरु गरौं, दृष्टिकोण बदलौं”.
In countries like Nepal where there is a lack of mental health awareness, it is often believed that suicide is a selfish choice individuals make and disregard the influence of external factors. The stigma surrounding suicide attempts and deaths prevent people from talking about the various risk factors and exploring preventative measures. The current narrative around suicide views it as a personal failure that is best hidden rather than a complex issue that needs to be addressed collectively as a society. Until little earlier the law criminalized those who attempted suicide, which with lot of publics outroar has been abolished. This year’s World Suicide Prevention Day has the theme “Changing the Narrative on Suicide” with the call to action “Start the Conversation”. Various institutions in Kathmandu Valley came together to raise awareness thought a rally displaying slogans such as, “It’s not the person but the situation”, “If you share your burdens, it halves; when you share your happiness, it doubles” and “Let’s talk openly about suicide”.
Few of the Leaflets and the Banner presentation by different organization on Changing the narrative on suicide.
