It’s not always about how you feel how you look whether you’re smiling or not. It’s about your mental well-being, whether your soul is happy or not. Whether you are in a state of mind to take on the world and be confident. Mental health and suicides is a very complex issue. September 10 is the suicide prevention day, which then leads up to world mental health day on October 10.
Mental health and suicide is something we need to speak about each possible day because we don't know that the next possible victim could be someone very close to us. Hence it becomes very important not only speak about mental health suicides but also have a robust system that would ensure the triggers of suicides are taken care of. But is this happening in our society? Are we really aware and sensitive to the issue of mental health and suicides?
Ronald Martins, Co-ordinator GOACAN said that over the years of working with the society, we have seen that people have discussions about problems, but when it comes to solutions there is always finger pointing - whether government or non government.
“We joined hands with COOJ Mental health Foundation and decided bring the issue of mental health in public knowledge, because we found while talking to panchayats, consumer clubs, gramsabhas that although there was concern about suicides, there was unawareness about the solution,” martins said.
First thing done in this direction was to petition the government twice or thrice and asked the Directorate of Health Services to set up a task force, assist the NGOs to address the problem.
“We found that there are a lot of incidents that are being reported in the media which weren’t getting across to the people. Then we started a mailing list for go a suicide watch and started sharing the facts of what has been happening. Then we found that people were interested and we needed to set the ball rolling,” Martins said.
Problem is people look at mental health as any other disease like malaria, dengue and not as a separate health condition.
Why does Goa have so many suicide cases? Suicide numbers are going up every year. In 2022 up to June already 150 cases of suicide has been recorded.
Dr Tanvi Pednekar, Consultant Psychiatrist, North Goa District Hospital said, “We can’t pinpoint on anyone aspect as reason for suicides. Suicide is an outcome of multifactorial things, one of them being social stigma. For most of the people, it is like any other physical ailment. When we ask a basic question how are you - we think about physical well-being and not mental health. Along with that there are a lot of other factors like that of societal pressure, family factor, illness, and many others. There are a lot of factors which work together.”
Speaking about Goa, Dr Pendekar said that substance abuse could be one of the factors along with unemployment. During the COVID pandemic unemployment was a huge issue come.
“Goa is a tourism driven State. During COVID lockdown, people stopped traveling which affected the people’s livelihoods associated with the tourism sector. The pandemic also forced people into isolation. Social connectivity was lost at that time. So there are a lot of factors which are responsible for triggering suicide,” Dr Pednekar said.
“What we have is only the NCRB data collected by police, typically a constable there is no trained mental health professional to do a psychological autopsy. So definitely, these numbers are a conservative estimate. Psychological autopsy includes asking family members about what was the behavior of the deceased before death, if there was any change in behavioral pattern in the NCRB data where the reason for suicide is not known it is put as others who stop there are unnatural deaths which are reported as accidental deaths,” she said.
According to her, there’s lot of gap in the NCRB data. There is a need of comprehensive data because there is a need to know exactly what is causing people to take their lives.
“It is a very complex issue. What we do know from the data is that suicide is the number one cause of death among population in the 15 to 39 years age group, which is 15 per cent. There are various reasons for that, including alcoholism. Studies show that those who are intoxicated are three times more likely to attempt suicide it increases the risk factor, especially in case of adolescents,” the psychiatrist said.
“In India, suicide is not exactly entirely mental health problem. for almost 50% of the cases in India are outcome of sociocultural issues like not being able to choose their life partner especially if there is love, or career they want to pursue,” she said.
Goa is known as the land to come and relax. But the irony is that data shows there’s a huge population in Goa which is unhappy. So why is this paradox that people living in the land are taking their lives, whereas others come to relax here?
Dr Gaurav Haldankar, Consultant Psychiatrist said that outsiders come to Goa for enjoying themselves. But where do Goans go for their relaxation? Are there appropriate places where the people can come together to share their ideas and difficulties?
