adminPastor Tawanda Mvere
World Mental Health Day is observed on 10 October every year. The overall objective of this day is to raise awareness of mental health issues around the world and mobilising efforts in support of mental health.
This year’s theme set by the World Federation for Mental Health is “Suicide prevention.” Suicide is a major preventable cause of premature death.
Suicide is the act of deliberately killing oneself or, more specifically, an act deliberately initiated and performed by the person concerned in the full knowledge, or expectation, of its fatal outcome. It is a tragic event with strong emotional repercussions for its survivors and for families of its victims. Suicide should be prevented at all cost.
According to the World Health Organisation, close to 800 000 people take their own life every year and there are many more people who attempt suicide.
Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the second leading cause of death among 15-29 year-olds globally in 2016.
Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world. In fact, over 79 percent of global suicides occurred in low- and middle-income countries in 2016.
It is sad to say Zimbabwe has not been spared from this horrendous act. Over the past few years there has been an upsurge in the number of suicide cases.
According to a Zimbabwe Republic Police report published in the Health Times a total of 129 suicide cases were recorded from January to March 2019 compared to 91 reported in the same period last year. Out of these 87 were for hanging and 42 for poisoning.
Most of these suicide cases are caused by social problems which include marital or relationship and financial problems.
An understanding of suicide can be used to assist us in preventing the event. Suicide is a multifaceted event in which biological, cultural, sociological, interpersonal, intrapsychic, logical and philosophical elements are present, in various degrees, in each suicidal event.
It was once believed that all suicidal people were depressed, but this is a myth. The fact is that not all suicidal people are depressed, and that not all depressed people are suicidal. Depression and suicide are not equivalent. However, depression distinguishes many suicidal people from non-suicidal groups.
Depression can be noted in mood and behaviour, ranging from feeling dejected and hesitancy in social contacts, to isolation and serious disturbance of appetite and sleep, verbal expression ranging from talks about being disappointed, excluded, blamed, to talking of suicide, being abandoned, mistreated and helpless. Behaviours such as excessive aggressiveness, change in work performance and expressions of somatic complaints or loss of energy have all been associated with depression.
However, not all depression is overt or expressed, especially in youth. Some children and especially teenagers exhibit what has been termed masked depression. They may dissemble promiscuity and drug abuse. As noted earlier, it is important to remember, however, that depression does not equal suicide in a simple one to one fashion.
Most suicides experience unbearable pain, but not necessarily depression. The unbearable emotion might be hostility, anxiety, despair, shame, guilt, dependency, hopelessness, or helplessness. What is critical is that the emotion pain is unbearable. Unendurable psychological pain is the common stimulus in suicide, not depression alone.
Specific environmental precipitating events may be risk factors for suicide combined with life-long coping patterns of individuals; for example, when a young man gets rejected and is so in love, he may kill himself if he does not have a coping mechanism.
One event often taken for granted which needs special mentioning is bullying or abuse. Some people will remember the bully in the school yard (although they are also in the workplace, or home, or anywhere).
The bullying can be a precipitating event for suicide and reports of bullying by children must be taken seriously and in addition schools must have zero tolerance to bullying.
Another precipitating event for suicide is the death of a loved one such as a parent especially in young people. This calls for grief counselling for those who would have lost their loved ones.
The family system and its functioning is a central factor associated with suicide and suicidal behaviour in children, adolescents, and even older people, although by no means do all families show these characteristics some, none at all.
Denial, secretiveness, dissembling and especially a lack of communication characterises the family’s interactions, even in the suicides of the elderly. Some families have rigid family rules. In teenagers, such families have strong discipline patterns and limit setting that bind the individual in his/her identity development, which is critical at this time of a person’s life.
Parents may interfere in the romantic relationships of their children, even in late adolescence. The parent also does not provide the emotional protection and support that a parent usually provides intuitively to a youth as he/she grows. Adolescence is a time of stress and turmoil. It is not, as some believe, a time of simple joy and peace.
Often, parents do not allow any conflict, turmoil, and development to occur. Family disorganisation for example, recent moves, unemployment in the home, physical or mental illness, parental conflict have been noted as being risk factors for suicide.
A previous attempt is a good clue to future attempts, especially if no assistance is obtained after the first one. However, not all previous attempters make another attempt (or kill themselves). All too frequently such behaviour is not taken seriously. As with behaviour, the attitude towards individuals making verbal threats is too frequently negative.
Statements are seen as “just for attention”. This attitude results in ignoring the behaviour of a person who is genuinely perturbed and potentially suicidal. The important question is, “Why use this way of getting attention when there are so many other constructive ways?” Examples of verbal warnings are: “I’m going to kill myself” or “I want to die”, both being very direct.
Changes in behaviour are also suspect. Those who may be at risk are the outgoing individual who suddenly becomes withdrawn and isolated and the normally reserved individual who starts being outgoing and seeking thrills. Such changes are of particular concern when a precipitating painful event is apparent. Changed performance in school or work, such as sudden failure, may be an important clue.
A sudden preoccupation with death, such as reading and talking about death, may be a clue.
Suicides are preventable. There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. These include:
– reducing access to the means of suicide (e.g. pesticides, firearms, certain medications);
– reporting by media in a responsible way;
– school-based interventions;
– introducing alcohol policies to reduce the harmful use of alcohol;
-early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute emotional distress;
-training of non-specialised health workers in the assessment and management of suicidal behaviour;
– follow-up care for people who attempted suicide and provision of community support.
Suicide is indeed a serious public health problem. However, suicides are preventable with timely, evidence-based and often low-cost interventions.
For national responses to be effective, a comprehensive multi-sectoral suicide prevention strategy is needed including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defence, politics, and the media. These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide.
–Tawanda Mvere is a Senior Pastor at Abounding Grace Ministries and chairperson of Christian Counselling and Depression Trust, a Bulawayo-based non-profit making organisation whose primary purpose is to raise awareness on mental health disorders. For further information contact him on 0717637160 or [email protected]
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