At the media meet, Modi spoke in front of an audience in Hindi and his speech was broadcast live on a television channel. The following is a translation of his speech. It may be triggering to some, so caution is advised.

Modi said: “In our childhood, we would hear a joke. I want to tell you that.

“There was a professor and his daughter committed suicide. She left a chit, ‘I am tired of life and don’t want to live. So I will jump into the Kankaria Lake and die. In the morning, he saw his daughter was not at home. On the bed he found the letter. The father was very angry. “I am a professor. For so many years I have worked hard, and even now, she has spelt ‘Kankaria’ wrong.” (Kankaria is an area in Ahmedabad, the home state of the prime minister!)

The audience bursts into applause at this point. Modi is also seen laughing.

He then said, “I am happy that Arnab [Goswami, Republic TV head] has begun speaking great Hindi.” More applause followed.

“I didn’t hear what he said but I was paying attention to whether his Hindi is correct or not,” Modi added. “Maybe you have learned Hindi properly because you have been living in Mumbai.”

It is unclear why this “joke” was necessary to “compliment” Goswami’s Hindi.

High suicide rates, distress in the young

According to the National Crime Records Bureau’s latest data, 1,64,033 people died by suicide in India just in 2021. This means that 450 people died each day. This was an increase of 7.2% in terms of absolute numbers as compared to the previous year.

According to this paper published in Indian Journal of Psychiatry, this was the highest recorded ever since the NCRB came into existence. Over a third (34.5%) of those who died by suicide belonged to the age group of 18-30 years. Another 31% were aged between 30-45 years – thus showing that the very people who are referred to as India’s “demographic dividend” are who are dying by suicide.

The fact that mental health does not figure in as priority and people don’t consider suicide a serious issue was revealed in a survey carried out by the The Live Love Laugh Foundation.

In a survey of 3,556 respondents from eight cities across India, a staggering 47% could be categorised as being highly judgmental of people perceived as having a mental illness, Quartz had reported.

Recent reports have also shed light on how academic distress among young Indians is combined with factors like caste discrimination even in elite institutions, rising unemployment and financial struggle, leading students to feel isolated like never before.

Young persons on twitter were articulate.

Pooja Tripathi’s Video on her twitter handle is powerful

कहते हैं छोटी ताबूतों का वजन सबसे भारी होता है विश्व में जो बाईडेन नेशनल मेंटल हेल्थ एक्ट ला रहे , इंडोनेशिया में मेंटल हेल्थ पालिसी 2014 से लागू है , लग्ज़मबर्ग लेटर्स टू स्ट्रैंजर्स पालिसी चला रहा और हमारे प्रधानमंत्री चुटकुला सुना रहे !

Listen to Congress spokesperson  @SupriyaShrinate slammed Narendra Modi on his insensitive & Shameless comments on suicide . She said since 2014 there has been an increase of 60% cases of suicides because the people can’t cope up with inflation, high price, unemployment .

https://twitter.com/i/status/1651496001092595713

Shrinate said this was his (Modi’s) real face peeping out through his carefully crafted image. “This is your truth. The shining image of yours, painted and polished by the media, is just a mask that slips frequently and the truth comes in front of the people. The cheap jibes, the meanness, the cruelty… that’s the real face,” Congress social media head Supriya Shrinate said. RJD Rajya Sabha member Manoj Jha said what was more distasteful was the laughter and clapping from the audience at the Prime Minister’s joke. “We have become a very sick society,” he said.

https://twitter.com/i/status/1651795545739116545

Other Opposition leaders are among those who have registered their outrage against Modi’s comments.

Congress leader Rahul Gandhi said on Twitter in Hindi that thousands of families lose their children due to suicide and the Prime Minister should not make fun of them.

Rahul Gandhi tweeted: “Thousands of families lose their children because of suicide. The Prime Minister should not make fun of them.”

News of suicide by a 19-year-old girl, Rashi Jain, who was preparing in Kota for the medical entrance exam, had come in barely hours before the noise of laughter from the Republic TV event where Modi spoke.

Many social media users reacted with horror. Some put out an old video that appears to show Modi laughing while purportedly speaking on the people’s miseries following the 2016 demonetisation.

Priyanka Gandhi Vadra posted a message saying: “Depression and suicide, especially among the youth, is not a laughing matter. According to NCRB (National Crime Records Bureau) data, 164,033 Indians committed suicide in 2021. Of which a huge percentage were below the age of 30.

“This is a tragedy, not a joke. The Prime Minister and those laughing heartily at his joke ought to educate themselves better and create awareness rather than ridicule mental health issues in this insensitive, morbid manner.”

