X-raying the suicide menace
IT is quite worrisome that in the last few weeks, the number of suicides and attempted suicides in Nigeria has reached a disturbing level that requires immediate attention and intervention. According to recent evidence, about one person in 5,000–15,000 dies by suicide every year (1.4 per cent of all deaths), with a reported global rate of 10.7 per 100,000 population in 2015 (WHO, Cutliffe et Al, J O’Brien). The World Health Organization (WHO) has declared Suicide a public health priority, and documents suicide as the second leading cause of death among 15–29-year-olds with 79 per cent of global suicides occurring in low- and middle-income countries. It states that ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally, and estimates that self poisoning with pesticides account for 20 per cent of global suicide, occurring in developing countries.
In sub-Saharan Africa, paucity of data on the subject has made it challenging to understand the magnitude of the problem. Prior to this period of the increased incidence of this public health emergency, it was thought that Africans do not experience mental health challenges, especially as anxiety, depression and triggering factors for mental health challenges(substance abuse, alcohol use, and overwhelming stress- physical, emotional, social, economic). Suicidal thoughts, ideation, and mental illnesses are highly misunderstood, mismanaged and stigmatized; attempted suicides or the actself is labelled a criminal offence. Even without data or accurate records on suicide rates, Sub-Saharan Africans are constantly faced with challenges that increase their risk for depression, anxiety and suicide. These factors include unemployment, poverty, loss of loved ones, social isolation from displacement and marginalization from wars,political unrest, insurgency, terrorism and ethnic clashes. Chronic illness, Ill health and the aftermath of the HIV pandemic in Africa have been found to increase the risk of depressive illnesses in persons affected by the scourge (S.Eschun, P.Bartoli 2012).
Nigeria is currently listed by the World population review of 2019 as 67th globally and 6th in Africa (http://worldpopulationreview.com/countries/suicide-rate-by-country/) for suicide rates per 100,000 population. More of the suicides attempts in Nigeria have been associated self drowning, self hanging and more recently with pesticide self poisoning with the use of “Sniper”, Dichlorvos or 2,2-dichlorovinyl dimethyl phosphate (commonly abbreviated as an DDVP) which is an organophosphate, widely used as an insecticide to control household pests, and protect stored products. Originally designed to be a rodent killer and used in horticultural/ agricultural settings, “Sniper”, in Nigeria has become a self poisoning option for persons with suicidal thoughts and ideation. Even though many young people in Nigeria have called for a ban on sniper by relevant authorities, some others argue that the ban may not be the solution, but addressing deep seated mental health issues that make at risk persons, choose that option.
There is a critical need for establishing national and states suicide prevention programmes and centres (incorporated into mental health services) urgently and initiating or continuing existing preventive measures, with an emphasis on a multi-system approach that focuses on the multifaceted issues that are predisposing young people in Nigeria to committing suicide. Furthermore it is important that cultural, social and economic contexts be considered in planning these interventions as well as the improvement of the health care structure in Nigeria to meet the health needs of persons with mental health challenges who require social support, counseling, psychotherapy and treatment. The WHO has just recently published a document “National Suicide Prevention Strategies – Progress , examples and indicators” which highlights approaches to planning national suicide prevention programmes, implementation,overcoming barriers to their implementation, programme monitoring and evaluation and the success stories of ten countries’ adoption of suicides prevention interventions. A strategic approach to national suicide prevention programmes recommended by the body includes the following: 1) Identification of stakeholders, 2) Undertaking a situational analysis 3) Assesing available resources 4) Achieving political commitment, 5)Addressing stigma and Increasing awareness 6)Stating clear objectives of the national strategy 7) Identifying risk and protective factors 8) Selecting effective interventions 9) Improving case registrations and 10)Conducting research and monitoring and evaluation.
The suicide prevention strategy adopted by the WHO combines the ten strategic approaches with proven interventions is a key goal in suicide prevention tagged “ LIVE LIFE”, which represents Leadership Intervention
Vision and Evaluation(LIVE), and summarizes the ten key approaches highlighted above and LIFE which means Less means (restricting access to means of committing suicide), interaction with media (it is recommended that the media should not glamorise and stop sensationalizing the act, but increase awareness, air stories of survivors, and encourage ending stigmatization); Form the young ( help young people learn leadership, problem solving and coping skills with social support in school counseling services), and early identification (Identification of at risk persons, risk assessment, and management of cases, follow up of cases to ensure they receive required medical intervention and adequate capacity building for health care providers to deliver mental health services).
The Federal Ministry of Health(FMOH) should take a bold step to tackle this issue and urgently adopt the WHO recommendation for suicide prevention adapting it to our specific context in the Nigerian space. The FMOH health providers and health facilities in Nigeria as well as the States and National House of Assembly (House of representatives and Senate House committees on Health) should develop a national document that should serve as guidelines for suicide prevention in Nigeria. In the interim more awareness should be created about suicide prevention. Families( parents, spouses, siblings), friends, neighbours, bosses, co-workers and colleagues should be more emotionally sensitive to the people around them, and reach out and inquire what’s going on when someone they know is excessively withdrawn or unusually elated.
Institutional and organizational abuse, child, sexual, psychological and emotional abuse should be discouraged, reported and punished. Perpetrators of maltreatment (neglect, exploitation and trafficking) should be arrested and brought to book. Social issues related to “body shaming”, stigmatization for any reason, discrimination of any sort, segregation, racism, dysfunctional family experiences, poor upbringing, sibling rivalry, rejection, deprivation, victimization, marital issues (separation, divorce), incest, rape, work place conflict, examination failure, sexual harassment, bullying (school or cyber), overwhelming stress, low socioeconomic status, infrastructural decay, economic recession and insecurity, should be wholistically addressed through family support programmes, social security provisions by relevant institutions and authorities responsible for ensuring a sane and healthy society and Governments. Several studies have shown that persons who have experienced any or multiple forms of abuse and any of the emotional, environmental,physical, mental, psychological or socio-economic challenges previously mentioned at any point of their lives, are at risk of mental health illness, substance abuse and have higher odds of being suicidal.
Social media posts across platforms which insult, incite or troll people should be reported to avoid any form of emotional or sexual abuse, which can trigger emotional stress and depressive illnesses. The access to and purchase of “Sniper” should be regulated, patrols and law enforcement agents should be stationed around large water bodies especially in urban areas and helplines should be accessible to all Nigerians across the country to get helpful information, counseling and report of any suspicious behaviour.
Let’s prevent suicides in Nigeria, let’s encourage everyone to LIVE LIFE.
- Dr. Olugbade is a primary care physician with the Ministry of Defence