Suicide: Have we not still taken the bull by the horns?
Suicide is a major problem in Sri Lanka. In mid-nineties Sri Lanka had the world’s no. 1 suicide rate. At that time over forty people died out of every 100,000 within a year due to suicide. That is over 8,000 people per year. That was 20 or more people a day.
In this context, then President appointed a Presidential Task Force (PTF) for Prevention of Suicide. This task force studied the situation scientifically and gave its recommendations, which were readily accepted. Since then the suicide rate of Sri Lanka has been declining every year steadily. Currently it is less than half of the rate we had in 1990s. A situation we can be proud of but not satisfied, as still Sri Lanka has one of the highest suicide rates in the world. Still a number more than ten times of the deaths, attempts self-harm every year.
However it is worth learning more about the recommendations of the PTF, made way back in mid 1990s. As they were apparently effective in turning around the statistics, it may be interesting to guess what those recommendations were.
How to reduce suicides in Sri Lanka?
One common guess in answering this question is to increase mental health services, especially counselling, available for the people. The underlying thinking here is that people commit suicide because of the problems or stressful situations they face with. Hence a this could be a way to identify such situations and individuals and help them to cope more effectively. At a glance, this seems to be intuitively correct. In other words more counsellors a country has less should be its suicide rate. However this is not suggested by the PTF.
Some argue that we need more psychiatrists. The underlying thought is that suicides happen mainly due to mental illnesses. However PTF is not very supportive of this unless for some focused service provisions.
Another common remedy people suggest to reduce suicides in a country is to look deeply at the root causes of the suicides and provide solutions to eliminate the root causes. It is even more intuitive than the previous guess. However the underlying theory/ thinking still remains same: People commit suicide due to certain problems, which may be financial challenges, relationship problems or some other issue. Finding out the root causes and fixing them, again, is not favoured by the PTF recommendations.
Some people argue that it is because of the economic constraints people commit suicides. Provision of more welfare services or increasing salaries are ways to reduces suicides according to that argument. The PTF recommendations certainly do not advise this. And Japan, where economy is very strong, has a very high suicide rate in the world.
Recommendations of the Presidential Task Force for Prevention of Suicides
Now if we turn to the recommendations made by the PTF in 1996, we can’t help but notice that that they are very different to what we have been thinking of.
A very prominent recommendation they made was to ‘reduce easy access to lethal methods of suicide’. One such common method is the ingestion of agrochemicals. Several agrichemicals were banned and many were ordered to be sold in diluted forms. And apparently it worked, not alone, but together with other interventions.
Scientific studies have repeatedly shown that restricting access to means of suicide is a very effective way of reducing suicide in a country/area. One may argue that people might now switch to another method in the absence of the previous method, but it does not happen to that extend. There is a small increase in suicides due to other methods after the restriction, but overall the decline is quite marked.
Removing carbon monoxide, a toxic gas, from domestic gas supply in Europe over a half-a-century ago, installing physical barriers at many famous places of suicide jumps, restriction of dispensing of certain medications are few of the well-known examples from the world over.
Another important recommendation was to change the suicide culture. Suicide culture means a system of thinking/ talking/ behaving about suicide in a way to promote it. For an example, a person might lament saying that “I would rather have taken a poison, than taking up this job.” A mother may ask her daughter “Why you thought of taking your life when we all really love you this much?”
The underlying thinking of above dialogues highlights the core features of the suicide culture. “I would rather have taken a poison, than taking up this job.” means that it is better to commit suicide when faced with very difficult situations. “Why you thought of taking your life when we all really love you this much?” means that if somebody is not loved that much, it is okay to take his/her life. The core theme here is that when faced with difficulties/ stresses/ problems/ unhappiness, suicide is an option.
Another core theme of the suicide culture is that suicide is a heroic thing to do. Some would say “He must have been a tough guy to shoot himself like that, no?”. This means only tough people could kill themselves. More commonly this is done in an indirect way. “She was the best girl in our school!” laments a teacher following the suicide of a school girl. Now this is called glorification of the one who committed suicide.
The act of suicide itself could be glorified. Discussing fine details of how the act was planned and committed, showing others the pictures and sharing the details, writing elaborate obituaries are some ways people do this. Many artistic creations, novels, movies and other glorify suicide in many ways.
Changing suicide culture
Changing this suicide culture is fundamental to the reversal of suicide trends in Sri Lanka. This was clearly recognised and highlighted by the PTF way back in 1996. Since then the media took a keen interest to change its way of reporting to minimise, if not eliminate, its role in glorification of suicides by harmful reporting. Suicide culture alone, or harmful reporting that promote suicide culture, does not cause suicides directly. The suicide culture greatly increases the chances of committing the act of suicide in people.
All over the world ethical journalists have come up with various documents to guide their own reporting on suicide. These are applicable to our setting as well. It is high time that our local media renew their attention to these well-accepted guidelines.
These guidelines caution journalists against the common harms media reporting may bring about. One such well-known harm is ‘presenting simplistic explanations for suicide’, such as the headline ‘father hangs himself after daughter fails at A/Levels’. Presenting suicide as a tool for accomplishing certain ends is another related harm. For an example a news report may tell us that after a certain person killed himself in protest of a certain decision of a local authority, they reversed the decision.
‘Engaging in repetitive, on-going, or excessive reporting of suicide in the news’ together with ‘providing sensational coverage’ are other harms media may cause. These directly promote the suicide culture. None of these isolated reports may cause a suicide, but they contribute in general to the suicide culture and then to actual suicide in the end. Sometimes these news reports give us “how-to” descriptions of committing suicide, teaching us the method.
It is time that we, society in general, people involved with media in particular, pay serious attention to the suicide problem in our country. It is true that we halved the number of people who die of suicide in this country. But we need to do more. Because still ten or more of our own brothers, sisters, daughters, sons die every day.
Mahesh Rajasuriya
[Dr. Mahesh Rajasuriya is a Senior Lecturer at the Department of Psychological Medicine, Faculty of Medicine, University of Colombo as well as a Consultant Psychiatrist at the University Psychiatry Unit, Ward 59, National Hospital of Sri Lanka, Colombo.]
