This year’s World Mental Health Day, might have come and gone, but the good thing is that it has left a message that would continue to challenge individuals irrespective of race and world leaders to hold fast all efforts and public policies towards prevention of suicide, a potential consequence of mental health.
With theme: “Suicide Prevention,” the aim according to World Federation of Mental Health was to attract attention of governments so that the issue might be given priority in public health agendas around the world.
Suicide, according to experts is killing oneself either with implicit or with explicit intent. Implicit intent means that the individual really wants to die and he actually killed himself, explicit means that he may not have thought of dying but through hallucination or through any other mental illness he eventually finds himself doing an action of destruction that is self directed at that point.
The World Health Organisation (WHO) fact sheet records that close to 800, 000 people die due to suicide every year which is one person every 40 seconds, for every suicide there are many more people who attempt suicide every year, suicide is the second leading cause of death among 15 – 29 year-olds, 79 per cent of global suicide occur in low-income countries and ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally.
In Nigeria, there has been a lot of arguments as to whether it is on the rise or less because of knowledge, Honorary Consultant Psychiatrist, Grace Cottage Clinics / Lecturer University of Lagos, Dr. Peter Ogunnubi, said either way nobody can argue it because research has not been done earlier on but if we had had earlier researches, it would have helped us to know the base line, what it used to be before and what it is now.
But because suicide was a crime and still a crime and suicide used to be highly stigmatised in society then, people will tell you it’s a shame for anybody in the family to have died of suicide so they will cover it up, but people are coming up now to say so that others can learn. So could it be because of more publicity or because of economy problem, unemployment, terrorism here and there, financial problems, burdens, poor healthcare delivery system, so many things in Nigeria that could have made this to be high incidence and prevalence but either way, we are knowing more about suicide and seeing more of it.
Symptoms /signs of suicidal behaviour
Unlike other illnesses and diseases that have signs associated with them, suicide according to Ogunnubi has no symptoms because it is the act of killing oneself, which makes death the only symptom.
His words: “However, there are spectrums, for example you have suicidal ideation, that’s the first thing that happens, someone will have an idea that what if I kill myself , then he or she will shelve the idea and move on. After some time, the suicidal idea becomes suicidal intent. In suicidal intent, the person actually didn’t want to die but he is still thinking about it so it is on and off.
“When he is happy, everything is okay but the moment he is down, he goes back to suicidal behaviour, so that’s intent, he really wants to do it, it’s no longer idea. Then the next thing is suicidal plan, oh let me use gun, let me use insecticide, different things so he is now planning on what to do, I will write a letter, I will allow them to leave home; and after that, you have suicidal attempt. So it is first an idea, it turns to intent if nothing is done, it becomes a plan, if nothing is done, it becomes an attempt so you see people attempting suicide. It is the attempted suicide that amounts to suicide if he succeeds, if he does not succeed, you say the person has attempted suicide.”
Signs associated with suicide
The health expert enumerated signs associated with suicidal behavior to include: loneliness, depression, having a feeling of worthlessness, helplessness they will not want to interact, they feel they are failures, they feel they are not amounting to anything, dejected, totally cut out, repulsive, some get angry.
“Others can be addiction, some people will be so addicted and then they will be hearing voices, some take substances and those substances will make them to be psychotic, some have psychotic symptoms as seen in schizophrenia, where the voice will be telling them to kill themselves.
“Anyone that wants to commit suicide will not go to work, will not do anything, some will however be laughing with you but you will not know what they have in their mind so you have to be very suspicious.
“Another thing about suicide is that you must look out for high risk factor like unemployment, someone that had a marital breakdown, someone with chronic conditions that hope seems to be lost,” enlightened the mental health expert.
