An unnoticed wound

- Sandhya Subba (Singzango)

The WHO constitution states: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” A healthy life includes both physical fitness and mental well-being. A good health reflects positivity and functioning of one’s potentialities with the society and environment around. There is a famous proverb, “He who has health, has hope; and he who has hope, has everything.”

“The key to a healthy life is having a healthy mind” this is a simple wellness quote with strong message which has been ignored in today’s times. According to WHO, “Mental health is a state of mental well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.” Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior.

Mental Disorders:

Unlike physical disease and wounds, mental wounds are often not seen and ignored. People strive to conceal their mental health difficulties because people view them as taboo. They avoid discussing about mental disease and depression. Fever is considered more vulnerable, serious than depression in our society because fever can be diagnosed, expressed and visible unlike mental illness. A person with mental health problem is viewed as a lunatic who needs a mental institution. Example, visiting a dentist is much comfortable to share than visiting a psychiatrist in our society. People are scared to disclose their mental health problems in public as they fear losing face or bringing shame to their family. Mental health is often viewed through a lens of superstition, misunderstanding, and ignorance. The link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established. Therefore, “Mental illness is an unnoticed wound in our country.”

Suicide in Sikkim:

Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. As per WHO reports, more than 720,000 people die due to suicide every year. It is the third leading cause of death among 15-29 years old. 73% of global suicides occurred in low- and middle-income countries in 2021. Suicide is a serious public health problem that requires a public health response.

The prevention of suicide has not been adequately addressed due to lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it. Only 38 countries report having a national suicide prevention strategy. Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.

In 2008, Sikkim earned the dubious distinction of being the state with the highest suicide rate (48.2) in the country and in the last decade the state has continually been referred to as the ‘Suicide capital of the Northeast.’ The rate of suicide is increasingly high in Sikkim as compared to its population density. Over the span of thirteen years (2008-2020), Sikkim has consistently registered the highest suicide rates, followed by Tripura in second position.

According to the National Crime Records Bureau (NCRB) report, Sikkim registered a 43.1 per cent suicide rate, followed by 42.8 per cent in Andaman and Nicobar Islands. The national average was 12.4 per cent, with a total of 1,70,924 suicides reported across the country in 2022. Sikkim reported 293 suicide cases in 2022 according to the report.

As per sources, the counselling helpline number in Sikkim need to be expanded and information spread about the helpline. More awareness and sensitizations including free counselling to persons suffering with depression and suicidal tendencies is crucial and urgent.

Concern and Causes:

·       Many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.

·       Experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. By far the strongest risk factor for suicide is a previous suicide attempt. Suicides rates are also high amongst vulnerable age groups from 15- 35 years old in Sikkim.

·       Rapid urbanization, unemployment, depletion in the traditional source of income, depression, and substance (narcotics) abuse are some of the key reasons.

·       High expectations from parents, society and extreme academic competition often lead the students to suicide.

·       Use of narcotics leads to intense depression and which eventually leads one to commit suicide.

Prevention and control:

·       Suicides are preventable by limiting access to the means of suicide such as pesticides, firearms, medications etc.

·       Interaction with the media for responsible reporting of suicide.

·       Fostering socio-emotional life skills and Life skill education (LSE) must be imparted to adolescents and young adults in schools and colleges.

·       Awareness raising, proper sensitizing, and health counseling is important for suicide prevention efforts.

·       Vocational and livelihood oriented academic programs need to be introduced at school and colleges.

·       It requires coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defense, politics, and the media.

·       Local bodies, representatives, neighborhoods, and society at large should analyze, coordinate and work for the awareness of mental health to avoid depressions and mental disorders.

·       A comprehensive multisectoral suicide prevention strategy is needed.

·       Improved surveillance and monitoring of suicide and self-harm are required for effective suicide prevention strategies.

·       Vital registration of suicide, hospital-based registries of self-harm and nationally representative surveys collecting information about self-reported self-harm.

·       Breaking the taboos of suicide. Openness and discussion on the topic are vital for proper diagnosis of the problem.

The family who has succumbed to such tragedy, their pain and loss cannot be expressed and explained. It is important to understand the importance of mental health and well-being in our society. Its time for the representatives, state authorities, health sectors and educational sector to imbibe life skill consciousness, awareness, and activities to indulge young minds. The loss of life between 15- 32 years old is the loss of state and country for nation building. Hence, attention and concern are crucial and urgent to prevent suicide and suicidal environment in Sikkim.

Sources:

·       World Health Organisation, 2021. Suicide worldwide in 2019: global health estimates.

·       “SUICIDE AND SUICIDAL BEHAVIOUR IN SIKKIM: AN OVERVIEW” by Nancy C. Lhasungpa, post on September 16, 2022 at SIKKIM PROJECT, the land and its people. (https://www.sikkimproject.org)

·       “This State Had The Highest Suicide Rate Per Lakh In India: Centre’s Report”, article from Dec 05,2023. (https:/www.ndtv.com)

·       “Sikkim is Suicide Capital”, an article by Kunal Rai.

(The writer can be reached at: sandhyasubba310@gmail.com)