Reaching out to the most vulnerable Suicide can strike whenever CONDITIONS are CONDUCIVE

For over 3 decades, Sri Lanka has consistently presented some of the highest rates of suicide in the world. In 1995 Sri Lanka earned the dubious reputation of having the highest rate of suicide – 47/100,000 people. There had been a 700% increase in suicides in the country, from 6.5/100,000 in 1950 to 47/100,000 by 1995. Since the peak in 1995 the suicides in the country have been coming down steadily and by 2012 there had been a decrease in suicide by 58.6% from the 1995 figures.Available statistics indicated that 75% of the suicides in Sri Lanka took place in the rural areas and a majority of these suicides came from the poorest and most vulnerable remote rural communities in the North Central, North Western, Central and Southern Provinces of the country which were mainly agriculture based.

The steady rise in suicides in the 1960’s – coincided with the widespread use of agro-chemicals in the country. Since then the commonest method used in suicide and deliberate self-harm was the ingestion of lethal agro-chemicals and remains so up to date. One may well ask,‘What do the Sumithrayo Rural Programme workers do to achieve these results? Here, I would like to quote Mother Theresa who said:“It is not the magnitude of our actions but the amount of love that is put into them that matters.We can do no great things, only small things with great love.”

SUICIDES IN SRI LANKA– 1990 – 2012

The lack of suitable human resources and adequate financial help remain the biggest constraints that limit the extent of the work of the Sumithrayo Rural Programme. If rural suicides are to be reduced, which in turn will have a significant effect on the suicide rates of the whole of Sri Lanka, we will need more attention paid by the state and adequate financial help from the public

Column 2 depicts total suicides. Column 3 depicts male suicides and Column 4 depicts female suicides

The Sumithrayo Rural Programme was set up in May 1996, in an effort to address the problem of escalating suicides in the remote rural areas of the country and reach out to some of the most vulnerable communities in the country, in the hope that thereby the Sumithrayo could contain the high incidences of suicidal behaviour in these areas.

The steady rise in suicides in the 1960’s – coincided with the widespread use of agrochemicals in the country. Since then the commonest method used in suicide and deliberate self-harm was the ingestion of lethal agro-chemicals and it remains so up to date. The high rate of suicide in the rural areas of the country was directly linked to the easy availability of these poisons commonly found in all farming households in the country. In 2012, after a lapse of over 3 decades, though the commonest method used in attempting suicide remained the ingestion of agro-chemicals, the highest number of deaths by suicide was by hanging. The ingestion of agrochemicals were lethal in the early years but now with more stringent laws in place pertaining to the import of lethal agro-chemicals into the country, the mortality rate of deliberate self-harm or suicide by the ingestion of pesticides has greatly reduced. Deaths by pesticide poisoning have gradually reduced, but suicide by hanging has increased.

Initially in 1996 the Sumithrayo Rural Programme commenced work in 2 small suicide prone villages in the Hettipola Divisional Secretariat area of the North Western Province. The villages were medium sized and both were agriculture based and had a high level of suicidal behaviour.At the end of two years the results were beyond all we had hoped for. Suicide and incidences of DSH had fallen to zero in both villages. Encouraged by these positive results the Programme slowly expanded and by 2014 the Rural Programme was working in approximately 100 villages, in seven Divisional Secretariat areas in the North Western and Southern Provinces of Sri Lanka.

The people of these villages are farmers of very modest means, many of them living in circumstances of abject poverty and deprivation. Their homes were very often only thatched mud huts or one roomed un-plastered, un-baked mud brick structures. Drastic changes in weather patterns and resultant crop failures compound their economic difficulties. Every few years, due to failure of the North East monsoon the villages in the South go through severe drought conditions that leave them without clean drinking water and their crops totally ruined. Marauding wild elephants are a further hazard in these areas.

There are little or no social support systems in these villages.Ahigh literacy rate coupled with lack of employment led to frustration and despair. Alcoholism and mental illness together with extreme poverty were major problems and still remain so. These factors contributed towards a high level of suicide and suicidal behaviour in these villages. There are no Psychiatrists or trained mental health workers in these remote rural areas. Mentally ill patients have to travel to the nearest big town, which may be 50 or more kilometres away to see a psychiatrist or get other specialised help.

