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Opinion Sandisiwe Mahlangu
BACK in 2009, I had an experience which I can call tragic, devastating and regretful at the same time. A final year student nurse sat her final exams for the second time and did not make it still. Being the last attempt for her career-defining examination, it was expected that she would show some sorrowful emotion upon receiving her results but that was not the case. Instead she was laughing, smiling and continuously saying, “It’s ok”.
Later on she approached me and shared her results. We had what I thought was a good chat, with me comforting her, telling her it was not the end of the world. I vaguely recall her saying something about how tired she was of life. She claimed that it seemed whatever she tried to do never came to fruition. It was not worth it, she said.
As we parted after the talk, my friend appeared hesitant to leave. It was as if she wanted to say something but I was busy then congratulating others. Instead, I promised to call her later on.
An hour later, I received the shattering news that she had passd on. Imagine how I felt at that moment. I was crushed and felt guilty about her death. I blamed myself for missing the subtle message that she was, “tired of life” and life was “not worth it”. How I never gave her enough attention when she wanted to tell me “something” and I could only promise to call her instead.
Little did I know that she would shortly take her life by taking a fatal concoction.
“If only”……was all I could say.
What really drives an individual to take his or her own life?
Every suicide is a personal tragedy that prematurely takes the life of an individual and has a continuing rippling effect. The impact on families, friends and communities is devastating and far reaching, even long after persons dear to them have taken their own lives.
It is estimated that 800,000 people die each year through suicide globally. In some countries, suicide rates are highest among the young and globally are the second leading cause of deaths in the 15 to 29 age group according to a World Health Organisation report on suicide. Suicide prevention is an integral component of the Mental Health Action Plan, with the goal to reducing the rate of suicide in countries by 10 percent by 2020.
What causes suicide? Why do so many people end their lives every year? Is it because of poverty or the breakdown of relationships? Or is it because of depression or other serious mental disorders? Are suicides a result of an impulsive act or are they due to the disinhibiting effects of alcohol or drugs?
There are many questions but no simple answers. No single factor is sufficient to explain why a person commits suicide.
Suicidal behaviour is a complex phenomenon that is influenced by several interacting factors that are personal, social, psychological, cultural, biological and environmental. However, many suicide cases are impulsive and in such circumstances, easy access to a means of suicide can make the difference as to whether a person lives or dies.
The ingestion of pesticide, hanging and firearms are among the most common methods of committing suicide globally. There are, however, many other ways of ending one’s life with the choice of the method varying according to population group.
Suicidal behaviour refers to a range of behaviours that include thinking about suicide (or ideation), planning for suicide, attempting suicide and suicide itself. Suicide is the act of deliberately killing one self.
Suicidal attempt is used to mean any non-fatal suicidal behaviour and refers to intentional self-inflicted poisoning, injury or self-harm which may or may not have a fatal intent or outcome.
The taboo and stigma surrounding suicide persist and often people do not seek help or are left alone. And if they do seek help, many health systems and services fail to provide timely and effective help. With timely and effective evidence based interventions, treatment and support, both suicides and suicide attempts can be prevented.
The burden of suicide does not weigh solely on the health sector: it has multiple impacts on many sectors and on society as a whole. Thus to start a successful journey towards the prevention of suicide, countries should employ a multisectoral approach that addresses suicide in a comprehensive manner, bringing together the different sectors and stakeholders most relevant to each context.
Frequently, several risk factors act cumulatively to increase a person’s vulnerability to suicidal behaviour. Risk factors associated with the health system and society at large include difficulties in accessing health care and in receiving the care needed, easy accessibility of means of suicide, inappropriate media reporting that sensationalises suicide and increases the risk of “copycat” suicides, and stigma against people who seek help for suicidal behaviours or mental health and substance abuse problems.
Risks linked to the community and relationships include discrimination, a sense of isolation, abuse, violence and conflictual relationships. And risks factors at the individual level include previous suicide attempts, mental disorders, and harmful use of alcohol, financial loss, chronic pain and family history of suicide.
Trauma and abuse increases emotional stress and may trigger depression and suicidal behaviours in people who are already vulnerable. Psychological stressors associated with suicide can arise from different types of trauma, disciplinary or legal crises, financial problems, academic or work related problems and bullying. Young people who have experienced childhood and family adversity (physical violence, sexual or emotional abuse, neglect, maltreatment, family violence, parental separation or divorce) have a much higher risk of suicide compared to their counterparts from normal families.
The effects of adverse childhood factors tend to be interrelated and correlated and act cumulatively to increase risks of mental disorders and suicide. Sense of isolation and lack of support can be a risk factor.
It is often coupled with depression and feelings of loneliness and despair. This occurs when a person has a negative life event or other psychological stress and fails to share this with someone else. Compounded with other factors this can lead to an increase in risk for suicidal behaviour.
Postvention support has been identified as an important component of suicide prevention. Bereaved families and friends of people who have died by suicide also require care and support to help them go through the grieving process and reduce the possibility of imitative suicidal behaviour. It also helps reduce immediate emotional distress such as depression, anxiety, despair and feelings of guilt because the family may actually blame themselves for the incident.
There is need for gatekeepers to develop knowledge, attitudes and skills for identifying individuals at risk, determining the level of risk and referring individuals at risk for treatment. A gatekeeper is anyone who is in a position to identify whether someone may be contemplating suicide.
Key potential gatekeepers include teachers and other school staff, primary and emergency health providers, social welfare workers, spiritual and religious leaders, traditional healers, police officers, human resource staff and managers.
Crisis helplines are public call centres which people can turn to when other social support or professional care is unavailable or not preferred.
Myths and facts about suicide
- Myth- People who talk about suicide do not mean it.
- Fact- People who talk about suicide may be reaching out for help or support. A significant number of people contemplating suicide are expressing anxiety, depression and hopelessness and may feel that there is no way out.
- Myth- Most suicides happen without warning.
- Fact – The majority of suicides have been preceded by warning signs, whether verbal or nonverbal or behavioural. This can be in the form of some negative comments about life, diary writing of negative emotions and talking of after life and how very soon it would be over, etc.
- Of course there are some suicides that occur without warning. But it is important to understand the warning signs and look out for them.
- Myth – Talking about suicide is a bad idea and can be interpreted as encouragement.
- Fact – Given the wide spread stigma around suicide, most people who are contemplating suicide do not know who to speak to. Rather than encouraging suicidal behaviour, talking openly can give an individual other options or the time to rethink his/her decision thereby preventing suicide.
The writer, Sandisiwe Mahlangu, is a Health professional with psychiatric mental health qualification. Contact details: [email protected] , cell 0774 782 282.
Online Reporter
Sidumisile Mabena