Health is defined as a state of complete physical, mental and social well-being.

Suicide is the result of a breakdown in this balance due to complex factors. Suicide is the second most common cause of death among 15 to 29-year-old age group.

17% of all suicides in the world occur in India with male to female ratio being 2:1Click To Tweet 

Also for every individual who died of suicide, there have been at least 20 others who have contemplated or attempted it. Also though most patients are in contact with healthcare providers, they are unable to seek help because of the stigma attached to mental disorders and suicide. The government and policymakers are now becoming more aware and taking more steps towards decreasing this number. The WHO published its first report on ‘Suicide Prevention’ in 2014.

Two Important things have to be remembered about suicide prevention:

  1. Most people are ambivalent about committing suicide. This gives us a window and also a starting point where effective intervention can occur.
  2. Clinicians cannot win the battle by getting the patient to the hospital for a day or two, not because the judge orders the patient or their wife/husband threatens to leave them, the war can be won only if the patient decides he wants to live.

Unless patients develop the will to live, they may keep on attempting suicide. They have to be taught other ways of coping with stressors if actually, all attempts have to be prevented. Hence, involving the patient themselves in the prevention strategy is important.

One such strategy is the Collaborative Assessment and Management of Suicidality, or CAMS, an outpatient approach pioneered by David Jobes, Ph.D., a professor of psychology at Catholic University in Washington, D.C. Under CAMS, they have developed a form that asks patients to rate their psychological pain, stress, agitation, hopelessness, self-hate, and overall risk of suicide.

Next, they enlist their five most significant reasons for living and for dying. Thus the patient becomes an expert on his or her case and the patient and the clinician both can then work in collaboration. This form can guide in assessment, help in direct treatment and also measure outcomes.

CAMS also begin the process of helping patients to develop new skills to cope with their suicide drivers and the patient can get a second chance at life.

A good suicide safety plan should be a written document that includes the following:

  • Recognition of what triggers a crisis
  • A list of personal warning signs of possible crisis (e.g., thoughts of suicide, increased urge to drink)
  • Effective internal coping strategies (ways to respond to warning signs to reduce distress such as using deliberate breathing techniques, exercising, and going for a walk)
  • Social supports and social settings that can reduce emotional distress (e.g., using a social setting as a distraction or obtaining personal social support (family or friends), going to a movie, sitting in a public area, or interacting with people)
  • If self-management and/or social supports do not reduce distress, a list of professionals or resources that can be contacted
  •  Steps to remove access to lethal means (e.g., remove weapons, lock up pills)

Source: Stanley & Brown, 2012

Various treatment modalities are available for patients at risk for suicide include:

  • Cognitive behaviour therapy
  • Dialectical behaviour therapy
  • Interpersonal therapy
  • Problem-solving therapy
  • Milieu therapy
  • Group therapy
  • Creative arts therapy
  • Occupational therapy
  • Medications

All these except medications help the suicidal patient to develop ways to cope with triggers in the future.

Throughout life, the needs of a man remain the same:

  1. The need for affection
  2. The need for belonging
  3. The need for Independence
  4. The need for Achievement
  5. The need for Recognition or approval
  6. The need for sense of personal worth
  7. The need for self-actualisation.

Once a person is satisfied that these needs are fulfilled or gets on the path to fulfilling them, they will have the will to live and will not consider suicide as an option.

ULTIMATELY IF WE SEE, WE ALL HAVE A ROLE TO PLAY AND TOGETHER WE CAN SAVE LIVES.

  • Aasra: 24×7 Helpline: 91-22-27546669, http://www.aasra.info/
  • iCall, Mumbai – +91 22 2556 3291, e-mail – icall@tiss.edu
  • The Samaritans, Mumbai – 022 6464 3267

Dr Deepa Kala is a Professor in Obstetrics and gynaecology practicing since 16 years, based in Navi Mumbai. She believes that big changes in our healthcare status can be brought about by awareness and simple lifestyle changes by the people and the medium she has chosen for this is a patient education in various forms like talks, short articles or role-plays.

References:
  1. Suicide prevention: a study of patients’ views – JOHN M. EAGLES, DAWN P. CARSON, ANNABEL BEGG, SIMON A. NAJI – The British Journal of Psychiatry Mar 2003, 182 (3) 261-265; DOI: 10.1192/bjp.182.3.261
  2. Brown Stanley Safety Plan Template – www.sprc.org/sites/default/files/Brown-StanleySafetyPlanTemplatepdf