I am returning to akhilvaani after a month. Was bogged down due to professional responsibilities. But all along the four words that remained in the back of my mind perpetually are “Mission Zero Suicide India”.

Today I intend to discuss, the topic which has been bothering me since march.

On this year’s World Health Day 7th March, 2017 ( Dedicated to the theme Depression: Let us Talk) when I first raised the “issue of Mission Zero Suicide India”, I thought I was dreaming of an utopia (most still feel I am). I also thought I was giving birth to a brand new idea.

Today I dare say “Mission Zero Suicide India” is not utopia or a pipe-dream. Rather it is inspirational and most audacious BHAG (Big Hairy Audacious Goal) worth chasing and  eminently achievable.

By now i also know that “Mission Zero Suicide” is not my innovative idea. It is rather new goal being pursued internationally and the idea at least started formally at Detroit, Michigan in 2001.

I will return to these a little later.

On the World Health Day while talking in a Workshop on Depression at “Bombay Hospital”  I was visibly disturbed by the dramatic suicide of a Mumbai student by jumping from his room in the five start hotel and filming his suicide plan and releasing in on the social media network.

From that day on wards both  “Mission Zero Suicide India” and “Uptick in fast growing suicide in India” has  been churning my mind.  It has also led to my systematically recording the  news paper reported suicides from all parts of the country and their proximate causes. And what I learn is more disturbing and revealing.

Findings are both humbling and terrifying-

1. Of more than 100 individual cases reported an studied by me, the age group has varied from a tiny 8 year old to an octogenarian 85 year old.
2. The list includes school students, college students, engineering students (four from prestigious IITs Delhi, Kharagpur and BHU), medical students, nursing students, young blue collar workers and white collar executives, PHD and post doc researchers,  laborer, maid and farmers, government employees and officers, film and TV actor, film producer, scribe, army, paramilitary and police jawans and officers, suicides by two full families, house wives, husbands, grand parents,
3. Those committing suicide represent microcosm of both Bharat and India their circumstances of committing suicide has been different but there is a strong causative factor that unifies all the cases.
4. Let us add to the above sample of hundred plus cases-
   • More than one armed forces personnel or paramilitary personnel or police personnel commit suicide daily Actual total per annum is far more
   • As per government of India affidavit to the Supreme Court, for past few years every year more than 12000 farmers commit suicide
   • Every year at least 20000 house wives of India take their life, this year is no exception
   • Every hour at least one Indian student commits suicide
   • Suicide among 15-29 years of age is growing alarmingly fast in India
   • Geriatric suicide is also on uptick
   • Situation in between is no less alarming
5. After a detailed primary and secondary research I have zeroed down my sample size of reporting to 1000. I do not claim any immunity to sampling or sampler error
6. Before analyzing the findings of the sample let us discuss some bare facts-
   • WHO reports globally 800000 to 100000 commit suicide
   • Seen differently, the numbers translate to one suicide at least every 40 second. WHO prognosis is by 2020, it will accelerate to 1 suicide every 20 seconds. And this too is based on incomplete or unreliable data for most low income and developing countries
   • WHO also makes clear that in the age group 15-44 suicide is one of the top three causes of death. A more recent estimate puts it as one of the top two causes of death in the age group 15-29. This is a terrifying picture to look at
   • WHO also reports that in last 45 years, annual number of  completed suicides have seen a growth of 60% world wide. The attempted suicide have grown 20 times faster over the completed suicide cases
7. Etiology of suicide is complex but  by now it is also globally accepted and well recognized that 90 percents suicides belong to two categories-50%  of 90% are the cases with prevalent mental illness and balance 50% are such where prevalence of mental illness  is provable or proved by psychological autopsy
8. Another WHO study of 2014, reports that in 2012, number of Indians who committed suicide stood at 258075, ranking India as No-1 country with regard to completed suicide. More worry some is the finding that in the age group 14-29 the suicide rate is abnormally high- 35 suicides per 100000 population.
9. Another sad commentary in the context of suicide and suicide attempt in India is that despite bold provisions in Mental Health Care Act, 2017, due to dogged continuation of Section 309 in Indian Penal Code, attempt to suicide remains a criminal offence and who so ever attempts to commit suicide can be fined or imprisoned for one year or both. Prevalence of this Section despite two recommendations of Law Commission of India to scrap it from the statute book remains the biggest deterrent in even knowing the exact number of suicides in the country
10. Another more pernicious but associated issue is that dated (present statistics is two year old) suicide reporting is done by National Crime Record Bureau (NCRB) as if it is collecting data of criminals and the source is police records. The country is yet to come to terms with the fact that the Suicide, Suicide Attempt and Suicidal Ideation is today the single biggest preventable public heath epidemy.
11. Even incomplete and unreliable NCRB data reports 17.3 percent increase in one decade between 2005 and 2015 (well ahead of decadal population growth). But rea problem is its pedestrian and stereo type reporting without doing the root cause reporting. As if no one wants to bell the cat, the NCRB report provides , too many reasons of suicide- “professional career problems, discrimination, sense of isolation, abuse, violence, family problems, insanity, mental disorders, drug abuse and addiction to alcohol, financial loss, chronic pain”.
12. Of varied causes, sadly NCRB latest data reports highest 38%  to other causes and causes not known following by non-explained family problems. Such an analysis is plain stupid work of untrained people. Its other causal explanations are as pedestrian. Sadly in the category of illnesses, word insanity is also mentioned which is an outright insult on the psyche of 21st century India.

