Reality Check
–    Waking Up to the Suicide Scourge
SUICIDE – a taboo word, much less topic, in many circles – is all around us and many, directly or indirectly, affected by it agree that suicide is a reality which more people should wake up to.
Statistics from the Ministry of Health indicate that Guyana averages about 180 suicide deaths per year, with an additional 500 suicide attempts. For every one person that succeeds in committing suicide, there are between five and 10 persons who will attempt to secure, what is in their mind, an absolution.
In Guyana suicide averaged between 150-200 deaths per year during 2003-2007.
There were 946 reported suicide deaths in Guyana for the same period, which translates to a suicide rate of 25 per 100,000 persons; 80 per cent of these deaths were males, while 60 per cent of all suicide deaths are attributable to pesticide poisoning.
The highest numbers of completed suicides are consistently found in Regions Four (Demerara/ Mahaica) and Six (East Berbice / Corentyne), as compared to the rest of the country, but are consistently highest in Region Six with there being 50 suicide deaths per 100,000 persons.
But what was it that sparks the unraveling?
Kevin Caruso is the founder, executive director, and editor-in-chief of Suicide.org, a non-profit organization which conducts extensive online and offline work to help others.
Caruso, who champions the cause of persons who fall victim to suicide, contends that people who die by suicide never intend harm. They are trying to end their pain, and their thinking is very distorted because of their mental illness or mental state at the time.
The reason for their pain (coupled with their distorted thinking) is always different: parents expecting too much, a sense of loss, no sense of belonging, no one to turn to, confusion about something dark that lurks about inside, or sometimes a simple unwelcome change.
Sometimes the thing slowly snuffing the life out of a person is deeper that distorted thinking and unpleasant circumstance. For example, it might be an inherent mental condition like bipolar disorder.
Bipolar disorder, or manic-depressive disorder, which is also referred to as bipolar affective disorder or manic depression, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition and moodwith or without one or more depressive episodes. Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and environmental factors are also implicated. Bipolar disorder is often treated with mood stabilizing medications and, sometimes, other psychiatric drugs (Wikipedia).
However, from the research and the interviews I have done, I arrive at the conclusion that sometimes the cause is the way people make you feel inside.
Eleanor Roosevelt said, “No one can make you feel inferior without your consent.”
But that is much easier said than done.
In doing research for this article, I found that there are some who say people who commit suicide are weak and that they need to be stronger and just deal with life.
Psychologists say people heal at their own pace and the wounds one endure in life makes one more compassionate, but that said, the consensus is that self compassion must be nurtured.
The truth is that some persons are better able to deal with stressed and unpleasantness than others are.
People’s coping skills are varied.

People cope differently; it does not mean weakness, but that help is needed

Victims’ Perspective

I had the opportunity to speak to a young girl (barely 18 ), we will call her Tina, who was once on the verge of suicide.
She was so depressed and hurt over the things her mother had said to her because (in my view) the mother is scared that her daughter would make the same mistakes she made; so she is overly-controlling and harsh.
Tina has been a victim of emotional abuse for so many years and has very limited support. Her father is the ‘do what your mother tells you’ type.
Tina says she felt trapped and her situation, coupled with the distortions in her rationalisations, equals the urge to want an end, an urge to end the pain she feels drenched in.
Looking deeper, we see that the irresponsible manner in which people speak often results in a person’s breakdown – simply because everyone copes with situations differently.
You never know the past of someone or what they’ve had to deal with, so one must always be careful with what they say.

To add a little more perspective, here are some thoughts of persons, mostly teenagers, who are contemplating suicide :
“I see myself cutting my life. Here I am drowning in bile, so full of worries that are not my style. Hitting the streets, looking for release, but there is nothing.”

Suicide is very complex

“You say you wanna see into my soul. You say you wanna understand me. But how can you? When I don’t understand myself. Why am I here on this planet? What’s my purpose? No, don’t be stupid. There isn’t one.”

