A link with life

Chennai-based Sneha, Tamil Nadu's sole suicide prevention centre, has helped over one lakh callers contemplating suicide to court life once again.

THE telephone rings, and one senses great urgency in the call, as if it is to convey the desperation of the caller. Indeed, it is a matter of life and death for the caller, who is mentally so distressed as to contemplate suicide. Perhaps that compulsive human urge to live or the fear of death prompted the person to make this call.

At Chennai-based Sneha, such calls often come every 20-25 minutes. Sneha's suicide-prevention hotline (8115050) has received over one lakh calls since its inception in 1986.

There has been a rapid escalation in the suicide rate in the country, particularly among people of the 15-29 age group, which is considered one of the most productive periods in one's life. According to the National Crime Records Bureau (NCRB), one in three suicides committed in India is by a youth. While a suicide was attempted every 7.6 minutes in 1989, today it occurs every five minutes. Although more women than men attempt suicide, more men than women actually succumb. In India, men account for 58 per cent of the suicides. Data published recently by Befrienders International, a group involved in suicide-prevention work the world over, provide an alarming picture. According to them, when the annual rate of population increase is around 2 per cent, suicides rise by 6 per cent.

Of the one million cases of suicides reported the world over last year, one lakh were in India. With a suicide being committed every fifth minute and about 15 attempts being made for every suicide committed, India faces a major crisis. According to the NCRB, the number of cases of suicide has been rising steadily. From 40,245 cases in 1981, the number more than doubled to 84,244 in 1993, and reached one lakh by the end of 1999. While Kerala has the highest suicide rate, West Bengal, followed by Maharashtra, Karnataka and Tamil Nadu has reported the highest numbers.

Dr. Lakshmi Vijayakumar, vice-president, International Association of Suicide Prevention, says: "Suicide is a multi-dimensional malaise with social, economic, biological, environmental, emotional, psychological, philosophical, cultural and medical roots. Any attempt at suicide prevention has to address these complex issues in a systematic, structured and sustained manner." Psychologists believe that extreme emotional pain due to pent-up frustrations drives people to suicide. Of the reasons for attempting suicide, the NCRB cites bankruptcy, sudden change in economic status, poverty, unemployment, illness, family problems, and failure in relationships and examinations as the major ones.

The central question in all research on the subject is: Do people attempt suicide because of problems within themselves or with society? There is an argument that society cannot be blamed if depressed people commit suicide. But studies show that less than a third of the depressed people commit suicide. So in reality a combination of factors, including depression, is responsible for suicide. From a sociological perspective, on the basis of the "society is responsible" theory, suicides can be classified into four depending on how well people integrate with society. First there is egotistic suicide, committed by people in transitional societies - where aspirations are high and there is a breakdown of the traditional support systems, as in the case of Kerala. Secondly, there is anomic suicide, owing to sudden changes in, say, market conditions, and the consequent failure of entitlements - for instance, as in the case of weavers and farmers in Andhra Pradesh. The third is altruistic suicide, which results from extreme integration with society, such as self-sacrifice for the country or for a cause. The fourth is 'fatalistic' suicide, committed by people who have no hope of survival, such as prisoners of war.

Studies show that the incidence of suicide is inversely proportional to individual's level of integration with society. Major changes owing to economic crises and the failure of entitlements and support systems have been handled better by people living in a close-knit community. For example, massive unemployment that the seafarers of Canada faced at the beginning of the 21st century, not one suicide was attempted by them, thanks to the kinship and camaraderie in the community. Thus, it is important that any suicide-prevention effort instils in the minds of the depressed and who are on the verge of committing suicide a sense of "being wanted" and a feeling that "I am not alone".

SUICIDE prevention, or 'befriending' as it is called, was started as a movement in 1953 in the United Kingdom by a parish priest, Chad Varah. Varah felt the need for it when a 14-year-old girl committed suicide upon attaining puberty - as she had no one to explain to her the natural biological process. Chad Varah realised the importance of a friend, and organised a small group of volunteers to 'befriend' those in need. Thus started a movement which has now spread to 41 countries and has 35,000 volunteers and 357 centres.

There are 10 suicide-prevention centres in India which offer free services. The volunteers at the centres work only because of their commitment to the cause and not for any financial rewards. Sneha is the only suicide-prevention centre in Tamil Nadu, and it gives hope, and life, to 20-25 desperate callers every day. Started in 1986 by the Chennai-based psychiatrist Dr. Lakshmi Vijayakumar, Sneha has helped over one lakh people to opt for life, instead of death by suicide.

Says Sneha's director Ram: "Among the various routes to help those depressed, dejected, rejected and suicidal, we have opted for the path of providing emotional support." None of those who intend to commit suicide wants to die; it is only that they are at the end of their tether. They feel they have nothing left in life - no friend to talk to, and no one who cares for them. It is a desperate situation that calls for a multi-dimensional approach. The approach has to vary from person to person.

Sneha does not counsel callers, it merely "listens to them carefully and brings to their consciousness all the options that had always been there but which they had not noticed in their desperation". The help-seekers have to choose for the best option for themselves.

This approach requires that the volunteers - of which Sneha now has 50 - are chosen carefully as they have to deal with "human emotions" and that too during moments of extreme despair, pain and stress. The main criteria for selection are referred to as 'CARE' criteria - compassion (for the needy), acceptance (of them as friends), respect (for their feelings) and empathy (with their problems). More than knowledge and skill, what is important is the ability to be affectionate and caring. Crucial, of course, is the skill to be able to reach out without being judgmental. As Ram says: "Most times the callers just want someone to talk to."

New volunteers are given a three-day intensive basic training, followed by a three-week extended work-out. Only then are they allowed to handle help-seekers. As with the help-seekers, the identity of the volunteer is not revealed. Neither the help-seekers nor the volunteers identify themselves. No record is maintained and no follow-up done. Of course, the caller is free to get back to Sneha, but no one would even know he or she had come or called earlier.

The majority of the help-seekers contact Sneha on the telephone; some write, and a few come in person. There is, according to Ram, no norm relating to time; calls sometimes extend from half an hour to a few hours. Most often it is the person contemplating suicide who calls, though parents, friends and neighbours of the person concerned also do so. In the case of callers who are not the ones contemplating suicide their distress is first heeded, and only in cases of extreme emergency do Sneha volunteers visit their houses.

According to Ram, over the years there has been an increase in the number of persons attempting suicide and this is largely because of the breakdown of the traditional support systems and coping mechanisms, such as the near-disappearance of the joint family system; change in lifestyle where there is little time even for one's family, leave alone friends; and ever-increasing social aspirations and demands.

A trend observed recently in Tamil Nadu is an increase in the number of suicides among students. Sneha, which can be reached 14 hours a day, from 8 a.m. to 10 p.m., kept its telephone lines and doors open for 24 hours a day from the last week of May until the third week of June, when the results of school and college examinations results were announced. Says Ram: "We were flooded with calls during those three weeks. Our volunteers were busy all the time."

Sneha operates with minimum funds - only what is needed to maintain a small office. It makes and sells greeting cards to corporate houses with a wafer-thin profit margin, in order to enable itself to run the office. The building has been rented out to it by a philanthropist at less than the market value. Says Ram: "We do tightrope-walking as far as funds are concerned. We do not accept any monetary help from the help-seekers and refuse money which comes with strings attached. Although a place of our own would considerably reduce our fund requirements, it is only a dream."

Even with its humble resources, Sneha has over the last 15 years lived up to its motto of providing "a link with life". A link that is just a ring away.