Sri Lanka has made progress in bringing down the number of suicide related deaths from being the highest in the world in 1996 to one that is fast declining in recent years. It is undeniable that the country has seen a vast improvement but research has revealed larger issues that may blow out of proportion if developing trends are not nipped in the bud. Sri Lanka in 1995/6 had the highest number of suicidal deaths in the world. Statistics show that 47 per 100,000 of the population committed suicide; more than double the highest number around the world. Recent research conducted in this field has revealed a decrease in the number of suicidal deaths but an increase in the number of attempted suicides, which indicates the social attitude towards suicide hasn’t changed since 1996.
A recent symposium organized by the University of Colombo revealed the decrease could not be attributed to a social and mental change towards suicide but the change in methods of suicide and better access to healthcare facilities.
Studies on suicide conducted over the years have enabled us to predict and prevent suicide but academics say that gathered knowledge has not been effectively translated into practice. It has become an issue that has been understood but not addressed effectively.
“It can happen to anyone and research shows that those who do speak about suicide do commit suicide. Those who commit suicide are not mentally ill and one should inquire about suicide to know about it and the consequences to those around them,”
Sociologists point out that colonisation, resettlement and the start of the green revolution correspond with the sudden increase in suicidal deaths. Prof. Karunatissa of the University of Peradeniya said data collected over the time period coincided with these social changes. Polonnaruwa, Anuradhapura and parts of Badulla districts along with Divisional Secretariat areas such as Minipe (Kandy) and Pujapitiya corresponded with this hypothesis, he said.
“People were uprooted from one place and planted in another without any consideration given to the concept of family and community and this upset the social structure and led to many changes,” he said.
The green revolution as many academics point out gave easy access to pesticide and poison that were previously unavailable. While statistics collected at the time show that the number of people using traditional methods of suicide (hanging) did not decrease, the number of people using poison as a method of suicide skyrocketed.
Though the number of deaths has decreased steadily over the years it cannot be wholly attributed to the change in the public’s mindset and government intervention, it is the inexplicable change in the method of suicide that has decreased the numbers.
Dr. Raveen Hanwella of the University of Colombo stated that data collected from police records and hospital admissions confirmed the decrease in deaths but hospital admissions due to poisoning spoke a very different story altogether. “The number of those admitted to hospital has increased over the years though statistically there has been a decrease in the number of deaths,” he said.
Dr. Hanwella said that better healthcare facilities played a large role in reducing the number of deaths. “Poison and hanging were the main methods used for suicide but the change to medicinal drugs has reduced the number of deaths as it is less lethal,” he said.
“The number of those who use hanging as a method of suicide has not by any means changed but the number of those who were admitted for poisoning has decreased. At the same time those using medicinal drugs have increased over the years,” Dr. Hanwella said.
Both Prof. Karunatissa and Dr. Hanwella agreed the green revolution was a major social change that increased suicides as it gave easy access to poison and pesticides. “The change to medicinal drugs is quite inexplicable as the media has not widely publicised its use,” he said.
The change could not be explained but the increasing number of those using medicinal drugs was bound to be a huge burden on the state which provided healthcare free of charge. “It would only take a person Rs. 50 to buy medicinal drugs and attempt suicide but it costs the state close to Rs. 50,000 to provide antibiotics to one person,” he said.
The number of deaths was not a point for celebration as the country had another problem looming in the future. The number of old age suicides they said was on the rise and steps needed to be taken to control the trend as it could be a serious problem in the future if left unchecked.
“Sri Lanka has an increasing older population and if the trend is not controlled and managed we can predict high numbers of suicide among the elderly in the future. We will have to concentrate our efforts on them rather than on the youth and child suicides,” Prof. Karunatissa said.
Though youth suicides are high at the moment it did show a declining trend, he said. “More adults committed suicide in the 1950/60’s, then by the 1970/80’s there was an increase in the number of youths who committed suicide and there were even children who committed suicide but now it is the older population that is showing an increasing number of suicides,” he said.
