Narrative report of world suicide prevention day 2015

Background of Issue

According to the recently released World Health Organization (WHO) report: Preventing Suicide: A Global Imperative, over 800,000 people die by suicide across the world each year. The report notes that this estimate is conservative, with the real figure likely to be higher because of the stigma associated with suicide, lack of reliable death recording procedures, and religious or legal sanctions against suicide in some countries. We may not be able to pinpoint the exact figure, but we do know that each individual suicide is a tragic loss of life. It is hard to imagine the extreme psychological pain that leads someone to decide that suicide is the only course of action. Reaching out to someone who is struggling can make a difference.Commemoration of World Suicide Prevention Day, 10th September 2015.

As per Nepal Police, there were 4,350 suicide incident recorded in the fiscal Year 2071/072(16th July 2014-15th July 2015). Similarly, the recent devastating earthquake and its repeated frequent aftershocks which killed thousands of people in the country and have increased another dimension of suicidal risk amongst its survivors. Ever since this terrible incident there has been reported completed suicides and also suicidal ideation amongst the now vulnerable Nepalese population. The tragedy and effects of this earthquake has had a psychological impact and there is a fear that as a result a propensity toward suicidal attempts are emerging. This has derailed relief to Nepalese persons on a grassroots level and could potentially have some role for creating frustration or depressive environment amongst the people of Nepal. In this context, there is a prime need for proper relief and psychological counseling to the risk people must be made available to prevent further deprivation and potential suicidal losses.

The International Association for Suicide Prevention (IASP) and the World Health Organization (WHO) are committed to preventing suicide. These organizations recognize World Suicide Prevention Day as an important day in the international calendar. World Suicide Prevention Day brings together individuals and organizations with an interest in suicide prevention, and mobilizes efforts to save lives. Since 2010, Nepal has been also celebrating World Suicide Prevention Day in the country from non government organization in closed coordination and support with WHO and Nepal Government specially Ministry of Health and Population. In the year 2015, Nepal Health Society (NHS) is also taking the leading role to celebrate the World Suicide Prevention Day in 10th September in the country because we feel the prime need to connect one world for suicide prevention activities. In Nepal, activities for prevention of suicide have not been adequately addressed due to a lack of awareness of suicide as major public health issues and the existing taboos in Nepalese society to discuss openly about it. There have not any interventions for suicide preventive and care in the country from government and non government side. It is needed of urgency of national policy of suicide prevention and care. Need based research with scientific evidences also should be addressed to effective suicide prevention intervention in the country.

Participants of the World Suicide Prevention Day 2015 in open floor discussion.

“Preventing Suicide: Reaching Out and Saving Lives“ sis the theme of the 2015 World Suicide Prevention Day (WSPD), an initiative of the International Association for Suicide Prevention (IASP) and the WHO, a co-sponsor of meetings and events related to WSPD 2015. Since 2003, WSPD has taken place on 10th September each year. It serves as a call to action to individuals and organizations to prevent suicide. This year, the theme encourages us all to consider the role that offering support may play in combating suicide.The act of showing care and concern to someone who may be vulnerable to suicide can be a game-changer. Asking them whether they are OK, listening to what they have to say in a nonjudgmental way, and letting them know you care, can all have a significant impact? Isolation increases the risk of suicide, and, conversely, having strong social connections is protective against it, so being there for someone who has become disconnected can be life-saving.

Reaching out to the suicide prevention community.

There is strength in numbers. Around the globe, many individuals and organizations are involved in efforts to prevent suicide. We can learn from each other, and strengthen the evidence base for effective interventions. Reaching out to those who are travelling the same road increases the likelihood that our collective efforts to reduce the numbers of people who die by suicide, and the numbers of people for whom these deaths have shattering effects, will be successful.

Reaching out to those who have been bereaved by suicide.

Suicide is devastating for families; friends and community members who are left behind. They may experience a whole range of emotions, including grief, anger, guilt, disbelief and self blame. They may not feel that they can share these overwhelming feelings with anyone else. Therefore, reaching out to those who have lost someone to suicide is very important. As a result of the stigma surrounding suicide, those who are bereaved by suicide are often perceived differently from those who lose a family member through another cause of death. People who are bereaved may find that they are avoided by people who don’t know how to broach the subject or offer their condolences. Or they may just feel that others do not understand the intensity of their emotional response to the death of their loved one. Once again, a pro-active approach and offering a sympathetic, non-judgmental ear can make all the difference. Giving someone who has been bereaved by suicide the opportunity to talk about their loss, in their own time, on their own terms, can be a precious gift. Allowing them to express their full range of feelings can be cathartic and can help them to take the first small step in moving through their grief. Starting the conversation may be difficult, but it will almost certainly be appreciated.