Modi has been known to crack questionable jokes on unfortunate people earlier too. He had ended up mocking dyslexic students (who have difficulty reading) a few years ago while taking a dig at Rahul Gandhi during a video conference with students. When a student spoke of a project to boost the creativity of dyslexic children, Modi asked whether it would also help “children who are 40-50 years old”. When the student said it would, Modi responded: “The mothers of such children will be very happy in that case.”

In a Hindi tweet, Rashtriya Janata Dal MP Manoj Kumar Jha, incisively, noted the applause that followed Modi’s comments:

“Malaise is visible when the Prime Minister of the country tells a joke on a sensitive issue like ‘suicide’. But even more frightening is the applause and laughter after the joke. We have become a very sick society…Jai Hind.”

Shiv Sena MP Priyanka Chaturvedi shared 2021 NCRB data to show India’s numbers when it came to deaths by suicide. She also called the video triggering.

Respected PM,

I won’t share the triggering video where you cracked a joke on suicide while the audience laughed at the insensitive ‘joke’, however I’d definitely like to remind you that 2021 NCRB data shows that over 1.5 lakh Indians committed suicide, also deaths by suicide… pic.twitter.com/nWysoJSIRL

— Priyanka Chaturvedi (@priyankac19) April 27, 2023

Aam Aadmi Party tweeted through its official handle, “Imagine the insensitive disregard for human life by our Prime Minister who needs to crack a joke on suicide!?!?”

Samajwadi Party’s Gaurav Prakash cited a report from The Quint, to note that “every nine minutes a woman in India takes her own life.”

Journalists, too, have spoken on the joke.

“No aspect of insensitivity should be devoid of your indulgence,” Abhishek Baxi tweeted.

“Modi outdoes himself,” wrote Swati Chaturvedi.

BJP’s Selective Outrage on PM’s Image

The ruling party , the BJP was on Thursday, April  27, more outraged about a comment by Congress president Mallikarjun Kharge.“Modi andre, ee vishada havidhange. Neevandru, edu visha ada illa nodona swalpa nekki nodona antha nekkakka hogiri…. Nekkra satha. Illa idu visha adano illvo Modi kottana, olley manushya pradhana mantri, naavu swalpa nodona, nekki nodona antha heli aa vishavanna nekki nodidare, neevu malage bidtiralli,” Kharge had told a poll rally in Karnataka.

A translation: Modi is like a poisonous snake. Do not try licking it to confirm whether it’s poisonous. If you do it you will be dead. If you think it’s been given by Modi, a good man, the Prime Minister, so let’s lick and see, you’ll be left sleeping (you’ll be dead) there itself.

Kharge was quick to issue a clarification, asserting that he was talking about the divisive politics and hateful ideology of the RSS-BJP and not about Modi the individual. He said he had nothing personal against Modi and that the fight was against the ideology he represented. Kharge said he had suffered a lot in life and never made fun of people or launched personal attacks. But the BJP pounced on him, alleging that Kharge had revealed the mindset of the Congress.

Karnataka chief minister S.R. Bommai said the poison was in Kharge’s mind, while Union minister Anurag Thakur said “this is worse than Sonia Gandhi’s maut ka saudagar (merchant of death) comment”.

Sonia had made the comment during the 2007 Gujarat election campaign. Modi, a dab hand at playing the victim of personal vilification, had exploited the remark to seek voter sympathy. With the BJP so far on the defensive in Karnataka, the party and Modi are expected to use Kharge’s comment to divert attention from bread-and-butter issues.

Congress spokesperson Gourav Vallabh sought to undo the damage by recalling how Modi had used foul language all along, going to the extent of describing Sonia as “Congress ki vidhva (the Congress’s widow)”. But the Congress fears that its issue-based campaign might get hijacked now.

Related: 

REPLUG: Rohith Vemula, Your Sacrifice was Not in Vain

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India surpassed Brazil in the daily record of active Coronavirus cases to become the world’s second largest country with the Corona infection. Crippled by one of the stringent nationwide lockdowns in the world, India witnessed a deep plunge as the economic pandemic with the GDP touching an all-time low at -23.9% this August, China’s incursion on the LAC threatening the Indian security and geographical integrity, repeatedly imposing its dominance. None of this could beg for attention as well as the scripted high voltage drama unfolding on most of the Indian news channels ad nauseaum . 

What does this suggest of us, the viewers. In the absence of the new releases and the exhuasted options of OTT, the entertainment starved nation has transformed the untimely tragic death of SSR into a Box Office hit with the news channels introducing new twists and turns every day, leaving intoxicated viewers guessing, and demanding more. The news-cum-entertainment channels have deployed all the tricks in the hat to be the SSR best seller even launching their own parallel investigation and devising improbable theories with the most trending hashtag of NationWantsToknow hammered down our throats with unparalleled histrionics. 

