On World Suicide Prevention Day 2023, Community-based Mental Health Project of ADD International Bangladesh and the Dhaka Tribune jointly organized a webinar titled ‘how Bangladesh can create hope to reduce suicide’ through advancing actions. Financed by Comic Relief UK, the webinar was held on September 13, 2023, in collaboration with the Innovation for Wellbeing Foundation (IWF), the Nasirullah Psychotherapy Unit (NPU) of the Clinical Psychology Department under the University of Dhaka, and the Disabled Child Foundation (DCF), Dhaka, Bangladesh. The webinar was moderated by Md. Shafiqul Islam, the Asia Regional Director of ADD International, a UK-based international development organisation working for persons with disabilities globally. The opinions of expert panellists are published in this supplement.
Panelists:
Professor Dr. Md. Robed Amin
Line Director, NCDC, Directorate General of Health Services (DGHS)
Monira Rahman
Founder and Executive Director, Innovation for Wellbeing Foundation (IWF)
Dr. Helal Uddin Ahmed
Associate Professor, National Institute of Mental Health (NIMH)
Rubina Jahan
Head of Clinical Service, Mental Health Programme, Sajida Foundation
Farzana Akter Laboni
Head of Research, Aachol Foundation
Moderator and Panelist: Md. Shafiqul Islam
Asia Regional Director, ADD International
Discussions:
In the discussion, mental health and psychiatric specialists and social counselors emphasised that preventing suicidal tendencies, which often arise from multifactorial problems, necessitates joint efforts. “The most important part is to start prevention from childhood, establish an appropriate control system to manage emotional trauma, and ensure easy access for these vulnerable individuals so that they can receive emergency support services,” experts underscored in the webinar to support the theme of the day this year “Creating Hope Through Action”.
Mental health and social stereotype
Md. Shafiqul Islam
Suicide is a manifestation of severe mental distress, and due to social stereotypes, these issues are often neglected. Most individuals still feel uncomfortable while discussing suicide due to stigmas, superstitions, religious beliefs, and legal implications present in many countries. The misconceptions among families and communities can deter those in need from seeking help.
With this statement, different speakers commented on the imperative of raising awareness, reducing stigma, and encouraging informed actions to decrease suicide rates in Bangladesh.
Multifactorial indicators
Helal Uddin Ahmed
Why people die by suicide is a generic question. There is no one-way answer. Sociologists have many theories. According to the theory of the French philosopher Emil Durkheim, different personality traits like fatalistic, anomic suicide, believing in either being related to society or departed from society, loneliness, and being different from social structure are the reasons for suicide.
Nevertheless, these are not the only causes of suicide. Different research or surveys, especially media surveys, show numerous factors, such as relationship strain, financial issues, education and career setbacks, family problems, and social isolation, can compound, pushing an individual into a vulnerable mental state, which ultimately leads to suicidal tendencies. When multiple factors converge, they can create mental instability in an individual. These factors are not the direct cause of suicide. It is suggested that these causes have a great impact on people who died by suicide.
The main reason for suicide depends on the personality traits and developmental phenomena of a person. If their personality becomes fragile as a result, they may not struggle to cope with their emotional state and could choose to end their life. Those multiple factors like joblessness, poverty, academic pressure, family relationships, and relationship problems are not the causes. They are risk factors. There are some protective factors. Like social skills, busyness, resilience, etc. So, to prevent suicide, we should focus on the person, not the cause and risk factors. We should focus on how a person can increase their resilience capacity, how family can make them resilient, and how schools, teachers, and their ecological system can make them increase their coping ability against all odds and accept all failures. Following this, suicide can be prevented. Most mental illnesses, like depression, anxiety, mood disorders, schizophrenia, and drug abuse, are related to suicide. So, the final message will be to take care of mental health. Society should nurture resilience so that an individual can overcome suicidal tendencies. We (the government) already have an operational plan that is going to launch in 2024. Suicide is one of the main parts of a strategic plan. We need to focus now more on implementation than mere planning.
Criminalization of suicide
Monira Rahman
People are still reluctant to communicate openly about suicide, especially in the Bangladesh context, where it is deemed a criminal offence under the Indian Penal Code inherited in Bangladesh, often involving law enforcement before medical professionals, which perpetuates the notion of it being a secret.
IWF is providing mental health first aid training, where a specific session remains on suicide and suicide prevention. In every training session, we found that, on average, 4 to 5 people shared their experience regarding suicide or suicide ideation. When a person shows loneliness, severe sadness, or feelings of unworthiness, we should talk to them openly. It is a myth that talking about suicide makes people vulnerable to doing that. At first, it was a cultural shock to talk about suicide openly. But research findings as well as our experience show that talking about suicide with people is useful. People get hope to live. Language is important here. Sometimes media writes that someone is failing to die by suicide or details the stories of suicide, like the ways of suicide, which can influence someone who has suicidal thoughts.