Reaching out to put people in touch with relevant services.

Although the support of friends and relatives is crucial for people who may be at risk of suicide and for people who have lost someone to suicide, it is not always enough. Often more formal help is also needed. Such help can take many forms, and is likely to vary from country to country. In high-income countries, it may include specialist mental health services and primary care providers, both of which offer clinical care. It may also include a range of community organizations which provide non-clinical support, as well as support groups and self-help groups. In low- and middle-income countries, the more clinically-focused services are less readily available, and there is a heavier reliance on community organizations. Part of reaching out to vulnerable individuals can involve helping to link them to relevant services.

Reaching out on World Suicide Prevention DayOn September 10th, join with others around nation and the world who is working towards the common goal of preventing suicide. Check in on someone you may be concerned about, listen to what they say, how they say it and show them kindness and support. Investigate ways of linking in with others who are trying to prevent suicide in our community, our country, or internationally. Show our support by organizing or taking part in a World Suicide Prevention Day activity in our community and/or join in with IASP’s Cycle Around the Globe.

National scenario of suicide incident in Nepal:

Fiscal Year 2071/072(16th July 2014-15th July 2015)
• 4, 350 suicidal incidents were recorded
• 11-12 person died by suicide per day in an average

Fiscal Year 2061/062 to 2071/072 (16th July 2004- 15th July 2015)

• 36,402 suicide incidents were recorded

(Sources: Nepal Police)

Major Risk Factors for Suicide Incident in Nepal
Social factor, Economic factor, Family factor, Psychological factor, Physical health factor and
Others factor

Program introduction:

On 9th and 10th September, 2015, as one of the pioneer national level non government organization of Nepal advocating for suicide prevention activities in the country, Nepal Health Society (NHS) organized a national level advocacy workshop and press meet in the occasion of observing World Suicide Prevention Day 2015 with the slogan ‘Preventing Suicide: Reaching Out and Saving Lives’. The chief guest of the program was Dr. Som Lal Subedi, Chief Secretary of Office of Prime Minister and Ministry of Council, Government of Nepal and special guests of the program were Mr. Shanta Bahadur Shrestha Secretary of Ministry of Health and Population, Mr. Mingmar Lama, Deputy Inspector General of Police (DIGP), Police Head Quarter Nepal, Dr. Ros Vandelaer, WHO Representative for Nepal, Dr. Nirakar Man Shrestha, Senior Consultant, Psychiatrist and Former Secretary, Ministry of Health and Population and Mr. Lav Kumar Mainali, Senior Advocate of Nepal and Mr. Suraj Shakya, Psychologist. This program was organized by Nepal Health Society in the coordination of Ministry of Health and Population, Government of Nepal and with the financial support of World Health Organization, Country Office for Nepal.

Commemoration of World Suicide Prevention Day, 10th September 2015

In the program suicide prevention activists, governmental officials of different ministries, representatives from UN agencies, Legal profession, health professional, Academician, N/INGOs, person of suicide survivor and their family, Students, sports personnel, journalists, and civil society were participated in the program. The program was organized Hotel Shanker, Lazimpat, Kathmandu to highlight the issue among concerned higher level governmental authorities and other concerned stakeholders. There were 101 national level stakeholders and media participated for observing the World Suicide Prevention Day 2015 to make suicide prevention: slogan ‘Preventing Suicide: Reaching Out and Saving Lives’ to international level to each of the individual, family and community of Nepal. 

Similarly, dated 9th September 2015, Nepal Health Society organized “A Press Meet in the issue of World Suicide Prevention Day 2015” targeted to national level electronic and press media to sensitize the issue of the suicide prevention and management in the country.

“A Press Meet in the issue of World Suicide Prevention Day 2015” targeted to national level electronic and press media to sensitize the issue of the suicide prevention and management in the country.