Amidst this increasingly politicised investigation now, a very relevant discussion and debate is drowned into the rhetoric of inanities. What could have been a discourse, an awareness and understanding of mental health is rubbished and downplayed by the news channels primarily because it lacks the essential ingredients for a perfect Bollywood script which is replete with toxic masculinities where SSR remains chivalrous yet gullible, but a valiant hero. 

Most importantly when the world under the lockdowns and quaratine is struggling to keep the mental equilibrium, any admission of SSR’s mental health problems would be not only the negation of his Bollywood heroic stature sadly mirroring our deeply entrenched patriarchial society where men cannot be weak. Men are made weak by the women in their lives. This is the most acceptable narrative of the society where mental health is still a women’s problem, where fragility is despised at all cost to develop the pumped up muscular masculinity and where there is still no acceptance for a live in relationship. Hence the upward mobile social climber girlfriend makes a perfect fit for a beautiful enchantress. All playing out with the visuals of the girlfriend dancing in skimpy clothes strategically on larger part of the screen while the TV anchors don the conscious keeper of the society call for the candle march. It was meant to be an instant hit, TRPs beloved. 

It is because prioritising the significance of mental health and its wider prevalence will put many news channels out of context in their crusading spree for the market of justice. Endless discussions on nepotism, drugs and mafia with many television actors making appearance on news channels with their sordid saga of struggle and failure laid bare the insecurities and anxities that dominates the glamorous world, yet the discourse failed to move into the right direction because very few dare to make it public. The stigma and shame surrounding the mental health issues often contibutes to its severity. Its widely known in public now that SSR was struggling with mental issues, he was deeply aware and  acutely conscious of it and was seeking treatment but was yet not ready to talk about it, painfully cognisant of the fact that it could affect his career and mar his public image of a “hero”, whose paid job is to save the damsel in distress and thus cannot be seen as a ‘boy who cries’. 

In contrast, when Deepika Padukone opened up about her battle with depression in 2015, she was in the race of one of the most sought-after Bollywood actress. Speaking up openly about her depression and anxiety, she admitted that her recovery was possible only because of professional help, medication and the support of  her family and caregivers. She described the feeling as persistent “strange emptiness”. Mental Illness is not easy to describe, its less dramatic and more profound. 

Suicide rates in India are on a spree, according to NCRB (National Crime Records Bureau), 10,159 students died everyday by suicide in 2018. Dr Tedros Adhanom Ghebreyesus, WHO Director General in 2019 made a startling revelation confirming “Despite progress, one person still dies every 40 seconds from suicide” and he further added “every death is a tragedy for family, friends and colleagues. Yet suicides are preventable. We call on all countries to incorporate proven suicide prevention strategies into national health and education programmes in a sustainable way.” 

While we do not know for sure what led to SSR’s death, the country’s top notch agencies at work will sooner or later distill the fact from fiction and thankfully this macabre media frenzy will also die its own death, regretfully leaving some very pertinent questions unaddressed. 

It’s about time that society recognises the extreme ramification of ignoring mental health issues. Emile Durkheim in his pioneering scientific analysis and empirical study on suicides confirmed suicide to be not just an act of individual but the breakdown of the entire social function. 

On this World Suicide Prevention Day on September 10, let’s talk about our mental health, our fears, anxities, agonies, trauma and insecurities with more empathy and compassion and let’s not be shy to seek help because we are not alone in this. We need more hashtags like NotAshamed as one by Deepika Padukone being a depression survivor. Unrelenting Coronavirus making social distancing a norm along with its economic fallout has only warranted an urgent need for a multi pronged approach with more accessible mental health services to address the myth and taboo surrounding mental health in order to save the youth of our country who are worst affected.

Amina Hussain is an Assistant Professor at Khwaja Moinuddin Chishti University, Lucknow

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Guilty as charged: Investigators, judge, jury and executioners of TV news ‘debates’ 

Over 42,000 workers from informal sector allegedly die by suicide

The post SSR’s tragic death: Are we missing the wood for the trees? appeared first on SabrangIndia.

My mother Smt Sangeeta Sen Gupta suffered from Bipolar Disorder. She was the strongest, brightest, smartest woman of my life.

I am watching many colleagues turning into mental health experts now. Apparently people with Bipolar Disorder can’t be functional and because Sushant Singh Rajput was successful he must have not suffered from any kind of clinical depression or Bipolar Disorder.

I am not an expert. However, let me tell you about my mother. My mother was a Professor of Sanskrit. She had excellent interpersonal skills. The most functional, wise and constructive person of my life. She also had Bipolar Disorder. You have no f***king idea what kind of depression and/or mania a person with bipolar Disorder suffers. It has nothing to do with being strong.

