23 October, 2018

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Tackling The Burden Of Suicide In Sri Lanka

By Kasun Kodituwakku

Kasun Kodituwakku

Kasun Kodituwakku

Over 800,000 suicide deaths are reported every year, 75% of these origination from the lower and middle-income countries predominantly within Asia.

Sri Lanka was listed as having the 4th highest suicide rate in the WHO report of 2014. The conflict-ridden history of the country has meant that suicide has been a major burden of the previous three decades, nevertheless the measures and interventions implemented by the governing body has shown to positively impact suicide mortality rates, particularly legislations on pesticides. But the numbers of attempted suicides continue to increase, highlighting the inadequate attention given to the central determinants of suicidal behaviour. Means restriction and addressing social and economic factors whilst providing mental support via a robust healthcare system have shown to be key in tackling suicide.

This report explores the dynamics of suicidal behaviour in Sri Lanka and the interplaying factors that contribute to the persistent national burden. It investigates the education and employment systems as well as assessing successfulness of interventions and policies implemented by the governing body.

Burden of Suicide

Suicide is a complex multifaceted behaviour, which is induced by various stresses and predispositions. It accounts for millions of non-fatal hospital admissions and over 800,000 deaths annually, a life every 40 seconds.1 Projections estimate mortalities to almost double to 1.53 million by 2025; with a further 15 to 30 million cases of attempted suicide, thereby demonstrating the major global health burden that suicide represents.2

Over 90% of suicides have been related to psychiatric illness in high-income countries (HIC)3, in which bipolar and major depressive disorders account for almost 60%.4

In the WHO 2014 report5, the overall suicide rate was marginally higher in HIC than low and middle-income countries (LMIC), 12.7 per 100,000 and 11.2 per 100,000 respectively. But the sheer population that reside in LMIC meant that it accounted for 75% of all suicides.

Sri Lanka

Sri Lanka is a small densely populated island located just off the southeast shores of the Indian subcontinent6. It’s regarded as a lower-middle income country7 with a relatively low expenditure on health – $89 per capita 8, 3.4% of the GDP6,9. But the widespread basic healthcare system available in Sri Lanka is admirable considering its economic profile. An extensive network of government funded public health units exists alongside a robust private sector providing basic health care to the majority10. Communicable diseases remain endemic in Sri Lanka; vector-borne diseases like dengue fever along with diarrhoeal diseases and hepatitis A pose the greatest threats6. Sri Lanka, like many LMIC, is facing the double burden of disease, today non-communicable diseases account for over 70% of mortalities, cardiovascular disease, chronic respiratory diseases and diabetes are extremely prevalent10,11. Mental health was previously a neglected topic, but in recent years especially post-conflict (1983-2009) there has been a greater focus on such conditions by the Ministry of Health. This resulted in the introduction of mental health policies and interventions to tackle the health burden; nevertheless only 1.6% of the total health budget is invested on mental health12.

A History of Suicide

A civil war that spanned over 25 years (1983-2009) left the country in social disintegration with an estimated 100,000 lives lost. Suicide rates were highest during the war and a significant reduction was established in post-conflict Sri Lanka. Financial hardship and loss of livelihoods was repeatedly affected families especially in the northern provinces, numerous individuals suffered from depression and posttraumatic stress disorder (PTSD) and many more resorted to suicide.13

During 1985 and 1989 male suicide rates were second highest in the world14, many studies fail to address a major contributory factor, the 1987-99 JVP Insurrection(15). The government faced a youth rebellion from the People’s Liberation Front aka JVP. In retaliation the government captured, tortured and killed the whole JVP politburo and an estimated 30,000 civilian supporters16. Many were thought to have committed suicide to evade capture or developed PTSD but due to the circumstances data is unavailable.17
Conflict has now diminished and Sri Lanka is at peace, but yet suicide rates still prevail. Since the 1970s Sri Lanka has endured extremely high suicide rates, peaking in the 1995 where it had one of the highest suicide rates in the world, 47/100,00018,19. A steady decline has been apparent in the past two decades but in 2014 the WHO listed it as having the 4th highest suicide rate globally, 28.8/100,0005. On average there are over 6,000 mortalities and almost 100,000 individuals attempt suicide annually20.

This essay will focus on contributory factors associated with suicide in Sri Lanka, exploring the suicide mortality control mechanisms, psychosocial determinants and investigating mental health policy and possible approaches of delivering primary care.

