Suicide Prevention in the Community

The Role of NGOs

Dr. Lakshmi Vijayakumar

by

Psychiatrists per 100,000Psychiatrists per 100,000

2.01.0

9.8

0.20.3

1.2

0

2

4

6

8

10

12

Africa America EasternMeditaranian

Europe South EastAsia

WesternPacific

World

0.04

Social Workers in Mental HealthSocial Workers in Mental Health

0.05

1.01

0.4

1.5

0.040.05

0.4

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

Africa America EasternMeditaranian

Europe South EastAsia

WesternPacific

World

NGO’s in Mental HealthNGO’s in Mental Health

89.190.9

85.0

92.090.9

77.8

88.2

70

75

80

85

90

95

Africa America EasternMeditaranian

Europe South EastAsia

WesternPacific

World

[ n = 184 ]

No. of MHP / 100,000 NGOs

Low 0.31 84.7%

Low middle 3.33 87%

Higher middle 12.3 93.9%

High 76.15 91.9%

No. of MHP / 100,000 NGOs

Low 0.31 84.7%

Low middle 3.33 87%

Higher middle 12.3 93.9%

High 76.15 91.9%

NGO’sNGO’s

IASP SPAN SAMARITANS

AAS SAS LIFELINE

AFSP LIFE BEFRIENDERS

IASR T. ZUFANIA

RESULTS OF META – ANALYSISRESULTS OF META – ANALYSISStudy Pearson r

df

Bridge et al. (1977) - 0.05194

Huang & Lester (1995) - 0.3515

Jennings et al. (1978) + 0.0897

Leenaars & Lester (1955) + 0.2296

Lester (1974) - 0.1122

Lester (1980) / Bagley (1968) - 0.3554

Lester (1990) - 0.1818

Lester (1993) - 0.10405

Lester (1994) - 0.1390

Lester et al. (1996) - 0.22183

Medoff (1984) - 0.11462

Miller et al (1984) - 0.05924

Riehl et al. (1988) no data

Weiner (1969) - 0.312

AVERAGE - 0.162,549

Study Pearson rdf

Bridge et al. (1977) - 0.05194

Huang & Lester (1995) - 0.3515

Jennings et al. (1978) + 0.0897

Leenaars & Lester (1955) + 0.2296

Lester (1974) - 0.1122

Lester (1980) / Bagley (1968) - 0.3554

Lester (1990) - 0.1818

Lester (1993) - 0.10405

Lester (1994) - 0.1390

Lester et al. (1996) - 0.22183

Medoff (1984) - 0.11462

Miller et al (1984) - 0.05924

Riehl et al. (1988) no data

Weiner (1969) - 0.312

AVERAGE - 0.162,549

Are Volunteers knowledgeable?Are Volunteers knowledgeable?

Reid (1980) Volunteers knowledgeable than

clergy, social workers, students

and public

Rogers (1990) Risk Assessment by

volunteers good

Reid (1980) Volunteers knowledgeable than

clergy, social workers, students

and public

Rogers (1990) Risk Assessment by

volunteers good

Are Volunteers Efficient?Are Volunteers Efficient?

Wenz (1982) only 19% of suicidal

callers - not helped

Mishara (2006) rating of depression

and

suicide plus

Contracting

Wenz (1982) only 19% of suicidal

callers - not helped

Mishara (2006) rating of depression

and

suicide plus

Contracting

Intervention FactorsIntervention Factors

Professional factors :

• Cotton & Range (1992) experience skill

Personal factors :

• Daigle (1995) Flexible and similar to professionals

• Neimeyer (2001) Acceptance of suicide SIRI

Acceptance of death SIRI

Suicidal thoughts &

behaviours SIRI

Professional factors :

• Cotton & Range (1992) experience skill

Personal factors :

• Daigle (1995) Flexible and similar to professionals

• Neimeyer (2001) Acceptance of suicide SIRI

Acceptance of death SIRI

Suicidal thoughts &

behaviours SIRI

MediaMedia

• Awareness

• Attitude

• Advocacy

• Awareness

• Attitude

• Advocacy

Farm suicides in 4 States

Farm suicides in 4 States

1.2 lakh people commit suicide every year

1.2 lakh people commit suicide every year

NEW DELHI : It's a number that will send a chill down your spine: As many as 1.2 lakh people end their lives every year in India by committing suicide. Besides that, more than four lakh people attempt to commit suicide. A majority of them have been found to be suffering from some sort of mental disorder or depression.