So many of you suffer from angina, blood pressure, diabetes, thyroid. Are you weak? Others suffer from Spondylitis, arthritis ….are you weak? Are your parents suffering from these conditions weak and that’s why they have these conditions? Or are they fragile because they have a condition?

Very few people from my Ma’s college or among our relatives knew about her condition. She suffered a lot when she suffered and I who was her primary care giver in my teens and in my thirties saw that pain. My mother, ask my school and college friends, was known for her dignified self, kindness, generosity, politeness… and intelligence. She worked till she retired. 

Lastly, do you feel that live-in partners share less than married couples? Why does a long term ‘live-in partner’ not have stake in her partner’s property and earnings? Our law recognises domestic partnership beyond marriage. Doesn’t it?

I really wonder are all patriarchs and regressive people journalists these days?

“Sushant depressed nahee ho sakta” (Sushant can’t be depressed). What does that even mean? Anyone can be clinically depressed or suffer from Bipolar Disorder. Anyone who is hopeful, optimistic and wise….any illness can happen to anyone….

And there are friends and family members who stand by their loved ones…you can’t lynch them and defame them and presume they didn’t care… because a person commits suicide.. you were not there when the person was suffering…the loved one you are abusing was there…

Can you be respectful for once? Your pain as a fan is not bigger than their agony.

Related:

Media, right-wing spew venom over Sushant Singh Rajput’s death

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On any other day when I was feeling low, I would probably have bought into the popular “influencer-peddled self-care quick-fixes” like going to a movie, a walk outside, visit the beach, or simply order some ice cream from a nearby restaurant. The tables have turned now. The COVID-19 crisis and the ensuing lockdown has revealed painfully, and glaringly, that all of the things that are marketed to us to make us “feel better” are just an illusion. Such “self-care” is also a matter of how privileged one is. Advertising moguls have created this aspirational privilege bubble around us, making us believe that capitalism is the saviour of our mental health and not the cause of mounting stress that may cause and exacerbate mental illness in the first place.

While experts argue that the next public health crisis we face will be in the domain of mental health, the lockdown has caused many existing conditions to worsen. The increased cases of domestic violence and child abuse are testament to the escalating catastrophe. In these trying times, triggers abound, sometimes perpetuated by our own families, and at other times by the people we interact with virtually on social media.

The rampant Islamophobia peddled by our News Channels has exploded its way onto our social media feeds and in family WhatsApp groups. While some of us choose to call out the bigotry, others have no option but to stay silent for their own safety- physical and emotional.For Mumbai based activist Karishma Khemlani, this is a time of disillusionment, “So many of us are facing ostracism for speaking out against Islamophobia- be it from families, friends, acquaintances, or colleagues. I think we’ve always been surrounded by Islamophobic people, but we’re seeing them be more vocal now that they know that their Islamophobia is state-sanctioned. I’m privileged enough to voice my objections to so called ‘jokes’ and misinformation without facing severe outcomes, but I know of people who are physically abused in their homes for speaking up”.

On the one hand, while calling out Islamophobia becomes the prerogative of informed people from all communities, facing Islamophobia as a Muslim is another battle altogether. Sidrah Patel introduces herself as a professional working for a non-Profit, and as a conscientious Muslim Indian. Talking about her identity, Sidrah told me, “Each time I introduce myself I realize I have become very conscious and protective about my Muslim identity over the past year which is also a consequence of the Islamophobia that is being peddled. I call out Islamophobia on public platforms on a daily basis. There is an increasing awareness about Indian media that has been dedicating a lot of air time and energy into projecting the Muslim as the ‘other’. This is a very perilous discourse which considers Muslims guilty even before any facts are established. The Muslim identity is constantly targeted, criminalized and vilified.”

Her words ring especially true in the context of the fake news tsunami that was launched against the Tablighi Jamat. Even though the news items that debated and ranted for hours of airtime over fake videos that claimed the CoronaVirus positive patients from Tablighi Jamat were desecrating the hospitals, the retractions or apologies never happened after all these allegations were disproved. Be it the abominable “Jihad Charts” or the vilification of Shaheen Bagh protestors which preceded the CoronaVirus outbreak, media organizations have made a business of propagating conspiracy theories and fake allegations with impunity.

Sidrah suggests that as a citizen it becomes our duty to call out fake news and Islamophobia by stating facts, “The media has very successfully de-humanized people. All that is left, is a projection of a collective identity of either Hindu or Muslim. It is time for people to reject these notions that any religion is a monolith. We should connect and listen to each other as humans. There is also a need to showcase the stories of love when the propaganda churning machine is relentlessly serving information focussed on hate, most of which is untrue. We can’t let the media run amok with no one calling them out because a lot of people believe the News Channels and portals thinking that these are reputed organizations and thus can do no wrong”.

