Don’t Plan To Die; Please Plan To Live

By Niranjala Ariyawansha

Out of 100 people who think of suicide, 10 carry it out and one will die” says Dr Neil Fernando, specialist psychiatrist at National Institute for Mental Diseases.
According to Dr Fernando there are about 3,700 suicides taking place annually in Sri Lanka. Thus around 11 people commit suicide every day.  In 1996 Sri Lanka was number one  in the world  for suicides. In that year there were around 9,000 suicides which amounted  to 24  individuals killing themselves every day. Thus there was a suicide every hour. Although this suicide rate has come down gradually, Dr Fernando says we are still among the few countries with high suicide rates. World Health Organization has revealed that annually around one million people  commit suicide world wide. This amounts to one person taking his life every 40 seconds. Further,  according to the World Health Organization around 10 – 20 million people attempt to commit suicide, which amounts to an attempted suicide every 3 seconds.
Suicide rate of a country is calculated as the number of persons committing suicide annually  per 100,000 of the population.  Thus if 40 persons per 100,000 of the population kill themselves  annually, it is considered as  a  high suicide rate in a country.
On this scale all the countries in the world are  categorized  into three groups. i.e.  high, medium  and low  suicide rate countries.
1.   The countries where 8 or less number of persons  per 100,000 of the population commit suicide annually are considered as countries with low suicide rates  such as Norway, Italy, Sweden
2.  If this figure is between 8-16, they are categorized as countries with medium suicide rates. USA, India, Cuba, China, Australia, Singapore, Canada fall into that category
3.  Where 16 persons or more per 100,000 of the population kill themselves are considered  high suicide rate countries.  Sri Lanka, Hungary, Japan, Finland, Austria have held this position for decades.
In 1950 Sri Lanka was among the low suicide rate countries as the annual suicide rate was 6.23. This gradually increased and peaked in 1996.
Why do people kill themselves?  What is a suicide?
Answering these questions, Dr Neil Fernando said “suicide is a very complex  phenomenon. According to World Health Organization there are three factors involved in a suicide. First it is a process ending with death. Secondly it is a process initiated by the particular person and carried out by him. Thirdly it is an action undertaken with the  knowledge that it will end up in death. There are a number of factors that drive a person to commit suicide.  First he thinks that he has lived enough. With this he develops a desire for death. Then he carries out his wish. With this the person may either die or be saved.” In Sri Lanka as well as globally the most vulnerable  group  to commit suicide are males between 15-30 years of age. When we consider the female/ male ratio it is 1:3. But in Sri Lanka more women commit suicide than men. When the percentage of males committing suicide is 27 the  female percentage is as high as 73. Dr. Fernando says this is a unique situation. On the other hand, when we consider all attempted suicides,  more men die and more women are saved. In Sri Lanka 70%  take poison to kill themselves. Others mostly kill themselves by hanging. However Dr Jayan Mendis, Specialist Psychiatrist and Director of the National Institute for Mental Diseases is of the opinion that when we consider globally, there are a number of special reasons for committing suicide. “Foremost among these are the unidentified mental disorders. 15% commit suicide due to depression. 10% of the suicides are due to  schizophrenia and addiction to alcohol accounts for 12% of the cases.  Fourth reason is the personality disorders.”
Dr Mendis categorize these reasons in the following manner:

1.  Social reasons – Aging, social isolation, lack of social interactions, Media publicity.
2.     Cultural reasons.
3.     Situational reasons -  such as if there is a bottle of poison at home, the person is tempted to  take it during a problematic situation.
4.    Health reasons -  (Mental and Physical)  Chronic diseases, Painful diseases, Illnesses where a person is dependent on other  (disabilities),  Incurable diseases  such as HIV and Cancer.

According to Dr Fernando the reason for  50 per cent of the suicides and attempted suicides is mental diseases. But the aim of 40% of the people who attempt suicide is not to die. They want to get the attention of the loved ones or to dominate over them. He further says there are about 10% who think that suicide is the only answer to their misery and poverty.
Dr Jayan Mendis says that Sri Lanka became world famous in 1996 for two things. “First is the winning of the World Cup in Cricket. Second is becoming the country with the highest suicide rate. The President at that time established a Presidential Task Force to minimize the suicides in the country.  A number of specialists worked on this and  it was possible to bring down the suicide rate during the next few years. Sri Lanka is one of the few countries where there is a policy to minimize suicides.” Dr Mendis  says  although the following recommendations of this Presidential Task Force was not implemented hundred percent, they were implemented to some extent.
1.    Limiting the use of  Pesticides
2.    Limiting the sale of Pesticides
3.    Adopting bio-control
mechanisms
4.    Taking necessary steps to minimize the damage caused by
pesticides
- Selling these as dilute solutions
- Selling these as solids and not as  liquids
- Producing these to trigger vomiting
- Storing in a secure way
5. Training people on treatment
6.  Creating an attitudinal change  It is a sin to kill oneself
(giving a  religious meaning)
7. Reporting these incidents without any special emphasis Reporting suicides not as heroic acts but to highlight the value to life
8.     Improving the Mental Health Services
9.    Introducing Life Skills to the school curriculum and developing the decision making capabilities
10.    Training teachers in counseling to identify metal disorders
However Dr Mendis says that we do not have enough psychiatrists to make the people aware about suicide or to treat mental disorders to the required level. Post Graduate Institute of Medicine is the main organization training psychiatrists. Although this institution had trained 210 psychiatrists there are only 48 in the country. Others have gone to countries like England and Australia for higher studies and never returned.  Dr Fernando says  during the period between 1985-2000 around 50,000 people died due to the war in the North-East. But during the same period 160,000 persons died by committing suicide. This very clearly shows where Sri Lanka is with regard to suicides.
In conclusion Dr. Fernando  said, “there are many myths about suicides. Some think that they will never commit suicide. But that may be wrong. Some think that talking about suicide is promoting it. There is no truth in it. There is belief among people that those who talk about it will never commit suicide. It is a wrong assumption. We must be careful about such people as they are likely to kill themselves.”
He is of the opinion that providing children with life skills and broadening their cultural outlook  through the school education, children could be convinced that the only answer for any problem  is not suicide. Why can’t we direct all our efforts for living instead of directing it to die as a solution to a particular problem?