Often acute poverty and alcoholism lead to strife within families, resulting in frustration, humiliation and despair leading to self-harm and suicide. This is eloquently depicted in drawings by village schoolchildren. The Sumithrayo Intervention Programme concentrated on volunteers building up close trusting relationships with families in crisis. It was found that the intense involvement of trained Sumithrayo volunteers in the life of the community was the key to working in this setting.

The Sumithrayo presently use a three-pronged effort to contain the problem of suicidal behaviour in the villages.

Providing SuicideAwareness and Education Pogrammes in schools. A high percentage of deliberate self harm in the villages is in the under 20 age group, especially amongst young girls. Suicide awareness programmes forA’ level students in all the village schools, and youth groups in temples and churches are also held on a regular basis. They are in an extremely vulnerable age group. The Sumithrayo also conducts research oriented studies on suicide prevention.

Befriending - the offer of emotional support to the depressed and despairing {the key tool we use in suicide prevention}

Conducting research oriented studies on suicide prevention. From annual art competitions held by the Sumithrayo in village schools we learned from the drawings by children that violence and subsequent attempts at suicide were mostly centred on the home and home garden.This led to two research studies, one in collaboration with the University of Oxford, and the other in collaboration with WHO in the provision of lockable Secure Storage boxes to farming families for safely storing of pesticides and household poisons, to reduce suicide in rural Sri Lanka. The results of this study have been published.

The boxes carry a message. “Poisons are not the answer for anger or sadness. Talk to a trusted friend about your pain of mind. Keep all poisons locked securely in the box.” One village woman commented that the message was more useful than the box. Reading it every-day she said helps a person not to make hasty decisions, but to reach out for help, be stronger and to try to cope with life.

By year 2006 suicide and suicidal behaviour had reduced significantly in all the villages the Sumithrayo Rural Programme had worked.

In 2008 the Rural Programme was the recipient of an IASP, short for ‘International Association for Suicide Prevention’and an AccreditationAward for Suicide Prevention Services in the Asia Pacific Region.

In 2011 they received a similar Award from the IASP. This time it was an International Accreditation Award for its Suicide Prevention Services.

One may well ask, ‘What do the Sumithrayo Rural Programme workers do to achieve these results?

Here, I would like to quote Mother Theresa who said

“It is not the magnitude of our actions but the amount of love that is put into them that matters.

We can do no great things, only small things with great love….”

The lack of suitable human resources and adequate financial help remain the biggest constraints that limit the extent of the work of the Sumithrayo Rural Programme. If rural suicides are to be reduced, and suicidal behaviour in the remote villages contained, which in turn will have a significant effect on the suicide rates of the whole of Sri Lanka, we will need more attention paid by the state and adequate financial help from the public and mercantile sectors towards meaningful suicide prevention measures to be taken. Is it the fact that most of the suicides occur amongst the poorest of the poor in our country whose choices are limited that makes us blind to this terrible tragedy? Do we have to wait for a rude awakening, that suicide is no respecter of where we are on the social ladder. It will strike wherever conditions are conducive; such as isolation, little or no acceptable choices, feelings of helplessness, hopelessness and despair. Can we not lend a hand to help?

Sri Lanka Sumithrayo was till recently the only volunteer based organisation in Sri Lanka whose primary focus was on the prevention of suicide. In June 1974 the first of the Sumithrayo Crisis Intervention Centres was opened in Colombo by Mrs. Joan de Mel, a former Samaritan from the United Kingdom, together with a few like-minded people, in answer to the steadily rising rate of suicide in the country. Today there are 11 such Crisis Intervention Centres in the country, the latest being in Jaffna and Ambalantota, and a thriving Rural Suicide Prevention Programme in over 100 remote farming villages.

For contact details of all Sumithrayo facilities please call 2682535 or email sumithrayo.

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