Calling out or confronting hate is equally challenging online and in real life. For many of us, the battle starts at home. Yet, it is not easy on anyone’s own mental health to go head to head with their families and friends. Rashi Vidyasagar, Director of The Alternative Story which provides affordable online therapy services, asks everyone to ‘pick your battles’. She suggests a gentle approach when dealing with people who are close to you and can hence affect your mental health,“You need to figure out how much you can push back against something. I avoid heated discussions or confrontational fights with family. What can work, is to casually bring up these topics when the mood is otherwise relaxed. You may bring up some verified facts or good examples to counter Islamophobia. Most times these beliefs are very deep seated, and hence, you will need to chip away at them slowly. You might be the only person who can affect this positive change in your near and dear ones. The important thing to remember is to preserve your own mental health first”.

As the lockdown continues and the disparities around us become ever more glaring- be it caste, class, gender, sexuality, or disability- we can feel helpless and overwhelmed. One needs to remember that picking our battles and drawing boundaries is also a form of self-care. We must do what we can, when we can. Islamophobia has become a loud cacophony even as the streets are silent.UAPA is being used to silence more and more journalists and activists even during lockdown. Poverty and starvation are looming threats hanging over the majority of our population.Many more battles wait in the wings as a changed world may greet us after the lockdown ends, whenever that will be. To fight, we must remain strong and take care of ourselves too. We have to find those pockets of time for ourselves. As they say on airplanes, “Put your own oxygen mask on first, before assisting others”, and maybe that is what we need to do as well, to live to fight another day.

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Whole swathes of US and global opinion were horrified by Trump’s election in 2016 and feared the consequences. A vocal minority, even before the election, based their opposition to Trump on their assessment of his psychopathology. The argument was, and remains, that Trump’s mental state poses a threat to US democracy and to global stability.

As the impeachment investigation and its fallout continues, Trump’s mental health is now receiving increased attention. In August, the Financial Times published a cartoon of a padded cell with a plaque on the wall saying “Oval Office”. In October, the lawyer George Conway wrote a lengthy article on the issue entitled Unfit For Office for The Atlantic magazine.

Discussing the mental health of political leaders, however, remains deeply controversial. The “Goldwater Rule” of the American Psychiatric Association states that it’s unethical for a psychiatrist to offer a professional opinion concerning a public figure unless he or she has conducted an examination of that public figure and has been authorised to do so. Some have argued that talking about the mental health of politicians could stigmatise those with mental illness and open the door to the misuse of mental categorisation in political debate.

Such concerns are valid and need to be addressed. Still, as I’ve argued in my own research, there are three compelling arguments for why we must talk about the mental health of political leaders.
 

Possible danger to society

The first argument is that leaders with certain mental disorders may be incapable of carrying out the duties of office and may even pose a danger to society. This is the argument in Conway’s article and the argument that motivates most mental health professionals, and others, who have spoken out against Trump, myself included.

Trump displays repeated and persistent behaviours consistent with narcissistic personality disorder and antisocial personality disorder. These behaviours include craving for adulation, lack of empathy, aggression and vindictiveness towards opponents, addiction to lying, and blatant disregard for rules and conventions, among others.

The concern is that leaders with these two disorders may be incapable of putting the interests of the country ahead of their own personal interests. Their compulsive lying may make rational action impossible and their impulsiveness may make them incapable of the forethought and planning necessary to lead the country. They lack empathy and are often motivated by rage and revenge, and could make quick decisions that could have profoundly dangerous consequences for democracy.

But there is a crucial caveat. The argument that a leader’s mental health may pose a danger to society doesn’t apply to most mental illnesses, such as depression, bipolar disorder or anxiety disorders, for example. In the vast majority of cases, evidence clearly shows that people with mental illness are not violent and do not pose a danger to others. The argument does apply, however, to narcissistic personality disorder and antisocial personality disorder, and so discussion on the mental health of political leaders should be confined only to this small number of disorders.
 

The rise to power

A second compelling reason for discussing psychopathology in politics is that it allows us to better understand the dynamics of how dangerous leaders rise to power. Their rise requires all three elements of a “toxic triangle” comprising leaders with dangerous psychological disorders, a core base of followers and an environment that is conducive to their rise to power. Such people do not rise simply on their own, but rather as part of a political party that adopts their values and enables their rise to power.

Part of a ‘toxic triangle’. Erik S. Lesser/EPA

This understanding of how pathological leaders emerge has profound implications for democracy. It suggests, for example, that mechanisms such as impeachment and the 25th amendment of the US constitution, which determines what to do if a president become unable to discharge their powers, fail to address the very real dangers that pathological leaders pose to democracy.