“Youth are seen mostly venting their emotions on social media. That has to do a lot with post pandemic situation. We usually sit in our homes and stop discussing matters in a social setting. That really restricts our means of expressions. Sometimes through social media interaction, we get information that may not be very appropriate and there is a lot of rise in cyber suicides,” Dr Haldankar said.
Explaining the concept of cyber suicides he said it is getting ideas for suicides online. “When a person is getting certain suicidal thoughts, he’s always in a dilemma whether to do it or not. When you search the Internet on suicides, mind gets what it wants. Internet has humongous information. If you are tuned towards negative outcomes, you will get the same. The restricted means of social networking may be a cause of worry in Goa,” Dr Haldankar said.
Dr Peter Castelino, Director COOJ Mental Health Foundation, is the pioneer in setting up suicide prevention helpline and starting the mental health movement in Goa.
When asked about why he decided to address this issue, and how he got into this space of mental health awareness before many others, Dr Castelino said the motivation came from interacting with youngsters and started talking to them.
“As the interactions increased, I realised that they did not have a confidential or safe space to express themselves. At that time there were hardly any counselors and those who were there, were very expensive. Nobody even thought of going to a counselor for basic issues like personal relationships. After just talking to them we realized that there was a great need to start a helpline. As we went digging deeper, we realised many of these young people had suicidal thoughts,” the COOJ Director said.
“Initially they were very apprehensive in sharing their thoughts. But as we started making them feel more comfortable, those thoughts started coming out. So we decided to observe one day that is September 10 as World Suicide Prevention Day. But we realised that one day was not enough. So we decided to stretch it to one week and within this period we collected a lot of information from grassroots level by visiting schools and colleges,” he said.
Over a period of time, there has been a substantial increase in awareness on suicide in the community.
“In earlier days when the education institutes would be approached for allowing them to speak to youth, they would tell that we could hold sessions with the youngsters but not use the word suicide. Because by doing so we will be planting ideas in people’s minds. That was the sign of huge stigma and unawareness amongst the educationists. But today people are inviting us to have suicide prevention programmes. The word is out of the closet,” he said.
But while there is a lot of awareness amongst people, there is need for all the participants in this journey to join hands for taking the suicide prevention campaign ahead.
The question is what is triggering suicides? Is it loneliness, breaking down of joint families to nuclear families, missing the confidence of peers or emotional interaction becoming more digital from human? Are these factors responsible for suicide?
Dr Castelino said that one can't pinpoint any one reason because all the reasons which have been cited contribute to suicide.
“There are many other reasons. Like during pandemic, many youngsters who would have distressed themselves in an open environment could not do that. They were forced to face their issues inside the homes. Domestic violence increased at home, that increased suicides,” the mental health expert said.
According to him, difference between the West and India, here a lot of suicides are impulsive. Access to means of attempting suicide is easily available.
“In the West, if you want to jump off a bridge, there would be obstacles in terms of railings. Nearly 90% of people who feel suicidal have actually cried out for help, spoken to someone, but haven’t got the right kind of help they required. People who are first responders need to be trained in basic psychology first-aid so that they know what to do when a person is feeling suicidal.
Has the society at large starting with the immediate family, become more equipped to sensitively handle this situation?
Dr Haldankar said for every one completed suicide, there are at least 10 attempted suicides. That is the degree of penetration of suicidal ideations into people’s minds.
“When I go to the bedside of a person in the hospital, it is very crowded and I can’t engage with the person. So we have to look for some privacy and then engage. But the person who has attempted suicide or the family members are always stigmatised speaking about their condition. Family wouldn’t want to get into the hassles of any police inquiry, even though suicide has been decriminalised. The fear and the stigma related to suicide in the family is huge. So, we try to talk to these individuals, usually most of the time they call it an accident,” he said.
People are not free to tell their stories because of pressure and shame caused by suicide attempt.