 Controlling Suicide Mortality

Targeting the means of suicide have shown to be effective in reducing mortality, in the UK legislation on the sale quantities of paracetamol have shown to lessen hospitalisations and case fatalities due to overdose21. In contrast LMIC especially in rural Asia face a sever issue with impulsive self-poisoning due to the easy accessibility of highly toxic pesticides19,22.Fig-1

Pesticides

Studies have estimated the suicide by pesticide ingestion accounts for up to 300,000 deaths globally per year23-25. The agricultural sector in Sri Lanka represents 31.8% of the national labour force6; they are often subjected to many stressful situations due to finance, weather, workload and farm related disputes26. Suicide amongst farmers is a global phenomenon and agriculture has the highest rate of mortalities amongst all industries27.

Prior reports have shown that pesticides were accountable for two thirds of all suicides in Sri Lanka25,28; such alarming statistics provoked the government to introduce laws prohibiting import of highly toxic organophosphate compounds in 1995 and chlorinated hydrocarbon insecticides like endosulfans in 199829. This directly coincided with a ~50% reduction in suicide mortality rates from 1995 and 2005, as shown in Figure.125. This study did lack data from the northern provinces in which 1.5% of the population reside and nonetheless the evidence presented was deemed to be conclusive.

The pesticide burden remained relatively high and therefore initiatives encouraging the safe storage of pesticides, provided a practical measure. Hawton et al30 demonstrated the effects of providing farming households with lockable boxes for pesticide storage in two villages. Each box displayed a message for anyone with the intention of suicide, encouraging them to seek counselling from close friends. This approach was widely accepted but the study did show that over 25% of the boxes were just left unlocked after an 18-month follow-up. The study lacked generalizability due to the small sample size used but it was able to demonstrate the general acceptability of the intervention. Other similar studies31,32 found alike results and therefore introducing these lockable storage facilities would reduce accessibility to pesticides in the domestic environment. None of these trials addressed the knock-on effect on other forms of self-poisoning such as the ingestion of the widely available poisonous seeds from the yellow oleander tree – a factor associated with many sucides.14

Safe storage and prohibitions on highly toxic pesticides may have positively impacted mortality rates nonetheless the self-poisoning related hospital admissions continue to increase29. Repeat admissions are likely but it demonstrates that the pesticide interventions represent a distal approach as it had little effect on suicidal behaviour.

Moreover Figure.2 displays an increase in male and female suicide rates through hanging following the pesticide accessibility restrictions enforced by the government19, thereby highlighting means substitution due to the lack of attention given to the proximal determinants of suicidal behaviour.Fig-2

Risks and Determinants of Suicidal Behaviour

HICs generally tend to have suicide rates directly linked to the increasing prevalence of mental illnesses with age, peaking in the middle aged and elderly. In contrast the majority of suicides in Sri Lanka are not associated with mental illness, therefore HIC suicide preventive strategies cannot be effectively applied. Interventions addressing central causes of suicidal behaviour are essential.

Underlying determinants of suicide

Social factors

A mental health stigma still exists in Sri Lankan society. Patients are subjected to discrimination, especially by employers, which have only proven to exacerbate the condition. Self-stigmatisation has led to significant delays in seeking aid; patients were often withdrawn opting for secrecy rather than disclose any emotions33. Fernando et al stated that doctors have also shown to have stigmatising attitudes towards depression and alcohol and drug addiction patients.

Sexuality plays an undeniable part in suicide. Homophobia is common amongst families, they disown and force out homosexuals, who then face a lot of discrimination by relatives and society in general, and many have opted for suicide due to the constant torment and mental stress34. Engaging in homosexual acts is currently against the law35 and is punishable by up to 10 years in jail34. Even today private clinics exist with the sole aim of ‘curing’ homosexuality.

Such findings call for anti-stigma campaigns for the LGBT community and certain mental health disorders. General education for the public is vital and also efforts must be made to reduce poor attitude towards mental health disorders in medical education.

