National Suicide Prevention Week starts on the 6th of September, Monday through 12th of September, Sunday surrounding World Suicide Prevention Day, September 10th, 2020. It’s a time to share resources and stories, as well as promote suicide prevention awareness. The week focuses on informing and engaging health professionals and the general public about suicide prevention and warning signs of suicide.
By drawing attention to the problem of suicide in the United States, the campaign also strives to reduce the stigma surrounding the topic, as well as encourage the pursuit of mental health assistance and to support people who have attempted suicide.
With the same objective, we reached out to Dr. Anagha Jog Karve a MBBS, DPM who works as a consultant psychiatrist in Pune and asked her a few questions. She has completed her undergraduate as well as postgraduate degree from the Institute of Psychiatry and Human Behaviour in Goa. She has 8 years of clinical experience and is currently working at the Institute for Psychological Health (IPH), Pune.
1) How do you identify someone who has suicidal tendencies?
In day to day practice, when a person comes to us to seek help, we ask them various questions to understand their psychological history. These questions include “Do you feel like you are going to die?” or “are you experiencing any suicidal thoughts?”. Understanding and analyzing the history of a patient while cross-examining him or her to address any mental health issue like depression, anxiety, etc. which they may be going through helps us find solutions to their problems. Apart from this, the assessment scales available to us, such as the suicide severity rating scale, Manchester self-harm rule, etc. are also important.There are also a few guidelines set by the American Psychiatric Association (APA) which provide an accurate framework regarding the same. So, by the process of routine testing, we can observe whether a person is suicidal or not. These methods help us track the progress of the patient and also help us implement the necessary changes in their treatment.
2) Do patients openly talk about what they are going through? If not, then what strategies do you use for rapport development?
Patients generally do talk about what they are going through. If they have any mental disorder symptoms like anxiety or depression, then they usually do talk about it. There are very few people who initiate a conversation about suicidal intent or suicidal ideation. Hence it is our job to ask them to gain their trust. These questions include “Do you know what you are going to do?” or “Since how long have you been thinking/ planning this?”. These questions help us understand the intent of the attempt. So we can examine and react upon the situation depending on how severe it is.
3) As we know that acceptance is key to finding a reasonable solution when it comes to mental disorders. So, how do you help the patient come to terms with their situation?
A lot of people have a mental block regarding medication. Most people are okay with the idea of counselling, but they are reluctant towards taking medication. We cannot force the patient to take medication as it is their decision. However, we can persuade them by making them understand the long term benefits of the same. If the patient denies medical treatment, then I usually give them a comparison. I explain to them that as we are not hesitant towards taking medicines for a medical disorder, we shouldn’t be afraid of doing so, for a psychiatric disorder.
4) Which are the warning signs in a psychiatric condition, according to you?
A few months back, I had encountered a concerned parent who had come to seek help as she had seen a change in her teenage daughter’s behaviour. The girl used to post dark or depressive quotes on her social media. Her mother reckoned this as a cry for help and immediately brought her to me. As it turned out, the girl did have a few issues and depressive features. So, early identification of such warning signs can help the patient recover faster. Other warning signs could be a sudden change in behaviour, a drop in appetite, increased or decreased consumption of food, social withdrawal, excessive anger or irritation, changes in students academic performance, etc. If these changes persist for months, one must seek professional help as soon as possible.
5) How can one deal with someone having suicidal thoughts?
The first step here will be to bring the patient to a psychiatrist. Then 50% of your job is done. Then we can start treatment immediately and help the patient get better. In any case, it becomes imperative to involve a family member to take responsibility for the patient.
6) What is the importance of the family in the process of healing of the patient according to you?
The family contributes massively to the recovery of the patient. The most important aspect is the support given by the family to the patient. Many people do not understand that a chronic condition is the result of a treatable mental disorder. They feel that by distracting the person, he/she will feel better. However, that is naturally not the case. It is essential to understand that there are logical changes taking place in the neurotransmitters of the brain. So if the patient needs medication, then the role of the family is to make sure that the patient complies to the medicines prescribed to him/her. Also, the family needs to keep an open atmosphere at home. Due to this, the patient will be able to reach out to the family members, and he/she will be able to communicate honestly and pave their path towards a better life.
7) Suicide is a result of a chronic mental illness. However, there are various other reasons for suicide apart from mental illnesses such as bullying, sexual violence, a sudden unfortunate event, etc. that can lead to suicide too. Can you please help us understand the relationship between these issues and suicide.