Objective of celebration of World Suicide Prevention Day 2015:
The major objective of the celebration of World Suicide Prevention Day 2015 was to initiate advocacy and sensitization to authorities of policy makers/planners and the mass general public for influencing policy makers and planner to bring out their dialogue and commitment toward prevention of suicide and suicidal attempts in the country. The following were the specific objective of the proposed program.To increase awareness for enhanced understanding of the damaging effects of suicide

• To bring together individuals and organizations with an interest in suicide prevention, and mobilizes efforts to save lives
• To implement interventions in an effort to prevent suicide in the society
• To provide services to help survivors deal with their loss
• To conduct advocacy for strengthening and supportive environment to address the issues of suicide prevention, treatment and care services
• To influence policy level authorities to address the issues of suicide in the plans and policy
• To make effort on slogan ‘Preventing Suicide: Reaching Out and Saving Lives’

Participants and Special guests of the program:

More than 101 national level stakeholders participated in the program of advocacy and press meet from representative of different sectoral activists, higher level governmental officials of different ministries; representative of different UN agencies, legal professional, health professional, police administration, donor agencies, journalists, suicide survival and their families, academician, students, sports personnel and other civil society stakeholders had important presented in the program. The event observed was honored with the presence of chief guest Dr. Som Lal Subedi, Chief Secretary of Office of Prime Minister and Ministry of Council, Government of Nepal and special guests of the program were Mr. Shanta Bahadur Shrestha Secretary of Ministry of Health and Population, Mr. Mingmar Lama, Deputy Inspector General of Police (DIGP), Police Head Quarter Nepal, Dr. Ros Vandelaer, WHO Representative for Nepal, Dr. Nirakar Man Shrestha, Senior Consultant, Psychiatrist and Formet Secretary, Ministry of Health and Population and Mr. Lav Kumar Mainali, Senior Advocate of Nepal and Mr. Suraj Shakya, Psychologist. This program was organized by Nepal Health Society in the coordination of Ministry of Health and Population, Government of Nepal and with the financial support of World Health Organization, Country Office for Nepal.

Participants for World Suicide Prevention Day, 10th September 2015, Kathmandu, Nepal

Program process
The day commemoration of World Suicide Prevention Day 2015 organized in Hotel Shankar, Lazimpat, Kathmandu at Sharp 9 AM with the slogan of ‘Preventing Suicide: Reaching Out and Saving Lives’. There were more than 85 people in the Program and it was started it with the master of ceremony by Ms. Poonam Shrestha, Program Coordinator of Nepal Health Society. First of all the program was begun from the welcome speech by the Executive Director of Nepal Health Society Mr. Rishi Raj Ojha. In welcome speech of Mr. Ojha he focused on propose of observing of World Suicide Prevention Day 2015, he asserts on the urgency of prevention of suicide and its management. He stated that government has not formed and policies and strategies to prevent suicide. Suicide has been one of the major causes for the death throughout the nation. Furthermore Mr. Ojha said daily, 10-11 people died by suicide in Nepal in an average. To address the current problem regarding suicide, he requested Ministry of Health and Population to consider the issue seriously with coordination to non government organizations. Mr. Ojha presented a power point presentation about the current situation of suicide scenario of Nepal and its impact details with need of the intervention and policy for suicide prevention and management in Nepal as well. The objective of presentation was to increase awareness for enhanced understanding of the damaging effects of suicide, to implement programs in an effort to prevent suicide in our society and to influence policy authorities to consider the issue of suicide in their plans and policies. After highlighting the objectives, he talked about the global scenario of suicide and following she talked about national scenario and she offered some ways out to prevent suicide from the society. Moreover the session was guided to find out the gaps that became hazards to prevent suicide in Nepal.
Furthermore, after welcome speech and highlighted of the program issues there were resource person paper presentation in the different issues of the suicide perspective from the different sectoral expertise of suicide issues accordingly which are as followed ;

• Mr. Suraj Shakya, Psychologist ” Suicide, disaster and mental health: Perspective from a Medical Health professional”.
• Dr. Nirakar Man Shrestha, Senior Consultant, Psychiatrist and Former Secretary, Ministry of Health and Population” Suicide – General introduction”.
• Mr. Lav Kumar Mainali, Senior Advocate: Policy and strategy for suicide prevention in the country and analysis of gaps and their recommendations
• Mr. Mingmar Lama, Deputy Inspector General of Police (DIGP) ” Suicide incidence in Nepal”
• Mr. Rishi Raj Ojha, Social worker /Executive Director, Nepal Health Society: Scenario of suicide incident and analysis of their services in the country.

(The detail of the presentation paper attached in the annex)
In addition to this, program moved forward with the floor suggestion from the participants and key remarks of the chief guest and special guest of the event respectively. The floor suggestion and recommendation of the guest and participants have been mentioned in the section of program outcome and recommendation accordingly.

