Health: The suicide prevention action plan, which the cabinet recently endorsed, calls for suicide prevention activities to be embedded within the Government Performance Management System.

Since the work plans will be implemented at the dzongkhag and local government levels, the action plan recommends that a dzongdag’s suicide prevention response team be established to ensure effective response to rescue suicide attempts and deliberate self-harm incidents in the communities.

This is one of the strategies the action plan has worked out to implement suicide prevention programs starting this year until 2018. The prime minister has stated that the government is committed to addressing suicide prevention as a top social priority.

“That’s why the Lhengye Zhungtshog instructed the stakeholders to develop, the nation’s first comprehensive suicide prevention action plan,” the prime minister stated in the action plan. “Our aspirational goal is zero death by suicide; no families, villages, communities, and neighborhood would desire anyone dying of suicide.”

As one of the first responders in suicide prevention, investigation and in providing immediate services, the Royal Bhutan Police (RBP) will establish a suicide prevention unit by December 2016 within the crime prevention division in the headquarters. The unit will coordinate suicide prevention programs of the RBP.

The three-year suicide prevention action plan, which will be launched nation wide has come at a time when suicide has become one of the top six leading causes of deaths in Bhutan today.

Deaths from suicide outnumber the combined deaths due to tuberculosis, malaria and HIV and the male-to-female ratio of suicide deaths in Bhutan is two men to a woman, slightly higher than an average ratio of 1.5 men to a woman in low and middle income countries.

In a five year review of suicide cases from 2009 -2013, police recorded a total of 361 suicide deaths in the country.

The action plan highlights the need to improve the capacity of first responders such as the police, health workers and counselors in providing postvention services. “The disastrous handling of a suicide event in Bumthang in 2014 which led to the dismissal of an EMT staff for irresponsibly spreading suicide photos on social media indicates systemic weakness and very poor postvention service provision,” the action plan states.

It stresses on the need to improve the quality of forensic and death investigations. Doctors had shared that the basic training on wound identification, nature of injury covered in the undergraduate medical education was inadequate to provide a clear inference during field investigations and said that medico legal investigations may be wrongly concluded as a result.

During the drafting of the action plan, a chief nurse in Lhuentse had shared that he attended three cases of attempts to suicide and suicide investigation cases but was clueless on what he was looking for during the examination. A BHU staff referred a patient who had attempted suicide to Punakha as a poisoning case.

In a recent incident, a Health Help Centre (HCC) staff attended to a caller who was under the influence of alcohol and in severe financial stress, and who shared his suicidal intent. The staff provided counseling to the caller but was unsure whether the counseling worked.

By the end of this year, a 24-hour crisis helpline including webpage, and social media channel, and live chat should be established and trainings conducted for HCC paramedics to provide crisis helpline services for individuals with suicidal intent despite.

The action plan has also noted the growing concern for abandonment and social isolation of elderly. “The fact that around seven percent of suicide victims in the past five years were individuals above 65 years, highlights, the need for a deeper understanding of the problem faced by senior citizens and instituting adequate social welfare for the elderly,” it states.

About 69 percent of completed and 90 percent of attempted suicide cases were youth and young adults. Of the 2,496 cases of student counseling offered in 52 schools last year, 725 were counseled for substance abuse, 301 for family issues, 465 for academic and career issues, 270 for relationship issues and 69 for self harm incidents.

The action plan states that the school counseling service data formerly collected quarterly will be collected monthly from this year. “In order to adapt to the high inflow of information, the education ministry urgently needs to upgrade the data system from the current crude excel sheet which is found to be inefficient and burdensome,” it states.

There is also a need to reduce access to pesticides by strengthening implementation of the Pesticide Act because suicide attempts using pesticide appears to be common even though hanging is the most common means in Bhutan. Consumption of drugs/substance accounted for 64 percent  of the total attempted suicides while 17 people used pesticides and insecticides as mode of suicide.

The action plan has also called for an improvement in the curricula for health workforce by including topics on suicide prevention, suicide screening, and suicide investigation and postvention services at the nursing college.

The plan has also listed engagement of political and religious leaders in suicide prevention. Lams and monks can play a direct role in helping individuals exposed to suicidal risks as it was found that  among the suicide victims who availed help for addiction, seeking advices from Rinpoche/religious persons, and elders were common in search for calmness and tranquility of life.

Value based psychotherapeutic programs would be piloted in JDWNRH and Trashigang hospital by blending age old Buddhist traditions with the modern psychotherapeutic techniques for providing psychological support for individuals at risk of suicide.

It calls for improving mental health literacy for high-risk groups, gatekeepers, and public that suicide is preventable and mental health is treatable and on responsible media reporting of suicide  and use of social media.

Community healers, local practitioners, and  local lams would also be engaged in the prevention program because in the past, suicide attempters mostly received treatment from traditional healers.

At 64 percent, most suicide attempts were by consumption of drugs or substances. Since addiction and substance abuse programs have direct links to suicide prevention, the action plan stresses on enforcement to reduce harmful use of alcohol.

By Sonam Pelden