“Reaching Out and Saving Lives” was the theme of the World Suicide Day on September 10. The day was observed in Bhutan, where many stakeholders from different agencies met to discuss and find ways to curb the increasing suicide rate in Bhutan.
Dr Gembo Dorji, Department of Public Health said, “Prevention of suicide is a multi-stakeholder approach, for it is a multi-factorial reason that lets people to commit suicide.” He said people usually commit suicide when they have mental problems, family problems and run into financial depression.
He pointed out that no single approach or an organization can prevent suicide on its own. Therefore, comprehensive and synergistic approach and effort by multi-sectors, involving both government and non-government sectors, are required to address the issue.
According to the records with the National Statistical Bureau, it has been found that mostly the young people are committing suicides due to mainly family and unemployment problems.
Every month, around seven people commit suicide in Bhutan. Many more are being treated in the BHUs and hospitals for suicide attempts and deliberate self-harm. And there are some who do not even seek medical care and treatment.
The 74th Lhengye Zhungtshog held on 12 May 2015 granted and approved the nation’s first three-year comprehensive suicide prevention action plan (July2015-June 2018).
In a five-year review, from 2009-2013, Royal Bhutan Police recorded 361 suicide deaths, which is a 73 suicide cases in a year or six suicide cases in a month.
Bhutan saw a completed suicide rate of 10 per 100,000 population, comparatively lower than the global rate of 11.4 per 100,000 population per year.
Suicide deaths ranks among the top six leading causes of deaths after alcoholic liver diseases, circulatory diseases, cancers, respiratory diseases, transport deaths, and it also outnumbered the combined deaths due to HIV, TB and malaria.
In Bhutan, 87 percent of the deaths occurred within the age group of 15-40 years, and suicide rates have remained steady and increased particularly in 2012 and 2013.
The death of male to female ratio, with 2 men to every woman, in Bhutan is slightly higher than an average ratio of 1.5 men to each woman in low and middle income countries.
The key risk factor for suicide in Bhutan stands at 84 percent mental problems, 68 percent stressful events, 59 percent addiction and 46 percent due to domestic violence.
Suicide action plan states, prevention of suicide requires a combination of universal,
selective and indicated strategies to address the wide spectrum suicide risks.
Dr Gembo Dorji said it is not true that most suicide happen without warning, people usually convey message verbally or show signs of mental distress.
Therefore, he said the highest authority like, religious body, Dzongdags, local governments, RBP suicide prevention unit, BNCA, RENEW, NCWC need to give more attention to suicide prevention.
He also highlighted how the media can focus on de-stigmatizing mental illness, reducing stigma attached to suicidal behaviors and enabling help seeking among those vulnerable to suicide, and the capability of social media channels to be used for mass media communications for disseminating suicide prevention messages.
Since most of the suicide cases that happen in Bhutan are related to the youth due to mainly unemployment and substances abuse problems, Dr Gembo Dorji said the religious body can play a crucial role in helping individuals.
In 2014, out of 2496 cases of student counseling offered in 52 schools, 725 were counseled for substance abuse, 301 for family issues, 465 for academic and career issues and 69 for self-harm incidents. The identification of students in distress, requiring psychological help, can be improved through adequate peer network programs in schools.
A dzongkhag-level peer help conference was started in 2014, where 54 students from selected schools participated in a two-day conference, and in the long run coverage and quality of the peer group is to be improved through training and increasing participation of male and female peers.
Moreover, school counseling service data collected quarterly by the MoE has started to collect data from 2015.
In order to build greater synergy and coverage through partnership with the local governments and RENEW, in 2014, Dzongdags and RENEW agreed to combine dzongkhag¬led MSTF and RENEW activities under community based support systems (CBSS).
Mental health training initiated for volunteers will enhance the ability of volunteers to identify, recognize and improve referrals of mentally-ill patients suffering from severe depression, and has the potential to expand district outreach among people exposed to suicide risks.
The NCWC and the RBP has collaborated to institute women and child protection units and desks (WCPUs/ WCPDs) of the Royal Bhutan Police. The WCPUs/WCPDs provide services for women and children exposed to family, domestic or gender violence, which is a critical platform to identify suicide risks.
As a legal mandate to provide care and support to victims of domestic violence and child abuse, NCWC
instituted one- stop crisis center at the JDWNRH, OSCCs have a great potential to directly reach victims in psychological crisis and at a risk of suicide.
Seven drop in centers (DICs) supported by BNCA, YDF AND CPA6 have been established and provided with outreach services, counseling, referrals, relapse prevention services, reintroduction program for self help of Alcohol Anonymous (AA) and Narcotic Anonymous (NA).
DICs are managed by 2-3 counselors who are trained for a week in cognitive behaviors therapy (CBT) and another week in basic counseling. The counselors employ motivational interviewing (MI) technique for clients in denial and for relapse counseling.
“While we talk of preventing suicide, there is always a challenge, for the fast pace of country’s development and societal transition poses major stress on the society,” Dr Gembo Dorji said.
WHO Representative to Bhutan, Dr Ornella Lincetto, said, “Suicide is a complex issue, mostly young people in Bhutan commit suicide, and together we can prevent it. WHO will continue further aids in curbing suicide.”
The post 2018 suicide prevention program is to be developed towards the second half of 2018. It is to be implemented by 2019, and by 2020 it is targeted to bring down suicide rate from 14 per 1000 people to 11 per 1000 people.