World Mental Health Day 2019: focus on Suicide Prevention

  • By Dr Aung Tun (Ministry of Health and Sports)

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The World Mental Health Day is a global Mental Health Day celebrated every year on October 10 with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. The Day provides an opportunity for all stakeholders working on mental health issues to talk about their work, and what more needs to be done to make mental health care a reality for people worldwide. The main theme of 2019 World Mental Health Day is ‘Suicide Prevention”.

Every 40 seconds, someone dies by Suicide
Suicidal behaviour has existed throughout history, but due to several complex things, it’s increased gradually in all areas of the planet and, in the past couple of decades, has reached alarming statistical levels.
According to WHO, more than 800 000 people die by suicide a year and there are several individuals who attempt suicide. Every suicide is a tragedy that contains long-term results on the people left behind and affects families, communities and countries. Suicide occurs during the lifespan. With regard to age, suicide rates are highest in persons aged 70 years or over for both men and women in almost all regions of the world. In 2016, Suicide was the second leading cause of death among 15-29 year-olds globally.
Suicide does not only occur in high-income Nations, but is a global Happening in most areas. In reality, over 79 percent of global suicides occurred in low- and middle-income countries in 2016.However, since suicide is a sensitive issue, and even illegal in some countries, it is very likely that it is under-reported.
Suicide rates vary by sex. In high-income countries, three times as many men die of suicide than women do, but in poor countries, the male to female ratio is much lower at 1.5 men to each woman. Globally, suicide accounts for 50% of all violent deaths in men and 71% in women.

Current situation of Suicide and Suicide attempts in Myanmar
In 2001, WHO, in collaboration with UNAIDS, UNESCO, and UNICEF, and with technical assistance from the US Centers for Disease Control and Prevention (CDC), initiated the development of the Global School-based Student Health Survey (GSHS). Since 2003, Ministries of Health and Education around the world have been using the GSHS to periodically monitor the prevalence of important health risk behaviours and protective factors among students. School Health Division of Department of Public Health conducted the Myanmar GSHS during 2007 and 2016. The purpose of the GSHS is to provide accurate data on health behaviours including suicidal behaviours and protective factors among Myanmar students.
According to Myanmar Global School-based Student Health Survey 2007, in MYANMAR, overall, 1.1 % of students seriously considered attempting suicide during the past 12 months. Male students (1.1 %) are significantly more likely than female students (1.2 %) to seriously consider attempting suicide. Overall, 0.1% of students made a plan about they would attempt suicide during the past 12 months. Male students (0.1%) are not significantly than female students (0.1 %) to seriously consider attempting suicide.
According to Myanmar Global School-based Student Health Survey 2016, in MYANMAR, overall, 9.2 % of students seriously considered attempting suicide during the past 12 months. Female students (10.6 %) are significantly more likely than male students (7.6 %) to seriously consider attempting suicide. Overall, 8.4% of students made a plan about they would attempt suicide during the past 12 months. Female students (11.2%) are not significantly than male students (10.3 %) to seriously consider attempting suicide.
Hence we can conclude that mental health indicators concerning suicide among young people; consider suicide, plan to suicide and attempted suicide are increasing nine times in a recent decade.
According to the latest WHO data published in 2017, suicide death in Myanmar reached 2323 or 0.59% of total deaths. The age- adjusted Death Rate is 4.49 per 100,000 of population ranks Myanmar # 153 in the world.

Risk factors for Suicide
People of all genders, ages and ethnicities can be at risk.
While the connection between suicide and mental disorders (in particular, Depression and alcohol use disorders) is well recognized in high-income countries, several suicides happen impulsively in moments of emergency having a breakdown in the capacity to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.
Additionally, experiencing violence, conflict, tragedy, abuse, or loss and a feeling of isolation are firmly associated with suicidal behavior. Suicide rates are too high amongst vulnerable groups who experience discrimination, like refugees and migrants; native peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and offenders. Definitely the most powerful risk factor for suicide is a previous suicide effort.
It’s estimated that around 20% of global suicides are expected to Pesticide self-poisoning, the majority of which occur in rural regions in low- and middle-income nations. Other common methods of suicide are firearms and hanging.

The warning signs of Suicide
The behaviors listed below may be signs that someone is thinking about suicide.
/ Talking about wanting to die or wanting to kill themselves
/ Talking about feeling empty, hopeless, or having no reason to live
/ Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
/ Talking about great guilt or shame
/ Talking about feeling trapped or feeling that there are no solutions
/ Feeling unbearable pain, both physical or emotional
/ Talking about being a burden to others
/ Using alcohol or drugs more often
/ Acting anxious or agitated
/ Withdrawing from family and friends
/ Changing eating and/or sleeping habits
/ Showing rage or talking about seeking revenge
/ Taking risks that could lead to death, such as reckless driving
/ Talking or thinking about death often
/ Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
/ Giving away important possessions
/ Saying goodbye to friends and family
/ Putting affairs in order, making a will

Suicides are preventable
Suicides are preventable. There are a number of ways that can be taken at population, inhabitants and individual levels to stop suicide and suicide attempts. These include:
/ reducing access to this means of suicide (e.g. pesticides, guns, certain medicines );
/ reporting by media in an accountable way;
/ school-based interventions;
/ introducing alcohol policies to reduce the harmful use of alcohol;
/ premature diagnosis, treatment and care of individuals with mental and substance use disorders, chronic pain and acute emotional distress;
/ the practice of non-specialized health employees in the assessment and management of suicidal behaviour;
/ follow-up care for men and women who attempted suicide and provision of community support.

Working towards a comprehensive national response for suicide prevention
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. Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.
Suicide is a complex issue and so suicide prevention efforts require collaboration and coordination among multiple sectors of society, including other organizations such as education, labor, agriculture, business, justice, law, protection, politics, and social media and the healthcare sector. These attempts must be comprehensive and incorporated as no single strategy could make an impact on an issue as complicated.
National and regional governments need to mobilize and coordinate the various sectors and define a culturally-specific response through a national strategy which aims for at least a 10% reduction in the suicide rate initially, as agreed in the WHO Mental Health Action Plan 2013-
2020, and a reduction by one third by 2030 according to the SDGs. A strong health system and universal health coverage are fundamental to improved mental health and suicide prevention.
Communities play a crucial role in suicide prevention. They can offer social support to vulnerable people and take part in follow-up maintenance, fight stigma and encourage those bereaved by suicide.
Currently, the Ministry of Health and Sports is committed to promoting and maintaining the mental health status of Myanmar people through various health care services including mental health promotion and prevention, with the support and participation of the related ministries and sectors, international and local NGOs and the community as a whole. However, specifically youth-focused mental health promotion and prevention programs including suicide prevention under Myanmar Youth Policy should be implemented as joint efforts between the Ministry of Health and Sport, the Ministry of Education and the Ministry of Social Welfare in collaboration with related ministries.
Let’s work together to prevent suicide!

-Live Life: Preventing Suicide, WHO, 2018
-Message from WFMH President,WMHD2019, WFMH, 2019
-Myanmar GSHS Reports, SH, DOPH, MOHS 2007, 2016
-‘Preventing Suicide: A Global Imperative”, WHO, 2014
-Suicide In America: Frequently Asked Questions, NIH, USA, 2019
-World Mental Health Day 2019 Toolkit, WHO,2019

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