A cry for help that goes unnoticed

Mental health issues, academic pressure, and social stigma are driving India’s students to suicide. What can we do to prevent it?

Students appear for the Class 12 board exam conducted by the Madhya Pradesh Board of Secondary Education, in Bhopal. | Photo Credit: A.M. Faruqui

Arjun Gupta, 25, had a troubled adolescence. All of 17 in 2015, Gupta had just cleared the All India Pre-Medical Test (AIPMT), the predecessor of the National Eligibility cum Entrance Test (NEET). For months, he studied 15 hours a day—eight at school, five at a coaching institute, and two by himself: “The pressure was immense, but finally I was going to join my dream college. It was all going well. Then, suddenly, I was caught in a spiral of very negative thoughts, about myself, my career, my choices.”

The next 18 months were harrowing for Gupta; his thoughts turned to self-harm and worse. He was diagnosed with depression but refused to accept it. “Emotions, mental health, depression were all signs of weakness in my mind. Boys didn’t have such problems,” he said. Over time, Gupta’s parents started locking the terrace door and hiding sharp objects at their home in Hisar, Haryana. The turning point came when Gupta left a post on Facebook: “I wrote about what I was going through, and the support that came my way felt like a game changer.” He tweaked his dream of becoming a doctor and trained as a psychologist instead.

Suffering not accounted for

The annual report on accidental deaths and suicides published by the National Crimes Record Bureau (NCRB) does not tabulate the suffering that people like Gupta go through. It only counts the attempts that resulted in death. According to the most recent NCRB data, 13,089 students died by suicide in 2021, a 32.5 per cent jump compared to the 9,905 deaths in 2017. This amounts to nearly 36 student suicides in India every day of 2021.

While child and adolescent psychiatrist Dr Amit Sen believes the COVID-19 pandemic might explain some of these numbers from 2021, he told Frontline that India anyway accounts for a large chunk of youth suicides worldwide despite the gross underreporting. NCRB data reveal that of the 1,64,033 people who died by suicide in India in 2021, 10,732 were below the age of 18, and 56,543 were in the 18-30 age group. “We worry about how to prevent it, but what about the emotional suffering kids go through to take that step? Are we blind to that? There has been abject apathy,” Sen said.

Sen, who is the co-founder of Children First, a mental health service organisation in the Delhi-NCR region, believes distress is caused by a multitude of factors: “Our approach is systemic and multidisciplinary; it addresses various stakeholders. We focus on the family, the educational institution, the developmental history. We engage with all these.”

A billboard announcing exam toppers from a coaching centre in Kota. Such rankings add to student anxiety. | Photo Credit: R. V. Moorthy

Chennai-based psychiatrist Dr Lakshmi Vijayakumar founded Sneha, India’s first suicide prevention helpline, in 1986. Distilling the 2021 data, she told Frontline that the reasons listed by NCRB, such as “love affair”, “failure in examination”, “mental illness”, and “family problems”, may only be the final trigger, the larger causes lie elsewhere.

Suicide, said Vijayakumar, must be understood through its intersectionality: “It is determined by a combination of factors—biological, psychological, social, environmental, religious, contextual.” For instance, in the NCRB category of “family problems” it could be disputes and conflict, financial strain, an alcoholic parent, or sexual, emotional or physical abuse. “Exposure to violence when you are young often leads to suicidal behaviour. Bullying and academic pressure are also big determinants. Adolescents could also have issues relating to sexual identity and orientation.”

According to Arjun Kapoor, a research fellow at the Centre for Mental Health Law & Policy (CMHLP), half of India’s suicides are due to mental health issues while “the remaining 50 per cent happen due to other factors and a lot are impulsive”. Youth can be a perilous and turbulent time in life. If young people have no one to confide their distress in, they sometimes feel overwhelmed. “In a fit of anger or distress, they end their life,” Kapoor said.

According to a report published in The Lancet, the suicide rate recorded by the NCRB is 37 per cent lower than that reported by the Global Burden of Disease. Kapoor, who leads two of CMHLP’s youth suicide prevention projects, believes NCRB’s data are unreliable because they underestimate the real extent of the crisis. Equally, not all suicides are reported in India because of the attached stigma.

Unnoticed cry for help

Manjot Chabra, who was enrolled at a NEET coaching institute in Kota, Rajasthan, was found dead in his hostel roomlast month. Chabra left behind three sticky notes. In one, he wished his father a happy birthday. He said “sorry” in another, and in the third, he asked that his friends and parents not be harassed. Back in his hometown, Uttar Pradesh’s Rampur, Chabra had earned some renown as a Class XII topper. His friends in Kota remember him as fun-loving and driven, but they also said Chabra sometimes said he was “next in line”, in the context of the suicides happening in Kota.