Suicide is an endpoint in itself. It is more common in Schizophrenic and Depressive patients. The way you reach it differs on the intensity of the act. For example, it may be an impulsive reaction to an issue, mostly with the intent of self-harm that may lead to suicide. Sexual violence and bullying act like triggers. They lead to depressive symptoms and then may lead to Self-harm, further leading to suicidal thoughts. Here, while assessing any mental condition, we have to understand that there are personality factors involved. A person’s impulsivity level, temperament, characteristics, external stressors, psychological factors also heavily contribute to any triggered reaction. These triggers may lead to deep-seated psychiatric disorders or psychological disturbances. Hence they can be called as causative factors.
8) What changes need to take place at the societal front according to you?
Destigmatisation needs to take place on a large scale. People still feel the need to hide the fact that they are seeking therapy or medication for their mental health-related issues. It is mainly the acceptance of the fact that mental disorders need to be treated just like medical disorders. And as one doesn’t hide a fracture or a diabetic condition from society, similarly one shouldn’t have to hide a psychiatric disorder as well. If the creation of awareness receives the importance it deserves, then we will be able to erase the stigma associated with psychiatric disorders.
9) What do you think are the preventive steps that we can take at an individual level?
The creation of awareness needs to start at a young age. At an individual level, we need to make sure that people are more proactive about the same. These days many steps are being taken where we have awareness programmes or lectures in schools, and we also have counselling sessions in schools which are in turn making children more open and vocal about what they are going through. These sessions also contribute to making the parents as well as teachers aware that such issues exist. Many times people do not know the signs and symptoms which require a psychologist. So if we can create that cognizance in schools, then our children will grow up to be aware and vocal individuals. Even after they grow up, they will know when to reach out for help and how or to whom should they ask for help. We need to know that there is help available that can guide us to self-empowerment, coping strategies and so on.
10) If a person seems troubled, is it safe to ask if they are thinking of hurting themselves? Can asking them this increase the risk of suicide?
Not at all, one must ask. If at all you sense that a person is low/ acting different, then you should ask. Many times these issues go unnoticed or most people are afraid, to strike a conversation about the same. However, asking will not increase the risk of someone hurting themselves. It will give them the confidence that they are not alone. They feel more secure knowing that there is someone out there who is bothered about them. But asking is always not enough. Sometimes you need to go that one step further and then help them out by referring them to a professional. In case they are hesitant about doing so, then tell a responsible adult. Informing significant people in the patient’s life does not count as a breach of trust. Accompany them to the counsellor or psychiatrist till they are comfortable to go on their own. But push them to seek the help they need.
11) Are the motives behind self-harm and suicide identical? How should one react if someone talks to them about the same?
Deliberate self-harm 90% of the times does not involve an intent to die. Suicide is an act to injure oneself with the intent to die. Hence the intent factor separates DSH from Suicide. DSH is common in people who have a borderline personality disorder. It is usually a cry for attention, an impulsive reaction out of anger, frustration, etc. People who deliberately harm themselves know that it will not lead to suicide. Here the intent is not very strong. However, sometimes by mistake, it can cross over. Thought process varies between the two. In both cases, the responsible action will be to bring them to a psychiatrist. Then we can dissect the condition and come up with a reasonable solution.
12) Seeking professional help is extremely important in such adverse conditions. However, doing so is looked down upon in our society. How can we work towards changing that?
We can conduct awareness camps starting at a grassroot level. Teachers need to be more aware of the problems that children may face while learning. So if they see a child showing any signs or symptoms of a mental disorder, they should be able to interact with the students efficiently. If these problems go untapped, then there can be consequences in the future. People need to be more aware at every stage of their life to deal with problems associated with that particular age group. If people can change the way they think, then the long term consequences will not be ignored.
13) What is the age group in which suicide is most frequent? What plausible reasons can you come up with for the same?
15-29 is the most common age group for death by suicides in India. This age group consists of an individual’s student as well as work life. In India, academic pressure is very high, and so is the competition for a sustainable career. Many students die of suicide due to fear of failure, parental expectations, self-acceptance issues and so on. As this is a period of transition, many students struggle with meeting academic needs. When one is in their early 20’s, they experience work as well as emotional pressure which may also cause a lot of frustration and sadness. If they feel isolated and ignored, then it may lead to depression as well.
14) What changes have you observed in people’s way of thinking when it comes to mental disorders, over the past few years?
There have been several positive changes that I have witnessed. In urban areas, awareness is increasing. People are a lot more open to seeking professional help. I have been practising for about 6-7 years now. Initially, people used to visit me only in case of disorders like bipolar disorder, schizophrenia, etc. These days a lot of people come for their children or teenagers as they want to take control of any situation before it aggravates. People are also coming forward from the aspect of marriage counselling as well. These changes are going to prove to be instrumental for the future.
If you know anyone around you (or you for that matter) who is going through a stressful time and has suicidal tendencies, please reach out and get help by reaching out to Suicide Hotlines and Support Groups who help people in distress. (Emergency Contact List)