As stated at the outset of this study, youth suicide in India needs to be viewed using a multi-sectoral lens, as there could be multiple “political (policy perspective), social (stigma and discrimination on basis of caste, gender, etc.), cultural (beliefs and help-seeking behaviours), and economic (both direct and indirect costs of treatment) factors”, possibly acting as tipping points that contribute to suicidal ideation amongst young people (Kaur and Pathak, 2015). Considering this, we have identified the following gaps.

1. Lack of Awareness and Sensitisation

The treatment gap in India, in terms of number of people diagnosed with a mental health condition without adequate access to be treated, is very high. A general lack of awareness among primary stakeholders including teachers, faculty, administration, parents, and peer groups is observed. Emotional first-aid and sensitisation (around both mental healthcare and suicide prevention) is largely neglected. There is a need for “innovation and capacity building to develop and implement locally relevant, feasible, and effective community-based mental healthcare models”. (Becker and Kleinman, 2012)

2. Lack of Conducive Education Environment

The Indian State has made attempts in the past to make the HEI ecosystem inclusive, but precious little has been achieved, owing to variations in the extent of implementations across HEIs. Several committees* have passed recommendations to prevent bullying/ragging in HEIs. Even so, incidents of deaths by suicide due to caste and/or gender based discrimination, bullying, and unavailability of resources (counselling), continue to plague HEIs in India (Dhingra and Dua, 2018).

3. Lack of Policy/State Intervention

The implementation of MHCA (2017) suffers from the lack of a holistic roadmap. Mental healthcare is covered under different policies and requires smooth collaboration of different state departments to implement state initiatives.

India lacks a national strategy concerning suicide prevention. Public health policymakers need to increase awareness concerning suicide prevention. Also, it is essential for the State to take up academic research to ascertain suicide rate, help seeking behaviour, psychiatry referrals, and overall epidemiological data for the evaluation and effective implementation of MHCA.

4. Lack of Funding for Resources

Less than 1% of the national healthcare budget is spent on mental health. Although suicide has been decriminalised in India as per Sec 115 of MHCA, there continues to be a lack of clarity among stakeholders. Mental health initiatives predominantly have a bio-medical focus. This has had serious implications on both, public as well as private funding for mental healthcare and suicide prevention services (Kaur and Pathak, 2015).

Levers for Change

We have identified 22 levers for systemic change based on our research findings and gaps. Realising that these levers are varied in terms of implementation efforts, as well as the extent of impact on the system, we have classified them based on Donella Meadows’ Leverage Points to Intervene in a System (Meadows, 1997).

*contact us for permission to reprint/reuse

3. Youth Suicide Crisis in India: Gaps and Levers was originally published in Youth Suicide Crisis in India on Medium, where people are continuing the conversation by highlighting and responding to this story.

Knowledge and Awareness

• NIMHANS* and Live Love Laugh Foundation, create awareness through campaigns like #DobaraPoocho (‘Ask Again’), aimed at breaking stigma.
• Mental Health Collective, ‘Its ok to talk’, and Mithra Trust provide mental health comics and information that enable understanding and engagement.

Services

• Some of the HEIs offer online and/or phone therapy. Counseling services are also provided on campus.
• Specialized mental health hospitals as well as psychiatry departments for treatment are accessible.
• Private clinics and counselors are available in most cities. Rural and District mental health programs are available.
• Group counseling, peer support, and movement based therapy are available. Tele-counseling and chatbots, such as YourDost and Wysa, are available.
• Self-help products and tools, like ‘The Meh Kit Riding Out Depression’ by Mithra Trust are available and affordable.
• Suicide and crisis helplines such as SNEHA and iCALL are accessible.

Skills

• Community engagement programs like Gatekeeper Training are conducted by NIMHANS, and Suicide Prevention India Foundation.
• Mental Health First Aid training is made available by MHFA**, India.
• Public schools in Delhi^ have incorporated Social Emotional Learning (SEL) and Life Skills Programmes as part of their curriculum implemented.

Across the globe

Best practices for suicide prevention vary across the globe. For example, Sri Lanka has reduced access to pesticides, a commonly used means for death by suicide. JED Foundation (USA) provides students struggling with mental health, a platform to share their stories. They also promote usage of varied services such as counseling and peer group discussions.

Shifting the Burden archetype

An overwhelming focus lies with short-term solutions that are easier to formulate, less expensive and remedial in nature. This consequently, acts as a barrier to implement restorative solutions that address the root causes and could have a long-term impact on reducing emotional distress.

*NIMHANS — National Institute of Mental Health and Neurosciences
**MHFA — Mental Health First Aid
^ Aam Admi Party (AAP), the governing body in Delhi, has implemented SEL in public schools’ curriculum

*contact us for permission to reprint/reuse

(2) Youth Suicide Crisis in India: the existing solution Landscape was originally published in Youth Suicide Crisis in India on Medium, where people are continuing the conversation by highlighting and responding to this story.

We have taken a multi-sectoral approach to understand suicides in India. The focus has been on student suicides in Higher Education Institutions (HEIs), as spaces where psycho-social determinants play out in myriad ways.

Impact of Social Factors on Mental Well-being is Understated

The data demonstrates that varied social factors adversely impact mental well-being of students. Therefore, analysing the social determinants is critical to understand the problem holistically. At the time of research, we studied the impact of widespread student-lead protests concerning CAA* and NRC**.

Complex bio-psycho-social factors contribute to emotional distress in students, in some cases leading to deaths by suicide.

The micro level primarily consists of various biological and psychological factors such as diagnosed as well as undiagnosed mental and physical health conditions, hormonal changes, coping mechanisms, resilience, and other psychological constructs (Knipe et al., 2019).

