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Submitted by PatientsEngage on 9 September 2017

An estimated 2 lakh Indians take their life every year and not less than 25 times of this number attempt suicide. Akhileshwar Sahay, bipolar survivor and mental health leader, has embarked on an ambitious initiative, Zero Suicide Mission, to eliminate suicides from India. In this interview, he charts out the roadmap for his mission.   

What is Zero Suicide Mission?

Zero Suicide Mission seeks to eliminate suicides and suicide attempts from India.  It seeks to overturn the status quo and current thinking in the country that, in a nation with 130 crore, a certain number of people is destined to take their life. Now look, this is a fallacious assumption and Mission Zero Suicide attacks at the very core of the current societal thinking with its hypothesis that every suicide and suicide attempt is a preventable ppublic health problem. 

As I recently wrote in my comprehensive piece “Zero Suicide- Not an Utopian Goal” : “Mission Zero Suicide is a systems-based approach that that starts by saying every suicide death is preventable. It employs a holistic strategy for suicide prevention: one that is timely, patient-centric, and equitable. It then asks, what proximate and long-term strategies and interventions are needed to disarm, wean away, or engineer away a suicidal person from stress, distress, depression, anxiety, a deep sense of loneliness, nothingness, social and other alienation, traumatic conditions and/or other severe psychiatric disorders that propel humans towards suicidal ideation and suicide attempts?”

Mission Zero Suicide - This sounds like a utopian goal. Is it?

Not at all. Look here, completed and attempted suicide is already causing havoc in the country. Not a day goes without newspapers reporting a large number of suicides from different parts of the country. An estimated 2 lakh Indians take their life every year and not less than 25 times of this number attempt suicide. Now, if one looks at the real causes of the suicide – it is caused by extreme distress and stress irrespective of whether the person suffers from mental illness or not. 

When the problem is of such gigantic nature taking the position that “Mission Zero Suicide” is a utopian goal is taking a defeatist position. On the contrary, I dare say the time has come for the nation to embrace this goal. To me, however difficult though it may look, it is that Big Hairy Audacious Goal (BHAG) whose time came long ago. It has to start with screening vulnerable groups at macro level and vulnerable individuals at the micro level and the country has to purposely adopt it as a Mission and then create strategies to move resolutely.

What are the most vulnerable segments in India?

The way we collect data using police records in the country is very unreliable. Worse the system of registration of deaths is so awful that a large number of suicides go uncounted. The most authentic recent numbers of suicide in the country is available from the 2014 report, Preventing Suicide: A Global Perspective, published by WHO in 2014, which reported that 2,58,057 (158,098 men and 99,977 women, 61.26%:38.74%) Indians committed suicide in 2012. This is the largest in a single country, more than even China.  

As regards the most vulnerable sections, the data below speaks volumes:

A comprehensive study published in famous British Journal Lancet in 2012 (Dr. Vikram Patel et. al.) has returned the finding that 40% of all male suicides and 56% of all female suicides in the country are by those who fall in the age group 14-29. Now this is a truly scary position, as this is the most productive asset of the country which is dying unsung even though large numbers of these deaths are preventable.

Every hour more than one Indian student commits suicide. And the central point is once again, before the death they give ample opportunity to save their life but we do not take the cue.

Every year at least 20,000 housewives of India take their life. This is a really pathetic situation and death of housewives by suicides generally are due to such reasons where effective preventable steps are possible.

As per Government of India affidavit to the Supreme Court, for past few years, every year more than 12,000 farmers commit suicide. And the fact that even so called loan waivers have not resulted in reduction in suicides means that problem is more structural and the root cause analysis has not been done.

More than one armed forces personnel or paramilitary personnel or police personnel commit suicide daily. Actual total per annum is far more. This shows clear callousness of the nation that we are not able to even protect the life of those whose job is to protect us.
 
Make no mistake - the number of suicides, suicide attempts and suicidal ideation is on fast uptick in every age group including the geriatric population and India as a country has not yet woken up to this one of the biggest public health challenges of the twenty first century. Mere death of our youth through suicide should scare us, make us take notice and act because in the age group 15-29 suicide has already over taken road accidents as the biggest cause of death.

What are the challenges to this zero suicide mission?

There are numerous challenges.

The very first challenge is inertia and cultural stasis. We are yet to wake up and accept the enormity of the problem.  

Second problem is the resources.  It is one thing to say, let us start the process of eliminating the suicide. But it is not that simple. The country needs evidence based solutions customized and targeted for vulnerable groups at the macro level and vulnerable individuals at the micro level and this is easily said that done in a country where overall health budget is abysmal.  

Third issue is country has severe shortage of human resources for this type of intervention.  The challenges are so humungous in a country like ours that it is not possible to eliminate incidences of suicide and suicide attempts in near future.

But the key is to accept that suicides are preventable and proceed on the path of step by step reduction and eventual elimination using systems based approach. 

What are the different steps required to kick-start the process of first reducing and then eliminating suicide?

