India must focus beyond mental health to prevent suicide: Lancet study

Every year on September 10, we commemorate World Suicide Prevention Day to increase awareness of the need to lessen stigma and promote candid discussions to prevent suicides. The theme this year is "Changing the narrative on suicide".

To reduce suicide cases in India, where over 170,000 lives are lost to suicide each year, it is crucial to focus on issues other than mental health, according to an expert in a recent study that was published in The Lancet journal on Tuesday, the International Suicide Prevention Day. With more than 700,000 suicide deaths worldwide each year, suicide is a serious public health concern. India has among of the highest rates of fatal suicides.

According to this year's theme, a new six-paper Series published in The Lancet Public Health argues that a change in the narrative is needed to move from presenting suicide as a purely mental health issue to acknowledging the impact of social risk factors.

"Suicide so far, unfortunately, has been stigmatised as a crime, but suicide is a complex public health issue. Focus to date has been on mental health for suicide prevention, which is important, but we have enough data now to show that we need to broaden our focus beyond mental health for suicide prevention," Series author Dr Rakhi Dandona, Professor of Public Health at the Public Health Foundation of India (PHFI).

The Series highlights how clinical treatment services are critical for people in a suicidal crisis, but upstream measures that address social factors must also be included in national suicide prevention strategies to prevent people from reaching crisis points.

This is particularly relevant for India, which released the National Suicide Prevention Strategy in 2022, with the experts in suicide prevention highlighting the need for the country to widen the way suicide is viewed to also include social risk factors -- such as poverty, debt, domestic violence, addictions, and social isolation -- alongside mental health.

According to data from the National Crime Records Bureau (NCRB), 1.71 lakh people died by



suicide in 2022. The suicide rate has increased to 12.4 per 1,00,000 -- the highest rate ever recorded in India.

Worryingly, more than 40 per cent of all cases of suicides are among young adults below the age of 30. A young Indian dies by suicide every eight minutes, which is a loss to the family, society, the economy, and the future of the country.

Data from the NCRB reports based on police records that are published every year highlight the reasons why people take their lives.

Dandona noted these "include poverty, debt, financial hardships, domestic issues, domestic violence, family relationship issues, bullying, peer pressure".

Unemployment also appears to be one of the most important risk factors for suicide in Indian females.

The suicide rate among unemployed females in India was found to be 94·8 per 100,000 people, compared with 12·6 per 100,000 people for professional or salaried employees, 11·6 per 100,000 people for those who were self-employed, and 4·3 per 100,000 for students.

"All of these means that we need to start thinking about suicide with a broader public health approach to address these risk factors for suicide within their social and economic policies to make that difference to this large number of suicide deaths that happen in India," the public health expert said.

Currently, the suicide prevention programme in India lies under the National Mental Health Programme. The expert noted that it can continue to do so for mental health interventions, for suicide prevention, for those who are suicidal. "But we need a larger whole government public health approach to ensure that people do not reach the suicidal stage," Dandona said.

"Addressing the underlying socio-economic pressures in addition to mental health is a critical national priority. By taking a public health approach and fostering collaboration among various sectors, we can create a more supportive environment that prioritises early intervention, reduces stigma, and ultimately saves lives," the expert said.