Such mechanisms rely on the rogue leader being somewhat of an outlier and depend on the majority of legislators remaining wedded to democracy. However, because pathological leaders typically rise to power with the support of political parties and with mass support, this is often simply not the case. The congressional majorities needed to enact the 25th amendment or to impeach the president will not exist in this type of situation. New mechanisms to defend democratic institutions against authoritarianism are therefore urgently needed to account for the group nature of this phenomenon.
 

Finding a remedy

A third reason for talking about this issue is that an understanding of how pathological leaders rise to power allows us to devise effective remedies to escape from this dangerously divisive moment. The explanation of why dangerous leaders such as Trump rise to power doesn’t only include their psychopathology. It also encompasses the underlying economic, political and cultural reasons for their appeal.

So too then must the solution. Trump was elected because he came along at a time when many ills afflict the country. People voted for him in large numbers because he promised to right those ills by whatever means necessary, even if that included undermining democracy by attacking the press, demonising and threatening opponents, praising dictators and subverting the norms of democratic government. It is only by addressing American society’s genuine ills through democratic means, however, that the country can hope to recover from the narcissistic fog that Trump has created and regain its civility and moral leadership.

Those who wish to restore American democracy must begin to have a civilising conversation about personality disorders and politics. Such a conversation is urgently needed to recognise the true nature of the danger democracy faces, and contain it.

The post Three reasons why we need to talk about the mental health of political leaders appeared first on SabrangIndia.

India’s suicide rate stood at 16.5 suicides per 100,000 people in 2016, according to the WHO report. This was higher than the global suicide rate of 10.5.

The report presented suicide rates for countries and regions using data from the WHO Global Health Estimates for 2016. When classified according to region and income, India is part of the South-East Asia region and the Lower Middle-Income group of countries. India’s suicide rate (16.5) was higher than the rate of its geographic region (13.4) and the rate of its income group (11.4).

India also had the highest suicide rate in the South-East Asian region for females (14.5). India’s male suicide rate was not the highest in the region, but at 18.5, was higher than the female rate and the combined suicide rate. India stood third in the region in male suicide rates, after Sri Lanka (23.3) and Thailand (21.4). 

WHO recommendations
Despite having a suicide rate higher than the global average, India has not acted on the WHO’s recommendations for suicide prevention. In 2014, the WHO had released a report with a series of recommendations for successful suicide prevention. It proposed following the public health model for suicide prevention, consisting of four steps:
 

1. Surveillance
2. Identification of risks and protective factors
3. Development & evaluation of interventions
4. Implementation

India has not progressed beyond the first step, surveillance, defined in its 2014 report as the systematic collection of data on suicides and suicide attempts.

However, even in this, the National Crime Records Bureau’s (NCRB) 49-year-old practice of announcing suicide statistics was stopped abruptly in 2016 (when it released suicide statistics for 2015), and suicide statistics have not been made public ever since.

Farmer suicides
Up to 2016, every year, the NCRB compiled the preceding year’s suicide data in an annual report titled ‘Accidental Deaths & Suicides in India’ (ADSI). These reports presented the total number of suicide deaths in the country, categorised by cause, means, occupation, educational status and economic status.

In 2014 and 2015, the NCRB included a chapter with data on suicides within the farming sector. This chapter highlighted that five states (Maharashtra, Telangana, Madhya Pradesh, Chhattisgarh and Karnataka) had accounted for nearly 90% of all farmer suicides in the country in 2014 and 2015.

Two years after the introduction of the new chapter, the NCRB stopped publishing its annual report.

The NCRB had found discrepancies in the data submitted for 2016 and had asked states to re-verify the data, the government told parliament. 

 Monitoring methods
While the NCRB claims the 2016 ADSI report is being finalised, India’s data collection remains insufficient, when measured against the WHO’s suicide prevention recommendations.

The WHO’s 2014 report had suggested that countries must monitor data from multiple sources such as vital registration data (the number of births and deaths recorded), hospital-based systems and surveys; the NCRB collects suicide data for its ADSI reports from a single source–the police departments of states and union territories.

Claiming to have used years of high-quality vital registration data to prepare its suicide estimates, the WHO’s latest report said India’s death registration data was not usable by WHO standards.

The latest report on global suicide estimates rated the death registration data quality of each country on a scale of five, where one was the highest score and five the lowest. India’s was rated four and termed “unusable or unavailable” due to quality issues. 

India also does not compile and publish data on suicide attempts at the national level. The WHO recommended using hospital-based systems and surveys to monitor suicide attempts.

A previous suicide attempt is the single most important risk factor for suicide in the general population, the 2014 WHO report had noted. Failing to track suicide attempts can leave many at risk–the WHO estimates that for every person who dies by suicide, more than 20 others attempt it. 