This has now made the Union health ministry sit up. A special suicide prevention programme is now being planned that would counsel and protect mentally depressed patients from harbouring thoughts of ending their life.

This will be part of the Revised national mental health programme, due to be launched soon. According to Union health minister A Ramadoss, 60% of the deaths caused by suicide could have been prevented with proper counselling.

He told TOI that the National Institute of Mental Health and Mental Sciences, Bangalore, had been asked to make recommendations regarding the ministry's first suicide prevention programme.

"A comprehensive suicide prevention programme is desperately required. The main reasons behind such actions have been found to be depression, addiction and alcoholism. The recommendations from Nimhans should be ready in a few weeks," Ramadoss said.

As part of the programme, the ministry will give basic mental health training to doctors at the primary healthcare centres in the villages. MBBS doctors will also be trained on how to identify and counsel patients with mental health problems at the sub-division and district levels.

NEW DELHI : It's a number that will send a chill down your spine: As many as 1.2 lakh people end their lives every year in India by committing suicide. Besides that, more than four lakh people attempt to commit suicide. A majority of them have been found to be suffering from some sort of mental disorder or depression.

This has now made the Union health ministry sit up. A special suicide prevention programme is now being planned that would counsel and protect mentally depressed patients from harbouring thoughts of ending their life.

This will be part of the Revised national mental health programme, due to be launched soon. According to Union health minister A Ramadoss, 60% of the deaths caused by suicide could have been prevented with proper counselling.

He told TOI that the National Institute of Mental Health and Mental Sciences, Bangalore, had been asked to make recommendations regarding the ministry's first suicide prevention programme.

"A comprehensive suicide prevention programme is desperately required. The main reasons behind such actions have been found to be depression, addiction and alcoholism. The recommendations from Nimhans should be ready in a few weeks," Ramadoss said.

As part of the programme, the ministry will give basic mental health training to doctors at the primary healthcare centres in the villages. MBBS doctors will also be trained on how to identify and counsel patients with mental health problems at the sub-division and district levels.

Gatekeeper TrainingGatekeeper Training

Native healers / Faith healers

Practitioners of Alternate System of Medicine

Village leaders

Volunteers in HIV, Family welfare etc.

Teachers, Nurses

Police Officers, Private practitioners

Native healers / Faith healers

Practitioners of Alternate System of Medicine

Village leaders

Volunteers in HIV, Family welfare etc.

Teachers, Nurses

Police Officers, Private practitioners

EXAMS AND CONTACTS TO SNEHA

EXAMS AND CONTACTS TO SNEHA

1 May to 25th May to 1June to

10th June

25th May 31st May 10th June to

30th

June

Total 264 206 163

185

Students 26 99 40

12

Parents /

Teachers -- 22 6

--

1 May to 25th May to 1June to

10th June

25th May 31st May 10th June to

30th

June

Total 264 206 163

185

Students 26 99 40

12

Parents /

Teachers -- 22 6

--

Exam Failure and SuicideExam Failure and Suicide

Chennai Tamil Nadu

Year Male Female Total MaleFemale Total

2000 8 12 20 108 98206

2001 6 9 15 100 88188

2002 19 26 45 126 116242

2003 10 3 13 111 86197

2004 20 18 38 245 162407

2005 30 24 54 159 155 314

2006 15 25 40 99 127 226

2007 32 23 55 115 134 249

Chennai Tamil Nadu

Year Male Female Total MaleFemale Total

2000 8 12 20 108 98206

2001 6 9 15 100 88188

2002 19 26 45 126 116242

2003 10 3 13 111 86197

2004 20 18 38 245 162407

2005 30 24 54 159 155 314

2006 15 25 40 99 127 226

2007 32 23 55 115 134 249

Elusive, but not always unstoppableJun 21st 2007

From The Economist print edition

Elusive, but not always unstoppableJun 21st 2007

From The Economist print edition

FOR many people in the northern hemisphere, the spirits lift in June—but in India it is a time for examination

