Mental alert: Here's decoding suicidal behaviour in India
Gina D'Costa*, 29, remembers waking up in a hospital bed four years ago, tubes snaking out of her nose. She had swallowed 15 sleeping pills, taken from her mother's bedroom.
"Ending my life wasn't my first instinct," she says. "But I just couldn't eat, sleep, study, or function like I used to."
A week earlier, D'Costa's boyfriend of three years had broken up with her. "It was over a petty fight," she says. "It was clearly an excuse to end a relationship that I had thought would end in marriage."
Coming from a broken home herself - her parents were at the time on the verge of divorce - D'Costa was devastated. She stopped eating and started to spend all day alone in her room. To make matters worse, her final-year BSc exams were days away and she couldn't study.
"I felt like I had no one," she says. "Life had become too painful. In a split second, I decided to pull the plug."
Found by her parents and hospitalised, she initially refused to see a psychiatrist.
"I thought, I am sad, not mad," she says. "Eventually I understood that you don't have to be mad to see a psychiatrist."
D'Costa has been going to sessions regularly ever since, and is now down to one session every three months. "Now, I am enjoying life as it unfolds," she says. "Never again will I centre my will to live on one person."
D'Costa is one of the lucky ones. In 2013 alone, 1.34 lakh Indians committed suicide, according to data from the National Crime Records Bureau. Activists and counsellors say that the actual number is far higher, as a result of mis-reporting and under-reporting of deaths.
A World Health Organisation (WHO) report released last week would seem to bear out their claims. According to that report, there were an estimated 2.6 lakh suicides in India in 2012, making us the country with the highest number of suicides in the world that year.
"In India, one key factor is the low level of awareness on mental health issues. The high level of stigma attached to seeking help also plays a role," says Dr G Gururaj, professor and head of the Centre of Public Health at Bangalore's National Institute of Mental Health and Neurosciences. "Suicide in India is not an individual or family problem, it is a public health concern."
Suicidal behaviour, as pointed out in the WHO report, is a complex phenomenon influenced by several interlacing factors - personal, social, psychological, environmental, cultural and biological.
"Not every person who feels suicidal necessarily suffers from a mental health condition," says Aparna (last name withheld on request), director of Sumaitri, a Delhi-based suicide helpline that is part of the Indian chapter of the global Befrienders' Worldwide suicide prevention initiative.
"A lot of issues instigate the urge to end it all - parental pressure, relationship disputes, poverty, financial losses, loneliness, even too much expectation from society."
Sumaitri receives about 15 calls a day, up from 9 last year; and, according to Aparna, more women call in than men.
"In India, unfortunately, people don't look at depression, stress and anxiety as treatable conditions," says D'Costa. "They don't see it as most of the West does, like just another ailment with a cure, like a cold, cough or fever. They see it as a sign that a person is mad, creepy, weird or weak. This must change."
The key, adds Sameer Parikh, chief of the department of Mental Health and Behavioural Sciences at Delhi's Fortis Healthcare, is to create awareness, train various stakeholders and initiate city-wide suicide prevention programmes.
"India also needs more mental health experts," he says. "We have less than 4,000 psychiatrists. France [with a population of about 66 million] has more than 10,000."
Sensitive media coverage to discourage copycat suicides, more community support systems and policy intervention are other ways in which experts think the suicide rate can be stanched.
Perhaps the most important factor, says Mumbai-based psychiatrist Nilufer Mistry, is to teach people to recognise the early warning signs and reach out before rather than after the attempt.
"Though in a majority of suicide attempts, we find an untreated or unrecognised mental health condition, there are times when the triggers are more socio-economic or cultural - inter caste marriages, career crisis, competition with cousins and colleagues etc," says Mistry.
Parikh reasons that being the eighth-highest killer in the world, especially among those aged 15 to 25, which country has the highest incidence of suicide is not as significant as the issue itself.
"What is noteworthy is that many countries have introduced a national suicide prevention policy or programme. India still hasn't," he says. "Mental health needs to become a priority in our country."
(* Names changed to protect identities)