Now let us move to findings from my own sample of 1000 suicides reported in 2017 (actual will be much more but i had both time and resource constraint)-

Here are some simple conclusions from the study-

1. All age groups are reported in the sample-and all caste, class, religion too are reported
2. The conclusions are in sharp contrast with governmental statistics
3. Largest group of completed suicide, belongs to 14-29. The sample also includes suicides of 8 years old and 85 year old
4. Students suicides is growing fast, a number not well reported or analysed in NCRB statistics
5. Barring few exceptions, almost every suicide is committed under state of severe stress/distress including mental illnesses
6. It is proven from the sample that extreme stress is behind more than 90% of completed suicide

Quite clearly the problem of completed suicides, attempted suicide and suicidal ideation is humongous, rather is of monstrous proportion. But more important is totally preventable nature of suicide and it raises the moot question as to what can be done to better detect and treat Individual Indians with suicidal ideation and thoughts before they reach that state of point of no return. Present gvernmental and societal appreciation of Public Health Nature of Suicide is alarmingly poor and any effort to contain it grossly absent.

It is in this context that the idea of “Mission Zero Suicide India” takes center stage. It is not a romantic utopia. It is asserted that it is a goal worth pursuing.  The goal of zero suicide may look radical or antithetical to common sense thinking.

But it is this radical thinking which contains the seed of final success. And this is not my brand new idea. I am at least 17 year behnd in talking about mission zero suicide. Today this bold new way of talking about suicide prevention is sweeping the world and internationally it has become the new buzz word. Many countries and cities are embracing the concept fact.

My proposition is let we Indians take a vow to make India free from tragic experience of suicide and suicide attempt. If India can be cholera free, plague free, small pox free and free of new cases of polio, incidence of suicide too can be modularly controlled first and then eliminated. It will need systemic changes and stratified approach and it will be long war. A Mission Mode will be need of the hour.  Separate intervention, in different target groups will be needed.

Let us read the following quote-

“In 2001, the Behavioral Health Services division of Henry Ford Health System set out to radically transform its mental health care delivery system by participating in the Robert Wood Johnson Foundation’s “Pursuing Perfection National Collaborative.” Our “Perfect Depression Care” (PDC) initiative leveraged the power of an audacious goal — eliminating suicide — to achieve dramatic and sustained reductions in patient suicide, as well as improved performance of our entire delivery system. The goal of zero suicides has since become an international movement.”

If there is doubt about the efficacy of Mission Zero Suicide India, open the following link, and make your own conclusions-

“http://catalyst.nejm.org/dramatically-reduced-suicide/”

The above case story is the stellar success of Mission Zero Suicide” any where in the world.

If you are convinced like me that suicide in India is preventable, it is a public health calamity , it is controllable and we must eliminate it, join hands , let us make a national umbrella and start thinking how.

The purpose of this blog is to start the discussion on how How to Make Mission Zero Suicide India possible