Education and Unemployment

National statistics shown in Figure.3 no correlation between unemployment rates and the suicide rate, the unemployment rates have decreased even during the peak in suicide rates in 1995. But youth unemployment has always been a huge burden in Sri Lanka and is a considerable suicide factor.Fig-3

The education system in Sri Lanka is highly competitive and it often criticised for being overly academic orientated. Efforts have been made to modernize the program by offering apprenticeships and career opportunities36. Nevertheless over 20% of the youth remain unemployed. The highly competitive nature of education alongside deteriorating relations with parents and the desire to prove one’s self-worthiness has shown to be detrimental on the mental health of the youth37. Therefore psychosocial support and services focusing these matters are essential in tackling youth suicide rates, which are prevalent in both sexes – demonstrated in Figure.2.

Low skilled workers are often subjected to financial hardships due to the minimum wage system adopted by the government, which organises minimal pay according to the industry of occupation. Private sector employees have to be legally paid just $62/month, in a country where at least $100-$150 is deemed adequate for a very basic living with minimal food security38.

Mental Health Policy & Providing Primary Care

Neuropsychiatric diseases are estimated to account for 11.5% of the national disease burden. In 2005 an official mental health policy was approved to combat the previously neglected burden of mental health39.Fig-4

Funding was allocated from the general health budget and an effort was made to decentralise the delivery of mental health care from hospitals to community based mental health facilities. Focusing on refining stewardship functions at the central level has shown to provide a better delivery of the decentralised healthcare systems in smaller districts40. Yet, in 2011 there were only 1,538 beds in 278 facilities across the country with a lack of facilities in rural regions, therefore demonstrating the inadequateness of the current facilities39.

Recruitment and task shifting

Training was given to the majority of primary health care professionals and an official referral procedure was enforced to integrate mental health services into primary care delivery39. Jenkins et al12 found that a short 40 hour training programme for psychiatrists, medical officers and practitioners had positive impacts on patient assessments and treatment. Nevertheless a considerable deficit of healthcare professionals exists across the board, especially psychiatrists and psychologists as shown in Figure.4. Currently there are only 58 medical officers and 56 nurses trained in mental health in Sri Lanka – approximately 2 per district. In comparison Thailand has almost double the mental health care professionals41. Therefore further recruitment and training of healthcare workers is essential, but the stigma surrounding mental health often deters many medical students and even doctors42. Further education interventions aiming to improve and progress knowledge and attitudes toward mental health is paramount in order to increase human resources.

However alternatively other studies have suggested a task shifting approach43. Here tasks are delegated to less or narrowly trained individuals and can encompass a wide range of cadres, examples of this include:

  • Non-specialist physicians and nurses with minimal training are able to diagnose and treat moderate cases of mental health
  • Supporting community health workers in basic care
  • Collaborate with education professionals to increase awareness and involve them in the detection of mental disorders

Currently nurses in Sri Lanka are not independently allowed to diagnose or prescribe any psychotherapeutic medication, as doctors are the only authoritative figures empowered to do so39. Such hierarchical attitude is precautionary but with the correct training procedure allowing nurses to act independently would allow for a wider delivery of mental health care.

Emigration of healthcare professionals from rural to urban region or even abroad in search of better career opportunities poses an issue to the human resource availability in rural regions44. Thus it may be favourable to provide financial incentives to manage attrition and achieve a reasonable distribution of professionals.

Other possible interventions

Cognitive behavioural therapy (CBT)

CBT is a common treatment approach for many mental disorders anxiety, depression, and suicidal thoughts and behaviour. A current trial is being carried out by Kings College London45 in southern province in Sri Lanka, here a culturally appropriate manual for CBT is being used. A pilot randomized control trial of CBT46 in active suicidal ideation found that such intervention was having a positive impact on the target population. Thus training lay community health workers in CBT delivery provides another option to tackle suicide rates.

Media

The media is an influential role on suicide, it can be aid in the public awareness of suicide and mental health or it can promote suicide by portraying it as a means of escaping hardship and suffering. Journalists must adopt a sensitive approach when reporting on suicide cases as they have shown to be highly influential on the younger generation who are able to relate to the situation47.

Dubbed Indian soap operas have been associated with promoting domestic abuse towards women in Sri Lanka48, often these dramas depict gender inequality and women are subjected to physical and psychological torture. Plots where women have been forced to commit suicide by relatives due to marital disputes been broadcasted. The impact of such shows is immeasurable on the suicide burden.