Gupta is struck by how this cry for help from Chabra went unnoticed. “He was a topper, and I once heard a Kota administrator say it’s mostly the low scorers who die by suicide.”

Tanuja Babre worked as Programme Coordinator with iCall, a psychosocial helpline set up by the Tata Institute of Social Sciences, Mumbai, and researched the issue of student suicide in Kota from 2016 to 2018. “For many young students, Kota is a gateway to bigger things—their path to IIT, for instance. I came across families who had sold their land or taken a massive loan to send their kids to Kota. Think of the pressure these teenagers are under,” said Babre, who is nowState consultant for Mental Health and Psychosocial Support (MHPSS) to UNICEF (Maharashtra). Marooned on an academic island, lonely in their rooms, Babre saw students study for 16 hours a day. “It is not possible to focus on something for that long. The ecosystem puts pressure on students from all directions.”

Students experiment with robotics at an early age in this classroom. Rajasthan Chief Minister Ashok Gehlot recently slammed parents over the rising number of student suicide cases in the State due to academic pressure. | Photo Credit: G. Ramakrishna

To provide students “mental support and security”, district administrators in Kota in August directed all hostel and paying-guest providers to install springs in fans and thus make the stems flexible. According to psychiatrist Dr Abhijit Nadkarni, co-author of Life Interrupted: Understanding India’s Suicide Crisis, “stopgap measures like this can only limit the damage rather than hit the root of the problem”.

Speaking of the guilt that students live under, Lakshmi Vijayakumar said: “They feel they can’t justify the money spent on them, and there is no social support that tells them, ‘Education is not your entire life!’” According to her, around 40 per cent of those who call Sneha are below the age of 30. In May 2002, she noticed a threefold jump in calls from students: “We also saw a rise in calls from parents. We realised it was happening because of the Class X and XII results.” On studying the data, Vijayakumar and her colleagues found that a sizeable portion of the calls were from students who had failed one or two subjects by a few marks.

Vijayakumar approached the Tamil Nadu government and suggested that those who had failed be allowed to write the board exam again in a month or two. “Otherwise, they would lose one whole academic year, and some would drop out, feeling ashamed or guilty.” In 2004, a year after it became the first State to introduce the supplemental exam system, Tamil Nadu recorded 407 suicides of young people because of “failure in examination”, but by 2021, that number had dropped to 102. In Chennai the figure dropped from 38 to six.

As Babre pointed out, the supplemental exam succeeded in removing stressors from an education system where the buck often stops at one report card or one exam: “Our families and culture don’t encourage young people to have a plan B. What if things don’t work out? Has anyone prepared them for that?”

Highlights

• NCRB data show 13,089 students died by suicide in 2021, a 32.5 per cent jump compared to the 9,905 deaths in 2017. This amounts to nearly 36 student suicides in India every day of 2021.
• This emphasises the need to address the emotional suffering that students endure before taking such drastic steps, highlighting the lack of empathy and understanding regarding mental health issues.
• Various factors contribute to the suicides: academic pressure, bullying, discrimination, and societal expectations. The crisis highlights the importance of early intervention, support systems, and destigmatising mental health issues among students..

Parental support system can make a difference

Some young people are fortunate to have a strong parental support system. Ishita Mehra, 28, remembers struggling with suicidal tendencies from the age of eight or 10. The thoughts returned when Mehra faced bouts of depression, first in 2012, when she was 17, then two years later, when she went to a design school in Delhi: “The brain sometimes felt so foggy that not a single bit of information went through.” Her school counsellor was of little help, often dismissing concerns that were brought to her. Mehra found comfort in her understanding mother and father. Mehra said, “My dad doubled up as my therapist. He went through depression when he was younger and used his experience to tell me ‘You’ll pull through it.’”

Not everyone is so lucky. Dr Rajkumari Basu, a clinical psychologist and graphologist in Kolkata, told Frontline that parents often lack the intergenerational know-how required to help a young person in distress. “When someone starts showing symptoms of depression, anxiety, substance-misuse, self-harm or suicide, we should be totally involved with that person. My advice to parents is ‘do not leave them alone; show them they matter.’”

Basu believes in early intervention. “We focus so much on their physical health. Some emphasis must also be on mental health,” she said. Equally, however, while conditions such as bipolar disorder and schizophrenia do often first manifest in late adolescence, Nadkarni warned that everything cannot be dumped at the doorstep of mental health. There can be a variety of non-medical factors. Mehra, for instance, says she was bullied by professors at college when she questioned the education system. Other stressors can be ragging, blatant discrimination, or public humiliation based on caste, class, sexuality, class performance, or English-speaking skills.