Ambitions Response

Health Minister Dr. Leslie Ramsammy, in an interview with the Guyana Chronicle, acknowledged that suicide is a very complex public health problem, which requires an integrated and comprehensive approach.
Guyana’s response, according to him, is an “ambitious” approach that requires massive engagement of a cross section of Guyanese people.
As for the number of deaths recorded in the 1980’s, between 150 and 200, he noted the numbers have been relatively consistent, but the situation seems aggravated only because there is better reporting.
“All the cases are reported now so it is not that we have more suicide cases, but that these cases are reported. People know about them,” he said.
“It is important for us to see that people who look to suicide as a solution have a serious problem…some people have difficulty dealing with certain situations or there may a mental illness or both,” he said.
The Health Minster reiterated that suicide is a complex issue, but stressed that moves have been made and continue to be made to put mechanisms in place so that persons can access assistance.

“Guyana is aware of this problem. Suicide is in the top 10 causes of death…we have to take action,” he posited.
In 2001, the Ministry of Health completed its first National Suicide Prevention Strategy for Guyana, which subsequently underwent revision and highlighted primary areas for prevention intervention.
Ramsammy pointed out that, to date, several moves have been made. These include:

•    A support hotline;
•    The gatekeepers programme;
•    The follow-back methodology;
•    Provision of support services to vulnerable people;
•    Training health workers and other stakeholders; and
•    Public awareness.
The Health Minister explained that the support hotline is an opportunity for persons to seek help in an anonymous way.
“Persons who might commit suicide often times feel like they have no one to talk to and this hotline gives them some support. It puts the person in touch with a professional who has other professionals to consult with,” he said.
Ramsammy noted that, over time, a level of trust and confidence is built and the aim would be to have the individual come in to seek additional help.
The hotline, #226-1818 or #226-1819, became operational in November and averages  two to three calls a week.
“We are hoping for about 20 to 30 calls, but we are optimistic. The same thing happened with the HIV hotline and it eventually picked up…the hotlines help,” he said.
With the gatekeepers programme, he said, the approach is two-pronged in that it involves persons at the community level, mainly community leaders, who can be sought out to assist and who also act as their brothers’ keepers.
“Suicide is very complex,” he said, “We do not know what drives people.”
In that context, the Health Minister noted that this is where the follow back (or ‘psychological autopsy’) methodology comes in.
He explained this is basically a “postmortem on the person’s life” to learn more about the risk and protective factors specific to suicide.
Specifically, Ramsammy said that the methodology studies: family history and early childhood experiences; education history; relationship history; work history; mental disorders; substance abuse; previous suicidal thoughts/attempts; past medical treatment/seeking of help;  recent stressful life events; and other factors that may play a role in suicidal behavior.
The minister said the follow-back study researchers collect the detailed information needed to reconstruct the social, psychological and psychiatric history of the individual.
“Right now we have no clue; we cannot predict when someone might commit suicide. This is a footprint programme which will allow us to have some indications…we will not always know, but we will have something to work with,” Ramsammy said.

Training

The Health Minister maintains that training is quintessential to having a “complete response” to the public health problem that is suicide.
He highlighted that nurses are being brought into the Nurses Psychiatric Programme, which will equip them in 12 months to work at health centres as First Responders.
“In 10 years, we hope to have 100 First Responders to work at the Psychiatric Hospital as well as at the primary health care sites…we are working toward building capacity,” Ramsammy said.
He added that the University of Guyana currently has a Masters Programme in Mental Health, a three-year programme, to train specialists in treating mental illnesses.
“The persons involved in this programme will be deployed to the regional health care facilities. In time they can further specialise in Psychiatry,” the Health Minster said.
According to him, these moves are a response to fill the gap as it relates to professional human resource capacity.
Ramsammy made it clear that psychosocial support is not clinical support and added that here is where the social workers, gatekeepers and even school teachers come in – persons at the community level.
He stated that a curriculum to advance this form of support is being developed and stakeholders from a cross section are targeted for training.
“Much of what we do too is personal, but we are walking a tight rope. Suicide is not talked about much because of many reasons, including the stigma attached to it,” Ramsammy said.
The Health Minister said the goal by 2020 is to reduce the suicide rate from between 150 and 200 to between 70 and 100 per year.

“A multiple approach is necessary. It is impossible to know when the next act will happen, but the work we do will hopefully prevent the next suicide. The help we offer will hopefully make a difference,” Ramsammy opined.
Suicide is real. It has nothing to do with being weak or strong. It is a real problem. Wake up!