Suicide is preventable - raising awareness is a priority | Sunday Observer
World Suicide Prevention Day - September 10

Suicide is preventable - raising awareness is a priority

5 September, 2021

A few days ago psychiatrists, psychologists and activists around the world put suicide, its causes, how it can be prevented and eliminated forward so that there will be a suicide-free world in the near future.

Whether this miracle can be achieved or not is yet to be seen. Yet Sri Lanka has already achieved it own miracle by drastically reducing its previous record of a country with the highest number of suicides in the Asian region to what it is today, thanks to the intervention of the Health Ministry as well as many non governmental organisations.

The Sunday Observer spoke to Head of Dept of Psychiatry, Kotelawela Defence Academy, former President Sri Lanka College of Psychiatrists, and founding member of the National Institute of Mental Health (NIMH) Dr Jayan Mendis to find out the main underlying causes and how they could be uprooted.

Q: On September 10, the rising incidence of suicide which has not only become a global problem but a worrying concern in Sri Lanka grabbed the world’s attention. According to reports, suicide is the second leading cause of death among people between the ages of 15-29 with 800,000 persons dying from suicide annually around the world. How does Sri Lanka rank in comparison to these global statistics?

Sri Lanka had the highest suicidal rate in the world by 1995/96, (47/100000). However, due to various effective measures including the appointment of the Presidential Task Force to prevent suicide by the then President Chandrika Bandaranaike Kumarathunga in 1996, the number of suicide cases have fallen substantially to around 14/100000 by 2020, which is a huge development.

Q: The age group quoted in reports shows that the population most vulnerable are young people. Is the scenario similar in Sri Lanka ?

A. However, most of those suicides are also in 20-29 age group and larger number of those age (up to about 65%) of all suicidal attempts have taken place in this age group which is more concern for me.

Q: What are the most common causes for suicide in Sri Lanka?

A. Medical causes, Undetected and partially treated mental illness, alcohol and illicit drug related causes. Poverty, unemployment, migration of care givers, vulnerable individuals, frustration among youth and loneliness of the elderly.

Maternal suicidal rate increased from 2002 (0.8) to 2010(12.1)

Q: Methods frequently used in these suicides ?

A. Acute poisoning by pesticides and medical drugs – 80% are men

* Strangling


*Setting oneself on fire

* Using firearms, explosives, sharp weapons

Q: We are in the midst of a Covid pandemic which has raised panic and anxiety as the number of cases continues to climb with the Delta variant posing an added worry. In your opinion can the mental stress for this pandemic increase and aggravate the psychological issues of those who are already battling with mental problems?

A. My answer is big ‘yes’. Many causes contribute to this :

* Lock downs

* Prolonged staying at one place

* Children are more stressful

* The “fear” psychosis accompanied by the disease itself.

* Impact of Covid- 19 on the brain function, behaviour and cognition

* Issues relating the computers, mobile screening

* More problems relating to drug and substance related disorders

Q: What about elderly patients with non communicable diseases( NCD) who are cooped inside their homes and unable to go out to get their medicines How has this impacted on their mental health?

A. Elderly also has encountered with several issues such as unable to travel to their family members and to see their children. Unable to go for their religious observances, unable to go for their festivals, funerals of their known people. Unable to express their grief all have negative effect on their mental health.

Q: Are persons with pre- existing mental disorders more vulnerable to suicidal thoughts when a family crisis arises? If so why?

A. The chances are high as their coping skill are not that greatest at a time of stress.

Q: Family and social pressures -are they too a cause ?.

A. Yes, for those with family violence and unable to cope in stressful situations.

Q: What about broken relationships (mainly love-affairs)?

A. Relationships mainly will end up in 2 directions, either these will end up by a marriage and then break up. When you are going for a relationship always you need to be aware of both very well..

You should be able to face both aspects positively than negatively. Those who take this up negatively will try to believe it will be the end of their world. However committing suicide due to a broken relationship is not the answer.

Q: Financial problems and inability to pay off one’s debts?

A. Yes, these will lead to various psychological disturbances or psychological disorders. Some percentage of those might end up with a suicide.

Q: The media is often blamed for sensationalising suicide. It has been charged that watching a television drama that insensitively portrays suicide or glorifies impacts adversely on a person struggling with mental problems and even result in a copycat reaction. Your comments?

