National suicide prevention strategy of India: Great leap forward in field of mental health.

Abstract

Ministry of Health and Family Welfare, Government of India, announced the National Suicide Prevention Strategy[1] on 21st November 2022, which was highly appreciated and welcomed by the stakeholders and mainstream media and was covered in a big way. In India, suicide is the leading cause of death in the 15–29-year age group, exceeding road traffic accidents in men and maternal mortality in women. Through the last decade, we noticed a gradually declining trend in suicidal rates, with a suicide rate of 9.9 per lakh in 2017. Subsequently, there was an increasing surge in suicidal deaths, with a rate of 10.2 in 2018, 10.4 in 2019, 11.3 in 2020, and 12 in 2021 (per lakh population). The rise from 10.2 to 11.3 per lakh in the last three years is significant.[2] Apart from mental health issues in India, many psychosocial factors, such as family and marriage-related issues, illnesses, poverty, unemployment, etc., are reported to play a crucial role in suicide-related deaths. Daily wage laborers, migrant and marginalized populations, students, and persons engaged in farming are at higher risk for suicide-related deaths.[2] This document is aptly named as a strategy rather than policy because, in India, the term policy often leads to inertia, and strategy conveys a sense of necessity and urgency. The National Suicide Prevention Strategy aims to reduce the mortality due to suicide by 10 percent by 2030,[1] a modest goal compared to the Comprehensive Mental Health Action Plan 2013-30 by WHO[3]; perhaps it has been done taking into account Indian reality. But it would have been better if it was aligned with the WHO’s Global target 3.2 of the Comprehensive Mental Health Action Plan 2013-30 to reduce the rate of suicide by 1/3rd by 2030.[3] The goals delineated by the National Suicide Prevention Strategy include: Reinforce leadership partnership and institutional capacity in the country Enhance the capacity of health services to provide suicide prevention services Develop community resilience and societal support for suicide prevention and reduce the stigma associated with suicidal behaviors Strengthen surveillance and evidence generation. To achieve the goals, strategy has time-bound plans that define the time frame within which each indicator should be achieved. Immediate - This suggests that efforts should begin immediately and achieve the outcome in the next 1 to 3 years. The immediate goal includes advocacy for responsible reporting of suicide by media, reduction in easy access to one of the most common methods of suicide, i.e., poisoning through pesticides/insecticides, and augment cadre of qualified mental health practitioners to ensure services delivery to the person with a mental disorder. It also advocated providing support to those diagnosed with substance dependence disorder, building help-seeking behavior for mental health problems by removing stigma and myths associated with them, strengthening suicide prevention efforts targeting women, building farmer capacity to increase productivity despite restrictions on access to pesticides, and strengthen self-injury/harm/suicide data collection at national and state level. Intermediate - This suggests that efforts should begin immediately, and the outcome should be achieved in the next 4 to 7 years like leveraging policy-level addressal of underlying psychological issues such as addiction disorders, advocacy for the provision of psychosocial care to patients with chronic and terminal illnesses, integrating mental health services to general health care services, training and capacity building of helpline workers and volunteers on handling suicide-related calls, IEC strategy for suicide prevention and reducing workplace stressors. Long term - This suggests that effort should begin immediately, and the outcome should be achieved in the next 8 to 10 years like advocacy for suicide prevention and destigmatisation of mental disorders among multiple stakeholders, increasing availability of alternate methods of pest control, building capacity for psychosocial support for persons with mental disorders and substance use disorders, building capacity for providing psychological first-aid and psychosocial support for those who have attempted suicide and those bereaved by suicide and mandate focus on overall stress-free physical and psychological development of children and adolescent in general. What is inspiring is that the document goes beyond the health sector and not only discusses the restriction of the use of means of suicide like pesticides which may not be feasible due to economic reality but extends to intervention in the agricultural sector in developing alternative means of suicide and use of safe pesticides. It aims to educate farmers and students of Agricultural Universities regarding the potential hazards of pesticides and the use of alternative farming methods with less or regulated use. The document itself talks about the challenges to be faced by stakeholders in implementing the strategies and aims to channelize existing opportunities to overcome and deal with the challenges. CHALLENGES Prevailing stigma regarding mental health issues and myths about suicide, Limited skilled Human Resources in the areas of mental health and suicide prevention and Coordinating and collaborating with multiple stakeholders with different priorities. OPPORTUNITIES Suicide prevention is at the forefront of global health efforts to achieve UN SDG 3.4.2 regarding reducing the suicide rate. A legal and programmatic framework such as National Mental Health Policy, Mental Healthcare Act 2017, National Mental Health Programme, etc., helps legitimize suicide prevention efforts Overall strong commitment exhibited by the government toward mental health and suicide prevention The technical team has to be complimented for coming forth with such a comprehensive, elaborate and precise document. But ultimately, it needs to be implemented. We have the most remarkable constitution in India, but most of it is on paper. Similarly, we have a very progressive National Mental Health Policy[4] and a highly patient-centric Mental Healthcare Act 2017,[5] among other laws and policy frameworks. Despite such benevolent policies and laws, benefits seldom reach the target population. Government and all other stakeholders should make earnest efforts to make the strategy successful. Indian Psychiatric Society, the largest body of Psychiatrists in India with more than 9000 member strength, is in a unique position to be an effective partner for providing resources and a stakeholder in implementing strategies for reducing suicide rates. Sadly, IPS was not officially consulted as a stakeholder as an organization in formulating this strategy. However, most of the technical members are distinguished members of IPS and were instrumental in developing this strategy. We need more discussion and collaboration with all stakeholders if we want to implement the strategy successfully.