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Mental Health

Suicide Prevention: Listening To The Cry For Help

Snigdha Samantray, Clinical Psychologist

You have the power to say, “This is not how my story will end.”

While many like Hannah from ‘13 Reasons Why’ may not have ‘13 whys’ to end their lives, but even a single ‘why’, can be so tormenting that survival becomes a burden and most often, unlike Hannah, many end their lives without explaining their reasons. Suicide is often the last resort and a desperate attempt to escape suffering that has become unbearable. Clouded by feelings of self-loathing, hopelessness, helplessness and isolation, a suicidal person can’t see beyond death. 

According to the World Health Organization’s (WHO) global estimate, approximately 1 million people die each year from suicide. Nearly one-third of all suicides occur among young people. Suicide is the second leading cause of death among 15–29-year-olds.  It is estimated that for each person who dies by suicide, more than 20 others attempt suicide. In fact, suicide attempts are an important risk factor for subsequent suicide. Now that’s an alarming statistic!  

Now let me share a real-life experience other than reel life, of a 16-year-old boy who was a survivor of a suicide attempt. 

Nick (name changed) was bought to the department, during my tenure at a particular hospital, on a wheelchair by his parents. They approached us for therapy post his Craniectomy (a kind of brain surgery). His neck bent towards the left, there was no eye contact that he made and it felt like he was looking elsewhere. He was drooling and his limbs were Paralyzed. he could not speak but could marginally comprehend speech. He had lost his bladder control as well. Upon examination and going through his history of past treatment, we found that he has been diagnosed with a condition called ‘Hypoxia’ resulting due to insufficient oxygen supply to the brain during his attempt to commit suicide. The reason for this was unknown to the parents. Although he was rescued by his parents and rushed to the hospital, due to inadequate oxygen supply, certain tissues and important areas of the brain dealing with motor activities and speech got damaged. Even after repeated surgeries neither could he speak nor stand on his limbs. In fact, his functioning and cognitive capacity regressed to that like a 5-year-old child.

The simple reason why I briefed Nick’s story is to highlight the fact that, even if one attempts suicide, there is no guarantee that he would die! In fact, there are chances he might get handicapped just like Nick or deformed for the rest of his life and forever live with the stigma and guilt of attempting suicide. His decision to end his life does not necessarily predict death, as he only heard stories of death by suicide and not stories of surviving a suicide.

Why people attempt or commit suicide? 

People attempt or commit suicide when they have lost hope and feel the future is doomed and bleak. Most suicidal people are deeply conflicted about ending their own lives. They silently wish there was an alternative to suicide, but they have lost enough hope to see one. According to Durkheim’s theory of suicide, the reason why people commit suicide could be the following:

  • When one becomes socially isolated or feels that he is alone in this world. He usually feels a lack of belonging from the mainstream and ends his life for personal reasons. This kind of suicide is known as egoistic suicide.
  • When one and the group are too close and intimate and there is an over the integration of identity. One commits suicide for the sake of the other or to protect them. This kind of suicide is known as altruistic suicide.
  • When one faces a sudden unexpected situation like bankruptcy or loss of a loved one, leading to intense stress and frustration in the situation. This kind of suicide is known as anomic suicide.
  • When people are kept under tight regulation and extreme rule, usually by society or by law, leading to no sense of freedom or individuality. This kind of suicide is known as fatalistic suicide

Other than the above social factors, a lot of individual personality factors are also accountable for suicidal tendencies in a person. For example, in some passive-aggressive people, self-harm tendencies may be seen, where they vent their aggression by harming self. There are others, especially in case of personality disorders, who indulge in self-harm in order to draw attention they seek. Sometimes people don’t intend to take their lives but end up accidentally killing themselves. There are others who kill themselves to wreak vengeance on wrongdoers. No matter what the intention but it ends in fatal consequences.

What are some of the myths associated with suicide?

  1. ‘People who talk about suicidal thoughts won’t really do it’. In fact, it’s the other way round. People who talk about suicide do leave clues and warning signs hidden in their speech. No talk of self-harm should be taken lightly or ignored.
  2. ‘People who commit suicide have mental health disorders. Not all who commit suicide have a diagnosed mental health disorder. Being upset, grief-stricken, distressed or despairing are not necessarily signs of mental health disorders.
  3. ‘Nothing can stop a person who is determined to kill himself’. Mostly the impulse to end one’s life does not last forever. Even people who have severe depression have second thoughts about ending their life. In fact, their end goal is not to die but to stop the pain
  4. ‘Only cowards commit suicide’. That’s an absolutely wrong notion to hold on to. It takes both great courage and painful trauma to end one’s life.  
  5. ‘People who commit suicide are people who were unwilling to seek help’. Many people who commit suicide seek help before they end their lives. Just that it may not have worked for them and they feel despaired unable to think in terms of possibility or find a ray of hope. 
  6. ‘Suicide is always planned’. Majority of suicides are unplanned and occur at the impulse of the moment. If they survived, they would have regretted doing it.
  7. ‘Talking about suicide may give someone the idea’. Talking openly and honestly about suicidal thoughts and feelings can help save a life. In fact, talking about suicide makes them feel cared and valued. It gives them a sense of hope and belonging.

