We can prevent suicides
The World Suicide prevention Day falls on September 10 every year. “Connect, communicate, care” is the theme of the 2016 World Suicide Prevention Day. These three words are at the heart of suicide prevention. They will raise public awareness about the importance of having a conversation and, most importantly, how.
Suicide is a major public health problem worldwide and moreover it is considered as a social problem.
Every suicidal death is a tragedy bringing the life of the person to a sudden end; consequently, it has an unbearable effect on families, individuals and friends. The significant number of deaths and hospitalisations place a heavy burden on health systems and the socio economic impact is often huge.
In the world, one person dies every 40 seconds due to suicide. According to the first suicide prevention report by the World Health Organisation, more than 800,000 people lose their life to suicide every year, corresponding to an annual global age standardised suicide rate of 11.4 per 100,000 population with 15 for males and 8 for females.
In Sri Lanka nearly 3,000 people died in 2015 due to suicide with a death rate of 14.7 per 100,000 population (Department of Police. 2015). The rate of suicide is four times higher among men compared to women.
The reasons
In Sri Lanka, harassment by the spouse and family disputes were reported as the most common reason in 2014 while matters associated with love affairs ranked second. Chronic diseases and physical disabilities, underlying mental illness, economic reasons were the next common underlying factors for suicidal deaths, according to police reports.
Some mental health conditions such as depression, schizophrenia and substance use disorders are major recognised risk factors for suicides and addressing these risk factors will result in suicide reduction. Many suicides are the result of an impulsive act, therefore identifying the people who are at high risk and attending to their psychological, physical, mental and socioeconomic needs are of paramount important.
Impact
Those who attempted suicide or died of suicide and their families experience considerable stigma, and may not seek care. This in turn affects the mental health of survivors and their families. Therefore, those who attempted suicide and their family members require continued support from health care providers for long a period as they face enormous difficulties in leading their life.
Interventions available in Sri Lankan health system for suicide prevention:
Promoting competencies of school children through curriculum changes and life skills enhancing programmes Awareness programmes for schoolchildren on study techniques, anger management, coping with stress and for parents on good parenting through school health programmes De-criminalising suicides in health system (not referred to as criminal acts) and provision of better care for those who admitted to hospitals with attempted suicides Screening for depression and suicidal risk – especially for mothers during post-partum period Provision of psychotherapy and psycho-social interventions for patients with mental illnesses Availability of hotline for counselling – 1333 Strengthening community based mental health services to detect those at risk and provide them care
Media Influence
Both print and electronic media have an enormous impact on the lives of people and therefore responsible media reporting is important in suicidal deaths. The vulnerability and susceptibility of the people often acts as a platform for individuals who are at a greater risk and media events that sensationalise and describe the act in its various dimensions can trigger these acts.
Media can play an effective proactive role in suicide prevention by minimising the prominence given to suicide reports, informing public about sourc- es of help and emergency helpline numbers, encouraging people to take action and seek care, conveying positive stories of people who have overcome suicidal thoughts and ideations.
Actions to minimize suicides:
Encourage good social support for adolescents, youth and elderly who are at a higher risk Good parenting care especially for young persons Establishing counselling services in schools, community and work places Identifying those who are at higher risk and provide care especially psychosocial care Ensure correct medical treatment and follow up of patients with depression and other mental health problems Establish hotlines for counselling and popularise among the community Restrict the easy access to means of suicides (safe storage of pesticides, chemicals and drugs at both individual and community levels) Supporting and strengthening emergency care (including first aid care), in hospital care (including management and referral services) and, supportive after care services (psycho-social and counselling services) Reduce the stigma associated with suicides and attempted suicides Control use of alcohol and drugs Strengthen good marital relationship while minimising the gender-based violence Mental health promotion and suicide prevention are complementary to each other and policies and programmes addressed for mental health will also contribute for suicide prevention. “Suicides are preventable… and requires coordinated and sustained effort from multiple sectors of society, both public and private, including health and non-health sectors such as education, labour, agriculture, industry, justice, law, defence, politics and the media. These efforts must be comprehensive, integrated and synergistic as no single approach can impact alone on an issue as complex as suicide “(WHO 2014).