Societal role in suicide
Nothing in life happens without having a link from the society or environment that people find themselves. The increasing rate of suicide in Nigeria has been linked to the vacuum that has been created in our extended family system and communal living. Lack of care for another person’s welfare, lack of trust, religious fanatism, advent of the internet, social media, harsh policies and hard times and the media reportage on the subject matter have been speculated to have in one way or the other contributed to the high rate of suicides / suicidal attempts in Nigeria.
Eroding extended family structure
Highlighting the above mentioned, the Grace Cottage Clinic MD said, “It’s quite unfortunate that Nigeria and Africa as a whole are gradually drifting away from the extended family structure that we used to have where then we used to be our brother’s keeper, we used to watch over each other, be there for one another, you can imagine a woman at work will not have to be rushing home to pick the children from school because the school bus will eventually drop them with the neighbours, they will be fed by the neighbor and when the woman comes back, she will just go and pick them there, they may even be asleep by then.
“But what concept do we have now, everyone on their own and this has made our extended structure to be more nuclear oriented so the co-existence that we share is gradually eroding.”
Societal stress/ borrowed western culture
“The stress of the society, people trying to look for their daily meals, not watching each other’s back again. People will tell you that they have not even eaten not to talk of your own, that their problems are enormous than yours, that they have not even sorted their own. So all these are borrowed westernized culture, science and technology, youths looking up on the internet thousands of ways to die, thousands of things on the internet where people can actually contact them or they can help one to kill themselves, different games that have different levels that will ultimately lead to suicide.
“Different preaching, religious fanatism, that, if you kill yourself for the sake of God, you will go to heaven to enjoy.
“Different narratives in the media, how they narrate suicide act from the beginning to the end, even supporting it with pictures, makes things to become worse because it creates what we call copy-cat-suicide. The media can just narrate that so and so person was found dead in his house haven killed or poisoned himself, telling the story from point to point suggests that your are being suggestive, there may be some one that is watching or reading the news and may eventually want to do the same. I have a patient that said he first attempted suicide was from the TV when she watched how a young man died and that she really craved for that because she had been a weakling because suicide is not easy to be carried out, it’s an oxymoron, people are depressed and the next thing, they take on the strongest act on earth which is the act of killing one self, so that’s how you know that it is not quite due to weakness or personality defect because suicide is a strong action, so she said she envied the guy and said if that guy could do it, she could also do it.
“So when you mix all these things together, the narratives, change in conjugality, inclusion of the westernized culture, science and technology, social media – I have 1000 likes after almost 6 months but my friend putting his own picture, after 1 day, 35, 000 likes, 18, 000 shared and that put me in a state of despondency and the next thing I told myself was that nobody cares for me, even my friends on facebook don’t like me and the next thing I told myself was to exit the world which does not like me.
“Most people that commit suicide have a reasoning defect either through hearing or hallucination, wrong perception, a state of depression, hopelessness, helplessness, or an aggression. Some do it because they just want to be observed. For example, most people that commit suicide never intended to die of suicide, some are just a deliberate self harm, turned more fatal, but once you die through your own action, against natural death it’s suicide, some are due to medical problems, it can be through hallucination, deliberate self harm or attention seeking but the fact is that you killed yourself and that’s why it is suicide. Most due to mental illness, so you have to first rule out mental illness in any act of suicide before you conclude that it is either attention seeking that turned the other way,” stressed the expert.
How / where to find help
Although there are no known national suicide prevention strategies by the Nigerian government, groups and individuals have however put some measures in place to help people and one of such is SURPIN – Suicide Research and Prevention Initiative of Nigeria, now in over 13 state, it was originally started in LUTH, because of the vacuum in suicide prevention in Nigeria. Other NGOs and hospitals like, Dr. Ogunnubi’s Grace Cottage Clinic in affiliation with Mind Plus Practitioners, are also offering help to a lot of people with mental illness. Those who need help can reach Grace Cottage Clinic on this toll free line- 09090 10055. SURPIN could be reached on 09080217555, 09034400009, while the Lagos suicide hotline by Lagos state government are 08058820777 and 09030000741.