The cumulative economic loss from suicide in Kenya is unknown but it could run into billions of shillings. The family bears the brunt in the event of a suicidal death having to endure grief in the midst of stigma. When suicide attempters are dragged to courts for punishment, they suffer a double tragedy: Psychological pain and possible jail terms. Family disruptions caused by suicide can themselves become the seismic focus for a vicious cycle of psychological problems in the family.
The thinking that ‘suicide is caused by disturbed social forces when individuals are not supported by society or when they are not integrated into society’ is attributed to sociologist Emil Dukheim. It continues to hold validity since 1897.
Other theories have focused on family disruptions as well as a desire to escape from psychological pain. In recent times studies have cited the abnormal regulation of the serotonin neurotransmitter in the brain in addition to a psychosocial stressor as the cause of suicide. This latter biological theory has been supported by postmortem examination of brains of suicide victims.
A common denominator in suicide is the major role played by mental disorders. Over 95 per cent of suicide victims have an underlying mental disorder. Disorders such as depression, bipolar mood disorder, anorexia nervosa and schizophrenia have been shown to increase the risk of a person dying by suicide.
Substance use disorders, especially alcohol abuse, also increase risk of suicide. The prevention of mental disorders should begin at conception through proper antenatal care and continue throughout life because psychosocial needs exist at every stage of life. Improved access to high-quality mental health services at all levels of the health system is key to prevention of suicide.
There is no difference between the body and the mind. A disturbance of the physical body affects thoughts and emotions and vice-versa. Conditions such as traumatic brain injury, back pain, sleep disorders, HIV-Aids, heart disease, epilepsy, migraine and cancer increase the risk of suicide even in the absence of a diagnosable mental disorder. These disorders also increase the risk of suffering from a mental disorder such as depression.
Chronic conditions such as arthritis and Parkinson’s disease are associated with increase in suicidal tendencies in the elderly. We can therefore reduce cases of suicide if we can provide preventive and curative services for physical illness. This necessarily involves a revitalisation of the health system by strengthening system pillars: infrastructure, human resources, drugs, equipment and financing.
Political leaders at every level of government must be challenged to implement expert recommendations made to meet our health challenges such as those in the Musyimi task force report of 2012 and other policy documents.
Loss of employment or business is accompanied by financial loss and the potential risk of sinking into abject poverty. This too could potentially lead to suicide. This factor can find mitigation in a society that is less individualistic. Financial institutions must be encouraged to come up with credit facilities that assist people who have just lost their jobs or businesses back on their feet.
Self-help groups that can cushion members from sudden financial losses must equally be encouraged. With regard to suicide cases related to examinations, all learning institutions should strengthen their student psychological support systems before, during and after examination.
The media plays a crucial role in both informing and educating the public about mental health, including suicide. There’s need for the society to change its negative attitude towards people who attempt suicide. The government should decriminalise suicide because evidence that suicidal feelings arise from a disease process is overwhelming. The burial of people who die by suicide should not be dramatised; religious leaders should lead the effort to normalise the burials in the interest of reducing stigma.
We cannot wait any longer before implementing these common sense suggestions in our collective effort to prevent suicide.
Medical doctor and mental health advocate