The surge in suicide cases in Nigeria is worrisome. Two specialists in suicide treatment and prevention spoke to Good Health Weekly about the development and what steps Nigeria should take to stem the tide. They are Dr Raphael Ogbolu, the Coordinator, Suicide Research and Prevention Initiative Nigeria – Lagos University Teaching Hospital, SURPIN-LUTH, and Dr Funmilayo Akinola, Consultant Psychiatrist at the Federal Neuro Psychiatric Hospital, Yaba, Lagos.Excerpts: Why the upsurge in suicide cases There has been an increase in awareness and increase in reporting but there is an increase in suicide going by the number of cases we have seen in a space of fives. We now see at least one related case of suicide every month. There are several factors.
The single largest factor is medical depression and unfortunately, it is often misunderstood and undertreated in this part of the world. When clinical depression is not treated it can progress from mild to moderate and severe depression and then lead to suicide.
Why people are not treating depression One is ignorance, lack of awareness, not knowing where to go and other treatment parts. Before they present in the hospital they would have tried other alternative treatment like churches, mosques and healing centres. They explore other alternative care but by the time they know the case will have been bad.
Then the cost of treatment. Unfortunately, mental health is not covered under the National Health Insurance Scheme. So a lot of people have to pay out of pocket and where you cannot treat depression very well you will have increased suicide cases. We do know that when you people think of factors of people becoming depressed the first thing that comes to their mind is financial. Yes, we do know that it is an important risk factor or contributor but from the cases, we have analysed we found out that the commonest causes are illness and mental disorders.
How common is suicide?
Eighty-five percent of suicide occur in low and middle-income countries where Nigeria belongs, unfortunately, data is not available for 70 percent of these countries and that is one of the reasons why we personally decided to set up Suicide Research and Preventive Initiative SURPIN. It is not about taking up the preventive perspective it but we need data and research to know how to plan an intervention strategy. What we rely on largely is World Health Organisation, WHO, statistics but we do know that suicide is underreported globally not only in Nigeria because a lot of them will never get to a health establishment.
There is still a lot of stigma associated with it. Even when we have clear cases after a post mortern that a person died of suicide the family tell the mortician not to state that even in death. We must also not forget that it is not only the person that dies who is affected. It also affects the bereaved. Even the figures we have are underestimated. We have far more cases that we have estimated. Even with the fact that we were seeing an average of one case monthly in LUTH alone, that will tell you that it is far more than we have reported.
Even with the WHO statistics that we are using which is about 800 to 1 million that means every 40 seconds somebody is dying of suicide globally and it is estimated to increase by 2020 to 1.53 million and that is why the WHO is asking countries who don’t have National suicide prevention plan to get on board so that we could even reduce it by 10 percent by 2020. That is why we established SURPIN. What Nigeria should be doing We need to recognise that suicide is preventable and build outlets and resilience and this starts from the home. We have seen an increasing number of young people who are breadwinners.
We are putting too much pressure on children. We have so many of them in the universities; there are too many destructive families. We need to address the issue of destructive families where mothers and fathers are not together because it affects children. Early childhood experiences are the bedrock of depression in future.
Because of our culture, we used to have this communal thing. When a husband and wife are longer together, an uncle or aunty will come and take te child and that used to save the child from destructured family but now it is no longer happening. These children train themselves. We have destructive families all over the world but there is a system that protects the child but we don’t have it here. These are some of the things we should do. Physical connection helps build resilience, there must be deliberate effort. Since there is no structure if a child goes to school he or she sees it as a second home. It is unfortunate that the school is taking over roles of fathers and mothers.
This wasn’t happening in the ‘60s. There is need to train religious leaders on how to identify depression. We are doing that. There are no cardinal signs but you will notice real change in behaviours. In 2017 the theme fo rthr World Health Day was “Depression Ask. Nobody wants to die. The fact is that all the people that die by suicide do not want to die. But they simply do not want to continue living the way they were living. If you give them an option, they will take the option. This is where the idea of the hotlines come in. If you catch them at the early stage before the period when they will be having worthlessness or hopelessness, they will change their mind.
Role of drug abuse
You could say that depression causes about 90 percent of suicide cases but what happens to the remaining 10 percent? Substance abuse, relationship problems and financial issues and other human issues account for this 10 percent. In recent times the younger generation – adolescents and youths are engaging more in drug and substance abuse, particularly, prescription drugs. They want to withdraw but there are withdrawal syndromes, all the side effects and problems of family members getting to know. All these are causing issues that will make them want to die by suicide. We should also not forget the old substances like Indian hemp, cocaine etc, they abused in the past. They also don’t take care of themselves. Overdose from all these can lead to suicide.
Experience at Psychiatric Hospital,Yaba Because of SURPIN, We want to have a register to get our data right and also know the trend. It is already on the pipeline. What we have now are those in the wards that are trying to kill themselves. What we really have in the ward or on admission now is those that trying to kill themselves. As regard to depression and when they can think of killing themselves, it is an individualised act. But I think it starts when a person began to have feelings of unhappiness and not sleeping well.
It is progressive. When they don’t have a person they will talk to about their feelings. Some clients do say that is like staying in a dark hole and by the time they are getting in, there is no way of getting out. They start feeling helpless and it is usually at this point the idea of worthlessness sets in and they begin to think of suicide. No one to talk to and nobody to tell them to see a psychiatrist or psychologist. It is in that deep place that they think they cannot get out and a thought will just come that, why don’t you end it all? That is where we talk about relationship problems, exams failure where they think that they have put in everything. It is usually an impulsive thought. Sometimes those that actually survive are those that do not mean it. The act of suicide is actually a cry for help.
Decriminalisation of suicide
If somebody ends his life that person is dead so what is the essence that it is a criminal act? On the other hand, you know we said when somebody is talking of dying, that is a cry for help. They are saying “I cannot continue this way.” The only way they can get help is by trying to kill themselves but unfortunately, most of them die before they get help.
The few that survive, the medical people will rally round and find out why they want to die. So I don’t think to arrest them and take them to prison is the best. Rather than getting lawyers I think it is better to get medical docors trained to find out what the problems are and help them. I don’t know how we will be able to help those with financial probems but we can counsel. I don’t think they should be arrested, but to be helped because they are tired. They should be referred to the appropriate quarters.
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