 NGOs

Prevention programmes run by NGOs are increasing. Sumithrayo is the principal organisation involved in Sri Lanka. They aim to provide confidential emotional support for anyone suffering from distresses that may progress to suicidal thoughts49. Sumithrayo continues to raise awareness through education programs in schools. Their rural program covers over 80 suicide prone villages and here they are issuing lockable storage boxes for pesticides in an attempt to actively prevent self-poisoning related deaths18. The work of NGOs continues to positively impacting suicide rates.

 Conclusion

A conflict-ridden history has meant that suicide has become a common method to escape a distressed and psychologically unbearable life. Tackling suicide in Sri Lanka necessitates a multifaceted approach.

Means restriction has proven to be extremely effective; the introduction of legislation prohibiting the most toxic of pesticides greatly impacted suicide mortality. Lockable safe storage of pesticides represents another effective strategy but these distal interventions have shown to potentiate means substitution. Therefore tackling the proximal determinants of suicidal behaviour is paramount.

However the current understanding of these factors is limited, the rising cost of living and the social stresses due to education and employment have shown to be contributory to the suicide burden. Cultural ideology and stigma surrounding aspects such as mental health and sexuality have shown to hinder progress. A lack of public awareness and understanding exacerbates the issue; therefore public education campaigns are vital interventions.

Current governmental mental health policies are commendable but a lack of human resources is apparent. Task shifting provides a potential alternative but the social hierarchy and attitude towards delegation of authoritative figure roles to less qualified individuals proves to be a major barrier.

The task at hand is vast, as it essentially requires a social revolution, but the combined efforts of the government, the general public and NGOs would positively impact the persistent suicide problem in Sri Lanka.____________________________________________________________________References

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(4) Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. Jama 2005;294(16)  2064-2074.

(5) World Health Organization. Preventing suicide: A global imperative. 2014.

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(10) World Health Organisation. Country Cooperation Strategy – Sri Lanka. [Online] Available from: http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_lka_en.pdf [Accessed 07/12/2014].

(11) Liyanage, T. Sri Lankan Ministry of Healthcare and Nutrition. Non Communicable Diseases – Sri Lanka. [Online] Available from: http://www.health.gov.lk/en/NCD/index.php [Accessed 07/12/2014].

(12) Jenkins R, Mendis J, Cooray S, Cooray M. Integration of mental health into primary care in Sri Lanka. Mental Health in Family Medicine 2012;9(1)  15-24.

(13) Rodrigo A, Owada K, Wainer J, Baker R, Williams S. Comparison of suicide rates in Sri Lanka during and after the civil war. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists 2013;21(4)  410.

(14) de Silva VA, Senanayake S, Dias P, Hanwella R. From pesticides to medicinal drugs: time series analyses of methods of self-harm in Sri Lanka. Bulletin of the World Health Organization 2012;90(1)  40-46.

(15) Lock M, Nichter M. New Horizons in Medical Anthropology: Essays in Honour of Charles Leslie. : Taylor \& Francis; 2003.

(16) Porter SE, Hayes MA, Tombs D. Images of Christ. : Bloomsbury Academic; 2004.

(17) Chandraprema CA. Sri Lanka, the Years of Terror: The JVP Insurrection, 1987-1989. : Lake House Bookshop Colombo; 1991.

(18) Befrienders Worldwide. Sri Lankan Rural Programme. [Online] Available from: http://www.befrienders.org/sri-lankan-rural-programme [Accessed 02/12/2014].

(19) Knipe DW, Metcalfe C, Fernando R, Pearson M, Konradsen F, Eddleston M, et al. Suicide in Sri Lanka 1975-2012: age, period and cohort analysis of police and hospital data. BMC public health 2014;14(1)  839.

(20) Commonwealth Health. Mental Health in Sri Lanka. [Online] Available from: http://www.commonwealthhealth.org/asia/sri_lanka/mental_health_in_sri_lanka/ [Accessed 06/12/2014].

(21) Gunnell D, Hawton K, Murray V, Garnier R, Bismuth C, Fagg J, et al. Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified? Journal of epidemiology and community health 1997;51(2)  175-179

(22) World Health Organisation. Suicide. [Online] Available from: http://www.who.int/mediacentre/factsheets/fs398/en/ [Accessed 03/12/2014].

(23) Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. International journal of epidemiology 2003;32(6)  902-909.

(24) Buckley NA, Karalliedde L, Dawson A, Senanayake N, Eddleston M. Where is the evidence for treatments used in pesticide poisoning? Is clinical toxicology fiddling while the developing world burns? Clinical toxicology 2004;42(1)  113-116.

