Governments and communities must acknowledge that suicide is a major threat to public health. Fighting it requires a multi-sectoral and sensitive strategy
According to a new World Health Organisation report, India accounted for the highest estimated number of suicides in the world in 2012. Globally, suicides accounted for over 8,00 000 deaths that year and the estimated suicide rate is the highest in WHO’s South-East Asia region which includes India.
As suicide is a sensitive issue — and even illegal in some countries — many cases go unreported. World Suicide Prevention Day, observed each year on 10 September is, therefore, a global opportunity to raise awareness and promote joint action to protect those who are vulnerable to suicide.
Suicide characteristics differ based on a country's economic status. The age-standardised rate of suicide is higher in high-income countries. However, given that a much larger proportion of the global population resides in the low and middle-income countries, the latter account for the bulk of deaths, with 75.5 per cent of all global suicides occurring in these countries. Thirty-nine per cent of the suicides in lMICs are reported from WHO’s South-East Asia region, which has 11 countries and is home to a quarter of the global population.
Overall, more men commit suicide than women, but again there are variations based on the economic status of the country. In richer countries, three times more men commit suicide than women, but in lMICs this ratio is 1.5 men to each woman. In most countries, suicide rates are highest in people 70 years and over, but young people aged 15-29 are also particularly vulnerable.
Pesticide self-poisoning is the most common method of suicide, resulting in one third of all deaths, in lMICs. In high-income countries, hanging and firearms are more common methods.
The prevalence, characteristics and methods of suicidal behaviour vary widely between different communities, in different demographic groups and over time. Consequently, up-to-date surveillance of suicides and suicide attempts is an essential component of suicide prevention efforts. This task is much more difficult than it appears. Obtaining high-quality actionable data is difficult. Until this changes, and communities recognise suicide as a public health danger, we will be on the losing side of the fight to prevent suicides.
Governments play a pivotal role in this fight. The first step in this battle is to create a national strategy, stating a clear commitment to suicide prevention. Currently, only 28 countries have such a strategy. Ensuring collaboration between multiple stakeholders and sectors-public and private-is essential.
Countries must restrict access to the most common means of suicide. In India and Sri lanka, restricting access to pesticides locally through locked storage facilities has been effective in lowering suicide rates. Evidence from Australia, Canada, New Zealand, the US and several European countries suggests that restricting access to firearms has been associated with a drop in firearm suicide rates.
Follow-up care for people who have attempted suicide is critical, as they are at great risk of trying again. Social support within communities can help protect the vulnerable by building up their coping skills and sense of connectedness.
Responsible media reporting has also been shown to decrease suicide rates. This includes educating the public about suicide, risk factors and where to seek help; avoiding sensationalism; and avoiding detailed descriptions of suicidal acts. Governments can help by releasing public service announcements that raise awareness, identifying and treating mental and substance-use disorders as early as possible, and ensuring those vulnerable to suicide receive the care they need before it is too late. Mental health and alcohol policies should be integrated into overall health-care services, and Governments should ensure sufficient funding to improve these services.
Worldwide, the prevention of suicide has not been adequately addressed due to lack of awareness. Only a few countries have included prevention of suicide among their priorities. It is clear that suicide prevention requires intervention from outside the health sector as well. It calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, for example education, labour, police, justice, religion, law, politics and the media.
(The author is Regional Director of World Health Organisation, South-East Asia Region)