According to the latest report issued by the World Population Review, the suicide mortality rate in Sri Lanka for year 2018 is 14.6 per 100,000 population, ranking 29th in the collection of 157 countries. Compared with the position in 2016 (which was 16.0 per 100,000) it shows a slight improvement.
However, we must not forget that for each person who died, an estimated 20 others attempted and/or considered suicide. These attempts range in intent and medical severity from the mildly self-injurious to the determinedly lethal.
Suicide occurs throughout the world, affecting individuals of all nations. Statistics reveal that countries with the highest suicide rates in the world are incredibly diverse. For example, in 2018, among the top five were Lithuania (East Europe), Russia (East Europe), Guyana (South America), and South Korea (Asia).
The only western European nation with a high suicide rate is Belgium, which however has some of the world’s most liberal laws on doctor-assisted suicide, which is likely to be a factor in its statistics.
The World Health Organisation estimates that each year approximately one million people die from suicide. It represents a global mortality rate of 16 people per 100,000 or one death every 40 seconds.
Crisis
Sri Lanka has experienced major changes in its suicide rates since Independence. According to the statistics of the Registrar General’s office, at the time of independence (1948), the suicide rate in Sri Lanka was nine per 100,000 people. In the 1970s, it rose to 19 per 100,000, and in the mid-1980s, it reached 33 per 100,000. Subsequent reductions in our suicide rates have been attributed mainly to the introduction of restrictions on the availability of highly toxic pesticides and numerous other measures.
Yet, we cannot be satisfied with the current status. With firm determination, hard work and proper planning, we could do better than the prevailing status. We are losing far too many with every suicide, while also profoundly hurting those left behind.
When one studies the statistics carefully, it becomes clear that we still have a crisis of suicidal behaviour among our youth and the old-aged. Police statistics reveal that in 2018, 3,281 people committed suicide, of which 41 per cent were over 56 years and 35 per cent between 21 and 40 years. Research is needed to find out the reason for these two age groups to be susceptible to such disastrous activity.
State intervention
Global studies suggest that a range of social, personality, childhood and related factors indirectly contribute to suicidal behaviour. The largest contributory factor comes from mental health problems showing that 90% of suicides are associated with mental disorders.
Depression is the main reason for mental disorders. A depression (whether mild or severe) can happen due to many reasons, such as, childhood sexual and physical abuse and poor parenting. Other groups at risk are persons with severe somatic illness, the socially disadvantaged and those with a recent loss of a loved one or negative life events in the past. Substance users are positioned as a special group at high-risk.
Multi-sector approach
By acknowledging that the multiple causes of suicide are not amendable by the healthcare sector alone, many EU countries have successfully developed comprehensive approaches across multi-sectors at all levels.
Each EU country has a solidly-structured national suicide prevention program associated with documented reductions of suicide rates. Each program carries a tripartite approach integrating individuals, community organisation, and related government sectors.
Each country’s mission is to identify and minimise circumstances that encourage suicidal behaviour. They have identified that suicide rates cannot be reduced unless the circumstances that galvanise suicidal behaviour are also reduced. Therefore, the program was given sustained government and community support and resources.
The program includes (a) improved recognition and treatment of depression, (b) restriction of suicide means, (c) restrict glamourizing of media-coverage of suicides, (d) improved access to mental healthcare, and (e) healthcare staff capacity building.
Approaches
The following suggestions may be worth considering when we start a national program to minimise suicidal behaviour in Sri Lanka.
1) The elevated rate of suicidal behaviour among the youth should be researched first to learn what factors have attributed to it.
2) The level of ‘suicide alertness and intervention’ skills among the entire adult population needs to be raised so that people in distress (e.g. a family member or friend) can be identified and encouraged to seek help.
3) More training is needed on elementary counselling methods for interested community members
4) Government and local bodies must identify and address the underlying social determinants of elevated rates of suicidal behaviour. They may include, early school dropouts, overcrowded housing, sexually abused children, unemployed youth and youth involved in violence.
5) Early childhood development programs (e.g. home visitation programs for young mothers), would have a positive impact. A culturally appropriate approach to improve lives of young parents could help prevent many problems from occurring later on in life.
The role of the community
Communities play a critical role in reducing the suicide level. They can provide social support to vulnerable individuals and engage in follow-up care, fight stigma and support those bereaved by suicide.
They can give individuals a sense of belonging and a feeling of connectedness by being part of a community. Communities can also implement specific suicide reduction strategies assigned to them.
The Government has a responsibility to facilitate community engagement in suicide prevention.
Whereas the Government needs to take the lead and develop multisectoral suicide prevention strategies, communities can incorporate and enhance these efforts. It would be a fine combination.