National strategy needed
To lower its suicide rate, India must first collect high-quality data and build a comprehensive suicide surveillance system, as the WHO recommends. A national strategy and action plan, informed by better data, could drive the implementation of the four-step public health model of suicide prevention.

While India has implemented a National Mental Health Programme, it has no national-level response system. A national suicide prevention strategy is required to raise awareness of suicide as a public health issue and prioritise suicide prevention, as Vice President of India, M. Venkaiah Naidu, said in an address to the Indian Association of Private Psychiatry in 2018.

(Ahmed is a graduate of architecture from the University of Kent and is an IndiaSpend contributor.)

Courtesy: India Spend
 

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Nishat Garden, opposite Dal Lake, a popular tourist destination in Srinagar, has remained closed since the abrogation of Article 370. The political and armed conflict has had an adverse impact on economic growth and infrastructural development in the erstwhile Jammu & Kashmir, also impacting citizens’ mental health.

Zahra was one of 15 patients waiting to see neurophysicist Akash Yusuf Khan at his clinic in Baramulla, 55 km from Srinagar. Housed in a poorly maintained municipal complex, the clinic is open only on Sundays; on other days, he consults at the district hospital.

Doctors predicted a rise in the number of cases presenting with stress and anxiety, as a consequence of the removal of Article 370 and the accompanying communications blockade that has prevented many from talking to their families, or stepping out of home for fear they will be unable to contact their families when out.

IndiaSpend reported on the health crisis that has ensued, as well as the impact on Kashmir’s economy, of the events following August 5, 2019.

The blockade has also resulted in fewer people accessing mental health care in August 2019. Médecins Sans Frontières (MSF, or Doctors Without Borders) has shut down mental health services in four districts of Kashmir valley as they are unable to reach their staff.

As a conflict-torn region, Kashmir has historically reported widespread prevalence of mental health issues. Nearly 1.8 million adults in Kashmir Valley–45% of the population–showed symptoms of mental distress, a 2015 survey by the humanitarian organisation MSF said. The survey found that 41% of the population showed signs of depression, 26% showed signs of anxiety and 19% showed probable symptoms of post-traumatic stress disorder (PTSD).

Locals huddle around technicians as they restore landlines in Haiderpura, Srinagar, September 7, 2019.

Unemployment, conflict
Currently, people are unable to resume work and there is little distraction or entertainment. Many Kashmiris we spoke to said they did not mind the civil strike–the shutdown of shops and businesses–but were anxious about the uncertainty of what lies next. Many said they felt hurt and humiliated, their sense of identity taken away.

Even outside of times of peak conflict, the unemployment rate in Jammu & Kashmir has been high–in 2015 it was 22.4% in the 18-29 years age group, almost double the India average of 13.2% for this age group, according to the 2016 Economic Survey.

Patients reluctant, unable to access healthcare
Since August 5, 2019, it has been difficult for people to access health facilities, and hospitals have reported a drop in patient numbers, as IndiaSpend reported on September 6, 2019. Even in a normal situation, few people access mental healthcare, in particular.

About 44.5% fewer patients visited the Institute of Mental Health and Neuro Sciences (IMHANS), Srinagar, in August, when compared to July, but this data is inconclusive as the number of patients was even lower in May.

On the other hand, in recent weeks, more patients have been visiting general out-patient departments (OPD) with symptoms of anxiety and reporting palpitations since August 5, said a general physician working at the Baramulla district hospital, who did not want to be identified. Such patients are referred to the psychiatric OPD. Chemists outside the hospital said there was an increase in the demand of antidepressant and anti-anxiety medicines, especially in the 16-30 years age-group.

Srinagar’s old town, where IMHANS is, has more restrictions on movement than other areas, which has led to a fall in the number of patients. Patients find it easier to reach district hospitals, such as the one in Baramulla.

The exact impact of the communication blockade and the political decision on people’s mental health will only be known after a few years, said a senior psychiatrist at IMHANS, who wished not to be named. “The average lag between people facing mental health issues and seeking treatment is about 3-5 years.”

This gap is now reducing but people still take a few months before they ask for psychiatric help, the IMHANS psychiatrist said, giving the example of the 2016 unrest in the Valley–when Indian security forces had killed the militant Burhan Wani, causing the state to suffer an estimated loss of more than Rs 16,000 crore between July and November that year.

Patients had started coming in only after a year of that incident, the IMHANS psychiatrist said. People prioritise their basic needs and not mental health during periods of turmoil and seek help after things normalise, he explained, “Also a very minuscule proportion of people seek help, rest find other ways to cope. Human beings are very resilient.”