(25) Gunnell D, Fernando R, Hewagama M, Priyangika WD, Konradsen F, Eddleston M. The impact of pesticide regulations on suicide in Sri Lanka. International journal of epidemiology 2007;36(6)  1235-1242.

(26) Ramesh A, Madhavi C. Occupational stress among farming people. Journal of Agricultural Sciences 2009;4(3)  115-125.

(27) Behere PB, Bhise MC. Farmers’ suicide: Across culture. Indian journal of psychiatry 2009;51(4)  242-243.

(28) Hettiarachchi J, Kodithuwakku G, Chandrasiri N. Suicide in southern Sri Lanka. Medicine, Science and the Law 1988;28(3)  248-251.

(29) van der Hoek W. Analysis of 8000 hospital admissions for acute poisoning in a rural area of Sri Lanka. Clinical toxicology 2006;44(3)  225-231.

(30) Hawton K, Ratnayeke L, Simkin S, Harriss L, Scott V. Evaluation of acceptability and use of lockable storage devices for pesticides in Sri Lanka that might assist in prevention of self-poisoning. BMC Public Health 2009;9(1)  69.

(31) Konradsen F, Pieris R, Weerasinghe M, van der Hoek W, Eddleston M, Dawson AH. Community uptake of safe storage boxes to reduce self-poisoning from pesticides in rural Sri Lanka. BMC public health 2007;7  13.

(32) Weerasinghe M, Pieris R, Eddleston M, Hoek W, Dawson A, Konradsen F. Safe storage of pesticides in Sri Lanka – identifying important design features influencing community acceptance and use of safe storage devices. BMC public health 2008;8  276-2458-8-276.

(33) Fernando SM. Stigma and discrimination toward people with mental illness in Sri Lanka. 2010.

(34) Immigration and Refugee Board, Canada. Sri Lanka – Homosexuality. [Online] Available from: http://www.justice.gov/eoir/vll/country/canada_coi/sri%20lanka/LKA102743.E.pdf [Accessed 07/12/2014].

(35) BBC News. Where is it illegal to be gay? BBC News. 10th February 2014.

(36) Gunatilaka, R. Mayer, M. Vodopives, M. World Bank. The challenge of youth employment in Sri Lanka. [Online] Available from: http://documents.worldbank.org/curated/en/2010/01/12228851/challenge-youth-employment-sri-lanka [Accessed 06/12/2014].

(37) Ministry of Youth Affaris and Skills Development. National Youth Policy Sri Lanka. [Online] Available from: http://www.wcy2014.com/pdf/nyp-english.pdf [Accessed 07/12/2014].

(38) Salary SL WN. Minimum Wages in Sri Lanka – Frequently Asked Questions. [Online] Available from: http://www.salary.lk/home/salary/minimum-wage/faq-on-minimum-wages [Accessed 07/12/2014].

(39) World Health Organisation. Mental Helath Atlas 2011 – Sri Lanka. Department of Mental Health and Substance Abuse, WHO; 2011.

(40) International Development Association 2. Improving Quality and Access to Rural Healthcare. [Online] Available from: http://web.worldbank.org/WBSITE/EXTERNAL/EXTABOUTUS/IDA/0,,contentMDK:22321149~pagePK:51236175~piPK:437394~theSitePK:73154,00.html [Accessed 07/12/2014].

(41) World Health Organisation. Mental Health Atlas 2011 – Thailand. World Health Organisation; 2011.

(42) Fernando SM, Deane FP, McLeod HJ. Sri Lankan doctors’ and medical undergraduates’ attitudes towards mental illness. Social psychiatry and psychiatric epidemiology 2010;45(7)  733-739.

(43) Kakuma R, Minas H, van Ginneken N, Dal Poz M,R., Desiraju K, Morris JE, et al. Human resources for mental health care: current situation and strategies for action. The Lancet 2011;378(9803)  1654-1663.

(44) Kingma M. Nursing migration: global treasure hunt or disaster‐in‐the‐making? Nursing inquiry 2001;8(4)  205-212.

(45) Kings College London. Projects – Cognitive Behavioural Therapy in active suicidal Ideation/ Sri Lanka. [Online] Available from: http://www.kcl.ac.uk/ioppn/depts/hspr/research/CEPH/SocPsychandPsychEpi/projects/CBTinSuicidalsinSriLanka.aspx [Accessed 07/12/2014].