results, and they can bring despair as well as joy. In any event, the Sneha suicide-prevention centre in Chennai stays open round the clock in mid-June, and the telephones have been ringing hard. Suicide rates have been rising in India, especially among the young, and over a third of those who kill themselves are under 30 years old.

But suicide is a mysterious phenomenon; it defies generalisations. Emile Durkheim, the father of modern sociology, wrote in 1897 that suicide rates were a key sign of the state of a community. It was commonest, he reckoned, at two extremes—highly controlled societies, or loose, atomised ones. Since then, his successors have filled thousands of books with theories about what makes people take their own lives: the negative factors which remove the desire to live, and the positive ones that can make self-killing an attractive or even “fashionable” option.

FOR many people in the northern hemisphere, the spirits lift in June—but in India it is a time for examination

results, and they can bring despair as well as joy. In any event, the Sneha suicide-prevention centre in Chennai stays open round the clock in mid-June, and the telephones have been ringing hard. Suicide rates have been rising in India, especially among the young, and over a third of those who kill themselves are under 30 years old.

But suicide is a mysterious phenomenon; it defies generalisations. Emile Durkheim, the father of modern sociology, wrote in 1897 that suicide rates were a key sign of the state of a community. It was commonest, he reckoned, at two extremes—highly controlled societies, or loose, atomised ones. Since then, his successors have filled thousands of books with theories about what makes people take their own lives: the negative factors which remove the desire to live, and the positive ones that can make self-killing an attractive or even “fashionable” option.

People end their own lives for many reasons, only some of which are well understood—but governments should not simply shrug their shoulders

People end their own lives for many reasons, only some of which are well understood—but governments should not simply shrug their shoulders

Intersectorial Alliance

Innovation

Intersectorial Alliance

Innovation

Suicide in NPM Villages

Village Year Before NPM After NPM

Punnukula 2001 3 -

Pullaigudem 2003 3 1

Kodipunjalavagu 2002 4 1

Devijathanda 2003 4 1

Suicides in CP Villages

1998-2003 2003-2006

Keshavapuram 4 2

Pandurangapuram 5 3

Rangapuram 3 2

Bikkuthanda 3 1

Suicide in NPM Villages

Village Year Before NPM After NPM

Punnukula 2001 3 -

Pullaigudem 2003 3 1

Kodipunjalavagu 2002 4 1

Devijathanda 2003 4 1

Suicides in CP Villages

1998-2003 2003-2006

Keshavapuram 4 2

Pandurangapuram 5 3

Rangapuram 3 2

Bikkuthanda 3 1

Suicide & Attempted suicide Study villages A & B in North Western

Province

Suicide & Attempted suicide Study villages A & B in North Western

ProvinceYear Study Village A Study Village B

Total attempts

Deaths Total Attempt

s

Deaths

2000 2 0 1 0

2001 1 0 3 0

2002 3 0 1 0

2003 6 0 2 1

2004 3 1 1 0

2005 0 0 0 0

Suicide & Attempted suicide Control villages A1 & B1 in North Western

Province

Suicide & Attempted suicide Control villages A1 & B1 in North Western

Province

Year Control Village A1 Control Village B1

Total attempt

s

Deaths Total Attempt

s

Deaths

2000 0 0 1 1

2001 1 1 2 2

2002 1 0 0 0

2003 2 0 4 1

2004 4 2 1 0

2005 4 0 2 1

Self Immolation Community Intervention

Self Imm S.A.

Gilangharh (INT) 57% 19%

Sarpazahab 27% 24% (p=0.04) (p=0.001)

Self Immolation Community Intervention

Self Imm S.A.

