Building a community-based approach for sustained suicide prevention in India

India accounts for 17.5 percent of the world’s population and yet sees more than 25 percent of the world’s population. suicide deaths. Such reports are often accompanied by discussions of suicide or crisis hotlines, as well as expert opinions from psychiatrists or psychologists. This is a dangerous oversimplification that narrowly focuses on the individual, one factor (mental illness), and one point on a trajectory (acute crisis).

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To illustrate, suicide help lines they tend to be designed for those who may be in acute danger or at risk of attempting suicide. While these services are critical, they are not a panacea for suicide prevention. The same applies to considering psychotherapy or psychiatry as a single approach to suicide prevention, especially if such services are decontextualized and expert-led. This is because suicide is a complex problem that cannot be separated from its social, cultural, economic, political and historical contexts.

In recent days, reported suicides and suicide attempts have included the deaths of six farmers in Vidarbha, Maharashtra due to crop failure and inability to access loans, seven factory workers who attempted suicide in Bhopal, Madhya Pradesh for non-payment of wages for months. These examples are indicative of the general picture: reports the National Crime Records Bureau (NCRB) showed that in 2021, Maharashtra had the highest number of suicide deaths of people working in agriculture. The same report showed that 25.6 per cent of suicide deaths in India were of day laborers. That’s one in four suicide deaths in India in 2021.

Distress, crisis, and suicidal ideation arising from challenging life circumstances, such as poverty, systemic social exclusion, structural violence, and discrimination, cannot be addressed through medical diagnoses and interventions alone. Therefore, suicide prevention necessarily requires a community, intersectoral, multifactorial and decentralized approach. Community-based care involves people from local communities or organizations who provide support and services to those who need care.

If India is to undertake comprehensive suicide prevention efforts, we must look beyond acute crisis services. (Photo: Getty/Thinkstock)

A community-led approach to suicide prevention would include both: providing psychological support through counseling and allowing access to social benefits such as employment, health services and education, among other things. One such program run by the Shivar Foundation follows that approach to work with farming communities in Osmanabad, Maharashtra. Funded and supported by the Mariwala Health Initiative (MHI), Shivar trains local community volunteers to create suicide awareness, talking about common stressors experienced by farmers, providing psychosocial first aid; share details about government schemes; allowing access to cash support, credit and farm equipment. In addition to this in-person outreach, they also run a psychosocial helpline for farmers, as well as Farmer Friends Centers for people to visit. With over 550 local community volunteers addressing distress, through advice, advocacy, market links, debt relief and even seeds in the last 2 years, 4670 farming families have accessed these supports.

This approach allows services and supports to be available where people already are, making such programs accessible in times of crisis. Not only does this reduce the need for expensive expert-led interventions, it also lowers the cost of accessing care for individuals, which is important in low-resource settings. This way of working builds on the existing experience of communities to create a collective effort to address not only crisis situations, but also to provide support to prevent crises from arising in the first place.

This is also the rationale behind the Center for Mental Health Law and Policy’s Suicide Prevention and Implementation Research Initiative (SPIRIT) program which runs in 116 villages in Mehsana, Gujarat. An important facet of SPIRIT is a school suicide prevention program among students from 14 to 16 years of age. The ‘Mental Health Aware Youth Programme’ training focuses on this age group because trends in South Asia show that from the age of 15, suicide rates begin to rise.

This intervention, delivered by school teachers trained by expert trainers, includes workshops, active role plays and educational posters related to mental health and suicide, in local languages. This training enables youth to understand their mental health, ways to seek help, and also how to talk to a peer who may be in distress. The examples of community work shared above can be very effective in fostering public conversation, helping to combat stigma, and providing culturally appropriate support.

Community-led models may also be appropriate to support people grieving suicide. Research has shown that family and friends are at higher risk for suicide. A suicide death can affect people beyond immediate friends and family, other people, and even an entire community. Tamil Nadu, one of the top three contributing states for suicide deaths in India, is the location of Project SPEAK, a community program to support people distressed by suicide, an ‘aftercare’ of the MS Chellamuthu Trust and Research Foundation.

This MHI-funded program aims to provide both short-term and long-term support to mourners, including both psychological support and psychosocial referrals for their various needs after a suicide (including financial, legal, educational support, funeral expenses, etc. .). Together with these services, 20 community actors are sensitized on suicide prevention and can carry out community meetings to raise awareness on suicide prevention, as well as support groups for those affected.

The community examples above illustrate that local and contextual knowledge and empowerment are key to addressing multiple factors that lead to suicide and its trajectories, whether prevention, intervention, crisis response, or postvention. If India is to undertake comprehensive suicide prevention efforts, we must look beyond acute crisis services and biomedical expert approaches to community-led work that is contextual and based on lived experience.

(The writer is the director of the Mariwala Health Initiative (MHI.org.in), which is a personal philanthropy of Harsh Mariwala, Chairman of Marico Limited. MHI is a grantmaking, advocacy, and capacity building organization with a focus on the mental wellbeing of marginalized people. Read the MHI report on Suicide Prevention: Changing the Narrative – here)

If you feel suicidal or have suicidal thoughts, help is available; contact Sneha Suicide Prevention Helpline – 044 -2464000 (24 hours)

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