(46) Samaraweera S, Sumathipala A, Siribaddana SH, Sivayogan S, Bhugra D. RCT of Cognitive Behaviour Therapy in active suicidal ideation-as feasibility study in Sri Lanka. 2007.

(47) Media Wise. Suicide. [Online] Available from: http://www.mediawise.org.uk/suicide/ [Accessed 07/12/2014].

(48) Gunatilleke N. Dubbed Indian Teledramas cause much Damage to Sri Lankan Women. Transcurrents. [Online] Available from: http://transcurrents.com/tamiliana/archives/348 [Accessed 07/12/2014].

(49) Sri Lanka Sumithrayo. Sumithrayo – Suicide Prevention and Awareness. [Online] Available from: http://www.srilankasumithrayo.org/ [Accessed 07/12/2014].

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Latest comments

  • 7
    0

    Damn. For a moment I thought “Over 800,000 suicide deaths are reported every year” in Sri Lanka.

    What a blessing in disguise it would have been. In a matter of a decade or so we would have ceased to exist. No problem with that. This race called Sri Lankans who are subject to the iron grip of culture vultures and subject to economic deprivations imposed by pseudo statesman giving rice to a degenerate, hate filled, snake under the grass type, intolerant, viciously violent, scheming, sexually repressed, deviant people would have gone for good. What a shame.

    • 2
      1

      I really dont think that srilanka s current suicidal rates claim it to be the 4th highest in the world. There were days, that Ltters professionally trainined suicide soldiers to fight the war. Those days were the saddest in the history.
      I think what I notice in lanka each time visiting them is -mostly parents dont hve closer relationship with their offpsrings. There is a big distance bwetween father and the son in a family unit. In EUrope, fathers explain things to thier kids like parrots do their job. Last week, I noticed it myself the way how a german father went on explaining to his 5 year old son, he how is asked to collect the bun (bread) from the racks. This was in a suppermakert… there is a proper way of taking them out.. father was all along teaching the child… how to do it… this means fathers and mothers teach their offsprings ina manner they learn them from the begining on.. this is lacking among the srilankens. Even if in a middle aged family – father s role is just being away from the nurture leaving it on the mother. Mothers in lanken families are exausted: This is the tradition in the country. Even today with information technology evolutionzed the world, not even 4% of them work hard to teach their kids in a proper manner. And self learning should be taught from very begining on. ALmost everything should be discussed within the family – the kind of steps should be introduced to family units if CHILDREN to be grown in a healthy manner. May be this is a common problem for any devleoing nation.

    • 2
      0

      Alone the kind of topics seem to be not taking serious by this folks.

      Had this been on sinhala buddhist, every minion would have added their comments.

      From the numbers of comments to this article,the difference is contrast.

      For them, no care about anyone woudl commit suicide… alles egal für sie (just living passively, even if the lovely ones would have been abductured, tortured, raped out and even killed out) the average would not consider it as serious.

      This nation – i m talking about the majority, they are born indifferent.

    • 0
      1

      Said it in a nutshell, BBS Rep.

    • 1
      1

      Just this article – with not enough comments yet as it is the case fo any gossips about anyone s issue- indicates clearly that the nature of interest of the people in general. The writer seems to have done a good job bringing the kind of article- this kind of writers should be rewarded… since the issue must be focused by the authoriteis of the island – why the youth fall to commit sucide and they become the 4 th among the highest in the world.

  • 3
    0

    Sri Lanka is also one if the highest consumers of alcohol per capita.

    I am sure that has a correlation with the number of suicides. Alcohol is classified as a drug.

    I know 2 families who were destroyed because of alcohol. They were wealthy but somehow got addicted.

    On a Poya day there is hardly any males at temples – its mostly females. There has to be greater engagement with the monks and lay people. Rituals needs to be replaced by practical lessons how to master ones mind.

    • 0
      1

      Vibushana….”On a Poya day there is hardly any males at temples …”

      I am sure you meant Sri Lanka Sinhala Buddhist men.
      And let me filter it down …..you mean working class Sinhala Buddhist men
      Perhaps they are moonlighting doing coolie jobs to pay fir their kassipu.
      The rich and middle class are spending their time in hotels bribing their way to alcohol

      • 1
        2

        Hello there,

        This article is about mental disorders.

        So you are in the correct place.

