Hope is an integral part of suicide prevention and at-risk individuals need to be listened to and empowered. — 123rf.com
Every year, the World Health Organisation (WHO) marks Sept 10 as World Suicide Prevention Day (WSPD), focusing on the issue to reduce stigma and raise awareness among organisations, governments and the public. And each year, the message is singular: Suicides are preventable.
This year marks the 20th anniversary since WSPD was established in 2003 and the world still has a long way to go in its collective effort to prevent suicide.
Miri Hospital psychiatrist Dr Ravivarma Rao Panirselvam, who is a vocal advocate of suicide prevention, stresses that a good starting point is literacy on the subject. The public, he says, “need to know more about the topic instead of just making assumptions”.
Dr Ravivarma says to be listened to without judgement could be a starting point in instilling hope. — Dr RAVIVARMA RAO PANIRSELVAM“Too often, people who are suicidal are ‘otherised’ – they are pitied, said to be weak, even faithless. Anything less than complete acceptance is not helpful to the person who has a suicidal crisis because this inadvertently promotes disconnect,” he says.
Universiti Tunku Abdul Rahman (UTAR) department of psychology and counselling head of programme Pheh Kai Shuen says generally, the public isn’t equipped with mental health literacy, so we don’t see the condition as a medical or clinical problem that needs treatment.
“In many instances, people moralise the issue. Those with mental health crises are called weak or tak cukup iman (not having enough faith to brave through life’s situations),” he says.
Dr Ravivarma says what is useful is for the society to realise that people who have suicidal behaviours are diverse and the process is complex.
“Untreated mental illness could be a cause in some people but not the only difficult situation that drains an individual of his or her resources.”
Pheh says more often than not, those with suicide crisis have “been too strong for too long, and they are in a lot of pain.”
“They are trying to regulate their pain and may have tried ways to reduce it but they didn’t work. Coupled with a lack of social connectedness, they feel painful, hopeless and cornered,” he says.
Young and old
Pheh says social media has made teenage life 100 times more complicated than it was 20 years ago. — PHEH KAI SHUENThe National Health and Morbidity Survey (NHMS) 2022, recorded increasing suicidal behaviours among young people. It found that one in eight Malaysian teenagers has thought about suicide, with one in 10 has attempted it. Both suicidal thoughts and attempts, according to the survey, are more prevalent in girls (18.5% and 13.4% respectively) than boys (7.6% and 5.7%).
The same survey recorded that one in four adolescents is depressed with more than one-third of girls (36.1%) dealing with depression compared to 17.7% of boys.
Among the respondents, 46% say they have helpful friends and only 24.2% say their parents understand their problems and worries, further raising the issue of the lack of meaningful connection, another mental health risk factor.
Dr Ravivarma says young people’s brains are still developing, which means their ability to deal with adversities is dissimilar to adults, along with the ability to get care on their own.
“Young people also have a lot of different and evolving stressors with the advent of the digital age. Validation, for example, has become instantaneous and the impact of these platforms is growing because they are digital natives,” he says.
Pheh says biological and hormonal changes and the social landscape shaped by social media has made the 16 to 24 age group high-risk for suicidal behaviours.
“Young people have a lot to deal with – body shape, emotions, peer pressure, friendships and relationships. They have no idea how to cope with these changes and adults don’t talk to them about it. They are not equipped with the mental tools to cope and they have nowhere to turn to,” he says.
Social media, Pheh adds, has made teenage life 100 times more complicated than it was 20 years ago
“When I was in school, if I didn’t like a classmate, I would probably tell my desk mate and at worst, only the whole class of 35 pupils would find out. But now, with social media, the whole school will know. Imagine the pressure a student feels having to face that,” he says.
And that’s not even the end of the story. When anyone goes online in an extremely overwhelmed stage, he or she is more likely to look for dangerous content. Given the algorithm of social media to want to feed its users with what it thinks they are looking for, there will be no end to the amount of dangerous content a person can be exposed to.
“So that one self-harm video will escalate into a massive amount of other dangerous content, all consumed silently and reinforced dangerously in a growing person’s mind,” Pheh says
Aside from adolescents, Dr Ravivarma says older people are also at risk of a suicide crisis and there are also segments of working age adults who are vulnerable. “Old age increases vulnerability, because as one gets older, newer problems set in, including becoming dependent, frail and falling ill. The elderly also have less socioeconomic ways to overcome problems and they are also plagued by loneliness.”
“Suicide rates are also higher in people who are suffering discrimination and find it hard to get help. You can fill in the space with people who are from the low socioeconomic group, refugees, migrants and anyone else who fits the bill,” he says.
Suicidal behaviour among the young shows a worrying trend. — TheStargraphics
Compassion and hope
In some ways, the suicide crisis is reflected in the Greek myth about Pandora, who was given a box said to contain special gifts from the gods, but one that she was forbidden to open. Her curiosity got the best of her, and as Pandora opened it, all the hardships and illnesses the gods had hidden were released to the world. But at the bottom of the box, she found hope.
