Thiruvananthapuram: For a state which has set an ambitious target to bring down suicide rate from 24.9 to 16/lakh population by 2030, the ground reality sets alarm bells.
The suicide risk in Kerala is more than double the national average and even high suicide risk is the highest among all states. Though the state witnessed a noticeable dip in suicide rate over the past one and a half decades from 28.8 in 2001 to 24.9 in 2016, the mental health of Kerala society continues to face a host of challenges that need to be addressed on priority.
According to experts, depression is the most untreated and undertreated mental health malady. If untreated, nearly 15 per cent people might develop suicidal tendencies at a later stage.
Dr R. Jayaprakash, additional professor paediatrics and child psychiatry SAT hospital, said there was an urgent need to address the high prevalence of mental illness. “Depression especially in adolescent age and among middle aged persons is easily identifiable. The focus needs to be on middle-aged women, men, adolescents and children,” he said.
In adult depression, the affected person might send out suicidal notes to close friends or relatives. “I don’t want to live. I am trying to find my own way,” are some of the common statements made by people who are depressed. "Such statements should be taken as cry for help. But in the midst of hectic, fast-paced life people tend to take such notes lightly," he said.
A 30-minute chat with people sending out such distress calls can actually bring down their suicidal tendency. “This is called ventilation. I think awareness needs to be created about ventilation process among different groups, offices, kudumbasree and sensitisation is required,” said Dr Jayaprakash.
Psychiatrists say there is also a tendency among people with depression to show reluctance for psychiatric help, counselling and medication. In many cases people on medication tend to stop medicines midway and even refuse to see the doctor again once they feel better.
The reluctance could be because of various factors: hopelessness, sense of isolation, lack of cordial atmosphere in family, conflict among couples and even an element of psychosis. There are other psychological and social factors as well.
In such cases medicines are not enough, psycho-education, family counselling, strengthening of family relations, opting for short interval reviews (if it was once a month make it once every fortnight) are some of the positive interventions required.
Partners and family members will have to make extra effort to show compassion and empathy towards the affected person.
“In many cases the underlying depression goes unrecognised. Depression can happen without any particular reason. Even in cases which are reported to be due to financial problems, trigger for suicide could be financial issues. But in depression family and societal support is very important”, said Dr Anish N.R.K, psychiatrist mental health centre Peroorkada.
Among men, alcoholism is seen as a major cause of depression which often leads to suicides. Alcoholism–depression-suicide should be read together as alcohol dependence syndrome leads to impulsive behaviour.
Experts say adolescent depression is a peculiar problem. “I came across a case recently where an 18-year-old girl just refused to step out of the house fearing that something bad might happen to her mother if left alone. This was a case of depression and anxiety coming together. The poor mother couldn’t go for work. The girl was given antidepressant and after regular medication, she became alright. Now mother goes to work. This issue was brought to my notice by her teacher. Had it not been the case, she could even have taken extreme step,” said Dr Jayaprakash.
It is in this context that sensitisation and training programmes are needed for teachers so that they can monitor behavioural issues of children closely. The government initiative, Ashwash Clinics, for detecting minor and major mental ailments at the level of Primary Health Centres need to be expanded across the state. As of now only 170 family health centres are using diagnostic criteria known as PH Q 9 questionnaire. WHO-approved questionnaire objectifies and assesses the degree of depression severity.
Experts believe the expansion of Ashwash is required to ensure first line of treatment of mental ailments reach across the state. On the policy front, they say the government should announce a comprehensive State Depression Control Programme to combat the challenges posed by mental health problems.
Mental health scene in Kerala
- Suicide risk 12.6 per 100 persons (national average 6 per cent)
- Prevalence of high suicidal risk 2.23 per cent (highest among all states)
- Anxiety related disorders 5.43 /100 (national average 3.5 per cent)
- Current prevalence of any mental disorders - 11.3 per cent
- Rate of smoking 7.22 per cent (national average 20.89 per cent)
- One in eight persons (12.43 per cent ) has mental illness requiring psychiatric intervention.
- Alcohol related problems 1.46 per cent.
- Dementia and cognitive impairment prevalence 10.48 per cent among 60 years and above.
- 75 per cent mental health patients under treatment coverage
- 42.88 per cent depend on government hospitals for treatment, 29.24 on private hospitals.
- Prevalence of freelance of intellectual disability - 0.21 per cent, epilepsy - 0.23 per cent
Source National Mental Health Survey report and state mental health survey report
Symptoms of depression
- Subjective — what a particular person feels about himself — lack of appetite, energy to wake up in time, interact with others, reading newspapers, lack of energy to take initiatives, cannot enjoy the pleasures of life, the world appears to be colourless, lack of concentration, feeling of worthlessness, hopelessness and feeling of suicidal tendencies.
- Objective — what others feel about him.
- Objective assessment: When other people, relatives or colleagues find someone absenting from work regularly, not energetic, looks sleepy and drowsy because of lack of sleep, feeling sad, avoids company of others, increasingly uses alcohol, then one can say he has some kind of medically treatable illness like depression.
- Clinical state of depression does not make anybody unfit for the job for the entire life
- Intervention needed only when one is passing through such an emotional state
- In cases of severe depression one should not shy away from psychiatrist help.
