KUCHING: A fragmented approach to suicide prevention is leading to missed opportunities for effective intervention, according to psychiatrist Dr Ravivarma Rao Panirselvam.
According to him, suicidal behaviour is complex and deeply rooted in an individual’s experiences within their community.
“Where and how we live can deeply affect our feelings and thoughts. There are many reasons behind suicidal thoughts. At the same time, we’re all deeply connected to our community, and our surroundings play a significant role in our emotional wellbeing,” said Dr Ravivarma in an interview with New Sarawak Tribune in conjunction with World Suicide Prevention Day on Sunday.
But beyond this initial challenge lies a deeper issue. It’s essential to check our personal biases when assessing someone’s mental health state.
“Sometimes, it’s hard to know if someone is really in trouble or just needs someone to talk to.
“It’s like trying to hear a whisper in a storm,” he said.
Dr Ravivarma, who leads the #ZeroSuicideSarawak campaign, offered crucial advice.
“We all have our battles,” he said, adding, “What might seem like a small issue to you could be overwhelming for someone else.”
He stressed, “Just because a situation seems easy for us doesn’t mean it’s the same for everyone. It’s crucial we understand and respect that first.”
Then he drew attention to the gaps that persist, particularly regarding community support, addiction treatment services, and resources for gender, sexual, and neurodiverse individuals.
“Services must be tailored to the individual. A one-size-fits-all approach often fails those it intends to help.”
He also pointed out the alarming delays faced by many seeking aid. “The wait, avoidance, and delay in seeking help – is where we lose people.”
Recent trends in mental health have prompted experts to urgently advocate for the reinforcement of social protections. Vulnerable young populations, battling the challenges of today’s digital age, academic pressures, and societal norms, are particularly at risk.
According to Malaysia’s 2022 National Health and Morbidity Survey (NHMS), among teenagers aged 13 to 17, 13.1 per cent have had suicidal thoughts, and 9.5 per cent have tried to act on those thoughts.
Drilling down, the data is even more alarming for girls. Nearly one in five teenage girls, or 18.5 per cent, admit to having had suicidal thoughts, compared to just 7.6 per cent of boys. Furthermore, 13.4 per cent of these girls have attempted suicide, a rate that’s double that of boys, which stands at 5.7 per cent.
The situation has been exacerbated by social media, especially as our youth are constantly bombarded with unfiltered content.
Awareness presents its own dilemmas.
“While it’s crucial we stay informed and ready to help, it’s not always easy. We want to respect the person’s privacy, but we also want to keep them safe,” Dr Ravivarma said.
For families who have faced the loss of a loved one to suicide, their grief often remains overlooked.
“Death by suicide is not just a loss. It’s a profound tragedy that brings about a specific kind of grief, one that often goes unnoticed.”
This specific grief, often termed as ‘disenfranchised’, refers to the sorrow felt by those left behind after a suicide, which sadly doesn’t receive the same recognition or empathy as other types of grief.
“People struggle with layers of emotions – from anger to blame, to deep-seated frustration. Their grief isn’t like the usual sadness we see. It’s fraught with other emotions like anger, isolation, and being responsible for the loss.”
These grieving families and friends are also at a higher risk of taking their own lives. He emphasised the importance of aftercare or ‘postvention’.
“Such services shouldn’t operate in isolation. They need to be integrated with surveillance systems, ensuring no one slip through the cracks.”
Highlighting the World Health Organisation’s LIVE LIFE framework, Dr Ravivarma sheds light on some potential ways forward. The framework’s key strategies include limiting access to lethal means, promoting responsible media reporting of suicides, fostering life skills in the younger generation, and ensuring early identification and support of those at risk.
Furthermore, he pointed to the undeniable evidence of treating mental illnesses, especially depression, in suicide prevention.
“Antidepressant medications are not just safe, but they’ve proven to save lives.”
He also brought attention to newer treatment modalities, “There are now medications that show promise in reducing suicidal thoughts rapidly.”
Additionally, therapy plays a crucial role. According to him, therapies, especially cognitive behavior and dialectical behavioural format, have shown favourable outcomes.
“We need to make them more accessible to our people and ensure they fit our local needs.”
A community-centric approach also stands out in Dr Ravivarma’s recommendations. “Primary care providers, general practitioners, they need to be supported in addressing depression and suicide prevention.”
Furthermore, those who have faced a suicidal crisis require follow-up, ensuring they aren’t left feeling isolated after the immediate danger has passed.
He highlighted the crucial role of “safety planning” in suicide prevention, noting that when trained professionals assist those in emotional or psychological distress to develop a safety plan, it empowers them and helps them feel more in control.
Emerging therapies, including the realm of digital mental health care, offer hope. The potential of Artificial Intelligence (AI) in identifying at-risk individuals through health record screenings and internet-based interactions is being closely watched. Yet, older and time-tested methods like ECT (electroconvulsive therapy) continue to play an essential role in illnesses like severe depression.
Dr Ravivarma’s message for those undergoing treatment is clear – engage in open dialogues with healthcare providers. “Having a complete understanding of one’s treatment, its effects, and potential side-effects is of utmost importance.”
In a rapidly changing societal landscape, a multi-pronged approach is needed. Only through understanding, compassion, community involvement, and leveraging both traditional and contemporary solutions can we hope to address this pressing issue effectively.
