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September 11,2018

Let’s work together

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‘Working Together to Prevent Suicide’ was the theme of the 2018 World Suicide Prevention Day. You! takes a look...

The World Health Organization (WHO) estimates that over 800,000 people take their own life each year - that’s one person every 40 seconds. This means that there are many more people who have been bereaved by suicide or have been close to someone who has tried to take his or her own life.

‘Working Together to Prevent Suicide’ was the theme of the 2018 World Suicide Prevention Day. This theme was chosen internationally as it highlights the most essential ingredient for effective global suicide prevention: collaboration. We all have a role to play and together we can collectively address the challenges presented by suicidal behaviour in society today.

This year’s WSPD theme also complements the efforts of another movement called ‘R U OK? Day’ which will be celebrated on 13th September; which encourages and supports people to take time and notice what’s going on with their families, friends and colleagues.

Every year on 10th September, World Suicide Prevention Day is organised by the International Association for Suicide Prevention (IASP) along with WHO. They raise awareness of the ‘Blue Light Programme’ and their support for mental illnesses around this time, to reach as many members of the emergency services as possible. Thousands of staff and volunteers across these services have actively challenged mental health stigma, learnt more about mental health and made positive changes in their approach to well-being with the support of the Blue Light Programme so far.

Suicides in Pakistan

Pakistan is a developing country with a population of approximately 162 million. Traditionally, suicide numbers were low but in recent years, they have shown an increase and suicide has become a major public health problem in Pakistan. From available evidence, it appears that most suicides occur in young people (single men and married women) under the age of 30 years. The most common methods of suicide are hanging, use of insecticides and firearms. Interpersonal relationship problems and domestic issues are termed as the most common reasons for suicide. Mental illness is rarely mentioned. Lack of resources, poorly established primary and mental health services and weak political processes make suicide prevention a formidable challenge in Pakistan. Public and mental health professionals need to work with government and non-governmental organisations to take up this challenge.

There are no official statistics on suicide from Pakistan neither are suicide deaths are included in the national annual mortality statistics. Also, national rates are neither known nor reported to the World Health Organization (WHO). Under Pakistani law (based on religious beliefs), both suicide and deliberate self-harm (DSH) are illegal acts, punishable with a jail term and financial penalty. All suicide cases must be taken to one of the government hospitals, designated as medico-legal centres (MLC). In DSH cases, many people avoid going to these centres for fear of harassment by the police and stigma. Instead, they seek treatment from private hospitals that neither diagnose suicide nor report them to police. Incidences of suicide and DSH are therefore, grossly underestimated in Pakistan.

The only information available in Pakistan comes from newspapers, reports of non-governmental organisations (NGOs), voluntary and human rights organisations and police departments of different cities. Some studies show that suicide cuts across all ethnic, provincial and rural/urban boundaries. In one study, suicide was reported from at least 35 cities and towns (and their surrounding villages) of Pakistan.

It has also been reported from most major cities including Karachi, Larkana, Lahore, Multan, Bahawalpur, Faisalabad, Rawalpindi, Chitral and Peshawar; also including the remote Ghizer District, in the Northern areas of the country.

Preventive measures

Public education campaigns: A review of relevant studies that listed methods used shows that poisoning (with insecticides) and hanging to be the two most common methods, followed by firearms, drowning, self-immolation and jumping from a height. Use of medications for suicide featured in only a small minority of cases. Public education campaigns to promote safe storage of insecticides are needed.

Mental health & suicide prevention programmes: As far as suicide prevention is concerned, this requires a multi-sectoral approach. Almost 34 per cent of population suffers from common mental disorders, and depression is implicated in more than 90 per cent of suicides. This needs to be addressed at the community level. Ideally, mental health and suicide prevention programmes should be integrated within the primary health care (PHC) system. Training PHC staff to screen for suicidal patients would be impractical. Perhaps the solution lies in low cost community mental health programmes, involving mental health care workers and lay counsellors.

Management of DSH: It is estimated for every suicide there are at least 10-20 DSH acts. Based on current figures, there is an excess of 100,000 DSH acts annually. Along with medical management of DSH, the underlying psychological issues should be addressed as well.

Psychiatric assessment of survivors: The new Mental Health Ordinance, 2001, that superseded the Lunacy Act of 1912, has been a step forward and provides for a psychiatric assessment of survivors of suicide attempt. Section 49 of the Ordinance pertains to suicide and DSH and states: “A person who attempts suicide shall be assessed by an approved psychiatrist and if found to be suffering from a mental disorder shall be treated appropriately under the provisions of this Ordinance”. However, it does not go far enough to categorically decriminalise DSH.

Crisis intervention centres: Crisis intervention centres and suicide prevention telephone hotlines play an important role in helping suicidal people. There is a need to establish such services to reduce the incidence of suicide in young people with school- based interventions, as recommended by WHO’s Suicide Prevention Strategies.

Mental health assessment: There appears to be a strong association between poor socio-economic conditions and suicide in Pakistan. Government must implement social policies that are just, equitable and fair. Resource allocation for mental health is abysmally low and squandered away by corruption and mismanagement. There is need for increased spending on mental health as well as proper utilisation of available resources.

Mortality statistics: Mortality statistics on suicides should be collected through a standard system of registration, recording and diagnosis of suicides, at all town/city, district and provincial levels. Information obtained can be used for epidemiological-analytical, intra-country and cross national studies. A mandatory reporting of suicide mortality statistics to the WHO would improve data collection and surveillance on suicide.

Courtesy:

WHO | WSPD | Journal of Pakistan

Medical Association (JPMA)

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