JOIN USIn June 2017, the media reported a tragic series of death by suicide of all four members of a single family near Devanahalli, Bengaluru Rural District within a span of less than a week. There have been few such incidents in recent times where many members of the same family have taken their own lives.
There were nearly 11,000 suicides in Karnataka as per 2014 data, which was over 8% of suicides in the country. News about suicides can create a sense of unease and affect our emotions, which maybe a reason why it is not frequently discussed. Close family members or friends often experience thoughts such as "had I done something at the time, the person would have been alive." Family members also go through denial and anger as part of early grief reacting to the sudden loss.
It is not just the noticeable preceding events which act as a trigger that must be blamed for the suicide. One must consider the possibility that the individual could have already been vulnerable. Those having conflicting thoughts about ending their own lives may give cues to their relatives or friends. Such hints are not to be ignored. Suicidal thoughts should be taken seriously and must be engaged by trusted relatives or friends.
There is a need to create wider awareness about behaviours related to suicidal gestures. An early assessment of the person with suicidal thoughts can help manage the crisis. Psychiatrists will be able to assess the magnitude of risk of a suicide based on the person's mental state and the factors known through past experience or research.
People having persisting thoughts of suicide should also be encouraged to take some responsibility towards safeguarding their own life and health and verbalise. The flight-or-fight response is a survival instinct that helps a person overcome the threat to his/her life and find ways to remain safe. However, suicidal thoughts are abnormal and should be considered as a sign of severe stress.
For starters, an individual could attend the nearest casualty department for urgent consultation. Such cases must be regarded a medical emergency, similar to chest pain. At times of deeper crisis, to offer supportive care for underlying mental health symptoms,
s/he may be closely monitored in supervised mental health wards with the help of mental health nurses or trusted families in the community
There is a protocol in general hospitals where all patients admitted after an attempt to suicide are offered psychiatric consultation prior to discharge. This also serves as a screening method to further identify mental illness.
In a few cases, there could be triggering psychological or interpersonal relationship issue, where counselling or Cognitive Behavioural Therapy (CBT) may help. Generally, family members are also involved in the treatment plan after discharge.
Preventing isolation
Unfortunately, there is no protocol currently to support grieving, surviving families of those who have committed suicide. The stigma of death by suicide maybe a make it difficult for the family to confide in their trusted relatives or friends, leading to social isolation. Some may develop depression, anxiety or acute stress. They may need psychological talking treatments, besides bereavement counselling.
Guilt among family members, especially in mothers, is hard to overcome, and may persist throughout their lives. Attempts could be made to offer support, by letting them ventilate. There may be a mix of complex emotions of anger, sadness and fear.
The incidents involving the Devanahalli family may be an extreme one, but surviving families do require support. Awareness that suicidal gestures could be part of a mental illness and helping people to understand the medical model is need of the hour.
The World Health Organisation's guidance on media reportage of suicides emphasises the need for sensitivity. The reports should also provide basic public education on suicides, including helpline numbers. Sensationalising the news about any suicide should be avoided.
The health department could draw a protocol to support the grieving families to reduce the impact of the incident on their health and to enable early restoration to their usual level of functioning. Training people, especially youth, on problem-solving skills during times of crisis, coping skills, stress management and seeking support by better communication may reduce such suicides and save many lives.