The meso level consists of social issues like discrimination violence, pressures from family, bullying, unemployment, and so on (Pandey, 2017).

The macro level consists of factors like political instability, persecution of religious minorities, economic fluctuation, climate change, and so on (Ganesan, 2018).

Lack of General Awareness Concerning Mental Health

The survey included questions to gauge respondents’ understanding of mental health. Out of 436 responses, only few were able to clearly explain their understanding of mental health.

Respondents stated that they knew of peers (42.4%) and extended family members (20%) who faced mental health struggles. Nearly 71% of the respondents stated that they have faced mental health struggles. This aligns with a study that showed 12% respondents struggled with depression, 55% struggled with anxiety and 31% experienced high or moderate emotional distress (CSDS-KAS Report, 2017).

Suicide can have a Significant Impact on Others

Death by suicide can have a significant impact on close ones. With respect to exposure of respondents to death by suicide, media coverage tends to focus on death by suicides of students from engineering institutes. The diagram below shows the extent to which students are exposed to deaths by students in HEIs.

The survey showed an alarmingly low number (25.8%) of respondents with mental health struggles sought help even with the awareness of available services. This corroborates findings of earlier studies (CSDS-KAS, 2017). Also, it is observed that primary stakeholders face challenges to provide help due to societal norms and lack of awareness.

Systemic Issues

50% of people who die by suicide, do not have any mental illness, but rather face struggles owed to a combination of mental and physical health, social justice, environment, employment factors (Soumitra Pathare, 2020).

Social System

India witnessed transformation of economic, political, socio-cultural, and technological sectors, in the past decade. These transformations, coupled with the deeply entrenched caste system and patriarchy pervade HEIs, leading to emotional distress among students (CSDS-KAS Report, 2017).

Education System

Quality education remains inaccessible in India. There are not enough Tier I and Tier II institutes in the country to cater to the demands of aspiring students (Pushkar, 2014). On an average, 28 HEIs cater to 100,000 students (AISHE, 2019). Major focus lies on reputed institutes, which adds competitive pressure on aspiring students. Once a part of the institution, choices of courses, discrimination, low student-teacher ratio, are some issues that students encounter.

Health System

The budget allocated to mental health is negligent and private funding is also limited. India’s spending on healthcare is low with an annual expenditure of 1.28% of the GDP on healthcare, with mental health allocated only around 0.05% of the total healthcare budget (Chandna, 2019; Munjal, 2020). Consequently, resources for mental healthcare are limited with two mental health professionals and between 0.3 to 0.75 psychiatrists for every 100,000 of the population (in contrast to the global average of four) (Financial Express, 2019).

Policy and Legal System

MHCA* was introduced which decriminalised suicide and upheld the right of persons to make decisions regarding their mental healthcare (Galhotra and Mishra, 2018). However, a lack of awareness regarding the criminal status of the act remains (MHCA, 2017). This leads to challenges for the survivors (and family members for reporting a suicide) as they have to deal with strong socio-cultural and religious sanctions against suicide, and harassment by the police and/or legal authorities (HealthNet TPO, 2013). This also results in under-reporting of cases and diminished access or use of mental healthcare facilities.

*contact us for permission to reprint/reuse

(1) Youth Suicide Crisis in India: the Problem Landscape was originally published in Youth Suicide Crisis in India on Medium, where people are continuing the conversation by highlighting and responding to this story.

Many of us have been using Instagram for more than four years now. It is a part of our lives as much as Facebook was when it entered our student lives. Instagram as an application for social conversation has attempted to create a positive platform for all ages to share their life stories. It has encouraged many people to embrace creativity and share their progress with their peers. However, along with its upsides, the app has downsides as well. I have felt like quitting the app on numerous occasions. It will be interesting to note why we feel addicted to the app all the same. Why do we feel low when we don’t get enough likes? Why do we instantly get satisfied with greater number of likes? It is a social platform and we cannot keep emotions out of it. But why do we let it affect us on such a massive level? No matter what the creators’ intent was or still is, the app has been churning out toxic byproducts in its process that need to be treated with caution.

I tried to understand my journey of using Instagram, while referring to online articles and research papers. The issues are extremely complex. Though a simpler systems view has been illustrated.

There are six major aspects which Instagram profits on; Isolation, Need for validation, Fear of missing out (FOMO), Insecurity, Lack of inter-personal interaction and social anxiety. There must be more, but these six have been prominently observed by me.

The more insecure we feel about ourselves, the more need for validation, and hence we will keep using Instagram. We keep improving our posts maybe. The number of likes will matter to us, that is the reward experience all Instagram user thrives on.

FOMO or ‘Fear of missing out’ gives rise to temptation for using Instagram frequently, however when we use Instagram our FOMO can reduce temporarily, but it also intensifies our isolation by curtailing the inter-personal interactions with our friends. The intensified feeling of isolation not only causes FOMO but also makes us more tempted to go back on Instagram, further affecting our inter-personal interactions negatively. Sometimes, Instagram usage makes us feel less isolated temporarily. But is it worth it?

Excess Instagram usage not only can make us feel isolated and insecure, but also socially anxious. Increase in social anxiety can lead to yet again affect our inter-personal interactions negatively. When we try to quit Instagram, we start feeling left out and soon we get back on it.

There are deeper psycho-social factors that can emerge out of the above mentioned. Maybe not everyone is getting affected on this scale, maybe some factors are more prominent for you and some don’t even exist. Example, Inter-personal interactions can be subjective to the person’s ability to interact physically. But, we need to be aware and find out how to deal with these byproducts and not let them emotionally distress us.

For many individuals quitting Instagram might not be possible as of now, but being aware of how it may be affecting you, can help you reduce its power over your emotions.

Editor. ANSHUL AGRAWAL