Students take the Joint Entrance Examination – Main in Khammam, Telangana. | Photo Credit: By Special Arrangement

Mariwala Health Initiative is a Mumbai-based funding agency for innovative mental health initiatives that focuses on making mental health accessible to people from marginalised communities. CEO Priti Sridhar said, “When we look at students, we look at their performance in school or college, their marks, but what about their caste and gender location, their economic background? These things matter, too.” In March, the Union Ministry of Education informed Parliament that from 2014 to 2021, of the 122 students who died by suicide at India’s premier institutions of higher education (IITs, IIMs and NITs), 68 belonged to the Scheduled Castes, Scheduled Tribes or Other Backward Classes. In February, Chief Justice D.Y. Chandrachud said most students who die by suicide in India were from Dalit and Adivasi groups: “These numbers are not just statistics. They are sometimes stories of centuries of struggle. In 75 years, we have focussed on creating institutions of eminence, but we need to create institutions of empathy.”

Constant stress of caste

From her school days, Mehra noticed the constant stress of caste. At her convent school, she said, “Kids from lower castes ended up huddling together. They were the backbenchers, treated horribly by teachers.” When Mehra started volunteering as a peer support specialist at Outlive, a suicide prevention project that addresses urban youth suicides, she found the intensity of distress much higher among young people from lower castes, LGBTQIA+ communities, and those with disabilities. CMHLP’s Kapoor, who co-leads the project, said the ambit of Outlive included a public engagement campaign in colleges and community spaces to destigmatise suicide by enabling access to information. Outlive is in the process of rolling out India’s first youth suicide resource website (www.outlive.in) in English, Hindi, and Marathi. Since young people prefer to chat, CMHLP is training youth volunteers to provide chat-based emotional support. “Peer supporters,” Kapoor said, “are the bridge between young people and formal support—contacts to helplines, counsellors, and psychosocial organisations.”

Outlive also allows youth advocates access to engage in policy processes at the ward, State and national level. “Our idea is to look at policy from the urban level,” said Kapoor. One volunteer, he said, wants to focus on sexuality, education, and suicide prevention, while another wants to work with Muslim and minority youth. One is addressing trans people and another is looking at migrant youth. The young, it seems, can also offer us hope.

Kapoor said that compared to cities, there was more stigma attached to the issue in rural areas. He has trained teachers to help prevent adolescent suicides in Chhattisgarh, a State whose suicide rate is close to double the national average. “Suicide is very much there, but there is no discourse around it,” he said. Sen believes the urban-rural divide is more complex. “Urban, affluent families sometimes fail to bring their kids to us, but we are sometimes surprised by parents from a rural background who have the compassion to understand differences in human beings and take a reflective, compassionate stand.”

Policy, even when well-meaning, takes effort to implement. The 2017 Mental Health Care Act might have decriminalised suicide, but “the stigma of reporting suicide continues to be a challenge”, said Kapoor. The Act, according to him, apart from recognising the State’s duty to provide child mental health services, does not delineate the youth as a separate constituency.

Other government policies go further. Launched on November 21 last year, the National Suicide Prevention Strategy (NSPS), begins to see suicide as an inter-sectoral issue. “The NSPS makes clear,” Kapoor said, “that, say, to ban pesticides, several departments will have to be involved—Health, Agriculture, Human Resource Development.” The National Mental Health Policy similarly prescribes deinstitutionalisation and community support.

For two years, Vijayakumar lobbied the Ministry of Health to get the NSPS published. She said, “I think we have the resources and capacities, but we need the political will to undertake suicide prevention as a mission.” While the outlay for health in the 2023-24 Union Budget accounted for just 2 per cent of the Centre’s fiscal outlay, the total allocation for mental health (Rs.919 crore) is just 1 per cent of the Ministry of Health and Family Welfare’s budget. Not only is this meagre, the Rs.919 crore is then divided amongst three beneficiaries—the National Institute of Mental Health and Neurosciences in Bengaluru (Rs.721 crore), the Lokpriya Gopinath Bordoloi Regional Institute of Mental Health in Tezpur (Rs.64 crore), and the National Tele-Mental Health Programme (Rs.134 crore). “The issue isn’t just the deficit, there is also underutilisation,” said Kapoor. Clearly, a lot more effort, a lot more money, and a lot more thought has to be given to the issue if we are to protect India’s young people.

According to Sridhar, research shows that for every case of youth suicide, at least 20 people are impacted—family, friends, teachers. Doing the math is alarming, and the numbers they yield are distressing. But, as we have seen, even numbers often miss the big picture.