Preventing or reducing suicides; a psychiatric nurse’s viewpoint

By: Alberta Puplampu

About seven suicide cases have been reported in the print and electronic media over the past few weeks.

Though the term SUICIDE ( the Latin word sui of oneself + -cidium ,from caedere to kill ) which is the direct and purposeful action by an individual to end his/her own life, is nothing new; one wonders why currently the trend has increased both nationally and globally.

So the question is; why has suicide become the only way out to escape the problems we encounter in our everyday life?

Research by the World Health Organisation (W.H.O), indicates that suicide is thought to kill about a million people a year, and by 2020 this is expected to increase to more than 1.5 million with 85% of suicides occurring in low- and middle-income countries.

More than 800, 000 people die by suicide every year – around one person every 40 seconds. Also, more men commit suicide, whiles more women attempt suicide, a term known as Para suicide.

People are likely to commit suicide due to one or more of these reasons;

In an attempt to end unbearable pain or problems that are overwhelming e .g, unemployment, financial difficulties or extreme poverty.

- Health issues i.e people suffering from depression and other mental conditions such as alcohol/drug abuse, stigma from H.I.V/AIDS.

- Stresses of life e g, failure to achieve set ambitions, loss of a loved one, break-up in relationships etc.

- Lack of social support systems or inadequate coping strategies

Methods mostly employed include hanging, drug overdose, jumping from a height, stabbing, shooting one’s self, setting one’s self ablaze, suicide bombers, starvation etc.

Most relatives or friends of people who commit suicide claim to have no idea or hint from their loved ones who take their lives.

However, most people who take their lives do not just conceive that idea in a day.

Relatives should look out for these warning signs (verbal /non-verbal) from persons contemplating suicide. The person may make comments such as;

- “Life is not even worthwhile”.

- “This world has nothing to offer me”

- “People are better off without me”

Non-verbal warnings include;

- Giving away personal or prized possessions

- Increased use of alcohol or other drugs

- Loss of interest in social activities which use to be of much interest to the individual

- Too much or too little sleep

- Lack of interest in friends

- Change in mood mostly sad or depressed or social withdrawal.

An expressed intent to commit suicide should always be taken very seriously. Ways of reducing suicide or possibly preventing it include the following:

1. Building strong social support systems:

In the past, the extended family system was strictly adhered to and this went a long way in helping individuals cope or share their issues with one another since everyone was practically looking out for the welfare of the other. Unfortunately the process of modernization has eroded the ties of this family network and has led to the questioning of the cultural and societal values weakening it in the process.

Worthy of note is the fact that pressures faced by individuals today are different from those faced by past generations hence the need to have stronger social support systems. Many Western countries have robust social support systems to help prevent suicide. Churches, government organizations, community organizations are well distributed to identify, counsel

and respond to people on the verge of suicide .

Together with the human resource departments of many companies, these organizations can help people better integrate into a community and build up a new personal support network.Also professionals can be trained as volunteer counsellors to man a 24-hour free suicide prevention hotline that puts people considering suicide in touch with them as done in many western countries. As individuals we should always be on the alert for people who may not have a strong support network, and should welcome them into our communities.

2. Increased awareness creation of mental health as one of the components of good health:

Mental health has from time immemorial received very low recognition and attention world-wide. Perhaps most people who commit suicide are mentally ill as at the time of taking their own lives, hence psychiatric illness can be said to be a major contributory factor in the many suicide cases being committed.

Chief Executive Officer of the Ghana Mental Health Authority ,Dr. Akwasi Osei, said 93-95% of all suicides and attempted suicides are from mental disorders, with over 80% of the lot from depression.

A Danish study shows that mentally ill people have a far greater risk of committing suicide up to 36 years after they were hospitalised for their illness .It is high time mental health is given the needed attention and properly integrated into the health system so that persons with all kinds of psychological or emotional needs can walk into any unit of a clinic /hospital to have their needs met without any difficulty.

3. Viewing suicide as a health issue other than a “criminoreligiocultural” issue:

In Ghana and in most African countries suicide and Para suicide are illegal. For the former, the country’s criminal code identifies suicide and attempted suicide as a criminal offence.

The law in question, the Criminal Code, 1960 (Act 29) Section 57 (2) which says: ‘whoever attempts to commit suicide shall be guilty of a misdemeanour’. Though this law aims at discouraging people from engaging in such an act I shudder to think that it might be doing more harm than good to the survivor of an attempted suicide.

This is so because it is well known that about 95 per cent of all cases of suicide and attempted suicide suffer from mental illness, most of which is depression.This means that if one attempts suicide and is jailed, the chances are that we will be jailing somebody who has a mental problem. Clause 76 subsection (10) of the drafted mental health bill states that ‘A person who attempts suicide should first be suspected of mental disorder and taken for psychiatric assessment and if found mentally healthy, may be prosecuted.

Unfortunately parliament did not approve of the above clause and hence had it expurgated before passing the mental health bill in May, 2012 .Nonetheless since it is believed that almost all suicide and attempted suicide have an underlining cause of psychiatric illness, parliament’s last minute amendment of the bill would be very much appreciated.

Aside the legal implications, suicide and attempted suicide have religious and cultural implications on not only the victim but also the family. The victim does not receive a befitting burial and if it is an attempted suicide the survivor is shunned .In both cases the family members are either stigmatised and sometimes heads of other families refuse to give their daughters hand in marriage to such families’.

In some Islamic and Christian sects’ suicide is often considered a sacrilege .Obviously, much effort would be needed to change the cultural beliefs of these countries but much education can be given to make society more aware of how to identify the warning signs of people who are contemplating suicide and seek the needed health care.

4. Counselling centres and units:

Instead of providing care in the only 3 psychiatric hospitals we have, mental health can be integrated into primary health care, to provide mental health care in general hospitals and develop community-based mental health services.

Crises centres, units or centres for counselling can be created in schools, offices, churches, mosques and also in the community where people can have a one-on-one interaction with trained care-givers. Also these facilities could hold seminars and workshops to educate individuals on ways of coping and managing stress and its related issues.

5. Postvention:

It’s a term coined by Shneidman, is what comes after the attempt or the loss– it is helping the people who are left behind find hope again. And as Shneidman said, postvention after suicide is prevention for the next generation (Shneidman, 1972).

The true essence of unity and the real character of a community/society are often revealed when faced with adversity.

When a community’s coping skills have been overwhelmed by a critical incident, such as a suicide, an effective well-organized response can restore the community to a state of well-being and bolster a sense of trust that fosters resiliency against future dark times.

The Writer,Alberta Puplampu ,is a Nursing Officer at the Accra Psychiatric Hospital.

Email: dasheen@ymail.com