“We always insist upon follow-up with us. But we would get calls just before the person’s discharge from hospital, when the family is in readiness to go home. The follow-up never used to happen. That is why we have to engage a large section of the society. Being a multifaceted issue, suicides have to be dealt with very sensitively,” the senior psychiatrist added.
According to him school teachers, law enforcers, parents everyone has to be sensitized on how to converse with a person who’s struggling with the thoughts and deal with this issue very sensitively.
“When someone tells you about suicidal ideations, it really hits at you because you have a tough time figuring out what’s next. One feels more like a pressure rather than a structured way of how to help the person. That system has to be in place one way or the other,” Dr Haldankar said.
Ultimately when a person is mentally disturbed in a family how does he or she get that empathy when that is not available at home? You have to be ultimately having a very visionary home to be able to get that problem out of the home and take it to a mental health organization. There are so many cases where the problems don’t even leave the house. So how does one come to terms with this challenge of getting that door open from outside, when it is not opening from inside?
Miriam Sequeira, psychologist at mental health intervention centre Sangath, said that she has met many students who expressed shocked after knowing that their fellow student had died by suicide because he or she seemed fine and showed no indications of being mentally disturbed.
“This is one level of closure where I don’t even allow my thoughts to come out. Then even if external indicators are shown that something is not right, there are changes in my behaviour, or I take leaves more often, I don’t eat very well, I don’t feel like going out of bed, make statements like what’s the point of waking up or elderly people taking decisions about distributing their property - one just writes off these indicators as something normal. This could be indicators for death wish,” Sequeira said.
According to her, it is not possible always for families to intervene because they don’t have the resources. That is where mental health intervention centres come into the picture.
“People need to know when they go to these centres, They should also provide adequate services,” she said.
In many advanced countries, the response to mental health challenges is very robust. In Goa if someone calls on the helpline do we have the system in which the counselors are a call away? Do we have adequate trained manpower to take a person out of suicidal thoughts by calming down the person? Also do we have a robust infrastructure like an ambulance to get a person having such thoughts to the care center? How far away are we from that optimisation of infrastructure?
Responding to this question, Dr Tanvi Pednekar said that government has emergency services in place at both the district hospitals along with the tertiary care centre IPHB. There are counselors to see the patients.
“But the treatment gap is big. We don’t have adequate number of trained people, because of which the counselors are not available in large numbers. But emergency services are there,” Dr Pednekar said.
Ronald Martins said, “My gut feeling is that we do not have services that are needed by people. Looking at the cases that are being reported, huge number of working class, migrants are affected. But they are not going to call a Primary Health Centre or call on a helpline. Before and post COVID this is one group which is badly affected. Second is, being a tourism state, we are not looking at the needs of tourists who come here.”
He added that there is this concept of suicide tourism. Goa is the destination for international tourists. We need to be clear and watchful of this scenario when this happens how we will respond. That is why every village panchayat has to discuss this issue. It has to be a statewide discussion where emphasis would be on saying that mental health is the need of the hour, Martins said.
Majority of the suicides happen by consuming poison, drowning or hanging. A lot of people say that can we have deterrence in terms of early easy availability of sources like rat poison for instance, people jumping off bridges? Can it be achieved?
In his response Martins said, “I’m of the view that all the agencies haven’t been sensitized. We are doing suicide prevention campaign at panchayat level with newly elected members. We want to flag this issue to them by asking them what is their understanding of the problem and are they going to allocate at least one gram sabha meeting in a fortnight where they will allow the resource person to come and brief them on this subject.”
“Let’s say we are talking about farming areas in Goa like Sanguem and Canacona where farming is done extensively and pesticides are available freely. The question here is that if these are freely available then how to deal with it? We are going to identify these sources with the agriculture department and other agencies and put up this Information on the website. Municipal councils haven't tide up with urban health centers to run an awareness programme. This is what we are pushing for from citizens’ point of view this year,” Martin said.