Chief Guest Dr. Som Lal Subedi, Chief Secretary of Office of Prime Minister and Ministry of Council, Government of Nepal said there is big issue of suicide prevention both in developing and developed country. The issues of suicide is mainly come from weak condition of mental distress it is also linkages with economic, education, family relationship and others professional status so we should improve our health environment among them. Due to current modernization of our society as well as new structuring of family from joint structure such type of suicide incident has occurred rapidly in these days so we also improve to keep our family and society smooth relationship within us. Dr. Subedi further said the traditional culture of our society is very good to make balance of people physically and mentally so we also respect such type of culture and applied within our society to prevent such type of unpleasant event specially. Certainly, today our national need a specific mental health strategy and policy along with incorporation of suicide prevention policy however we encourage to implement individual and family counseling services from national to local community level respectively as per emergency crisis management perspective too.
Similarly, Special guest, Mr. Shanta Bahadur Shrestha, Secretary of Ministry of Health and Population accepted with the fact that Government of Nepal has not been able adequately to work on the issues related to suicide. Moreover, he asserted that stigma has become the major problem to work in the issues related to suicide. But he emphasized that suicide attempts depend upon individual decision so that those who work against suicide have to move into the community and have to counsel in the personnel level. He showed his serious concern in the suicide attempts made by young people of Nepal who commit suicide in the traumatic effect of academic results. To address the problem, he claimed, there must be the counseling inside the school or it has to be included inside the curriculum which will finally help to reduce suicide. Furthermore, he showed his serious concerns regarding the issue and also assured to work together the issues of suicide prevention in the days to come. He emphasized that the one of the responsibility of government to prevent suicide and it management in community however government cannot do everything so we request to non government organization to come with together for prevention and management of this issue in every individual, family and society. He also further said that Ministry of Health and Population always ready to workout regarding the strategy for national level policy and we request you all civil society non government organization come with us and make it effective for suicide prevention in the country to develop national policy and strategy to address this issues at community level.

Dr. Ros Vandelaer, WHO Representative addressed in the issue and he argued that this problem is priority of Public Health as well as development issue. Dr. Ros informed that World Suicide Day (WSPD) has been commemorating since 12 years internationally and we are seeing increasing death of people day to day and said a Global Imperative, over 800,000 people die by suicide across the world each year. Dr. Ros further said that WHO is committed to preventing suicide. These organizations recognize World Suicide Prevention Day as an important day in the international calendar. World Suicide Prevention Day brings together individuals and organizations with an interest in suicide prevention, and mobilizes efforts to save lives.The report follows the adoption of the Comprehensive Mental Health Action Plan 2013- 2020 by the World Health Assembly, which commits all 194 member states to reducing their suicide rates by 10% by 2020. Furthermore he said that ‘Preventing Suicide: Reaching Out and Saving Lives’ is the theme of the 2015 World Suicide Prevention Day (WSPD), an initiative of the International Association for Suicide Prevention (IASP) and the WHO, a co-sponsor of meetings and events related to WSPD 2015. Since 2003, WSPD has taken place on 10th September each year. It serves as a call to action to individuals and organizations to prevent suicide. This year, the theme encourages us all to consider the role that offering support may play in combating suicide .

Finally, he said that connectedness is necessary at a national and local level. Many clinical and non-clinical organizations are working towards the goal of preventing suicide, but their efforts are not always synchronized. World Suicide Prevention Day has proved to be very successful in encouraging organizations to coordinate their efforts and learn from each other. It has also assisted those who have been bereaved by suicide in making themselves heard in discussions about suicide prevention. This has sharpened the focus on activities that are effective in preventing suicide. Be part of the connectedness of World Suicide Prevention Day this year. On 10th September, join with others around the globe who is working towards the common goal of preventing suicide. Together, we can shine a spotlight on this major public health problem and ensure that it receives the policy attention that it warrants.

Senor Advocate Mr. Lav Kumar Mainali expressed his ideas on how stigma has been a major challenge to prevent suicide in Nepal. He said that he is in legal field since 40 years and involing in society research field also. In this legal experience, he informed there has some legal punishment written for people who attempted suicide in Nepal however policy has not applicable to victimized family who had already suffer that painful tragic incident of suicide in family. He argued that society has discrimination among mental health patients. He argued that in Nepal, there is the urgent need of qualified and reliable counselor having non judgmental attitude. Academies which produce human resource in psychology are rigorously theoretical having no practical understandings. And, he presented few examples on which suicide attempters were mainly victimized of stigma and discrimination. In one case, the bridegroom got the stigma and finally was compelled to commit suicide. Moreover, he stressed that mental hospital better be closed rather services available in mental hospital should make available in normal regular hospitals. He said that stigma has been a major obstacle to take actions against suicide. Being a survivor of suicide attempt himself, he said that society always has discrimination among people having the issue of mental health.
Dr. Nirakar Man Shrestha, Senior Consultant, Psychiatrist and Former Secretary, Ministry of Health and Population said on his speech during his paper presentation that primary prevention intervention for suicide prevention is prime need in these days society for that 24 hours hotline services should needed. Similarly, the existing stigma and discrimination should be minimized related sucide incident in our society. Mental health is one of the major causes for suicide so it should be early detection and treatment in each of the family. We need psychological and mutual health counseling from trained counselor and psychologist in the community.

