Trigger warning - suicide, trauma, self harm
With suicide being one of the major contributors to unnatural death globally, it is high time that we approach this stigmatic issue with a new point of view. A multi-staged process that shifts the focus onto mental health in a ground-up approach would probably be the way to cover all the aspects leading up to a suicide.
Suicide is undoubtedly one of the major health issues and a leading cause of death globally. Before we discuss the course of action often taken by professionals regarding this matter and our contribution to them as a society, we shall first delve into the psychology of the patient and the few common behavioral signs often demonstrated and the optimal moments of intervention.
A conservative estimate released by WHO in the year 2016, determined that over 8 lakh people annually lose their lives to suicide and a further 2 crore individuals engage in suicidal behavior. Behind each suicidal behavior and attempt, there is a long chain process that often pans out without the knowledge of any other individual. We must attempt, as a society, to improve on three points.
1. Paying attention to the subtle signs demonstrated and attempting to identify them
2. Direct and/or indirect interventions
These include, but are not limited to, safety planning such as reducing access to lethal means, structured problem-solving therapies with a professional caregiver, providing cognitive tasks to keep the patient engaged.
3. And finally, the subsequent prevention of suicide and suicidal behavior.
A few signs to look out for in a person consider at high risk would be:-
● Excessive sadness or moodiness: Sadness which lasts for a long time and mood swings can be symptoms of depression, a major risk factor for suicide.
● Sudden calmness: Displaying calmness to a level of stoic after a period of depression or moodiness can be a sign that the person has decided to end his or her life.
● Withdrawal: Choosing to be alone and avoiding friends, family, and/or social activities also are possible symptoms of depression. These include the loss of interest or pleasure in activities the person previously enjoyed.
● Changes in personality and/or appearance: A person who might have given a thought to committing suicide is likely to exhibit a change in attitude or behavior, such as speaking or moving with unusual speed or lethargy. Besides, the person might suddenly become less concerned about his or her appearance.
● Dangerous or self-harmful behavior: Potentially dangerous behavior, such as reckless driving, engaging in unsafe sex, and increased use of drugs and/or alcohol might indicate that the person no longer values his or her life.
● Recent trauma or life crisis: A major life crisis might trigger a suicide attempt. Crises include the death of a loved one or pet, divorce or break-up of a relationship, diagnosis of a major illness, loss of a job, or serious financial problems. PTSD is also one of the most common triggers of self-harm and suicidal behavior.
● Making preparations: Often, a person contemplating suicide will begin to put his/her personal affairs in order. This might include visiting friends and family members, giving away personal possessions, making a will, and cleaning up his or her room or home. It is common for people to write a note before committing suicide.
● Threatening suicide: Not everyone who is considering suicide will express so, and not everyone who threatens suicide will follow through with it. However, every threat of suicide should be taken seriously.
Suicide is one of the most complex and multifaceted phenomena exhibited by humans, with multiple contributing and facilitating variables. Some estimations can be formed by the interaction between various factors, such as neurology, personal and family history, traumatic events, and social environment. Given, it is one of the most severe human behaviors, a distinct focal point would be to identify the underlying psychological processes that may lead to suicidal thoughts and behavior.
A study undertaken by the American Journal of Psychiatry demonstrated that approximately 45% of individuals who die by suicide consult a primary care physician within one month of death, without declaring their suicidal desires and ideation. This study highlights the difficulty in communication on such topics and considering how vital it is to identify a person at risk, progress must be made on this aspect.
The most crucial factor leading to suicide is unbearable mental pain. The importance of psychache as the primary facilitator of suicidal ideation has been emphasized and the behavior is often motivated by the desire to escape from unbearable psychological pain. The majority of the patients suffering from clinical depression have reported feeling socio-cultural alienation, greatly due to the situation of discomfort faced by them while discussing issues related to this topic. This is even more profound in patients suffering from Post-Traumatic Stress Disorders and together these work in tandem to often implicate suicidal ideation and risk.
Psychological autopsies conducted since the middle of the previous century and onwards have revealed a correlation between the people who have died by suicide and mental disorders. One study suggested that this number could be at least 90%. On the flip side, most people suffering from mental disorders do not die by their hands. One proposal that might have a profound impact would be to conduct screening tests for suicidal behavior in patients seeking psychological counseling as that would form a base to identify those at risk of suicide and self-harm. This has to be made mandatory by the government medical body to implement it in a standardized manner which shall propel this screening test to be accessible across all demographics.
The stigma in discussing mental health and related topics are still omnipresent globally. There have been numerous studies whose results have made it certain that mental health is as much of a medical requirement as is physical health. Regrettably, much of this still has to trickle down to the general population.
The task needs to be undertaken from a ground-up approach in a multi-stage manner. Awareness of mental health and healthy practices for the same need to be taught to ensure the future generation does not take this issue in a lackluster manner as often witnessed at present. Government helplines need to be expanded to cater to mental health while an amendment to Article 42 – Workers’ welfare Act is required to involve the factors of mental well-being as a mandatory requirement for the workers’ safety. Organizations themselves can actively form a sub-department dedicated to the psychological welfare of the employees and act as the first measure in identifying the underlying issues and take the first step towards the path of rehabilitation. These measures have the power to save thousands of lives each year. For every life saved, is equivalent to giving birth to a new life.