The Bhutanese Leading the way.
361 suicide cases from 2009- 2013
| Dzongkhag | Number of completed cases | Number of attempted cases |
| Bumthang | 5 | 0 |
| Chukha | 39 | 1 |
| Dagana | 15 | 1 |
| Gasa | 0 | 0 |
| Haa | 1 | 1 |
| Lhuntse | 6 | 0 |
| Mongar | 22 | 0 |
| Paro | 15 | 2 |
| Pemagatshel | 13 | 0 |
| Punakha | 13 | 1 |
| Samdrup Jongkhar | 13 | 0 |
| Samtse | 59 | 2 |
| Sarpang | 37 | 4 |
| Thimphu | 35 | 63 |
| Trashigang | 32 | 0 |
| Trashiyangtse | 15 | 1 |
| Trongsa | 5 | 0 |
| Tsirang | 16 | 1 |
| Wangdue | 10 | 1 |
| Zhemgang | 10 | 2 |
| BHUTAN | 361 | 80 |
The first nationwide study on suicide undertaken in 2014 reveals that the highest incidences of suicide are among those who have mental stress, are married, live in rural areas, are poor and are younger in age.
Between the years 2009-2013 there were 361 completed suicide cases and 80 attempted suicide cases.
In detailed data gathered from 319 cases it was found that 210 victims were married. The figures implied couples not being able to handle relationship issues. On assessing the stressful events that cause suicide, multiple responses were collected, but it was found that the most common stressor reported was ‘disharmony with spouse’ at 79 percent.
Seventy percent of the married suicide victims were male.
Though the perception is that suicide is mainly an urban phenomenon the study shows that the majority of suicide victims are farmers or rural workers. Of the 319 respondents the largest professional group of suicide victims were farmers accounting for 132 cases or 41.4 percent. There is another 12 cases or 3.8 percent comprising of agriculture or forestry based workers. This would be a total of 144 cases or 45.2 percent of farmers and farm workers.
Most completed suicide cases are in rural areas while a higher number of attempted suicide cases occur in urban areas.
The second highest professional group came in at students who out of 319 respondents made up 46 cases or 14.4 percent of suicide cases.
The survey indicated academic pressure as being one of the crucial factors for young people in schools. Quite a number of respondents in the opinion column recalled the victims having failed in the exams or being worried about their academic performance.
About 66% of the completed suicide victims were within the age groups of 15-40 years out of which five percent was less than 15 years and 15% was over 55 years.
The majority of suicide victims come from households with low income. More than half of the completed suicide victims’ households had an average monthly household income of less than Nu.7000.
Economic reasons, however, are not seen as the prime trigger of suicide, according to the report, as more than 60 percent of the victims as well as suicide survivors (spouse, family, etc.) shared that they were “satisfied” with their living conditions.
In terms of cause of suicides the psychological aspect appears to be the dominant risk factor for suicide particularly mental problems at 84%, stressful events at 68%, and addiction for 59%. Domestic violence- a social factor is the next dominant risk at 46%.
Although this may be the case, 80 percent of completed as well as attempted suicide victims had or have never sought mental health support as they had or have been unaware of the existence of such support, and ignorant about mental health issues. A majority of the respondents in the study have pointed out the need for counseling and support services to deal with stress including that caused by marital problems.
The study also considers demography, biology and social factors.
A majority of 58% of those who completed suicide were reported to have been addicted to alcohol, and about 14% were also addicted to marijuana and other drugs. Among them, 67% of males and 40% of females who completed suicide had addiction to alcohol or drug.
In many occasions people who committed suicide also did so under the influence of alcohol or drug. In the study, 45% of the victims who had completed suicide were reported to have consumed drug or alcohol.
Amongst the completed suicide cases a majority of 41% were middle sibling. A majority of 77% of completed suicide cases had no diagnosis of any chronic or terminal illnesses while 22% had been diagnosed with some chronic or terminal illness.
Contrary to popular belief, a majority of the completed suicide victims at 226 cases do not come from broken homes.
The study also highlights the need for support systems for elderly citizens. Twenty- one completed suicide cases have been reported among ages 65 and above.
Dzongkhag wise the study shows the maximum number of completed suicides to have been in Samtse (55) while the highest number of attempted suicides is in Thimphu (24). Gasa, the least populated Dzongkhag, is the only dzongkhag to not have a single reported suicide case till date.
The frequency of completed suicides is greater in men (67%), while more women attempt suicide (85%).
On an average only about 20% of those who completed suicide and 23 % of people who attempted suicide had shown some signs of killing themselves, majority of them in the form of verbal or written expression.
Of the 319 people who completed suicide, a majority of 48% had attempted that at least once before, 28% had attempted twice and 11% had attempted three times.
The next of kin of the completed suicide victims expressed relationship, addiction and disease related issues to be the major cause of suicide. Relationship issues specifically included marital problems, ill treatment by parents or step parents, irresponsible parenting, etc. Addiction related issues were mainly to do with victim misusing alcohol. Disease related issues included victims suffering from mental disorders, epilepsy, hereditary and terminal illness. For attempted victims, relationship issues such as problems between partners and within families were mentioned as being the major cause of suicide.
“A Study on Reported Suicide Cases in Bhutan” was completed in August, 2014.
The study was undertaken after an Executive Order was issued by the Prime Minister’s office in February 2014 “considering the magnitude and seriousness of the (suicide) issue”. The study will help the Ministry of Health develop a national suicide prevention strategy. Draft completed august 2014.
Thirty-six enumerators from the Ministries of Education and Health, and RENEW carried out the field survey for the study. The National Statistics Bureau, The Jigme Dorji Wangchuck National Referral Hospital, and the Royal Bhutan Police were also involved in various capacities.
The Health Ministry has a general toll free helpline 112, but the ministry as part of the National Suicide Prevention Strategy will soon have in place a number to help and counsel people vulnerable to suicidal tendencies.
The Education Ministry has a toll free Nazhoen Helpline 214 to counsel and guide youth. The helpline is open 9-5pm from Monday to Friday.
The report also mentions various recommendations to help deal with suicide cases.
In terms of policy recommendations, the report recommends enacting a Mental Health Act to accord priority to mental health issues. It also recommends giving priority in developing mental health professionals. The report calls for enforcement of rules to control alcohol and drugs addiction.
Another recommendation is to establish an integrated data collection system that identifies at risk groups, individuals and situations. This would promote research, training and service delivery with respect to suicidal behavior.
The report says that religious institutions should be also involved in preventing suicides.
For prevention, the report recommends spreading awareness on mental health issues, risk factors, symptoms and a referral protocol to spot and refer those at risk. It also asks for instituting and expanding guidance classes and counseling services in all schools and forming peer support groups for those in and out of schools.
The report also lists intervention like family counseling centers, crisis management centers for those in psychological distress, programs for at risk groups and support network for elderly people.
The writer is an independent journalist who currently also works with the YDF.
Editors Note: The writer and the paper have jointly agreed to leave out the various methods of carrying out suicide from this story to prevent any copycat acts.
Namgay Zam/ Thimphu
