- Suicides must be acknowledged as a problem
Once Confucius said that life is really simple, but we insist on making it complicated. Then, the complications keep on multiplying and in the time of crises, humans are tested. But, human psychology includes multifaceted human behaviour and other processes. The very struggle with life starts from childhood and the Japanese concept of Ikigai, by which is meant a reason for being or in simple words the purpose of life, is tried to find for the expedition of self-discovery.
But, all processes rotate around the axes of cognition. When man earns his livelihood, and his needs are fulfilled. He gets into a state of stability on the material side if he overpowers his greed. However, most people due to socio-economic pressures, and others because of their emotional injuries, get into the constant state of unhappiness and hopelessness. In other words, mental disorders occur. These ailments happen in all regions and cultures of the world, the most prevalent being depression and anxiety. It is estimated that nearly one in ten people is affected by these two disorders on the planet (676 million cases). The depression prevalence among women is substantially higher than among men. At its worst, depression can lead to suicide. An estimated 804, 000 suicides occurred worldwide in 2012, an annual global suicide rate of 11.4 per 100 000 population, and for every suicide there are many more suicide attempts.
In some countries, increased levels of awareness about and treatment of depression and alcohol use disorders are aided. High rates of stigma surround depression and suicide, which impedes help-seeking by individuals and the development of services by health authorities. Many facilities in low- and middle-income countries do not have the capacity to provide basic treatment for depression, as health workers are not trained in mental health issues and medicines are not available.
To reduce the incidence of suicide in young people, school-based interventions, as recommended by WHO’s Suicide Prevention Strategies should be initiated. These include crisis management, self-esteem enhancement, development of social skills and healthy decision making
SDG Target 3.5 aims to promote mental health and well-being. Moderate and severe depression are included within the Mental Health Action Plan 2013–2020 target to increase service coverage for people with severe mental disorders by 20 percent by 2020. Member States have committed to developing and providing comprehensive, integrated and responsive mental health and social services in community-based settings. Suicide prevention is also an integral component of the Action Plan, with the target of reducing the rate of suicide in countries by 10 percent by 2020.
According to a study of JPMA(Journal Of Pakistan Medical Association), a few years ago, incidences of suicide appear to have increased in Pakistan and suicide has become a major public health problem. From available evidence it appears that most suicides occur in young people (single men and married women) under the age of 30 years. Hanging, use of insecticides and firearms are the most common methods and interpersonal relationship problems and domestic issues 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 organizations to take up this challenge.
Suicide is a condemned act in Islam. 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.
There are no official statistics on suicide from Pakistan. Suicide deaths are not included in the national annual mortality statistics. National rates are neither known nor reported to the World Health Organization (WHO).
Information on suicide in Pakistan comes from a number of sources including newspapers, reports of non-governmental organizations (NGOs), voluntary and human rights organizations and police departments of different cities. Further information is available from hospital based studies, for example on acute intentional poisoning, deliberate-self harm and autopsies carried out by Forensic Medicine departments.
Mental health must be part and parcel of every country’s education policy. Almost 34 percent of Pakistani population suffer from common mental disorders, and depression is implicated in more than 90 ercent 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. Unfortunately, in Pakistan public funded PHC system is largely ineffective. Training emergency room personnel can contribute significantly to suicide prevention.
In Pakistan, the three most common methods are hanging, ingestion of insecticides and firearms. While hanging is difficult to control, restricting availability of latter two can potentially prevent 50 percent of suicides. Public education campaigns to promote safe storage of insecticides are needed.
Crisis intervention centres and suicide prevention telephone hotlines play an important role in helping suicidal people, as shown in neighbouring Sri Lanka. There is a need to establish such services in Pakistan.
To reduce the incidence of suicide in young people, school-based interventions, as recommended by WHO’s Suicide Prevention Strategies should be initiated. These include crisis management, self-esteem enhancement, development of social skills and healthy decision making.
Government must implement social policies that are just, equitable and fair that address the problems of the common man. There is need for increased spending on mental health as well as proper utilization of available resources.
A mandatory reporting of suicide mortality statistics to the WHO would improve data collection and surveillance on suicide.
For national responses to be effective, a comprehensive multi-sectoral suicide prevention strategy is needed, including; firstly, improving coverage of mental health services and access to treatment for mental and substance use disorders, early identification and effective management of suicidal risk, as well as follow-up and community support of those who attempted suicide; secondly, reducing harmful use of alcohol and internet; thirdly, restricting access to the most common means, including pesticides, firearms and certain medications; fourthly, responsible media reporting and social media and crisis helplines; fifthly, public awareness programmes to raise awareness and reduce stigma; and lastly, targeted prevention strategies for vulnerable groups.
