Suicide is a word that carries so much stigma, that it affects how people view those who attempt to take their lives and how people seek help to prevent suicide.
What is Suicide?
Simply put suicide is the act of intentionally taking one’s life. It is important to note the word ‘intentionally’ because people can accidentally take their own lives, but intentionality means that the person has made a deliberate decision to take his or own life. This is a concept that seems alien to most people especially in Sub-Saharan African countries. The inability of the larger society to understand the meaning of suicide has created the basis for stigma against a group of people that are already vulnerable.
How serious is the issue of suicide?
According to the World Health Organisation (WHO), about 800,000 people die by suicide annually and for everyone who dies to suicide about 20-25 other people have attempted to take their lives but failed. In fact, the WHO says a suicide death occurs every 40 seconds. Suicide is the second leading cause of death amongst ages 15- 29-years and 79% of the global burden of suicide deaths occur in Low and Middle-income countries such as Nigeria. Based on officially recorded deaths by suicide, Nigeria ranks 15th in the world with a crude suicide rate of 9.9/100,000 people in 2016 which increased from 6.5 in 2012. Going by the statistics provided, it shows that Nigeria with over 50% population being young people is vulnerable to increased rates of suicide if the issue isn’t addressed quickly. The WHO shows only 38 countries in the world have developed strategies to prevent suicide.
Risk vs Protective Factors
There is no single cause of suicide but there are well established data showing links between suicide and mental disorders. It is often stated that over 90% of individuals who die by suicide have mental disorders (Bertolote & Fleischmann 2002) and some particular mental disorders confer a higher risk for suicide than others. Studies have shown that disorders such as depression (2nd leading cause of disability in Africa), posttraumatic stress disorder, conduct disorder, drug and alcohol abuse/dependence (Nock et al. 2009) are closely linked to the risk of suicide. Suicide has also been linked to various other psychosocial stressors such as financial problems, break up of relationships or chronic pain and illness, Family history of suicide or violence, cultural factors and societal pressures i.e. social media, etc. All of the above listed factors individually or collectively can leave an individual vulnerable to suicide. There are also protective factors, which are factors that lower suicide risk and they include: effective treatment for existing mental disorders, adequate social and family support, religious faith, strong therapeutic relationship with mental healthcare providers, building resilience and coping skills.
Signs to look for
People who are suicidal will sometimes share the fact that they are contemplating suicide while others will not share their ideations. It is important to be aware of the signs and symptoms to watch out for, they include:
Changes in behaviour i.e. Decline in hygiene, Trouble concentrating, running away from home, etc.
Social isolation and reduced interactions
Talks or writes about suicide and death often
Starts to hurriedly settle quarrels, debts, etc.
Gives away prized possessions
Talks about preparations for taking his/her life
Visits suicide websites
The Role of Stigma in Suicide
Stigma is a label that society places on someone. Stigma involves the hurtful attitudes and behaviours of society towards people with mental illness or people who have attempted suicide. People can also self stigmatize; the individual becomes accustomed to being stigmatised and discriminated against by society, that they start to believe what society says about them. Inadvertently what stigma leads to is:
Poor health seeking behaviours by people with mental health issues or people who are suicidal
Absenteeism from work and school
Social Isolation & exclusion
Secrecy: Hides illness from people who may be able to provide support
All of the above and many more consequences of stigma become part of a vicious cycle of maintenance and reinforcement for the mental disorder and emotional distress.
Suicide Prevention: Is it possible?
Suicide is preventable but it cannot be carried out in isolation, it takes the collaborative efforts of the patient, family, healthcare providers and the community (education, health, religious, legal sectors, etc.) at large to prevent suicide. The strategies include:
Really connecting with people by talking to them beyond the standard ubiquitous “how are you?”.
Reducing easy access to the means of suicide (e.g. pesticides, certain medications, reinforce bridges, etc.);
The creation of a comprehensive, inclusive and modern mental health act that decriminalizes suicide in Nigeria
School-based Mental health interventions programs
Provision of early identification, treatment and care services for people with mental and substance use disorders and people in emotional distress;
Community follow-up and care for people who attempt suicide
Address the chronic shortage of mental health personnel;
Reduce stigma and discrimination against mental illness and suicide through continued education of communities
Roles of Social Workers in the management and Prevention of Suicide
Social Work is a profession that prides itself on its ability to provide help and support to people by mobilizing social resources (human or material) to help individuals achieve their full potentials and to address psychosocial stressors affecting them. As Medical Social Workers (MSW), we interact with a wide range of people from patients to their relatives during stressful periods in their lives. MSW provides interventions that specifically focus on the prevention of suicidal intents which begins during the psychosocial assessments stage, whereby close attention needs to be paid to the patient (or significant other, relatives). Patients with mental disorders or life changing events may be susceptible to suicidal ideation, the MSW should look out for risk factors then identify protective factors that can be used in carrying out interventions to help the patient.
In providing support to people who are suicidal or people seeking information about suicide, it is important that the MSW has tools and resources to turn to. The tools and resources are ideal in providing continued support where the MSW will not be able to provide the necessary help. The tools can include leaflets, websites and hotlines that can be easily accessible to the patient. An example is a hotline for the Suicide Research and Prevention Initiative (SURPIN), which provides 24 hours hotline services for questions to be asked, counselling and referrals. They also provide face to face counselling, training, advocacy and research services.
Additional resources include: –
Ahmedani B. K. (2011). Mental Health Stigma: Society, Individuals, and the Profession. Journal of social work values and ethics, 8(2), 41–416.Bertolote, J. M., & Fleischmann, A. (2002). Suicide and psychiatric diagnosis: a worldwide perspective. World psychiatry : official journal of the World Psychiatric Association (WPA), 1(3), 181–185.
Houdmont, J., & Leka, S. (2010). Global perspectives on research and practice (Vol. 2). Malden, MA: Wiley.
Lawrence, D. and Kisely, S. (2010). Review: Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology, 24(4_suppl), pp.61-68.
WHO, (2017) Preventing suicide: a resource for media professionals, update 2017. Geneva. (WHO/MSD/MER/17.5).
Canadian Association of Social Workers (2016) The Role of Social Work in Mental Health https://casw-acts.ca/en/role-social-work-mental-health
World Health Organization Fact sheet on Suicide: https://www.who.int/news-room/fact-sheets/detail/suicide
World Health Organization: Mental health and work: Impact, issues and good practices (2000) http://www.who.int/mental_health/media/en/712.pdf
Ms.Titi Tade is a Deputy Director, Medical Social Services Department, Lagos University Teaching Hospital (LUTH), Idi Araba and also a member of the Suicide Research and Prevention Initiative (SURPIN). +23480 3725 8323
The Original blog post appeared on the Association of Medical Social Workers of Nigeria's website - https://amswon.org .ng/2020/02/14/social-work-and-suicide-prevention-in-nigeria/