When will our governments take mental health seriously enough to revisit present budgetary allocations?
Imagine looking out of your window on an especially bright morning to see a headless body dangling from the end of a rope attached to a neighbour’s roof. That was the nightmare several Corinth residents confronted last Sunday. Place yourself in the shoes of the dead individual’s immediate family upon discovering the unspeakable horror—that the latest suicide was one of theirs, who had jumped off a second floor balcony, a rope around his neck.
Police arrived at the scene at about 7:30 p.m. that evening. The victim was later officially identified as 56-yearold Paul Fanus. Investigations continue into the latest suicide. Meanwhile, there are the grieving relatives and friends of three other individuals who took their own lives just days after the universal observance of Suicide Prevention Day, on September 10. One of the victims was a 16-year-old female.
The cited tragedies put into perspective the theme of this year’s observance of World Health Day: ‘Depression, Let’s Talk’. Worldwide, discussions have persisted since the April 7 observance, meant to shed light on depression, the leading cause of suicide.
On a mission to avoid sensationalism, and oversimplification of suicide and its possible causes, the Pan American Health Organization (PAHO) hosted a webinar for journalists in March. Presenters underscored the undeniable power of the media, especially when it came to preventing suicide.
Considering the gravity of the topic, presenters urged journalists to talk about suicide in a responsible way as, according to Dr. Dan Reidenberg, Executive Director of Suicide Awareness Voices of Education, “Responsible coverage can help prevent suicide.”
Dévora Kestel, Chief of PAHO’s Mental Health and Substance Abuse unit acknowledged that suicide was often under-reported, and that the true figures were sometimes much higher.
“This topic merits a closer look because depression - and people suffering from it are going to have fewer days at work, perhaps productivity will drop off; there will be more expenses associated with that, and this has an overall effect on a country’s economy,” she said, before offering a reminder that depression could be prevented, or treated.
Of particular concern was the contagion effect, also known as copycat suicide, often occurring following suicide reports that did not follow best practices.
Prominent examples included that of Hollywood starlet Marilyn Monroe’s demise, and more recently, American comedian and actor Robin Williams in 2014. Suicide rates increased following both of their deaths, and extensive media coverage. In light of the reality of contagion, Reidenberg underscored the significance of media guidelines.
Other recommendations for combatting suicide included early identification and treatment, training of health workers, follow-up care and community support, restricting access to means, including pesticides, firearms, sharp objects; introducing alcohol policies, and researching techbased solutions.
The key, according to presenters, was avoiding misinformation, and offering hope.
“It is not just a North American or U.S. or Caribbean problem; studies from around the world have demonstrated that how media reports on this topic does make a difference,” Reidenberg concluded.
Though in some countries, including here in Saint Lucia, suicide, and aiding and abetting suicide, is considered a crime, presenters opted to switch the perspective to “a tragic but highly prevalent public health problem”.
For their part, local police have expressed that incidents of suicide are looked at on a case by case basis, with the understanding of the various reasons and social issues that could lead to a person wanting to take their life. As noted by the police press office: “Police use discretion, as charging could lead to more depression.”
This is the type of looming depression that led many to the National Mental Wellness Centre, which I visited this week. After making it through several security check points within the state-of-the-art facility, I was face to face with Dr Julius Gilliard, Consultant Psychiatrist at the Wellness Centre. It was 8:30 a.m. on the dot, and completely impossible not to feel like a patient under the discerning eyes of the experienced psychiatrist. I considered what it might feel like for a person struggling with mental issues of any sort, to finally be able to come to a place where their issues would be seen as something more than just imagined, and in their heads.
We got into conversation about the rising cases of depression, anxiety and other psychiatric matters and, even with those increasing trends, Gilliard gave the assurance that suicide was far from becoming an epidemic in Saint Lucia. In his words, “An epidemic implies something that is out of hand. I do not see the suicides that are going on now as being out of hand.”
