The stigma around mental health issues does not merely refer to whether mental health issues are being addressed, but also how they are being addressed. In terms of suicide, much is being done to create interventions for suicidal tendencies and behavior. However, there is still a lack of acknowledgment over the various factors that contribute to such.
When addressing the issue of suicide, one needs to recognize and work on both, the risk factors and the protective factors. The risk factors are those which create a situation wherein individuals are more likely to consider, attempt, or die by suicide. These can range from experiencing mental illnesses to socio-economic issues. Protective factors are those characteristics that make it less likely that an individual will die by suicide. These can be enhanced by providing interventions such as mental health services and improving socio-economic conditions.
In the popular discourses around mental health in India, the societal forces that contribute to the risk and protective factors remain ignored. It is not strange to have another western model of medicine and health being adopted in India, as much of that is evident in the discourses around mental health. However, has it been adapted enough for the various kinds of issues that are faced by the citizens of our country uniquely?
Suicide Prevention in India: Who is it for?
Suicide prevention in India is mostly addressed by mental health practitioners and helplines. The major strategy that has been adopted is to provide protective care in terms of emotional support and referrals in times of distress. In India, these helplines were established mainly to cover the treatment gap in psychological disorders, which is calculated as the absolute difference between the true prevalence of a disorder and the treated proportion of the population affected (reported to be as high as 83%).
Due to the lack of mental health practitioners and government allotted resources, many non-governmental organizations and voluntary agencies have stepped in to cover up for such gaps. Organizations such as Sanjivini Society for Mental Health in New Delhi, Sneha in Chennai, iCall, and Aasra in Mumbai provide a range of services over telephonic helplines such as referrals, information, emotional support, and psychotherapeutic interventions. Responding to the mental health crisis in the past few months, the Ministry of Social Justice and Empowerment also launched a mental helpline named KIRAN, which is available in 13 languages.
It is important to note here that mental health helplines address only protective factors, in terms of providing immediate intervention for mental illnesses. However, not all suicides are caused by mental illnesses.
There is a complete lack of engagement with the risk factors other than mental illness, such as socio-economic conditions and lack of material resources, which drive people to suicide
The Social Structures Behind Suicide
One of the major causes of suicide is trauma. Trauma is not only selective to a particular experience but can also be a result from continued social exclusion. In India, caste is a cause for distress for many people. However, it is often omitted in popular discourses of mental health. While illnesses are being addressed through psychiatry and psychotherapy, the impacts of caste-based trauma on mental health need to be addressed within these institutions. Incidents such as those of Rohith Vemula and Dr. Payal Tadvi, even after being brought forward as a form of institutional violence, are cast aside as individual incidents.
Cases of farmers’ suicides remain in headlines throughout the year. In lockdown, it has become even more clear that the causes for such are a lack of material resources. It is important here to note that mental health helplines can only do so much for people who are suffering from a lack of resources. It would be ignorant to overlook the material realities that end up becoming the risk factors for suicide. There was a conversation that arose addressing this when 14-year-old Devika from Kerala died by suicide because she could not access online schooling. However, there is nothing being done to address these factors. Schooling continues to happen online without support being extended by the government to those lacking resources to access it, caste-based discrimination continues in institutions, and what we are provided with instead are mental health helplines.
Are we doing enough?
While addressing mental health concerns, there is no ‘one size fits all’. This expression has been understood well enough for there to have emerged not only multiple ways of dealing with distress but also multiple forms of psychotherapy. When it comes to suicide, the measure that is being undertaken is mostly helpful for people facing mental illnesses.
Suicides are not just a reflection of mental health, but also a reflection of the socio-economic conditions and social structures that affect a person. It is high time we address the societal factors that contribute to the high suicide rates in the country. Mental health helplines might be effective in the short term, but they do not count as a preventative strategy.
Charvi Arora is a graduate in Psychology and Sociology aiming to work in the field of education.