Suicide in the highlandsWealthy Sikkim and poor Bihar have the highest and lowest suicide rates in India respectively, proving that affluence has nothing to do with it.
Drug addiction and suicide have reached alarming levels in the Eastern Himalayan highlands, mainly affecting Sikkim, Darjeeling, Bhutan and Nepal. Based on 2016 data, the National Crime Records Bureau of the Indian Ministry of Home Affairs revealed that Sikkim has the highest suicide rate in India—40.5 per 100,000 population. Bhutan has a suicide rate of 11.4, and Nepal 8.8, according to the World Population Review. The 2009 Maternal Mortality and Morbidity Study conducted by the Family Health Division of Nepal found suicide as the leading cause of death for women of reproductive age (15-49 years).
Mental Health Status of Adolescents in South-East Asia: Evidence for Action, published by the World Health Organisation in 2017, makes another set of far-reaching expositions in the highland ecology. This report based on global school-based student health surveys is a cross-sectional survey involving 13-17 years old adolescents. Suicidal behaviour, as reflected in suicidal ideation, plans, and attempts, was found to be a common problem among adolescents in Bhutan and Nepal.
The major causes
Loneliness, multiple substance use and anxiety were the major causes behind the attempts and plans to commit suicide. Over 50 percent of the students in Nepal and 27 percent in Bhutan felt bullied by other students, which also caused serious consideration to commit suicide. Interestingly, both in Bhutan and Nepal, over 50 percent of the parents did not understand their children’s problems and worries and did not know what their children were doing with their free time. These findings confirm the general observation that parents are devoting increasingly less time to their children. Professionally busy parents compensating for their absence in the family with the provision of money, gifts, video games, mobile phones and other material support to their children is now quite visible in the urban conglomerates of the highlands also.
At the all-India level, it is found that, among the total suicide victims, daily wage workers constituted the highest share of 19 percent, followed by housewives (16 percent) and self-employed persons (10 percent). Students committing suicide constituted 7 percent. Over 67 percent of the suicide victims were married, 70 percent had an annual income of less than Rs100,000 and 22 percent were educated up to matriculation/secondary level. The age groups (18-30 and 30-45 years) were the most vulnerable groups resorting to suicide. These age groups accounted for 33 and 32.8 percent respectively of the total suicide cases. Family problems, failure in examination, love affairs and illness were the main causes of suicide among children below 18 years of age.
Bihar state with one of the lowest per capita incomes (Rs38,860) in India and a much deeper and higher poverty ratio has the lowest suicide rate of 0.4. Sikkim has the second-highest per capita income (Rs297,765) and a poverty rate that is less than half of Bihar’s poverty rate. Yet it has the highest suicide rate. What does this indicate? Economic affluence could be more than offset by blatant inequality and mere material gains may not convert into social contentment and individual happiness. At the same time, it is found that most troubled nations like Afghanistan (4.7), Syria (1.9) and even a protractedly violence-ridden Indian province of Jammu and Kashmir (2.6) have comparatively low suicide rates. This could also imply that political instability and regular occurrence of violence and related mental stress and societal disharmony have very little to do with the suicides.
Hardly any studies have been done as to why such a huge suicide rate prevails in an otherwise harmonious and compact society like Sikkim. More than a decade ago, the Central University of Sikkim made an attempt to study both the critical issues of abuse of drugs and psychotropic substances and suicides in Sikkim. However, such studies were systematically discouraged, resisted and thwarted by various governmental agencies in the state including the police on the grounds that they are too sensitive a subject to be handled by academics. Interestingly, both these critical issues showed their ugly heads and became a major social stigma during the last two decades or so. The cost of political sensitivity not to address these issues has been exorbitant. It has, in fact, crushed preventive measures, de-sensitised civil society and de-humanised the otherwise vibrant communities in Sikkim.
The Bhutanese government launched an innovative three-year action plan on suicide prevention in 2015. Prime Minister Tshering Tobgay wrote, ‘It is alarming to note that every month around seven people die in our country by suicide. For a nation committed to upholding the values of Gross National Happiness..., there is a great sense of urgency to overcome the unhealthy trend in our society... The causes of suicide are complex.’
This document brings in some hard realities about why Bhutanese people commit suicide. While documenting the means to prevent suicide and programmes to restrict lethal means of suicide, it states that hanging is the most common means (91 percent) contrary to countries where firearms or pesticides are common means. This is equally true of other highland regions like Sikkim and Darjeeling. In fact, a case study of Ilam district in Nepal published in the American Journal of Applied Psychology in 2015 presented the ethnic distribution of suicide victims as indigenous Janajati 53.7 percent, Brahmin 29.5 percent, Dalit 8.9 percent and Chhetri 8 percent, and over 71 percent committed suicide by hanging.
In Bhutan, it was found that consumption of drugs/substances accounted for 64 percent of the total attempted suicides. As one of the preventive measures, the official position states that 'religious preaching highlighting the negative karma that could accumulate from suicide should be further advocated in the general public and targeted groups such as schools and institutions to discourage suicide'. While realising the community linkages and partnerships to reach individuals and households, it commends village health workers as a classic success story of community engagement in primary health care, and urges them to engage in providing suicide prevention messages in the communities.
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