Instead, he believed that people simply weren’t aware of the help that was available and, as a consequence, sometimes viewed suicide as a viable alternative when they felt hopeless, or overwhelmed.
A detailed look at suicide figures shows a decrease in suicides on the island from 2015: seven suicide-related deaths during that year, down from a number that fluctuated between 10-13 deaths annually from 2009-2014. Notably, the National Suicide Helpline was initiated in 2015. The figure for 2017 also stands so far at seven.
Though the island is not at epidemic proportions, as confirmed also by Ministry of Health Senior Medical Officer Dr Sharon Belmar, Gilliard said it was a problem that was being looked into.
Deviating from what could be proven by studies of a health and wellness nature, Gilliard shared his personal perspective on the root cause of the spike in depression and anxiety. He laid it all at the feet of a lack of human connection, which he felt was directly related to the increasing popularity of the Internet, and social media. “Before, people would interact a lot more, person to person,” he said. “Right now, everything is so depersonalized. So you’d chat with someone on What’s App, Facetime, and so on; the person is not there with you to see your emotional reactions.
“Persons now are feeling secluded. The loneliness comes on a lot faster when this kind of communication is the one that’s available. It’s easier for persons to become detached and hopeless, and feel that nobody is there. And I guess suicide becomes attractive then.”
In order to be referred to the Wellness Centre, a person would first have to see another doctor, whether that be a general practitioner, psychologist, or counsellor, who would then make a referral.
After consultations, medical professionals would then decide, based on the severity of the problem, whether or not there was a need for medication. Some cases could be managed through psychotherapy sessions with a counsellor. Others require both.
Gilliard spoke directly to the stigma often associated with health and wellness issues, which existed in all levels of society. “Mentally ill persons are often not seen as persons,” he said. “Persons tend to dehumanize the mentally ill, and maybe blame them for what is happening to them. Persons in turn become fearful of those who are mentally ill, and discriminate against them, which causes them to feel they are not normal, or they are not human, and that may cause a lot of the mentally ill to look for the attractive options of suicide.”
While some people tended to view psychiatric issues as an indication that a person was “raving mad”, Gilliard pointed out that depression, anxiety, and even drug abuse all fell under the same category. PAHO reports indicate that 90 percent of persons who commit suicide have some form of psychiatric problem, often exasperated by external stressors and other life events. Gilliard conceded, adding that a high percentage of persons struggled with these issues in the days and months preceding a suicide.
“I think before we can do anything about bringing numbers down, we need to do some research,” he said. “There is a scarcity of research in Saint Lucia about mental health issues, and the different things that affect it. We need to find the causes of the mental health issues we have in Saint Lucia and then, depending on the results of the research, we can try to implement certain measures to educate people more.”
That education and understanding extends to family and friends of patients, who have a huge role to play in supporting them through their recovery, something that extends way beyond forcing people to take medication and attend mental health clinics.
“In these cases, even though the families see it as getting involved, the patient feels they are not in control of their illness, and that always has a poor outcome,” he said. “The family needs to be more understanding, and educate themselves on how they can help with treating those persons.”
With only one percent of the total health budget allocated to mental health issues in Saint Lucia, the psychiatrist admitted there were challenges faced by the institution. The main was staffing, which prevented administration from reaching out and being present in the community in a more meaningful way. Nevertheless, he felt the Wellness Centre was doing an amazing job with the funds they received.
Dr Gilliard, the staff at the Wellness Centre, and other officials invested in changing people’s minds about mental health have a long way to go but they remain confident in the knowledge that education will see a turnaround in attitudes toward mental health, which will, undoubtedly, help save more lives.
Avenues available for help include the National Suicide Hotline, which is managed by trained professionals, and can be accessed by dialing 203, 24/hr a day, free of charge. Turning Point, and the Saint Lucia Crisis Centre also provide free and confidential counselling and other options.
Consultant Psychiatrist at the Wellness Centre, Dr Julius Gilliard.