A. Media has both positive and negative effects on suicide in a community, by why they report suicide. If they report unethical manner, that will increase the suicide by “copycat suicide’. Readers should be given accurate information about where to seek help.

Q: Myths about suicide itself, and wrong attitudes contribute to the increase of youth suicide?

A. Myths include the following:

People who talk about suicide aren’t serious and won’t go through with it. My answer is ‘yes they do commit suicide’.

If a person is serious about killing themselves then there is nothing you can do.

No we can do a lot to prevent it.

You have to be mentally ill to think about suicide. Not all who die from suicide are mentally ill.

Q: Signs to look for in a person with mental illness?

A. Sadness, unhappy, feeling suicidal, they may have attempted previously, they may do other various things by keeping his ideas hidden.

Q: Treatment – how do you treat persons with illnesses that could lead to suicidal thoughts?

A. Obtain proper history and doing a detail mental state examination to determine the risk of suicidal and then depending on the risks, we might have to admit the person to a psychiatry ward and commence treatment.

Q: Is there are National Plan to end Suicide?

A. Yes, in 1996, President Chandrika appointed a Presidential Task Force and it come one with very strong 10 recommendations. Recently, SLMA produced a guideline of suicide prevention in Sri Lanka, : Recommendations for action Dec 2019. They include: identifying and addressing suicides as a national priority based on the significant morbidity, mortality, social and economic costs of deliberate self-harm and suicides., establishing an independent authority that is exclusively responsible for addressing the prevention of suicides through multi-sector partnerships., taking steps to improve health information and develop surveillance systems to gather data and promote research on suicides.

Specific recommendations include : . addressing the use of pesticides and weedicides and pharmaceutical drugs in suicides , strengthen collaborations to restrict the use or discontinuing selected lethal pesticides currently in use and the practicalities of making available alternative chemical and other methods of pest and weed control. The prevention of the illicit use of these pesticides and increasing toxicity of the pesticides by mixing other substances too, should be addressed through this forum. Encourage research that is directed at identifying suitable eco-friendly alternatives for carbosulfan, profenofos and quinalphos.

Q: Drug overdose is also cited as another cause for suicide. What is the solution?

A. Again I quote the SLMA’s priority recommendations on pharmaceuticals which states that the SLMA in collaboration with the Ministry of Health and the National Medicines Regulatory Authority, in collaboration with the professional organisations of pharmacists should initiate a process to monitor and address deliberate self-harm using pharmaceuticals, and commence a program that addresses the issues related to over prescription of medications, safe storage and proper disposal of unused medications.

Q: You were a founding member of the National Institute of Mental Health (NIMH). What new services does this Institute offer to mentally ill patients today?

A. They have been contributing to the initial work which I started years ago. In addition, they have built a new ward complex for child and adolescent unit, A ‘1926’ help line, a day centre for counselling and minor psychiatric disorder since new facilities for patients with mental illness and Covid- 19 patients.

Q: What steps have been taken by the Health Ministry to prevent mental illness?

A. The Ministry of Heath has strengthened and implemented mental health services for patients island wide. It has developed several new clinics closer to the patients’ homes. This has reduced a time taken by a family to take treatments for anyone quite early and quickly than decade ago. Other than one district (Puttalam) all the other districts have at least one psychiatric unit for patients from the same district.

The cabinet has already approved a new mental health policy for 2020-2030 which will further strengthen the district mental health program in Sri Lanka.

Q: Uptil now, the focus is on how many persons attempt to commit suicide while the causes leading to this desperate act have been given low priority? Do you feel a change is needed in our health system where much more priority is given to the reasons for suicide ? What are the gaps you like to see filled in this respect?

A. I think we have a fairly dispersed and strong mental health system in Sri Lanka. But I personally feel this should be administered by a person who is knowledgeable in the field of mental a Psychiatrist, though we have been trying to do change from 2004 without success.

The proper follow up of patients, regular supply of medication, proper training for mental health staff need to be more improved.. We need urgently is to have a proper management of the mental health service.

Q: Your message to parents and guardians on reducing suicidal risks?

A. All suicides could be preventable and you need to suspect it and need to keep an eye on the person and take them for assessment and therapy as early as possible.

Q: As an experienced psychiatrist, have you any advice to young professionals dealing with mentally disturbed youth?

A. Psychiatrists have a huge role to play for the care of mental ill person in this country. Using a holistic personalised approach to patients that extends to their families as well they can help them achieve better mental health for all Sr Lankans.