We do not have a standard template to reduce and eliminate suicide, suicide attempts and suicidal ideation. And make no mistake, there is no magic wand. It is all hard and smart work on uncharted path and while the mission will remain constant to eliminate suicides, we will need to cross many hurdles and milestones.  At this early stage, it suffices to say that we develop a national consensus and start working immediately on at least the following, which I call as my 10 point Agenda, say Ten to Zero:

  1. Make the elimination of suicide not just a national mission but also every citizen’s mission
  2. Jump-start the National Alliance for Suicide Prevention in public, private and NGO-coalition mode
  3. Invest in multidisciplinary research: suicide has a complex aetiology
  4. Think global but act local: Indian states are as different from each other, if not more, than some countries are, and one size will not fit all.
  5. A dovetailed suicide prevention strategy is needed at central, state, city and village level; this is a long-haul effort.
  6. Learn from the successes and failures of others. Urgently create a National Task force for formulating suicide prevention strategies and implementation plans.
  7. Adopt an empirical, evidence-based approach to intervention.
  8. Reduce access to the means of suicide, and use technology (to count suicides and suicide attempts, as well as to disseminate why and how it has to be eliminated) and introduce multidisciplinary review of suicide attempts.
  9. There is a crying need for a best practices communication strategy, including for media and social media .
  10.  Or should I say, Point Zero: we must start now.

All these are laudable goals. But they will need complete devotion of governments at national, state, city and village level and, as the government resources will not be enough, it will need long term national collaboration all the stakeholders in the country. Mission Zero Suicide shall have to become the responsibility of each and every citizen of the country.

Most zero suicide initiatives in other countries are targetted at people with known mental health issues. In India, that itself is a challenge. So what would the roadmap for this mission look like in India?

You are correct there are truly not many instances of zero suicide initiatives and few, like Michigan Detroit in USA, which have succeeded to some appreciable degree have targeted people with mental illness. There is a reason for this. Globally research data has confirmed that ninety percent suicides are by those people who either had a confirmed history of mental illness or  in whom existence of such an illness could be detected through psychological autopsy. In India my own study does corroborate the fact that whether the suicide is on impulse or pre-meditated, extreme distress, extreme stress and/ or mental illness is the causative factor.

Given the size and population of the country, it is a real herculean task to map the people who are vulnerable to suicide or suicide attempts. And, given the reality that ninety percent Indians have no access to mental health care, the job becomes a lot more complex.

But this need not deter us. We need to create gate keepers for suicide prevention at every level - be it school, college, offices, home, NGOs, Asha workers. We need to move in a stratified manner – both regards to target group and target areas. Eliminating suicide from whole nation is a mammoth task. But if we break it down to manageable parts and start with a targeted approach before doing the carpet bombing across the nation, early success stories will create the momentum that is needed for broad basing the movement. 

Given all our various health and social challenges why should this be a priority?

Make no mistake, suicide is already the single largest cause of death in our youth - 15-29 year group. Suicide not only brings colossal distress to families but as I have brought out in my study, preventing suicides has a humungous economic and financial trade off. My ballpark figure is that life-time financial cost of just number of Indians committing suicide in one year is Rs. 25000 crore and it gets compounded every year with similar number.  Personal, social and economic cost to nation is so huge that there is no way for nation not to embark on the path of mission to eliminate suicide and suicide attempts

Why are you so passionate about this?

There are multiple reasons. First is existential. I have Bipolar Disorder and have lived a long life with suicidal ideation. It is rather common for people with Bipolar. Also, in the early days of my illness when it was undetected, as well as in later part when the treatment started, I did make attempts to take my life. Providence saved me. My crusade of Mission Zero Suicide thus resonates with me.

Second, I am in the vanguard of mental health movement of the country, was Member of Government of India Mental Health Policy Group and currently am part of the committee that is drafting rules and regulations for Mental Health Care Act, 2017.  I am aware that mentally ill are particularly prone to suicide, suicide attempts and suicidal ideation.  

Thirdly, my own study on prevalence of suicide in India indicates that time is running out to fix the problem. And lastly, because of my passion I do manage a Facebook Group- “Action Group-Mission Zero Suicide India”.  And, speaking about passion, who else is in a better position to start “Mission Zero Suicide-India” than the one who nearly crossed the Rubicon, who was long supposed to be dead taking life in his own hands  but on whom providence and serendipity smiled, and who is alive to talk of futility of taking one’s own life.

The one thing you would like each person to do to help achieve this mission 

Educate yourself about why people take their life or attempt suicide. Be there. Listen, those who commit or attempt suicide, give ample opportunity to save them. It is time for every citizen to become the gatekeeper to end suicide. If 1.3 crore Indians cannot save 2 lakh taking their life in a year, we are not doing our duty.

Akhileshwar Sahay is Principal Instigator Action Group-Mission Zero Suicide India and past Member of Government of India Mental Health Policy Group.

Reference: As regards what precisely the Mission Zero Suicide is, it is best exemplified in what I recently wrote in my comprehensive piece “Zero Suicide- Not an Utopian Goal” in national daily The Hindu on 6th August, 2017.  

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