Why suicide prevention is essential?

According to research whenever a person is going through low mental states or feeling suicidal, at a cognitive level there is an attribution error to these mental states.  A lot of people who are clinically depressed or having suicidal thoughts, attribute the reason for their feelings to outside circumstances like a person, situation or an existential crisis about the meaning of life. But in fact, its people’s own subjective attribution about their state of mind. Whereas, in reality, such feelings could have a certain underlying biochemical mechanism which practically seems to disappear under the influence of antidepressants.

At a basic level, we all misattribute the causes of our mental states. For example, when we are tired or hungry, we get irritable with others, mistaking they are the cause of our irritability. Many times, in my clinical practice I have seen if I ask my clients why they want to end their life or why they attempted suicide, they just seem to give a vague answer with statements like “I am not sure why”, “I just don’t understand myself”, “I don’t know what I was thinking” or “something just happened to me at that moment”. This is why suicide prevention is so important because people with suicidal ideations can be very persuasive in making them believe their life is worth living and if they get persuaded, then they live to see that the situation looks radically different months later, sometimes because of an antidepressant, sometimes because of a change in situation or just a change of mind.

What can one do when they feel suicidal?

Now that you have known that suicide is often the impulse of the moment, next time when you get such suicidal thoughts or impulses, practice the following self-help techniques.

  1. TALK to a trusted friend or family member.
  2. DON’T stay alone and seek the company of trusted friends. Invite them over or go to their place.
  3. DIVERT your attention whenever you get the impulse to end your life by distracting yourself doing activities like listening to music, going for a jog or anything that gets you occupied for the moment. When you want to give up, tell yourself you will hold off for just one more day, hour, minute and do whatever you can to hold off.
  4. RELAX and do some deep breathing & relaxation exercises
  5. ACT to find alternate ways to achieve success in whatever you seek, wish or dream of. Maybe, it seems like the end of the world, maybe people seem difficult at the moment, but the need of the hour is not death but an alternate perspective that can make life worth living. You would only understand that if you live.
  6. POSITIVE SELF TALK is very important as what you speak to yourself is what materialises. If you constantly say to yourself that you wish to die, that’s what your subconscious mind registers and your volition is directed to make that happen. Be mindful about what you speak to yourself, it does create an impact.
  7. POSITIVE LIFESTYLE CHANGES and need to follow a fixed routine is very important, especially when feeling suicidal. Even if a routine is monotonous, it plays a great deal in keeping your mind occupied. No way in your routine should there be a time when you are doing nothing. Idle minds are the devil’s workshop. 
  8. TAKE RESPONSIBILITY for your life, because if you don’t do, nobody else would. Sadly, but true enough, we are the reasons for what happens to us. Suicide takes away life but not necessarily the reason that caused it. 
  9. CONSULT a professional If the above doesn’t help despite trying your best. You may consult a Psychiatrist, Psychologist or a Counsellor for help. These days there are a lot of helplines and online portals available providing mental health services. The help you need at the moment is just a google search away.

What can one do when someone they love feels suicidal?

If someone you love feels suicidal, then other than suggesting them the above-mentioned self-help techniques, you may do the following for them:

