SOUTH-EAST ASIA REGIONALSTRATEGY

ONSUICIDE PREVENTION

นพ.ปทานนท์ ขวญัสนิท

สถาบันจิตเวชศาสตร์สมเด็จเจ้าพระยา

กรมสุขภาพจิต

Country Number of suicides ( all ages 2012)

(Global : 800 000 )

Crude all ages

( per 100 000 population) 2012

Age standardized suicide rates ( per 100 000 population) 2012

( Global : 11.4)

Bangladesh 10167 6.6 7.8

Bhutan 119 16.0 17.8

India 258075 20.9 21.1

Indonesia 9105 3.7 4.3

Maldives 17 5.0 6.4

Myanmar 6558 12.4 13.1

Nepal 5572 20.3 24.9

Sri Lanka 6170 29.2 28.8

Thailand 8740 13.1 11.4 ?

Timor-Leste 60 5.4 8.0

Source: Preventing suicide : A global imperative : WHO

Suicide in WHO South- East Asia Region

Source: Preventing suicide : A global Imperative: WHO 2014

Regional distribution of Global suicides

2012

• Global median percentage of government health budget expenditures dedicated to mental health is 2.8%. This level of allocation in SEAR is 0.44%

• Globally, the median number of mental health workers is 9 per 100,000 population, but there is extreme variation, from below 1 per 100,000 population in low-income countries to over 50 in high-income countries

• Median number of psychiatrists globally was 1.27 per 100 000 population whereas in SEAR the corresponding figure is 0.23

• Globally number of psychologists was 0.3 per 100 000 compared with 0.03 in SEAR

( Source: WHO Mental Health Atlas 2014)

Financial and human resources for mental

health

World Health Organization. Mental Health Atlas 2011

THAILAND 1.1 - 6.2 0.4 0.3 0.1

Rate of Psychiatric beds in general

hospitals per 100,000 population

WHO World Mental Health Atlas 2011

Rate of beds in mental hospitals

per 100,000 population

13.5

0.7

•WHO Mental Health Action Plan 2013-2020: WHO Member States havecommitted themselves to work towards the global target of reducing thesuicide rate in countries by 10% by 2020 ( adopted by the 66th WHA)

•WHO Mental Health Gap Action Programme (mhGAP), launched in2008, includes suicide as one of the priority conditions and providesevidence-based technical guidance to expand service provision incountries

•Launching of the report “ Preventing suicide: a global imperative”.Which contributes to a global knowledge base on suicide and suicideattempts

WHO actions: suicide prevention

• A vision, a plan and a set of strategies.

• Coordination and collaboration among multiple stakeholders

• Integrated actions, as no single approach can impact on an issue as complex as suicide.

• Assessment and management of mental disorders

• Restricting access to the means of suicide

• Policies to reduce the harmful use of alcohol through a range of policy options

• Responsible media reporting.

Suicide prevention requires

Methods adopted for suicide

• Many acts are impulsive and depends on the access to lethalmethods

• The most common methods include hanging, self-poisoning withpesticides and drugs, self-immolation and fall from heights

• The most common method adopted in LMICS and in SEAR, is self-poisoning by pesticides, including herbicides and rodenticides

• Hanging is the most adapted method for suicide and self-poisoning ismore prevalent for suicide attempts

Examples of surveillance systems

• Youth risk behavior surveillance system in USA• World Mental Health Survey• START study• WHO STEPS surveillance approach• WHO mortuary based surveillance systems• Several hospital registries in HICs• Hospital based Injury surveillance in Thailand• National Hospital reporting system in Sri Lanka

Surveillance: Key points

Provides information for action 3 important questions

What do you want to count? Where do you get the information? How do you use it?

Surveillance and Public Health Action

SurveillanceCollectionAnalysisInterpretationDissemination

• Public Health Action– Priority Setting– Planning, implementing and

evaluating interventions towards control and prevention

Sources of Surveillance data

Death certificate Hospital records Trauma registries Case reports Epidemiological studies Police data Industrial reports Bureau of crime records NGO’s reports

Suicide Prevention: Bangladesh

DR. MD. FARUQ ALAM &

Dr. Md. Helal Uddin AhmedNational Institute of

Mental Health, Dhaka, Bangladesh

Measures to reduce suicide suggested by people of Jheneidah district1

Measures Percentage (%) of respondents

i. Improvement of socioeconomic condition 59.25

ii. Bringing peace in family 29.62

iii. Developing love & affection between husband & wife

29.62

iv. Spread of education 22.83

v. Socialization of children 18.51

vi. Abolition of dowry system 8.02

vii. Prevention of polygamy 6.17( Some respondents gave more than one response)

1. Rahman HM. Socioeconomic and psychosocial causes of suicide in Jheneidah district, Department of social work, Rajshahi university, Bangladesh, 1986

Innovative Model• Media involvement

o Awareness build upo Play sensible role, following WHO guideline

• School Mental Healtho Focusing suicide

• Crisis intervention point at district levelo one stop crisis center

Country Experience and Current Gaps in Addressing Suicide in

the

Maldives

Meeting of Experts on Finalization of the Draft Regional Strategy on Suicide Prevention, WHO-SEARO New Delhi, India, 21-22 April, 2016

