Suicide is a global public health issue, with the majority of suicide fatalities happening in low- and middle-income nations (LMICs). People aged 60 and over have a higher risk of suicide than those of lower ages across the world.
During the pandemic, a comprehensive assessment of suicide fatalities in LMICs found “a reduction or no change in suicide and self-harm behavior.” In contrast, an examination of Indian news sources revealed that suicide fatalities may have increased in March-May 2020 compared to the same time in 2021. The National Crime Records Bureau (NCRB) compiles official suicide data in India in the yearly Accidental Deaths and Suicides Report.
This NCRB data gathering method has been chastised for its lack of thorough medical review and reporting of cause of death, implying that not all deaths or suicides are recorded. 4 The Global Burden of Disease Study5 estimated 230 000 suicide deaths in India in 2016, whereas the NCRB recorded 131 008 fatalities in the same year.
According to NCRB figures issued on October 28, 20216, the number of suicides among adults aged 60 and older increased significantly in 2020 compared to 2019. (table). This growth occurred at a larger rate for older women (218%) than for older males (183%). In India, the more deadly second wave of COVID-19, which occurred from March to April 2021, is not included in the cited timeframe. Suicide fatalities have increased as a result of pandemic-related disturbances including unemployment, economic recession, and migratory difficulties. These interruptions might have had a variety of direct and indirect consequences on elderly people’s mental health.
Suicide is a very personal and unique act, yet it is also influenced by a variety of personal and societal variables. The dispute over individual susceptibility vs. social pressures in the aetiology of suicide has split our thinking on suicide since Esquirol remarked, “All people who committed suicide are mad,” and Durkheim suggested that suicide was an effect of social / societal conditions. Suicide should be viewed as a multifaceted, complex illness. Suicide is seen as a societal problem in our society, therefore mental illness is given the same conceptual weight as family difficulties, social maladjustment, and so on.  According to government statistics, roughly 43 percent of suicides have no known cause, while sickness and family issues account for about 44 percent.
MENTAL HEALTH AND SUICIDE
Suicide is caused by a complex web of factors, one of which is mental illness. According to the majority of research, over 90% of persons who commit suicide have a mental illness.  The number of published publications particularly examining the mental diagnoses of patients who commit suicide (n = 15629) is quite modest. The majority of these reports originate from Europe and North America (82.2 percent), with only 1.3 percent from poor nations.  In India, two case control studies employing the psychological autopsy approach were carried out in Chennai and Bangalore. In Chennai, 88 percent of individuals who died by suicide had a diagnosable mental disease, while in Bangalore, 43 percent had a diagnosable mental disorder. The Bangalore research, on the other hand, did not include diagnostic assessments.
Affective disorders are the most common condition linked to suicide, according to several specialists. Mood problems were determined to be the cause of 25% of completed suicides in Chennai. When suicide patients with adjustment disorder and sad mood were included, the suicide rate rose to 35 percent. Depression’s critical and causative role in suicide has little relevance in India. Even those who were depressed had only mild to moderate symptomatology and were only depressed for a short time. More over 60% of depressed suicides had just mild to severe depression, and the majority of patients committed themselves during their first episode of depression.  Alcoholism has a substantial influence in suicide in India, despite the fact that social drinking is not a way of life.
In 35% of suicides, alcoholism and abuse were discovered. Thirty to fifty percent of male suicides were committed while under the influence of alcohol, and many spouses have been pushed to suicide by their alcoholic husbands. Not only were there a lot of alcoholic suicides, but many of them came from alcoholic households, started drinking early in life, and were strongly dependent on it. In Chennai, the odds ratio (OR) for alcoholism was 8.25 (confidence interval: 2.9-3.2) while in Bangalore, it was 4.49 (CI 2.0-6.8).  Suicides by people suffering from schizophrenia account for around 8% of all suicides in India. According to Srinivasan and Thara, the male-to-female ratio for schizophrenia suicides is roughly equal.
Suicides in clusters
Suicide clusters, which are a sequence of suicides that occur mostly among young people in a limited location over a short period of time, receive a lot of media attention. These can spread like a virus, especially if they’ve been glamorised, leading to imitation or “copycat suicides.” This phenomena has been noticed several times in India, particularly following the death of a celebrity, most commonly a movie star or a politician. Suicides have increased as a result of the widespread media coverage of these suicides. It is also fairly unusual for people to copy tactics seen in movies. This is a severe issue, particularly in India, where movie stars have legendary stature and exert great influence, particularly among the youth.
