Focus on social and economic factors to curb deaths by suicide

Farmer suicides cannot be addressed in the same way as student suicides, and so a one-size-fits-all approach will not work. Instead, we need approaches that address the unique stressors of each community

In 2021, the National Crime Records Bureau (NCRB) recorded 164,000 deaths by suicide in India. Yet, it comes up as a topic for conversation in living rooms and television studios only when a celebrity dies by suicide. It is almost always seen as a personal choice, rather than something that can be prevented through targeted strategy and consistent interventions.

In the context of low- and middle-income countries, research shows that poverty, social and economic exclusion, violence, and discrimination are strongly linked to distress, resulting in increased suicide rates(Shutterstock)

Suicide is preventable. Suicidal thoughts are usually temporary, and in response to a stressful situation; access to emotional support at the right time can prevent it. A significant number of people contemplating suicide are experiencing feelings of hopelessness, despair, and anxiety, and may believe that there is no other option; therefore, when people talk about suicide, they may be reaching out for help or support, and rather than encouraging acts of self-harm, talking openly about suicide can give them other options, or the time to rethink their decision.

It is also important to understand that suicidal thoughts and actions indicate deep unhappiness, but not necessarily mental illness. Many people living with mental illness may not have thoughts of suicide, and not all people who die by suicide have mental health issues. The tenuous link between mental health and suicides often fails to account for the range of social, economic, and/or political factors that lead a person to think about or attempt suicide. Importantly, there is no single explanation for why people die by suicide. More often than not, a range of everyday life events and experiences create distress within individuals. In the context of low- and middle-income countries, research shows that poverty, social and economic exclusion, violence, and discrimination are strongly linked to distress, resulting in increased suicide rates.

NCRB data shows that in 2021, daily wage earners, self-employed and unemployed people accounted for 44% of the total deaths by suicide in India, indicating heightened financial distress, possibly driven by the pandemic, being a factor. Data also shows that 50% of deaths by suicides among women are by those below 30, hinting at the role of rigid norms around gender and sexuality, a lack of agency, limited mobility, and the threat of early marriage and pregnancy, in hurting the mental and physical health of young women. A report by the Mariwala Health Initiative — Suicide Prevention Changing the Narrative — found that a person’s social context (e.g. where they live or what community they belong to) continuously influences and interacts with their psychological responses (emotions, thoughts, feelings, and reactions). NCRB data also shows that 38% of deaths by suicide were due to family or marriage-related problems. This is why taking into account the relationships, and sociocultural factors that influence a person’s state of mind is critical in providing support and care. A psychosocial approach to suicide prevention should focus explicitly on this link between a person and his or her environment. Such an approach will allow us to view (and respond to) suicide as the result of the complex ways in which people experience their daily life. The provision of social support will need to address social benefits across sectors, including food security, water, housing, shelter, education, sanitation, legal support, and employment support, among others.

A start was made in the form of the Union health ministry’s National Suicide Prevention Strategy that was released in November, which acknowledges suicide as a preventable public health issue, and recommends collaboration across ministries, including agriculture (phase out of hazardous pesticides), women and child development (suicide prevention across all programmes), information and broadcasting (media reporting guidelines) and labour and employment (strictly implement minimum wages). Budgetary and policy-level support will be key in realising these goals.

Unfortunately, much of the present work around suicide prevention is rooted in the idea that only mental health practitioners or experts can help. A community-based approach is equally needed because suicide is not a homogenous issue; the factors that cause it vary significantly from one context to another. Farmer suicides cannot be addressed in the same way as student suicides, and so a one-size-fits-all approach will not work. Instead, we need approaches that address the unique stressors of each community.

Priti Sridhar is CEO, Mariwala Health Initiative The views expressed are personal.