According to the World Health Organisation, someone commits suicide every 40 seconds. On average, there are 25 attempts prior to every actual suicide. Bangladesh is no exception, and one only has to look at print, electronic and social media to see that instances of suicide are growing at an exponential rate.
My work as a mental health professional began nine years ago in 2013 through "Kaan Pete Roi", the mental health support and suicide prevention hotline supported by Sajida Foundation. To ensure compliance and ethical best practices of Kaan Pete Roi and similar services, Sajida Foundation is working closely with Non-Communicable Disease Control (NCDC) and Directorate General of Health Services (DGHS), in line with the latest Mental Health Act 2018 and SOP for Mental and Psychosocial Support (MHPSS) Call Centre.
Kan Pete Roi is a not-for-profit, voluntary organisation, whereby anyone can receive mental health support over the phone from trained volunteers. We have trained nearly 500 volunteers in suicide prevention to date. Aside from providing critical mental health support to those with suicidal tendencies, a core activity of this organization is to provide awareness on the topic. This has entailed travelling nationwide to conduct suicide prevention workshops and training seminars amongst school children and faculty in educational institutions, management and staff of state and private bodies, law enforcement agencies and indigenous communities. What I am about to share here is a small slice of those experiences.
Any discussion about suicide would be incomplete without referencing the accompanying myths and misconceptions surrounding the topic. Invariably, the fiction far outnumbers the facts. I tend to weave this conversation into my training sessions in the form of a series of true and false questions. The objective? To highlight where each individual stands on this fact or fiction divide.
It often makes for an entertaining session when both true and false responses are offered for the same question! But more often than not, the most interesting answers are in response to a single specific question: whether questioning someone with depression about suicide plants the idea in his head or pushes him towards ending his life. This is just one of many misconceptions that exist.
This particular question generates a mixed bag of responses. My approach is taking note of each person's perspective, rather than reaching a group consensus. I noticed that nearly every trainee felt that questioning a depressed person about suicide does serve to encourage him/her to take his/her life. Given the limited opportunities for in-depth learning on this particular issue, I do not find this to be particularly unusual amongst respondents in many of the external seminars I conduct.
But when I find this response amongst our own "Kaan Pete Roi" trainees, it does give me pause. There are several assessment phases our trainees undergo prior to embarking on the training itself. Each phase entails a comprehensive analysis of each trainee's individual perspective on suicide. A trainee is selected only after ensuring that s/he is eager to work on the issue and is able to work with sensitivity, and with an open mind. It is assumed that our trainees will be far more knowledgeable and more empathetic than others. Therefore, when this "true" response is seen amongst our own cohorts, it is not much of a stretch to gauge the knowledge gap that currently exists in society. If this lack of awareness is not addressed in a timely manner, it could have far-reaching implications for our future generations.
Before delving deeper into the issue, it is important to unequivocally state that the correct answer to the aforementioned question is "false"- speaking to a depressed person about suicide does not encourage him to end his own life. The reverse is true- the person will be grateful that someone cares enough to understand the true nature of his pain or trauma, that his mental anguish is so intense that he is actually contemplating such a drastic step. Asking a deceptively simple question such as this may actually provide the courage he needs to share his thoughts and perspectives in a constructive, open dialogue.
For someone in a crisis, in pain, this is no small issue.
Due to the web of misinformation that surrounds us, we are extremely reluctant to speak openly about mental health, we disguise our true feelings and are not receptive to others' views on the subject. Asking a simple question about suicide could serve as that vital bridge and facilitate an important conversation between two individuals. A change in mindset takes time and it is imperative that we recognize the extent of societal stigma that is currently prevalent.
It is important to understand that a person does not take this extreme step because he wants to die; he views suicide as the only way out of an extremely difficult situation. When the pain reaches its peak, and he simply cannot bear it any longer, when dying is the easier and more straightforward alternative to staying alive, he may choose suicide as the only release.