Concerns about the law
Attempting suicide is a criminal offence in India. “Whoever attempts to commit suicide and undertakes any act towards the commission of such an offence will be punished with simple imprisonment for a time which may extend to one year, or with a fine, or with both,” according to Section 309 of the Indian Penal Code.
However, the law’s goal of preventing suicide by legal means has shown to be ineffective. Many hospitals and practitioners refuse to offer emergency care to persons who have tried suicide because they are afraid of legal repercussions. It’s difficult to get accurate data on attempted suicides since many attempts are classified as “accidental” to avoid getting into trouble with the cops and the courts.
PREVENTION OF SUICIDE
Even among health experts, the belief that suicide cannot be avoided is widespread. This pessimistic attitude might be explained by a variety of beliefs. The most important of these is that suicide is a personal affair that should be decided by the individual. Another idea is that suicide cannot be prevented since important variables, such as unemployment, are societal and environmental circumstances over which a person has little influence. However, for the vast majority of people who engage in suicide behaviour, there is almost certainly a better way to deal with the underlying issues. Suicide is frequently a long-term solution to a short-term problem.
On the basis of how their target groups are defined, Mrazek and Haggerty’s paradigm classed suicide prevention interventions as universal, selected, or suggested. The goal of universal treatments is to shift proximal or distal risk variables throughout the whole population in a positive way. Selective treatments are directed at subgroups whose members do not now display suicide behaviour but do have risk factors for doing so in the future. The indicated interventions are for those who are already thinking about or acting suicidally.
NON-GOVT. ORGANIZATIONS (NGOs)
India is plagued by infectious illnesses, malnutrition, infant and maternal mortality, and other serious health issues, therefore suicide is a low priority in the race for little resources. The country’s mental health services are woefully insufficient. Only roughly 3,500 psychiatrists serve a population of over a billion people. Social instability and hardship are being caused by rapid urbanisation, industrialization, and the emergence of new family arrangements. Traditional support structures are eroding, leaving people exposed to suicidal conduct. As a result, there is a growing demand for outside emotional assistance. The vastness of the problem, along with the scarcity of mental health services, has resulted in the formation of non-governmental organisations (NGOs) dedicated to suicide prevention.
The fundamental goal of these non-profits is to befriend suicidal people and offer them assistance. These centres are frequently used as a starting point for those seeking professional help. Apart from befriending suicidal people, NGOs have also conducted gatekeeper education, public and media awareness campaigns, and intervention programmes. However, the operations of NGOs are constrained in several ways. The skills of their volunteers as well as the services they give vary greatly. The bulk of their attempts are not reviewed, and their quality control systems are ineffective.
Suicide mortality in poor countries can be reduced with rapid, low-cost interventions, according to the World Health Organization’s (WHO) suicide prevention multisite intervention study on suicidal behaviours (SUPRE-MISS).
In India, there is a pressing need to build a national suicide prevention strategy. The priority areas are reducing pesticide availability and access, reducing alcohol availability and consumption, promoting responsible media reporting of suicide and related issues, promoting and supporting NGOs, improving the capacity of primary care workers and specialist mental health services, providing support to those bereaved by suicide, and training gatekeepers such as teachers, police officers, and alternative system of medicine and fai practitioners.
World Suicide Prevention Day is celebrated on September 10th. On September 10, 2003, the World Suicide Prevention Day was formally declared. Every year, the International Association for Suicide Prevention (IASP), in partnership with the World Health Organization (WHO), utilises World Suicide Prevention Day to raise awareness about suicide as a primary cause of early and avoidable death. “Suicide Prevention—Across the Life Span” is the theme for 2007. It emphasizes that suicide affects people of all ages, and that suicide prevention and intervention measures may be tailored to fit the requirements of all age groups. The subject is expected to focus on vulnerable, marginalized, and stigmatized populations, as well as bring together researchers, doctors, society, legislators, policymakers, volunteers, and survivors in a coordinated effort.
Suicide is a complicated problem, and as a result, suicide prevention programmes should be as well. To establish and implement a national plan that is cost-effective, suitable, and relevant to community needs, collaboration, coordination, cooperation, and commitment are required. Suicide prevention in India is more of a social and public health goal than a standard mental health treatment. Mental health practitioners must take proactive and leadership roles in suicide prevention in order to save the lives of thousands of young Indians.
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