Because of the criminalization, people who attempt suicide feel afraid to seek support. Britain decriminalised suicide in 1961. Even some Muslim countries—Pakistan, Uganda, and Malayasia—have recently decriminalised suicide.
A concerning trend in rural Bangladesh sees poison as a common means of suicide. We encourage healthcare professionals to approach such cases with empathy and care. We should focus on a more nonjudgmental attitude towards people and training to develop the capacity for dealing with suicidal people. Awareness of local leaders and community is very important to change the situation positively.
Challenges in strategic plan
Md. Robed Amin
The national mental health strategic plan places special emphasis on preventing suicidal tendencies with a goal to prevent suicides by 2030. While this is addressed as a mental health issue, implementing this plan is challenging, as it is not the sole responsibility of only the health department.
A publication (2003) named the Archive of Suicidal Research shows that 10 thousand people die by suicide every year, and females die by suicide more than males in Bangladesh. But globally, the male suicide rate is higher than that of women. 10–19-year-old adolescents and females are more vulnerable to this point. Research findings also show that the suicide rate is higher among ageing and over-60-year-old people. Using poison, as this research shows, is the main way to die by suicide in rural areas. The cause of suicide depends more on personal issues or problems. Suicide prevention is one of the main focuses of the SDGs. It is alarming that the suicide rate among medical students is also increasing. They suffer from depression, hopelessness because of academic pressure, and many other reasons.
Various government and private organisations must collaboratively work to prevent suicide in their respective places. I also urge social media and mass media to refrain from activities that promote imitation suicide trends. Education Institutions and the workplace environment need to change in this regard. The media should be trained by professionals on positive reporting. They should be aware of what they are broadcasting regarding famous people who died by suicide. Medical students suicide prevention should be more focused because they are future professionals. We are committed, and an operational plan for mental health has meanwhile been developed by the government.
Suicide prevention – inadequate helpline support
Rubina Jahan
The suicidal rate of women and teenagers is high in Bangladesh. Where misconceptions about suicide and mental health are a barrier to seeking support, we need easy access for women and teenagers in the support service. The Kaan Pete Roi (09612-119911) is the only helpline in Bangladesh providing mental health and suicide prevention support. The previous 6 months of Kaan Pete Roi data shows that 75% of people under no risk and 24% of people at moderate to high risk of suicide sought support through the app. Most of the callers to the Kaan Pete Roi helpline listed stress, depression, and loneliness as reasons for seeking help.
To prevent suicide tendency, it is needed to spread and increase the social support systems, make them learn to adjust with the problems.
Suicide prevention can be possible if health services are low-cost and available at both local and national government levels. If we create a social support system, an empathetic place, and a system in which they can share everything, it will be useful. We can also develop self-care tools and guidelines that they can access. They can benefit. Prevention can be possible by reducing the risks. And suicide is 100% preventive. If we develop helplines that are remotely accessible and free of charge, people with suicidal risk can access them. So, we should be aware of and promote this type of helpline.
Suicide statistics - alarmingly high
Farzana Akter Laboni
Our research analysed and found that, in the COVID situation, 14 thousand people died by suicide. Among them, 49% were between 18 and 35 years old, or young people. 61% of people suggested that they suffered from depression. Data shows that in the current year, 361 students have died by suicide. Emotion was the most responsible factor behind students who died by suicide. Female students have a higher suicide rate than male students. An average of 45.13 students died by suicide in the last eight months. Age-wise consideration of the suicides shows that students between the ages of 13 and 19 have died by suicide the most. The rate of suicide due to emotions will help us as parents to handle it wisely. We should focus more on resilience.
Md. Shafiqul Islam
The mental health policy was passed in Bangladesh in 2022. Section 7.13 (Suicide Prevalence and Risk Reduction) of this policy states suicide is a major problem in Bangladesh, especially among adolescents and youth community, which needs special attention. In the national mental health strategic plan, goals are there to prevent suicide by 2030. We have a policy but implementing is still a challenge. We should focus more on decriminalizing suicide.
Recommendations:
- Joint and multi-stakeholder initiatives among public and private organisations should be taken to prevent suicide.
- Increase awareness to reduce the stigma and social taboo on suicide. Develop simple message on suicide prevention and disseminate widely.
- Print and electronic media can be more sensitive and undertake awareness campaign.
- Decriminalise suicide for the sake of health support.
- Education institute-centric psychosocial support is required.
- Increase helpline support from public and private organisations.
- Increase and standardise data and research methodologies.
- We should focus more on implementation now than mere planning.