  1. LISTEN by lending your compassionate ears to your loved one. No matter how negative they may sound, but many people heal just by feeling heard.
  2. IDENTIFY the risk factors of suicide in your loved one. Your loved one may leave subtle cues in their speech, say goodbyes or talk of ending their life. Other subtle cues may include paying unexpected visits, making wills, giving away prized possessions, have exhibited self-harm behaviour in the past, write poems or stories about death, express hopelessness and feelings of guilt, express self-hatred, look out for means to commit suicide or a sudden unusual sense of calm or happiness after being extremely depressed. Sometimes the history of mental health disorders, terminal illness, addiction, history of trauma or abuse, family history of suicide may also be important risk factors in suicide.
  3. DO NOT JUDGE no matter what. Sometimes it may be difficult to comprehend people who feel suicidal, however, asking for clarification or just providing unconditional support goes a long way in saving their lives.
  4. OFFER HOPE as that’s the only thing that can make a suicidal person believe in life.
  5. GET PROFESSIONAL HELP and guide them through the consultation. Be in touch with their doctors and therapists and encourage them to follow up regularly for sessions.
  6. ENCOURAGE positive lifestyle changes in your loved ones and assist them in the process. Help them make a routine and ensure they follow it.
  7. DEVISE A SAFETY PLAN that ensures the safety of the suicidal person. Remove any triggers that may lead to a suicidal crisis, like potential means of suicide such as sharp objects, high stools, ceiling fans, glass objects latches from door and pills from drawers. If the person is likely to take an overdose, keep medications locked away or give them out only as the person needs them. lock doors to the terrace or balcony. Make sure to leave positive notes around the house using sticky notes. Hang pictures of family members and moments of joy and success. Leave contact numbers of doctors or therapists in their phones as well as friends and family members who will help in an emergency and most importantly never leave the person alone.
  8. BE PROACTIVE as it can be really taxing to take care of the suicidal person. Just don’t give up on them. Don’t wait for them to call you or even to return your calls. Drop by, call again, invite them out. Inform their family members about their condition even if they don’t like it. Keeping secrets doesn’t really help here. Have discretion enough to decide who to tell and when.

What can professionals do to offer help?

According to research by WHO, many people who die by suicide have seen a health worker in the previous month. Therefore, all health workers have an important role to play in recognizing, assessing and supporting people who are at risk of suicide. Make sure you provide your assistance whenever they reach out to you. Be available for them even at wee hours. Yes, there is a healthy professional boundary which your clients should never overstep, however, if they are suicidal just give them the space to reach out to you even beyond your consultation hours.

What are some of the suicide helplines in India?

Some of the resourceful suicide prevention helplines in India that can be the need of the hour are listed below:

  1. ICALL is an email and telephone-based counselling service run by Tata Institute of Social Sciences. They are available Monday to Saturday between 8 am and 10 pm. Helpline number: 091529 87821 and +91 22 2552111
  2. AASRA is a Mumbai-based organisation which has a 24×7 helpline service. Helpline number: 91-9820466726
  3. THE VANDREVALA FOUNDATION is 24/7 helpline service based out of Mumbai. Helpline numbers: +91 730 459 9836, +91 730 459 9837, and 1860 2662 345
  4. THE FORTIS HEALTH CARE 24×7 Stress helpline. Helpline number: +9183768 04102
  5. PARIVARTHAN  is a Bangalore-based counselling centre. Helpline number +91 76766 02602
  6. COOJ MENTAL HEALTH FOUNDATION is a Goa-based mental health organisation. They are available on call Monday through Friday between 1 pm and 7 pm. Helpline number: +832 2252525
  7. SNEHA FOUNDATION is a 24/7 suicide prevention organization based out of Chennai. Helpline number 044-24640050

According to the guidelines of WHO, every country must adopt a national level suicide prevention strategy which is tailored to their cultural and social context, multisectoral, involving not only the health sector but also sectors such as education, labour, social welfare, agriculture, business, justice, law, defence, politics and the media & entertainment.

India’s National Mental Health Care Policy, 2014, has pointed out a reduction of suicides and attempted suicides as one of its objectives. The Mental Health Care Act, 2017, has effectively decriminalised suicide and mandates the government to implement suicide prevention programs. Such policies have made suicide a public health emergency now. However, India is yet to develop a national suicide prevention strategy as recommended by the WHO, which is the need of the hour. The government also needs to take a more pro-active approach in developing suicide prevention cells across all sectors, that lets people lodge a complaint against bullies, power abusers, oppressors and tormentors, anonymously. It is also important that necessary steps are taken and the matter is investigated without revealing the complainant’s identity.

It’s sad that mental health awareness and discussion on suicides and attempted suicides take place in our society only when politics is concerned, on world suicide prevention day or when a celebrity takes their life. Quite contrary to this, suicide prevention is, in fact, an everyday concern. With a high rate of suicide among youth, Issues of mental well-being and effective coping strategies for distress need to be inculcated among adolescents and young children in their early life in schools, families and other peer networks. Suicide prevention is not the sole responsibility of health services but needs collaboration and participation between various sectors that influence a person’s life. We may never know why a person committed suicide. While it may appear to us that someone had everything to live for, it probably didn’t feel the same way to them. Let’s join hands together to prevent suicide.

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