(The writer is Director Mental Health, Ministry of Health, Nutrition and Indigenous Medicine)
The SLFP was formed to provide a voice for the long neglected grievances of the rural Sinhala Buddhist community in the country. Of course, the political ambitions of S.W.R.D. Bandaranaike and the internecine struggle among the UNP leadership at that time could have also paved the way for the emergence of the SLFP. However, the SLFP under Bandaranaike who clearly appealed to the Sinhala Buddhist countryside could not identify itself either with the right wing ideas of the UNP or extreme Marxist ideas. Owing to its poly-ethnic and classist outlook, the UNP too did not show much interest in representing the interests of Sinhala Buddhist nationalists, which, at that time, was thought to be sectarian politics. On the other hand, the Marxist parties, the then main opposition to the UNP, also insisted on maintaining their secularism to focus on the economic and social problems of the day. Therefore, at the outset, the SLFP was a party of ideas and values and was formed with the intention of tapping into the Sinhala Buddhist rural electorate.
Owing to this history, the SLFP has been widely perceived as a party of the Sinhalese Buddhists and marginalised social and economic classes in rural Sri Lanka. However, the SLFP has never been exclusively a party of Buddhists or the poor. The two-party electoral competition that came to govern the electoral politics in the country since 1956 not only changed the dynamics of the electorates, but also subjected both the SLFP and its rival UNP to continuous transformation. Following the strategy of the UNP, every time when it was voted out of office, the SLFP also exhibited a great deal of willingness to relax its ideological commitments for the sake of widening its voter bases to regain power.
Also in their quest for power, both the UNP and the SLFP paid more attention to the distribution of patronage. Therefore, once elected, both these parties relied chiefly on the distribution of patronage to retain power. In this context, especially after 1994, the SLFP did not bother to maintain a consistent and distinct ideological position on many vital issues. These electoral practices of the two main parties, over the past six decades, have contributed towards weakening the effect of traditional cleavages such as caste, class and religion among factions of the Sinhalese society. Instead, such politics has contributed to the emergence of a new political cleavage based on the voters’ party-identity.
Leader is ‘the institution’
During the initial phase of the formation of Sri Lankan political parties, political elites were more prominent than party institutions. Therefore, Calvin Woodward referred to the then party system as ‘parties of notables’. Although both main parties made successful attempts at building formal party organisational structures, during the period from 1960s to 1970s, they still failed to end the dominance of families in electoral politics.
Particularly with the introduction of the Executive Presidency, parties increasingly became servants of their leaders and their coterie of close confidants, who control the policies and strategies of the party. As a result, the same party would, under different leadership, often subscribe to different ideological and policy programmes. For example, the SLFP stood for slightly different or sometimes contradictory ideological and policy programmes under the leadership of Sirimavo Bandaranaike, Chandrika Bandaranaike Kumaratunga, Mahinda Rajapaksa and Maithripala Sirisena.
The Proportional Representation system influenced the SLFP to broaden its electoral coalition. Thus, Kumaratunga, reached out to minority ethnic parties, in addition to its traditional Leftist partners, to form the People’s Alliance regime. Later, her successor, Mahinda Rajapaksa further increased the number of constituent partners in his regime by inviting the Sinhalese Nationalist parties too. He also incited crossovers from many smaller parties across a wide ideological spectrum to strengthen his position within Parliament. The alliances that the SLFP formed with various parties and individuals, during the past decades, were actually personal initiations of the incumbent leader of the party, dictated by electoral calculations. As noted previously, this situation intensified with the introduction of the Executive Presidency which was more about the individual leader than the party as a whole.
Therefore, the phenomenon of the party leader having an independent organisational structure parallel to the formal party structure has become increasingly visible. These informal and parallel party structures are extremely helpful for the leader to consolidate and expand his powers within the party. When the party is in power, it is easy for the leader to replace the party institution with his/her own personal network of cronies. Therefore, as a result, once out of power, both these main parties -- the UNP and the SLFP -- struggle with a series of internal crises, and threats of disintegration and defections.
Today, what the SLFP is experiencing is simply a bitter consequence of the peculiar nature of the country’s electoral politics which, one must remember, is not a fate that is exclusive to the SLFP.