The pain may be caused by physical, mental, environmental, or social factors. One may feel suicidal tendencies if insulted, betrayed, bullied, or if in a difficult relationship, in the midst of separation, undesirable circumstances, or domestic abuse. One could be devastated if one is overwhelmed by mental anguish for any length of time, as a result of which the person's ability to logically think through and arrive at solutions to his problems significantly reduces. He is so engulfed in his own state of hopelessness and despair that he experiences tunnel vision, i.e., he is unable to see any range of available alternative solutions. He arrives at this extreme step, which he believes to be the only solution, refusing to entertain the possibility of other alternatives. Under these circumstances, if he is absolutely unable to talk to anyone about his crisis, his suicidal tendencies will naturally increase.
But there is a ray of hope: on the other hand, if someone approaches him with sensitivity and sympathy, if he is asked whether he wants to commit suicide, a safe space is created for an honest, open conversation about the innermost thoughts and feelings that he has been bottling up. This dialogue will serve to gradually mitigate that tunnel vision, eventually significantly reducing those suicidal tendencies.
Suicidal tendencies could be amplified by certain mental illnesses, e.g., bipolar disorder, personality disorder, schizophrenia, etc. In such cases, it is critical to get support from professionals (clinical psychologists, counselling psychologists and mental illness specialists). As required, the course of treatment could be either psychotherapy or medication, or a combination of both. Obviously, treatment is not a one-size-fits-all approach. Whatever the case, it is crucial to go to a professional, start a course of treatment and stay consistent on that path. Most importantly, a friendly, sympathetic stance is the first gate of response in suicide prevention.
As a mental health professional and trainer on suicide prevention, it is important to eliminate the aforementioned myths and misconceptions because – a) no matter how sympathetic a person is, if he falls prey to misinformation, he will never be able to summon up the courage to help one suffering from depression; b) if the friend in pain does express suicidal thoughts, the person, fearing the consequences, will avoid the topic completely.
Your approach, tone and method of delivery are crucial. Mockery, disrespect, and offering unsolicited advice could have severe consequences by exacerbating suicidal tendencies rather than reducing them.
A gentle, simple approach definitely goes a long way. It is worth keeping the following in mind.
- Try and understand the extent of the person's pain
- Try and be open while listening to his problem
- Refrain from taking a principled stand
- Refrain from religious proclamations
- Avoid asking judgmental questions
- Avoid taking a moral stand
- Refrain from offering advice
- Refrain from giving false hopes
- Maintain strict confidentiality
Keeping the above in mind will set the stage for a gentle, open conversation; also, someone in pain will get that much-needed boost of confidence to speak to a person who adopts this approach. We should also learn how to recognise the warning signs - https://suicidology.org. If you detect these in someone, approach him. Start with simple, straightforward questions like – how are you? Once a comfort level has been established, you can try and gauge if he has suicidal tendencies.
Remember, due to the prevalent societal stigmas, you or I will never be comfortable discussing our problems and even when faced with the direst of circumstances, we avoid approaching anyone for help. In the interest of self-preservation, we must break down these barriers. At some point or other, most of us have had suicidal tendencies at least once in our lives. It is possible to address most mental illnesses, including suicide, with the right support and treatment.
10th September is recognised as World Suicide Prevention Day throughout the globe, and this year's tagline is - Creating Hope Through Action. Suicide is 100% preventable - this is the key message we must disseminate far and wide. The very first step of prevention is to boost awareness of suicide, regardless of age, gender, race, or religion. We cannot hide from assuming that those with suicidal tendencies only live elsewhere in the world. You, me, our siblings, parents, classmates, or colleagues – anyone can have suicidal thoughts. We all have pivotal roles to play in suicide prevention by spreading accurate messaging on suicide and enhancing skills training.
Kaan Pete Roi helpline: 09612119911; every day, 3:00 pm to 3:00 am
Rubina Jahan is a clinical psychologist and the head of clinical services, Mental Health Programme, Sajida Foundation. She can be reached at firstname.lastname@example.org.