Taking your own life, a shame...!

by Shanika Sriyananda

Suicidal behaviour has a large number of complex underlying causes, including poverty, unemployment, loss of loved ones, arguments, breakdown in relationships, legal or work-related problems.

A family history of suicide, as well as alcohol and drug abuse, and childhood abuse, social isolation and some mental disorders including depression and schizophrenia, also play a central role in a large number of suicides. Physical illness and disabling pain can also increase suicide risks. - WHO

The class teacher made the 'discovery'. The love letter was innocently tucked in between the pages of the textbook belonging to a bright student of the class. And the next day, at the school assembly, the Principal read out the letter from word to word. The innocent party, sweating from head to toe, fainted. Everyone accused the girl for accepting the 'pink sheet of paper', a note of that nature which she never ever received in her life, let alone serious thought of saying "I do."

While the issue of the letter spread like a wild fire in the school at Angunakolapalessa, her parents were summoned by the Principal, next day. Evil elements in the village had a field day. Her brother gave her a severe warning.

The 'letter' had played havoc and there were no friends to accompany her home like other days. Straight after the school, she went to a hardware stores in the town. With tears pouring down she wrote a small note to amma - "Ane amme mata samawenna. Mama hithuwe hodata igenagena honda rassawak karanna. Eth mata bae). Meeta obe Sudu duwa". (Dear mother. Please, forgive me. I had planned to study hard and find a good job. But now, I can't - Your daughter).

An empty bottle of poison near her body, in her school uniform, textbooks strewn around were found, close to the paddy field. A brilliant student with a bright future, 17-year-old Samanthi, purely due to irresponsible handling of the entire episode by the school authorities, took her life that day.

"This was a true story and that reminds us the role of the school authorities, parents, friends and even health services in prevention of suicides of this country", Consultant Psychiatrist of the Mental Hospital, Angoda, Dr. Neil Fernando said adding, if the teacher and principal were responsible enough, the life of the bright student could have been saved easily.

Dr. Fernando, who to had lost two of his relatives who killed themselves, said committing suicide had become a common phenomenon in Sri Lanka, where over 4000 people kill themselves every year. Though the number of suicide cases has come down, still the country belongs to the category with high number of suicides.

He said that in other countries many youth die due to accidents but in Sri Lanka they take their lives. Majority of youth, who have committed suicide are between the age of 15 and 30 years.

The number of people committed suicide has exceeded the number of those killed in the war in Sri Lanka during the period of 1985 to 2000. Over 106,000 people had committed suicide and the number of people died in the war was 50,000.

"This shows the gravity of the situation. Every life is a loss to the country" he said adding that there is a decrease in the number after 2000 but still compared it with the suicide rate, it is high", said Dr. Fernando addressing a media workshop held recently at the Health Education Bureau .

In Sri Lanka, women maintain the record being the world's No 1 in committing suicide. Among women, those who attempted to commit suicide are high an of the total number of suicides in the country 27 per cent are women. Over 50 per cent of these cases were due to mental illness and 40 per cent without proper attention, to manipulate one's behaviour and due to stress and 10 per cent had ended their lives as they were really fed up living and no other choice.

Stressing the need of having a greater awareness on suicide prevention and extending the supportive care for mental disorders Dr. Fernando said that over 65 per cent of those who committed suicide had informed somebody, even to health workers, before killing themselves.

"When somebody is in misery, especially suffering from a mental disorder, it is good to talk about suicidal ideas with him or her. This will not influence him to commit suicide but will prevent him from doing it", he pointed out.

According to Dr. Fernando, more publicity should be given about the places where people can seek help for mental disorders.

To prevent suicides, physiological and social well-being should be improved while detecting mental disorders early and implementing a proper management system.

Dr. Fernando said that there was a big role to play by individuals, family members, teachers, spiritual leaders, government health services and NGOs in prevention of suicides.

Meanwhile, Sri Lanka joined the World Health Organization (WHO) to mark the World Suicide Prevention Day on September 10, focusing attention and calling for global action.

According to the WHO, suicide, which is the most preventable public health problem, is one of the major causes for the half of all violent deaths and is also over one million fatalities. The WHO estimates that the fatalities due to suicide could rise to 1.5 million by 2020, Suicide is a tragic global public health problem.

Worldwide, more people die from suicide than from all homicides and wars combined. There is an urgent need for coordinated and intensified global action to prevent this needless toll.

"For every suicide death there are scores of family and friends whose lives are devastated emotionally, socially and economically," says Dr Catherine Le Galos-Camus, WHO Assistant-Director General, Non-communicable Diseases and Mental Health. According to the WHO, the most common methods are pesticides, firearms and medication, such as painkillers, which can be toxic when consumed in excessive amounts.

One recent breakthrough was the move by many pharmaceutical companies to market painkillers in blister packs rather than more easily accessible bottles, which had a significant impact on their use as a suicide method. Therefore, the WHO stressed the need of focusing on encouraging a reduction in access to pesticides and encouraging enhanced surveillance, training and community action on their use.

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Protective factors of suicide

Protective factors include high self-esteem and social "connectedness", especially with family and friends, having social support, being in a stable relationship, and religious or spiritual commitment.

Early identification and appropriate treatment of mental disorders is an important preventive strategy. There is also evidence that educating primary health care personnel in the identification and treatment of people with mood disorders may result in a reduction of suicides amongst those at-risk.

In addition, psychosocial interventions, suicide prevention centres and school-based preventions are all promising strategies.

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Suicide: a 'global' problem

In the year 2000, approximately one million people died from suicide: a 'global' mortality rate of 16 per 100,000, or one death every 40 seconds. In the Western Pacific Region they account for 2.5% of all economic losses due to diseases.

In most European countries, the number of suicides is larger than annual traffic fatalities. In 2001 the yearly global toll from suicide exceeded the number of deaths by homicide (500,000) and war (230,000).

In the last 45 years, suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide.

Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020.

Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide; however, suicide results from many complex socio-cultural factors and is more likely to occur particularly during periods of socio-economic, family and individual crisis situations (e.g. loss of a loved one, employment, honour).

There are estimated to be 10-20 times the number of deaths in failed suicide attempts, resulting in injury, hospitalization, emotional and mental trauma, although no reliable data is available on its full extent.

Rates tend to increase with age, but there has recently been an alarming increase in suicidal behaviours amongst young people aged 15 to 25 years, worldwide.