Promoting mental health – a way of ending suicides

“When you get into a tight place and everything goes against you, till it seems as though you could not hang on a minute longer, never give up then, for that is just the place and time that the tide will turn.” – Harriet Beecher Stowe.

Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multi-sectorial suicide prevention strategy is needed.

History has is it that in the ancient world people took their own life in response to escape evil, avoid shame, express grief over a tragic death, or avoid capture or dishonor in battle. Overall, however, suicide was condemned.

There are six instances of suicide in the Old Testament whiles in the New Testament, the only suicide mentioned is that of Judas Iscariot (Matthew 27:3-5, Acts of the Apostles 1:18-20) who betrayed Jesus and proceeded to hang himself. Indeed the Bible suggests that this act is shameful.

Apart from the Christian religion all other religion does not approve of suicide as an appropriate means to exit the earth. The consequences of suicide beyond the fact that almost all religion disapproves of it, are not just that one person is dead, that a precious life has ended. It is also a tragedy of epic proportions for the people left behind.

This notwithstanding World Health Organisation (WHO) estimates that every year close to 800 000 people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the second leading cause of death among 15–29-year-olds globally in 2015.

Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world. In fact, over 78% of global suicides occurred in low- and middle-income countries in 2015.

Interestingly suicide is reported as a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world’s second most populous continent, are limited. Regional or national suicide incidence data were available for less than one third (16/53) of African countries containing approximately 60% of Africa’s population; suicide attempt data were available for 20% of countries (7/53). Crude estimates suggest there are over 34,000 (inter-quartile range 13,141 to 63,757) suicides per year in Africa, with an overall incidence rate of 3.2 per 100,000 population. The recent Global Burden of Disease (GBD) estimate of 49,558 deaths is somewhat higher, but falls within the inter-quartile range of GBD’s estimate.

Suicide rates in men are typically at least three times higher than in women. The most frequently used methods of suicide are hanging and pesticide poisoning. Reported risk factors are similar for suicide and suicide attempts and include interpersonal difficulties, mental and physical health problems, socioeconomic problems and drug and alcohol use/abuse.

Qualitative studies are needed to identify additional culturally relevant risk factors and to understand how risk factors may be connected to suicidal behaviour in different socio-cultural contexts.

Ghana records about 1,500 suicide cases annually, the Chief Executive of the Mental Health Authority, Dr. Akwasi Osei, has revealed. This figure constituted about seven percent loss of the Gross Domestic Product (GDP) but little attention is paid to suicide cases in the country. The Mental Health Authority Chief notes that, in every single reported case of suicide, there are four unreported case of suicide, this, therefore, bring the number of unreported cases to about 6,000 annually.

This is a primitively outrageous statistics which should prompt Ghana to prioritize and mainstreaming issues of mental health much more seriously.

Who is at risk?

While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.

In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. By far the strongest risk factor for suicide is a previous suicide attempt.

Indeed mental health is a complex issue and it’s easy to become confused and unclear about its impact. What is for sure is that everyone’s mental health is important and Ghana as a country should devise comprehensive measures to help anyone who is feeling stigmatized because of poor mental health.

Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need. The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it. To date, only a few countries have included suicide prevention among their health priorities and only 28 countries report having a national suicide prevention strategy.

Raising community awareness and breaking down the taboo is important for Ghana to make progress in preventing suicide.

Methods of suicide

WHO estimates that around 30% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries. Other common methods of suicide are hanging and firearms. Knowledge of the most commonly used suicide methods is important to devise prevention strategies which have shown to be effective, such as restriction of access to means of suicide.

Prevention and control

Suicides are preventable but certainly not what pertains in Ghana’s criminal code of criminalizing suicide. Section 57 Clause 2 of the 1960 Criminal Code of Ghana should therefore be expunged without further delay. Additionally there are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. These include: reducing access to the means of suicide (e.g. pesticides, firearms, certain medications);

reporting by media in a responsible way; introducing alcohol policies to reduce the harmful use of alcohol; early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute emotional distress;

training of non-specialized health workers in the assessment and management of suicidal behaviour;

follow-up care for people who attempted suicide and provision of community support.

Suicide is a complex issue and therefore suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defense, politics, and the media. These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide.