Dr Shekhar Saxena
Director, Dept of Mental Health & Substance Abuse
World Health Organisation
The first-ever WHO report on suicides Preventing Suicides: A Global Imperative has been published in September. In a remarkable initiative, WHO has given a call for coordinated action to reduce suicides worldwide.
In an exclusive interview with Debarati Das of Fijeeha, Dr Shekhar Saxena, one of the lead authors of this historic report, says that one should review legal provisions in different countries relating to suicide to ensure that they do not deter people from seeking help.
Q. The Report 'Preventing Suicides, A Global Imperative' could not have been more timely. The onset of globalisation and distortions in the notions of self is leading to large number of socio-psychological disorders, of which suicide exhibits itself most harshly. Is there a follow-up planned after this amazing piece of work - by way of bringing together multiple stakeholders and devising a blueprint of social and medical interventions?
A. Suicide indeed is a serious public health issue. The numbers of deaths due to suicide as well as those affected by suicide attempts are very large. WHO decided to publish this report based on the need as well as demand from countries. As a follow up, we plan to provide technical support to countries in developing their suicide prevention strategies, bringing together multiple sectors and stakeholders. We would urge them to use evidence- based interventions and build in evaluations so that they can learn as they go forward.
Q. You and your team have made a bold attempt - of declaring suicides as a large public health issue and asking all stakeholders to act. India - where suicide rates may not be alarming but surely on the higher side - does not have a program. Do you foresee the government working in this direction? Is WHO planning to work with the Government of India in this direction?
A. WHO is ready to provide technical assistance to all countries, including and especially to large countries with substantial numbers of suicide deaths. Since suicide prevention is already a commitment of all countries including India as a component of the Mental Health Action Plan 2013-2020, we certainly look forward to working on this with all governments.
Q. Your report says 75% of suicides occur in low-and-middle income countries. Is there a trend which you would attribute to this - such as the interplay of poverty, indebtedness, lack of social cohesion, or inadequate effects of poverty alleviation programs by the state?
A. All the factors that you mention are risk factors for suicide. In addition, ineffective policies on decreasing the harmful use of alcohol and inadequate mental health services are also responsible for suicide being such a large cause of death in low- and middle- income countries.
Q. It is sad to note that suicide is the second leading cause of death among 15-29 year olds. Do you think on a broader level this is triggered by withering social cohesion and diffusion of technology and large-scale proliferation of media. All this may be infusing a sense of alienation and disenchantment among youth?
A. We do not fully understand the various causes for suicide being one of the leading causes for death among the young. However, excessive stresses and inadequate social support perhaps play a large role. The role of technology is not clearly known.
Q. Along with family and social networks, media has a critical role to play as far as preventing suicides are concerned. Would you recommend a suo moto protocol that media agencies must establish on suicides reporting.
A. Responsible reporting of suicides by media is one of the evidence-based prevention actions. WHO has guidelines on this and we recommend that the media follow these.
Q. Many countries have decriminalised suicides? What have been the results in these countries? Would you recommend India also follows this trend?
A. Fear of criminal prosecution certainly is a barrier against seeking care. There is no evidence that decriminalisation increases suicides. While fully recognising the exclusive right of each country to enact their own laws, the WHO Report suggests that all countries should review their legal provisions in relation to suicide to ensure that they do not deter people from seeking help.
Q. Recently a 14-year-old child in Gujarat was found hanging because of torture by his teacher. Home and schools play a big role in shaping of human beings and a failure on the part of these two institutions can have disastrous consequences. Would you recommend a set of guidelines for families and schools?
A. What we really need is caring families, communities and institutions, including schools and workplaces. We need to be sensitive to the wellbeing of others and pick up early signs of distress. This can make a large impact on the incidence of self-harm and suicide.
Q. What are some of the steps WHO Member States are taking to reduce suicide rates which can act as models for other countries?
A. While suicide poses a large challenge globally, several countries have taken effective steps to meet this challenge. We identified 28 countries that have developed suicide prevention strategies. We know of state level policies to decrease access to harmful pesticides or firearms. We are aware of training of health-care providers in early identification and treatment of mental disorders. We would, however, encourage implementation of these evidence-based strategies on a larger scale.
Q. In some traditional societies, there are large number of superstitious beliefs that may be triggering suicides. What would you recommend to these societies?
A. Increased awareness of psychological problems and mental disorders can decrease misconceptions and increase help seeking. We can all play a role in achieving this.
Q. What is the frequency at which you would bring out follow up reports on suicide?
A. We intend to have fresh data on suicide every year and new interventions as the evidence accumulates.
Q. How do you think a development communication forum like Fijeeha and its member journalists can assist WHO and help achieve a suicide free world?
A. Journalists can play a large role in preventing suicides. They can increase awareness on this issue, help remove myths and misconceptions, decrease stigma and also follow WHO guidance on responsible reporting of suicides. This includes avoiding sensationalising or glamourizing suicides and providing information on where to seek help. We do hope that journalists will join hands with other stakeholders in the very important and timely task of decreasing suicides.
|