Dr. Aishath Ali NaazMaldives Institute for Psychological Services, Training and Research, MIPSTAR

Consultant Clinical Psychologist

Phd, Clinical Psychology, The University Of Manchester, UK

Mphil, Cl.Psy, NIMHANS, India

• Trained Mental Health Workforce• Attempting suicide is a crime• The National Drug Use Survey 2011/2012• Decriminalization• Stigma removal• Research • Carry out a National situation analysis• Develop Suicide Prevention Strategy• Responsible Media action

Nepal’s profile on suicide prevention

Dr. Surendra SherchanDirector

Mental HospitalLagankhel

Analysis• Easy availability of alcohol, drugs, pesticides

• Quality of media reporting – not satisfactory

• Policy documents (NMHP, MHL drafts, NHP 2015, NCD multi sectoral strategic plan 2013-2020) does not dwell on suicide

Analysis.. Contd..• Poor mental health care

• Great treatment gap of >85%• Lack of PSS mechanisms including rehabilitation services• NMHP revision expected, MHL expected to complete

• No alcohol policy

Dr. Chithramalee de SilvaDirector Mental Health

(MSC, MD Community Medicine)Ministry of Health

Sri Lanka

Sri Lankan Experience

In 1995, Sri Lanka recorded highest ever suicide rate

Presidential Task Force was established in 1997 to develop a National policy and action plan

on Prevention of Suicide in 1997

Sri Lanka was the first country in this region to ban the availability of the most

toxic pesticides

This led to marked reductions in the country’s overall suicide rates

National policy and action plan on Prevention of Suicide

• Goal 1 – Reduce easy access to lethal methods

• Goal 2 – Promote research on reducing lethality of pesticides in use

• Goal 3 – Educate public on less harmful use of pesticides

• Goal 4– Create a culture which discourages suicides

• Goal 5 – Ensure survival after poisoning• Goal 6 – Remove legal barriers to the correct

handling of those at risk

Current Interventions • School based competency promoting and life skill

enhancing programme• Awareness programs for school children on Study

techniques, Anger management, coping with stress• Programs on good parenting thro school health program• De-criminalizing suicides • Providing support after suicide attempts• Screening for depression and suicidal risk –especially during

post partum period• Psychotherapy and psycho-social interventions for mental

illnesses • Strengthening community based mental health services

by

Dr. LAKSHMI VIJAYAKUMARM.B.B.S., D.P.M., Ph.D., FRCP sych. (Hon.)

Founder, SNEHA Member, W.H.O. International Network for Suicide Research

Hon . Associate Professor, University of MelbourneMember, International Academy of suicide research

SUICIDE PREVENTION IN INDIA

StrategiesEnvironmental

• Reduced access to Methods

• Enlightened Media Reporting

• Cluster Prevention

• Alcohol policies

Individuals at Risk

• Identifying and Easy access

• Education of GPs

• Crisis Line

• Safety Planning

PsychotherapyPsychopharmacology

• Lithium

• Clozapin

• Ketamine ?

Challenges

• Unviability of good quality data

• Vital registration system documenting the numbers and details ofmortality is in initial phase

• Cause of death data, including suicide, not reported by countries tothe WHO Mortality database.

• Suicides are considered a medico legal problem and hence data arereported to police agencies, which leads to underreporting

• Misclassified as accidents, homicides and unknown cause.

• Stigmatization of individuals and families after a suicide or suicideattempt deters reporting

• Lack of well established health information systems

• Appropriate recognition of suicide prevention in policies and programmes ;

• Public awareness, stigma removal campaigns;

• Decriminalization of suicide

• Mental health promotion activities

• Strategies for early detection and community-based interventions;

• Appropriate infrastructure for comprehensive management and prevention of suicides

• Improve health information and surveillance systems;

• Promote context-specific research on the public health and service delivery

• Adequate human, financial and technical resources for mental health

We Need

• Individual vulnerabilities and socio-cultural factors differ between andwithin populations

• Address Region specific challenges in a comprehensive, coordinatedand culturally sensitive manner

• Help garner policy attention at Regional and country level

• Guide development of national suicide prevention action plans

Why a Regional Strategy?

• Promote research to determine the burden of suicide

• Design and implement a system for early detection and surveillance

• Promote comprehensive, integrated and responsive health and social care services in community-based settings for prevention of suicides

• Promote multisectoral approaches involving diverse groups of civil society and inter-ministrial collaboration for suicide prevention

• Conduct awareness campaigns, develop legislation and policy framework, advocate for allocation of resources

• Develop infrastructure and human resources within each Member State

What can we do?

• How can countries improve monitoring of suicidal behaviour?

• What is causing such huge differences in suicide rates across regionsand between countries?

• Among the many factors that influence suicide rates, which factorscan be modified by policies or programmes?

• Which are the strategies that will be feasible for the Region and willhelp in developing country action plans

Some pertinent questions we need to

answer

In SEAR…

• Strengthening national information systems• Establish surveillance systems in defined

populations• Develop Registry on attempted suicides in

select centers• Promote research in prioritized areas• Establish centers of excellence

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