        • 0
          1

          Thanks for welcoming me to the place where you belong, I am visiting as an observer.

  • 2
    0

    Kasun Kodituwakku

    RE: Tackling The Burden Of Suicide In Sri Lanka

    “But the numbers of attempted suicides continue to increase, highlighting the inadequate attention given to the central determinants of suicidal behaviour. “

    “The task at hand is vast, as it essentially requires a social revolution, but the combined efforts of the government, the general public and NGOs would positively impact the persistent suicide problem in Sri Lanka.”

    “Sri Lanka was listed as having the 4th highest suicide rate in the WHO report of 2014.”

    Thank you for bringing this Problem to the forefront. Why, 4 years after the war? This indicated that there are still many uncured wounds.

    Identification of the problem is 95% of the solution.

    You do have a lot of supporting data. I wonder if you have additional data breaking down as to

    1. Socio-economic status. Lower, Middle or Upper income

    2. Education Level

    3. Ethnicity

    4. Province

    5. Urban or rural

    6. Religion

    7. Any other group.

    This may allow identification of the problem , at the root, cause and source level. For example, the Muslims are not allowed to commit suicide, as it means the believer is taking over God’s job, i.e. deciding when the life ends. However, it looks like the Fundamentalist Wahhabi and Clone Suicide Bombers, due to brainwashing by the Satan-Iblis Followers, do commit suicide by killing themselves, and other, in the mistaken identity of 72 Virgins, which in fact is 72 Raisins.

    For Christians, in the fifth century, St. Augustine wrote the book The City of God, in it making Christianity’s first overall condemnation of suicide. His biblical justification for this was the interpretation of the commandment, “thou shalt not kill”, as he sees the omission of “thy neighbor”, which is included in “thou shalt not bear false witness against thy neighbor”, to mean that the killing of oneself is not allowed either.

    Suicide was a phenomenon known to the Buddha and commented on by him. On one occasion a group of monks doing the meditation on the repulsiveness of the body, without proper guidance, became depressed and killed themselves. When informed that the two lovers had killed themselves so that “they could be together for eternity” the Buddha commented that these actions were based on desire and ignorance. His attitude to suicide is clear from the Vinaya where it is an offence entailing expulsion from the Sangha for a monk to encourage or assist someone to suicide, and thus on a par with murder. Consequently, in Theravada it is considered as a breach of the first Precept, motivated by similar mental states as murder (loathing, fear, anger, desire to escape a problem) only directed towards oneself rather than another.

    While Mahayana takes a similar attitude to the more common type of suicide it did encourage suicide for religious motives. The Lotus Sutra and several other Mahayana works praise the burning of one’s own body, a sort of human incense stick, as the “highest offering”. Stories of bodhisattvas giving parts of their body or even their lives, which are immensely popular in Medieval India, gave self-mutilation and suicide legitimacy. During certain periods in Chinese history such practices became so common that the government had to issue edicts against them. In recent times religious suicide has become rare and even disapproved of.

    Suicide is definitely something that Hindus have to discuss, as the percentages are too high to ignore the problem that exists in far too many Hindu communities. Many advise, as many elders do – Don’t kill yourself. (After all, they became elders by avoiding such extreme solutions.) Suicide does not solve problems. It only magnifies future problems in the antarloka (the subtle, nonphysical world we live in before we incarnate) and in the next life. But do those who are all wrought up with emotion and confusion listen to such advice? No. Many die needlessly at their own hand. How selfish. How sad. But it is happening every day, as this write up shows.

  • 2
    0

    The author describes CBT etc as a solution. This is what western countries used to do. They still have huge problems with mental disorders.

    They are switching to other forms of mind awareness. This is an example where school kids are taught from a young age things like mindfulness.

    https://youtu.be/HMsvu-Yoq3c

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      This could well be right..

      Former President is said to be a drunkard – that could be the reason him to have ignored even almost everything not being looted.

      If first citizen of the nation is no exemplary, what best we can expect from the nation.

      Now with Walgama making loud statements the bugger president to lead the SLFP shold be mandatory – all in all, these men are on a move allowing idiots to take over power .. that is srilankens politics

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    Kasun Kodituwakku

    RE: Tackling The Burden Of Suicide In Sri Lanka

    Suicide Bombers bribed by Islamic State. Is it money, or economics or the Great Satan?