Gilangharh (INT) 57% 19%

Sarpazahab 27% 24% (p=0.04) (p=0.001)

Intervention StudyIntervention Study

Factors Intervention (45) Control (57) P

Age 38.6 37.9 0.79

Sex M 22 28 0.98

F 23 29

Marital Status

Single 8 8

Married 24 32 0.66

Widowed 12 17

No. of children 2.6 3.1 0.12

No. of person in family 2.9 5.6 0.000

Year of education 6.4 2.1 0.000

Income 1739 1870 0.69

Factors Intervention (45) Control (57) P

Age 38.6 37.9 0.79

Sex M 22 28 0.98

F 23 29

Marital Status

Single 8 8

Married 24 32 0.66

Widowed 12 17

No. of children 2.6 3.1 0.12

No. of person in family 2.9 5.6 0.000

Year of education 6.4 2.1 0.000

Income 1739 1870 0.69

Prevalence in the last 1 yearPrevalence in the last 1 year

• Suicidal Ideas 31.6%

• Suicidal Plans 15.8%

• Suicidal Attempt 12.3%

• Suicidal Ideas 31.6%

• Suicidal Plans 15.8%

• Suicidal Attempt 12.3%

Follow upFollow up

Intervention Control Mean diff. P

WHO 13.49 13.79 - 0.3 0.731

GHQ 8.714 14.07 - 5.4 0.000

(+ 6.5) (+ 2.5)

BDI 13.11 21.88 - 8.7 0.000

(+ 7.9) (+ 3.5)

PTSD 6.16 10.51 - 4.4 0.00

(+ 3.1) (+ 2)

Intervention Control Mean diff. P

WHO 13.49 13.79 - 0.3 0.731

GHQ 8.714 14.07 - 5.4 0.000

(+ 6.5) (+ 2.5)

BDI 13.11 21.88 - 8.7 0.000

(+ 7.9) (+ 3.5)

PTSD 6.16 10.51 - 4.4 0.00

(+ 3.1) (+ 2)

Regression AnalysisRegression Analysis

Adjusted ß P

BDI 53 (2.44) 0.000

GHQ 52 (1.81) 0.001

Adjusted ß P

BDI 53 (2.44) 0.000

GHQ 52 (1.81) 0.001

Follow upFollow upChange Intervention Control Change P

Factors

WHO 8.4 7.6 0.75 0.67

(+ 9.7) (+ 8)

GHQ - 5.1 - 1.20 - 3.9 0.001

(+ 8.2) (+ 2.8)

BDI - 5.3 - 0.67 - 4.6 0.006

(+ 11.7) (+ 3.6)

PTSD - 6.4 - 2.2 - 4.3 0.000

(+ 59) (+ 2.3)

Change Intervention Control Change P

Factors

WHO 8.4 7.6 0.75 0.67

(+ 9.7) (+ 8)

GHQ - 5.1 - 1.20 - 3.9 0.001

(+ 8.2) (+ 2.8)

BDI - 5.3 - 0.67 - 4.6 0.006

(+ 11.7) (+ 3.6)

PTSD - 6.4 - 2.2 - 4.3 0.000

(+ 59) (+ 2.3)

Post Intervention : Suicide Attempt

Post Intervention : Suicide Attempt

Intervention Control

Baseline 6 7

Follow up 0 3

Intervention Control

Baseline 6 7

Follow up 0 3

FET p = 0.02FET p = 0.02

Community Based Case FindingCommunity Based Case Finding

Referral to Health ServicesReferral to Health Services

Community Based Social

Support for Treatment

Adherence

Community Based Social

Support for Treatment

Adherence

CBRCBR

Comprehensiveness and Continuity

Community Care to Caring Community

Comprehensiveness and Continuity

Community Care to Caring Community

Monitoring

Implementatio

n

Monitoring

Implementatio

n

Evidence based

Quality Enhancement

Evidence based

Quality Enhancement

Never doubt that a small group

of concerned citizens can

change the world. In fact it is

the only thing that has.

(M. Mead)

Thank YouThank You