National Institute of Health Consultant Psychiatrist Dr. Sajeewana Amarasinghe, said yesterday that the suicide rates in Sri Lanka had improved with the country being listed at No. 22 in the Global Suicides List, in sharp contrast to being at No. 2 in 1995.
Dr. Amarasinghe holds an MBBS Degree from the University of Peradeniya and a MD in Psychiatry from the University of Colombo and has had his overseas training as Senior Psychiatry Registrar at the North-Western Mental Health Hospital in Melbourne, Australia. He was Board Certified as a specialist in Psychiatry in 2008. Previously, Dr. Amarasinghe has served as Consultant Psychiatrist at the General Hospital Trincomalee, Teaching Hospital Anuradhapura, and at the Puttalam, Tangalle and Avissawella base hospitals.
He also served as the Secretary of the Board of Study in Psychiatry at the Post Graduate Institute of Medicine of the University of Colombo and was also the Assistant Secretary of the Sri Lanka College of Psychiatry – 2015/2016 and Council Member, Sri Lanka College of Psychiatry – 2017/2018.
Commenting on the gravity of the issue of suicides in Sri Lanka, he said, “Contrary to the popular perception the suicide rate in Sri Lanka has been coming down steadily. We had a suicide rate of 47 per 100,000 populations in 1995 and we were the second highest in the world. Now matters are much better and by 2012 our suicide rate has come down to 17 per 100,000 populations. “We are currently ranked 22nd in the world,” he said. And went on to say ”But suicide still remains a major problem in Sri Lanka and according to Police Department statistics, 3025 people died by suicide, in 2016. This means that eight people die by suicide every day in Sri Lanka. So it is still a very serious issue.”
Commenting on how the suicide rate dropped in Sri Lanka, he said, “Interestingly the numbers of people who attempt suicide have not reduced in Sri Lanka. But the number of deaths has reduced. The main reason is that some of the most toxic insecticides and pesticides were banned in the late 1990s. In addition some of the more toxic ones were diluted. This has a direct relationship with the reduction in the suicide rate. In addition improvement in transport facilities and better medical care has resulted in increased survival of suicide attempts. But the core problem remains, as the numbers of people who attempt suicide have not reduced, he said.
Suicide is a major problem worldwide and according to WHO statistics 800,000 people die by suicides in the world. This means that one person dies by suicide every 40 seconds at a global level, Dr. Amerasinghe said.
Suicide is generally never the result of a single factor or event. It is usually caused by a complex interaction of many factors. This may include mental illnesses like depression, life stressors like relationship problems, family conflicts, financial losses, abuse and painful physical illnesses.
In Sri Lanka we can generally find two common groups. Many young people attempt suicide impulsively due to life stressors such as relationship problems and family conflicts. Many of them don’t really intend to die but may end up dying as they may use dangerous methods. Most of them don’t have a mental illness but they have personality issues like poor anger control, impulsivity and lack of coping skills.
“Then there is another group who has serious suicidal inclinations and who make well planned suicide attempts. Most of them are suffering from mental illnesses like depression or alcohol dependence,” he said.
There are many demographic and socio-economic factors associated with suicide. Completed suicide is three times commoner in males. It is also higher in the elderly. Suicide is also more common among those who are living alone and are socially isolated. Unemployment is also associated with a high
Identification and early treatment of depression and alcohol dependence can help prevent suicide. Depression presents initially with symptoms like persistent sadness, lack of interest in day-to-day activities, lack of enjoyment from previously pleasurable activities. Later on the patient might develop hopelessness, helplessness and suicidal ideas. Early identification and treatment can prevent the progression to this stage.
People who show at least three of the following symptoms can be regarded as dependent on alcohol. They are an increased craving for alcohol, difficulties in controlling alcohol use, the need to take increased amounts of alcohol to get an effect that was previously achieved with a much lower amount, withdrawal symptoms like insomnia and tremors when deprived of alcohol, continued use of alcohol despite obvious harm and neglect of all other alternative interests and such pleasures. Those suspected to have alcohol dependence should be encouraged to seek treatment.
“As I previously mentioned many people attempt suicide impulsively due to life stressors and they do not have any mental illnesses. There are no clear cut methods to prevent such suicides. But improving coping skills in children and adolescents may be helpful,” said Dr. Amarasinghe. He went onto stress on the need for schoolchildren to participate in team sports which will add to their coping skills in terms of losses and frustrations. “Today many children do not take part in any team sports or extracurricular activities. So they don’t learn to face losses and frustrations. In addition many parents are overprotective and shield children from stressors associated with day-to-day life. This prevents the child from developing good coping skills,” he said.
In addition children should be taught the principles of life skills and problem solving. Even now these are included in the school syllabuses but they are not taught in a systematic manner. Children simply cram up these things without any real understanding.
Asked whether someone at risk of suicide could be identified, Dr. Amarasinghe said: “Many people who commit suicide give some kind of warning to friends and relatives. Unfortunately they are not taken seriously. So it is very important that we take any warnings of suicide seriously and refer them to professional help.
“Many people who commit suicide are ambivalent about it. They are not sure that they want to die. So, suicidal thoughts and the intensity will fluctuate over a period of time. Certain stressful events can be the last straw that pushes the person to commit suicide: the final act. In the same way talking to an understanding friend or relative can help prevent suicide. Sometimes even talking to a stranger on a hotline might help,” he said.
Asked on what could be the impact either positive or negative, the mainstream media could be making in reporting on suicide, Dr. Amerasinghe said, “The media can have both a positive and negative impact on suicides. Unfortunately, sensational reporting of suicides can push a person ambivalent about suicide to commit the act. This is specially so with regards to celebrity suicides.”
A suicide is a newsworthy story and the media has the right and the obligation to publish it. But they should only present the relevant data, preferably on the inside pages without sensationalizing or glorifying the suicide. The media should not publish photographs or give details about the methods used. It is also important not to give very simplistic reasons for the suicide without analyzing the situation, such as stating – an affair, loans, failing exams and so on and so forth. This is because suicide is usually caused by a complex interaction of factors. It is also positive, if the article or story can give details of services available for treatment as well, said Dr. Amerasinghe.
Asked where a patient, who is suicidal, could be reported, he said: “Mental health services are available in all major government hospitals throughout the country. Now we have over 100 specialists in Psychiatry at the Ministry of Health.
“We also have medical officers in mental health as well as community psychiatric nurses working in the smaller hospitals under the supervision of specialists. In addition, nowadays, all doctors are given a basic training in psychiatry and mental health, during their medical training. There are many consultant psychiatrists as well as clinical psychologists working in the private sector as well,” he said.