Furthermore, research shows that men have always been more vulnerable to suicide than women. “There is a clear change in the number of suicides after 2000 but what has remained constant is the male to female ratio, which has remained the same with little variation since the 1950’s,” Prof. Karunatissa said.
The professor said that men were more likely to commit suicide. “Statistics show that more married men have committed suicide (75 percent) than married women (62 percent),” he said. Poverty and the additional economic burden he said were the main reasons.
Though the overall numbers of male suicides are high, it is not so in certain age categories such as the 10-19 and the 20-29 age categories where the number of female suicides are higher making Sri Lanka the second highest in female suicides the world over.
Given the steady decrease in the number of deaths over the years, suicide in Sri Lanka can be reduced to 15 per 100,000 by 2020, Prof. Karunatissa said. Though the number is high it is a considerable decrease from 47 per 100,000.
" The professor said that men were more likely to commit suicide. “Statistics show that more married men have committed suicide (75 percent) than married women (62 percent),” he said. Poverty and the additional economic burden he said were the main reasons "
While poverty and breaking up of love affairs were the main reasons for suicides in the 1970’s and the 1980’s it has been replaced by family problems, sexual abuse and harassment today.
Social anthropologist, Dr. Tom Widger of the University of Sussex explaining the changing affinities of suicide in Sri Lanka said the breakdown of caste and kinship relations were some of the reasons for suicide in Sri Lanka. “The rate of suicide does not only constitute intentional suicides but also the cases of deliberate self harm that have “gone wrong”,” he said.
Fluctuations in the suicide rate not only reflected the social and environmental changes but also changes in the way that individuals within a population may legitimately respond to their problems using suicide, he said.
However, the threat of suicide was also used as a tool of political leverage said Maurice Said of the University of Durham. He pointed out that while family was the strongest unit of support it could be easily fractured.
Taking the example of two suicides, Said explained that suicide made what was private, public and what was previously unacceptable into an interconnecting mass that had to be accepted.
The suicide of an unmarried teenage couple who were sidelined from both families when they discovered they were pregnant was the first example. “By committing suicide they made what was private public; they forced their parents and the villagers to accept what they refused to do before,” he said.
" While statistics collected at the time show that the number of people using traditional methods of suicide (hanging) did not decrease, the number of people using poison as a method of suicide skyrocketed. "
Researchers say that concrete reasons for suicide cannot be given but mental illness they assured was not one of them. Dr. Raveen Hanwella, said only one person out of 168 patients admitted to hospital, during a study, had a slight mental illness. Consultant psychiatrist at the Mental Health Institute, Dr. Neil Fernando said Sri Lanka was one of the very few countries that had policies to prevent suicide. However, the policies submitted by a Presidential Task Force in 1996, when Sri Lanka had the highest number of suicides in the world, are yet to be practiced.
“If there are a 100 people who think about suicide, 10 of them will attempt suicide and one person will die because of it,” Dr. Fernando said.
The task force put forward four suggestions to decrease the number of suicides. Suggestions if followed today would decrease the number of suicides further and address existing and future social issues.
Developing treatment services, training staff and providing life saving equipment, especially to preserve breathing was the second suggestion. “Research shows that patients admitted to hospitals with ICU’s have more chances of survival than others,” Dr. Fernando said.
Dr. Hanwella too stressed the importance of such equipment. “There was a time when we didn’t have enough ventilators and had to choose which patient needed it the most, the situation is much better now,” he said.
Most patients admitted to rural hospitals had no chance of survival due to the lack of life saving equipment and the long distance to the nearest hospital, Dr. Hanwella said. Development in the healthcare sector and infrastructure had provided better facilities to these hospitals and higher chances of survival for patients, he said.
Though mental illness is not a reason for suicide mental healthcare should be provided as a primary healthcare facility to detect and provide treatment for those who contemplate suicide, the academics said.
Dr. Fernando also said that myths such as “It cannot happen to me, those who speak about suicide do not commit suicide, those who commit suicide are mentally ill and those who inquire commit suicide” were false.
“It can happen to anyone and research shows that those who do speak about suicide do commit suicide. Those who commit suicide are not mentally ill and one should inquire about suicide to know about it and the consequences to those around them,” he said.