    So, what percentage of suicides are due to economics in Sri Lanka? we know women go to middle East ss maids due to economics.

    Face to face with Islamic State – BBC News

    https://www.youtube.com/watch?v=4HF36QPKgiM

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    Kasun Kodituwakku

    RE: Tackling The Burden Of Suicide In Sri Lanka

    “Over 800,000 suicide deaths are reported every year, 75% of these origination from the lower and middle-income countries predominantly within Asia.

    How many were killed on invasions, warns and inference by the great powers, especially the Great Satan and his cronies?

    How many suicides resulted because of these calamities?

    How many killings?

    Christopher Hitchens – On U.S. position on Middle East and war crimes [2005]

    Was Christopher Hitchens a Bush Apologist for the Crimes in Iraq” Ad hominem?

    https://www.youtube.com/watch?v=j9Jiv_4aa8c

    The Trial of Henry Kissinger

    https://en.wikipedia.org/wiki/The_Trial_of_Henry_Kissinger

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    Well done. Kasun@, no doubt this is a timeworthy article.

    Western world does more in the areas of awareness programs to tackle the problem while today generations in srilanka seem to be distant to their own parents. This I notice each time visiting my relatives back in the country. They the youth are busy with their cell phones and internet addicts. Unlike the case in Europe, parents have not the least knoweldge about the cell phone and internet in the country, makes it difficult them to realize what their offsprings are busy with. Even if those kids surf on sex web sites, for parents, it seems to be a thing to show off – saying their kids are busy with modern info technology. FACE book is more poppular in srilnaka than in Germany for example. What they exchange via FB are mostly garbage. Internet has infected the youth to change a lot. Surely not the good side of the internet. Unless parents do not really know what make their kids busy with, how can they trace even if they would have been abducted or killed out – through the connections made via internet chats. Not only internet abuses, but also increasing drug consume problem is also one of the other factors that lanken youth are busy with to this date.

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    It’s a sad reflection on our society that we have not come to recognize and acknowledge that suicide, alcoholism etc. is a very real problem and hiding it away is not the solution

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      I wish if we could encourage – those Rajapakshe supporters asking them all to commit suicide and leave this country for goodies-
      Like a human body metastized with a blood cancer – only a full blood tranfussion can save the life of the patient – the nation should be free from all kind of culprits if we at all want to raise the head – making this nation an another role model to the world.

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        Can anybody please encourage Buruwanse to commit suicide ?

        Thhere you may save over 300 000 people not getting abused. Even masses would be

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    Suicide is the end stage of untreated mental depression – mostly left untreated.
    Depression is common in most persons during family/personal crises and becomes worse in a good number, with neglect.
    Consumption of anti-depression drugs is high in affluent societies, but they do help during crises.
    Family physicians should identify early, counsel and prescribe.
    This happens in countries where all health care services are implemented by the state, and a good number are saved from end stage.
    Admission to facilities during acute stages are implemented in such countries, but we have no such facilities and legislation.
    The health minister should be aware, and discuss with health professionals.

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    Thank you Kasun Kodituwakku, for presenting a comprehensive report of this terrible dilemma of modern society.

    Somebody has to remain in the house and look after emotional, physical and mental health. When everybody’s thoughts are all about making money, making-money becomes the all-embracing compulsion, that leaves aside the intrinsic knowledge of human needs and wants.

    (what’s with the …..manic…..pic, btw?)

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    suicide help hotline in Sri Lanka is 1333 (free of toll charges)
    done by CCC Foundation of SL

    PS- im disheartened by some comments I see. Kasun writes something serious and for some people it is anti-Buddhist or pro-Buddhist. Just leave ur religious love/hate at home and lets heal our wounded country.

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    Once I have taken one of my relative who was suffering acute depression the psychiatric (he is a christian) told me since the patient is a Muslim risk of suicide is very low.

    Even though suicide rates in Sri Lanka is very high, in Muslim community it is very low when comparing to other communities. When I reviewed world map published on WHO suicide report most of Islamic countries have low rate of suicide.

    So I suggest the researchers should consider this factor also.

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      @Anas Hussain

      I am not surprised that Islamic countries apparently have low rates of suicide

      I think you will agree that such countries rarely report ANYTHING that is perceived to show them in a negative light. Abuse of foreign workers, abject poverty etc. Apparently they have none of that either!

      So I would take the report with a large grain of salt!

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