Finally, Mr. Mingmar Lama, Deputy Inspector General of Police, Police Head Quarter Nepal: presented in his speech in which he included his experiences regarding mental health. He admitted that it is urgent to address issues regarding suicide among the people from different walks of life. He also said that we are concerned in the issues on behalf of Nepal Police and first of all we need to find the root cause of suicide in our community for this we should do the scientific research based survey in this district where most of the suicide incident occurred. Nepal police has been keeping secondary level data however it is not sufficient so we are trying to keep up to date data as like primary source of data from community level in scientific system in coming days. Further he said that people who try to attempt suicide it should be give legal action to discourage to suicide in the community. He emphasized on his key remarks that comprehensive policy level strategy needed immediately to prevent current scenario of suicide and its management for this Nepal Police always for providing our humble support to Nepal government and civil society non government organizations respectively.
Mr. Suraj Shakya, Psychologist presented his paper on ” Suicide, disaster and mental health: Perspective from a Medical Health professional”. Mr. Shakya said that mental illness & MH issues increases during and after disaster there were 50 to 90% suicides are due to MH issues hence suicide rates might be affected by disaster. Mr. Shakya recommend for suicide prevention center will operate or coordinate helpline/hotline, epidemiological studies, training teachers students, media partnership for public awareness, training health and psychosocial professionals, run bereavement self help group and so on .

After key remarks of chief guest and special guest, and feedback of participants of the program the following achievement and recommendations provided to prevent suicide and its management in the country.
Achievements/Recommendations:

• More than 86 national level stakeholders participated in the program from representative of different sectoral activists, higher level governmental officials of different ministries; representative of different UN agencies, legal professional, health professional, police administration, donor agencies, journalists, suicide survival and their families, academician, students, sports personnel and other civil society stakeholders had important participated in the program for commemoration of World Suicide Prevention Day 2015.

National policy and strategy should be developed and implemented regarding suicide prevention and management intervention

• Clearly defined national policy and strategy for action
• Preventive interventions along with crisis management such as ;
• Awareness raising, sensitization, advocacy, orientation and training
• General awareness of possible harmful effects of stress, so coping skills
• Early detection of warning signs and symptoms
• Effective mental health care: early treatment and care for mental illnesses
• Hot-line services and crisis management.
• Sensitization of family members to create enabling environment for suicide victims
• Provide problem solving skills
• Provision of adequate treatment and follow-up for people who attempted suicide.
• Incorporation of innovative and comprehensive multi-sectoral approaches in both health and non-health sectors such as: education, labor, police, justice, religion, law, politics, civil society, media etc.
• Application of connectedness of one world for suicide prevention
• Authoritarian of open selling of insecticide and pepticide medication
• Reduction of stigma and discrimination to ward suicide cases
• Suicide prevention center will operate or coordinate helpline/hotline, epidemiological studies, training teachers students, media partnership for public awareness, training health and psychosocial professionals, run bereavement self help group and so on

Responsibility of the Government

• Develop national policy frameworks for national suicide prevention strategies.
• Establishment of separate unit of mental health desk related suicide in MOHP
• Generate empirical evidence through scientific research for designing interventions and plans
• Support and coordinate with international and non government organization

Local Level

• Policy statements and research outcomes need to be translated into preventive programs and activities in the community.
• Creating enabling environment to implement the suicide interventions in the community
• Incorporation of suicide awareness activities in school health program

Closing of the Program

The program was concluded with a thank you note by Executive Director of program organizing organization Nepal Health Society, Mr. Rishi Raj Ojha. He thanked all the guests and participants for being active and supportive regarding the issue. Furthermore, he requested all to come together to make society make a safe haven where people having any problems will not be stigmatized and discriminated. He repeated his request to government and other concerned authorities to work for the betterment of suicide prevention and its management in the country.Attachment

1. Attendance of the participants
2. Program schedule
3. Presentation papers of resource person
4. News cutting
5. Publication material for the World Suicide Prevention Day 2015
6. Press meet material
7. Sample of correspondence