Nishtha Shrestha

A school declared a holiday. The reason - one of its students committed suicide. The details of the suicide differed depending on sources. Everyone had their own theories behind the suicide which were shared regardless of the age. The students knew suicide was a bad thing but did not know what it meant and why their senior committed it. The concerned child was a bright student and the loss would be hard to explain to the family members.
The above scenario is a real life example that could happen anywhere. On the 10th of September every year, World Suicide Prevention Day was marked. According to World Health Organisation, close to 800,000 people kill themselves every year, with 79 per cent of suicides occurring in low- and middle-income countries. The risk factors such as family stressors, poor coping strategies, abuse or other life crises are highlighted on this day which helps in creating awareness of suicide. But there is a need for sustained efforts from all concerned authorities to ensure that the vulnerable population receives attention throughout the year.
Alarming scenario
Nepal has seen an alarming rate of suicide cases during the lockdown and it was a hot topic of discussion. The data suggests that about 15 people commit suicides every day in the country. Suicide is a preventable condition and yet as a society we are still failing to protect the vulnerable groups. The knowledge of warning signs of suicide such as history of suicidal behaviour, thinking frequently about death and changes in behaviour such as eating patterns, sleeping habits, and appearance, etc. might help us identify and offer timely help to the at-risk individuals. Though these warnings can provide a clue, there is no single answer to why people commit suicide. Alertness and empathy is the key to helping those who have attempted suicide and are experiencing suicidal tendencies. Along with this, there is a need to focus on another important part of suicide prevention called postvention.
Postvention refers to the care and support provided to those affected by the suicidal tendency. This could include the family, friends and the community who are dealing with the after-effects of the trauma. Many emotions such as guilt, shame, anger, blame, etc. emerge in those impacted by the suicidal behaviour. The stigma attached to suicide makes it difficult to deal with the effects of losing someone due to suicide. Furthermore, suicide also has a contagion effect which refers to the increase in suicide and suicidal behaviours due to the exposure to suicide through ways such as family, friends or even the media. The postvention plan targets the possibility of contagion effect by helping individuals under mental stress and providing the timely resources to prevent further suicides. Suicide has a ripple effect and therefore along with the victim, there is a need to focus on those who may be directly or indirectly affected by it.
Suicide is a painful event. Our first instinct is to try to keep our children away from such negativity. But when they know about a case of suicide, it is the duty of the adults to provide age appropriate information such that their doubts are clarified. Considering the recent focus on suicides, adults can initiate the topic in a safe environment. The curiosity and negative beliefs about suicide need to be discussed to avoid youngsters from choosing this option when they feel overwhelmed. School is the best place to target young minds. In the present scenario, it would be helpful if teachers conducting online classes talk about mental health. Children are struggling along with the adults in this pandemic and finding a place to share their issues would be helpful in reducing emotional distress. Children are learning to adapt to the frequent changes and the prolonged stay at home is bound to create frustrations and tensions. Parents and teachers can teach children to speak to a trusted adult when they feel unable to cope with the situation.
Instead of defining suicide in terms of good/bad behaviour, educating people about the factors that trigger suicidal thoughts would prevent and reduce the stigma attached to it. It is not easy to deal with the death of a loved one and stigma towards suicide makes grieving difficult. Isolating the family members, spreading rumours, constantly reminding of the incident are barriers to healing from suicide. Suicide, like any other traumatic event, takes time to process and has lasting impacts on those affected by it. It is a loss regardless of the circumstances in which it occurred and the concerned parties should be given the support that we would offer to any grieving person. The creation of protective factors in the form of financial support, positive relationships, responsible reporting of suicide, suicide help lines, etc. help people deal with the sudden loss. There is a need to focus on developing good postvention plans such that the stress does not lead to conditions like substance abuse, depression, anxiety or even further suicide.

Critical components
Prevention, intervention and postvention are the three critical components. Yet, postvention is the least focused area in suicide prevention. It is always better to be able to prevent suicide but in some occasions despite various prevention measures such incidents do happen. In such a scenario, it is the duty of the members of society to be sensitive and create a place for mourning to happen normally. Suicide may have been perceived by the victims as an end to their suffering but it leaves behind endless questions for the family members and friends. Humans are complicated beings and suicide is one among the many options that they wrongly judge to be an answer to their confusion.

(Shrestha is a psychologist working in the area of mental health for children. nishtha.shrestha@gmail.com)