Dr Ravivarma says hope is an integral part of suicide prevention and at-risk individuals need to be listened to and empowered.
“We may not have a solution to their problems, but we can – and should – listen. To be listened to without judgement could be a starting point in instilling hope and empowering an individual to choose to live.”
“We also need to recognise that each of us is dealt with different sets of protections and adversities and this could cultivate our collective responsibility towards others. Assisting someone in crisis might require just one person to listen – even if that person cannot help solve the issues. By listening, one can spark hope in another to choose to live,” he says.
When a celebrity dies by suicide, media coverage is massive. But what’s lacking, Pheh says, are stories about people who have managed to overcome their suicide crisis.
“I’m sure there are other celebrities who have beaten their suicidal thoughts. These stories should be told, because they highlight that it’s possible to cope with life’s difficulties and that help is available,” he says.
Dr Ravivarma adds: “Help also has to be contextualised and specific, because different people have different needs. A person in suicidal crisis who is facing heavy debts needs different assistance than someone living in an abusive relationship.”
He says to prevent suicide, conversation about the issue needs to go beyond WSPD. Reducing stigma becomes key in accessing help.
“The way media discusses suicide can aid in shaping public understanding. The discourse needs to avoid easy traps for clicks – the pity party, scapegoating and blaming.”
Suicide news stories, he says, should focus on empowering vulnerable people to seek help and provide readers with accurate information on suicide prevention.
“Avoiding the words ‘committed’ and ‘death by suicide’ can be a start,” he says.
Pheh says suicide stories should not get prominent positions and reporting should not be sensationalised.
“Do not romanticise suicide and don’t disclose the methods, where it took place, as well as photos, videos and suicide notes,”
He says individuals reading or watching these stories might already be contemplating suicide and reading about them could push them in that direction. “These stories give people who are already grappling with life’s adversities and contemplating ending their lives, an idea for their thoughts,” he says.
“Oversimplifying suicide to one cause and worst of all, revealing personal information that could traumatise the bereaved should also be avoided,” Dr Ravivarma says.
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Getting help
There are many channels from which individuals or concerned friends and family members can reach out for help. For urgent assistance, one can go to the nearest emergency department of any hospital. Otherwise, one can seek help from government health clinics, Ministry of Health community mental health centres or Mentari or make an appointment at government psychiatry clinics.
Dr Ravivarma says existing users can call for an earlier appointment if the need arises.
“If you have financial resources, then there are private psychologists, counsellors and psychiatrists.”
It’s also important, he adds, to not just depend on health services providers to be touch points.
“Sometimes they could approach be social welfare offices, paracounsellors, school counsellors, even financial and religious institutions.
“Financial and religious institutions are places that people go to in major life crises. Those who work there could be equipped with adequate tools in recognising and responding to suicidal behaviour. If someone says they cannot go on, spare a moment to listen and ask what they mean. That listening ear and the right information for professional services could be life-saving,” he says.
For those who find it hard to go to physical facilities, helplines like Talian Heal 15555 and Befrienders are helpful.
Mental health services, including operating hours, differ according to localities.
“It’s important that grassroot leaders and the public are aware of the services available in their own areas. Regular dissemination and updates of such information through traditional and social media can be helpful. Digital health is also a new frontier that can bridge this gap,” he says.
“Organisations can have a built-in evidence-based suicide prevention programmes with regular training to enable efficient navigation. When conversations become frequent, systemic change will follow,” Dr Ravivarma says.
There is also a need to engage in frank and honest discussions about current health services to persons who are suicidal, he says. “We must be prepared to enter new territories and sincerely consider alternative models of care.”
Views of service users must be genuinely gathered through research, consultation and collaboration. This means taking the opinions and experiences of suicide attempt survivors to shape services that will be useful.
“We need to move away from paternalistic and top-down approaches and begin to work with persons who are, or have been, suicidal. We need to acknowledge them as experts in the development of comprehensive, acceptable and useful services,” he says.
Suicide prevention, Dr Ravivarma says, is everyone’s responsibility that unfortunately, often gets pushed into healthcare.
“It requires a whole-society approach from policies to individuals. Social protection against further harm, especially for vulnerable individuals, is supreme especially when there is an interrelatedness that contributes to suicide risk,” he concludes.
Those suffering from mental health issues or contemplating suicide can reach out to the Mental Health Psychosocial Support Service (03-2935 9935 or 014-322 3392); Talian Kasih (15999 or 019-261 5999 on WhatsApp); Jakim’s Family, Social and Community care centre (011-1959 8214 on WhatsApp); and Befrienders Kuala Lumpur (03-7627 2929, go to www.befrienders.org.my/centre-in- malaysia for a full list of numbers and operating hours, or email sam@befrienders.org.my).
