• The British Council holds a live event to commemorate World Suicide Prevention Day

By Naveed Rozais The British Council held a live webinar and panel discussion to commemorate World Suicide Prevention Day, which took place on 10 September. The live event consisted of a presentation by suicidologist and researcher Dr. Alexis Palfreyman, whose expertise deals with global health, mental health and suicidology, sexual and reproductive health and rights, and maternal and child health. Dr. Palfreyman is the only suicidologist living and working in Sri Lanka. Her research covers everything to do with self-harm, and she is currently working with families who have been bereaved and affected by suicide as well as those who harm themselves, to gain greater insight into the changing nature of self-harm in urbanising Sri Lankan communities. The live event also included a panel discussion with Dr. Palfreyman, chartered clinical psychologist Dr. Fergus Kane, and counselling psychologist Nivendra Uduman. The event was moderated by Attorney-at-Law Mrinali Thalgodapitiya. Explaining suicide in a Sri Lankan context, Dr. Palfreyman said that South and Southeast Asia are epicentres for suicide globally. Sri Lanka had one of the highest suicide rates in the world. With the support of the Government, World Health Organisation (WHO), and large agricultural companies, this number was reduced by 70% by limiting access to pesticides and similar poisons. Additionally, Sri Lanka and India have the highest suicide rates among women. For the better part of the last 25 years, Dr. Palfreyman explained, Sri Lanka has adopted a singular approach to suicide prevention by preventing access to poisonous pesticides as much as possible. This has resulted in failing those people who use other strategies to harm themselves. Nonfatal self-harm is increasing year on year with women experiencing self-related violence more and more, while men face more deaths through self-related violence. Dr. Palfreyman also shared that families bereaved by suicide are ostracised, with people they know distancing themselves from such families. Survivors of self-harm are also met with shame and guilt-tripping, all contributing to negative stigma. Dr. Palfreyman also explained that suicide is a leading cause of maternal death globally, with mothers being chronically neglected across the board when it comes to healthcare, with services prioritising the health of the children and the physical health of the mothers over the mothers’ mental health. Dr. Palfreyman shared that one in six women in Sri Lanka experience depression when pregnant, and one in five women experience postnatal depression. There is an urgent need to identify mental health issues in women as early as possible during pregnancy. The care women receive during and after pregnancy is really critical in shaping their emotional and mental wellbeing. This is where midwife and family reactions play a part. Often, midwives enforce women to play this sacrificial wife-and-mother role to the detriment of their own wellbeing. They’re often more concerned about safeguarding women from damaged reputations than protecting them from harm. In Sri Lanka particularly, midwives have considerable power to shield mothers or expose them to more difficulty. As part of the panel discussion, Dr. Fergus Kane spoke on how to choose a good psychologist, explaining that clients need to feel comfortable discussing any thought that pops in their heads with their therapist. On overcoming the stigma around therapy, Dr. Kane explained that seeking out a therapist is a brave step on the part of any patient because they’re empowering themselves to share their innermost thoughts and secrets, get help, and solve problems in their lives, and this is not something to feel ashamed of. There is a strong tendency for patients to “handle things themselves”, but this is something that is societal; there are lots of things that you can’t do alone and reaching out for help regarding your mental health is one of those things. Therapy also frequently comes with the fear of being judged, which Dr. Kane stressed is not something that happens when you consult a therapist, because therapists are trained to provide a non-judgemental approach to your issues in a way that other people cannot. Counselling psychologist Nivendra Uduman spoke about overcoming the stigma as a whole, explaining that the process needs to begin at all levels, including how we perpetuate negative attitudes through our language, even as health professionals. For example, the word “committed” and using terms like “successful” and “unsuccessful” in association with suicide draws censure and negative dialogue, as opposed to more neutral language like “death by suicide” or “taking your own life”. This is also apparent in language around self-harm, with debate ongoing in the medical community on ceasing to use the word “deliberate” in regard to self-harm to create a safer space for victims of self-harm. Uduman also spoke about how communities can broach suicide as a topic with people they believe might be at risk, in a constructive way. He explained that it was important to connect in a personal and warm manner and let the person in question feel completely secure and the focus of attention. It is important not to rush the person and to possess the ability to ask direct questions gently. Uduman stressed the need for communities to use compassion and approach situations in a caring manner as this can make all the difference when dealing with someone who is suicidal. Uduman also explained that if a friend or loved one does confide that they are suicidal, it is important for the person that has been confided in to understand that it is not a burden that should be borne alone, and that this information can and should be shared with someone responsible who can ensure that no self-harm is done. Uduman stressed that it is important not to promise confidentiality to a friend who is feeling suicidal, because you may need to share what they tell you with someone else in order to keep them safe. On keeping someone safe, Uduman recommended looking at how support and intervention can be provided by taking away potential means of suicide, not leaving the person alone, and helping the person refrain from using alcohol and similar substances that can heighten or dull emotions. Commenting on affordability, particularly in the Sri Lankan context, the panel noted that while there is no regulatory body in Sri Lanka to oversee how therapists charge, this also means that there is added flexibility for payment plans, encouraging open communication between therapists and clients on finances to see if a sustainable payment scheme can be reached. The panel also addressed hospitalisation and institutionalisation, explaining that while this does happen, it is very much a last resort used only to help someone who is an imminent danger to themselves or others. The panel also spoke about detecting signs of mental distress in others, asking concerned parents and friends to look for changes in behaviour and interaction, keeping an eye on social media interaction and activity to make sure bullying and cyberbullying are not taking place, and building open and safe discussion spaces. --- Sri Lanka has several crisis hotlines for those in need of support. If you, or someone you know, is feeling suicidal or is otherwise at risk emotionally or mentally, please reach out on the following hotlines: 1333 – 24-hour hotline by the Courage Compassion Commitment (CCC) Foundation, a not-for-profit organisation based in Sri Lanka and Australia to provide services in the areas of cancer and mental wellbeing. 0112 696 666 – Government-approved charity Sumithrayo hotline, that provides confidential emotional support to those in need (in operation from 9 a.m. to 8 p.m. daily). 1926 – 24-hour national mental healthline at the National Institute of Mental Health, which provides emotional support to those in need until they can meet a mental health professional.