Kashmiri adults use prayer as a coping strategy, as well as talking to a family member or friend, and “keeping busy”, the MSF study said.

On average, an adult living in the Valley has witnessed or experienced more than seven traumatic events during their lifetime, the MSF survey had found. Exposure to traumatic events is associated with depression, anxiety and PTSD. The MSF survey had found that the most common problems faced by Kashmiris are financial issues, poor health and unemployment.

Because of the constant political conflict and violence, Kashmir has also seen a rise in drug addiction, as IndiaSpend reported in November 2017. 

Children stuck at home are upset, angry

Children from Rainawari in downtown Srinagar sitting in a courtyard. They have not gone to school since August 4, 2019, though the government said on August 19 that schools had been reopened.

All that Sadiya, 13, has done over the past month is sit at home and visit three relatives’ homes in the neighbourhood. “I feel suffocated, being indoors all the time but what can we do?” said Sadiya, dressed in a yellow salwar-kameez and black headscarf, sitting in an open courtyard near her house.
Sadiya lives in Rainawari, a neighbourhood in the old town area of Srinagar, which is heavily guarded by security forces and faces constant restrictions and curfews. She is prone to fainting spells and headaches, she said, attributing them to constant worrying for her father’s safety. “I am always worried whenever my father goes out to buy vegetables or to the masjid (mosque) to pray, I want him to be safe,” she said.

Sadiya has not been to school since August 4, though the government said August 19 that schools had been reopened. Parents are not sending children to school due to the uncertain security situation. “We were supposed to have our exams now… but now we are stuck where we were,” Sadiya said, adding that her fainting spells and headaches had worsened ever since she had been housebound.

If her father, a washerman, did not go to work, he could not support her education, Sadiya said, adding, “I want to become an engineer so that my papa doesn’t have to toil anymore. I don’t think I can fulfil my dream anymore.” 

Most children we spoke to were aware of the removal of Article 370 as they had read the newspapers and watched TV news.

A student going to her tuition classes in Srinagar, September 9. The government said schools reopened on August 19, 2019, but parents have not sent their children to school since August 5 due to security concerns.

Among the children we spoke to, muted Eid celebrations and no news of loved ones were frequently cited as factors that had left them disturbed, fearful and anxious. 

(Yadavar is a special correspondent with IndiaSpend. Parvaiz is an independent journalist based out of Srinagar.)

Courtesy: India Spend

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In response this open letter from senior psychiatrist, Dr Anirudh Kala, from Ludhiana, to the President, IPS raises crucial questions about both the motive and orientation of the IPSA President’s stance. It points out that in response to a 340 word editorial by Lancet, Vaishnav wrote a 900 word response, of which two-thirds dealt with Pakistan and how bad things were there.
 
Dr Kala asks, “How can commenting about something be interference or intrusion into another country’s affairs? Also, if that is interference, why is the IPS president commenting on Pakistan’s health care? And if students and doctors are going to carry unpleasant memories of an editorial, what must the Kashmiris be carrying?
 
Dr. Kala also clarifies that, “I am no longer a member of IPS since I resigned some years back on the issue of IPS refusing to acknowledge at that time that homosexuality is not a disease to be treated. So, technically you would be within your rights to tell me this is none of my concern, this is a society matter. To which my sincere reply would be I am raising concerns as a fellow Indian psychiatrist about possibility of even more PTSD in Kashmir after August 5.
 
The entire letter penned by Dr Kala may be read here:
 
Dear Mrugesh,
 
I have seen your letter as President of the Indian Psychiatric Society (which is also signed by Dr. Vinay Kumar, the General Secretary) addressed to the Editor, Lancet in response to Editorial of two days back about health and human rights of Kashmiris after the recent restrictions in J&K. 
 
Firstly it is revealing that you wrote a 900 words rejoinder to a 340 words editorial. Which would have been fine if you had not used more than two thirds of those words on Pakistan and how bad things are there, something which the editorial had not touched upon.
 
The editorial cites already high rates of PTSD quoted in various studies over the recent years( inspite of a better physical health parameters than rest of country) and points to UN High Commissioner for Human Rights’ report that 1253 people were blinded between 2016 and 2018 because of pellet guns. These are published facts researched by members of IPS, the psychiatrists of Kashmir. I am posting one such publication which reviews research on PTSD in children of Kashmir, both in orphanages and in general populace.
 
“I do think in a globalised world international medical community has a stake in health of the people anywhere. For example, ‘International Physicians for the Prevention of Nuclear War’ is a non-partisan federation of national medical groups in 63 countries, representing doctors, medical students and other health workers. It also has a very active Indian branch which exercises its rights to comment about nuclear flash points across the world. Similarly ‘Doctors Without Borders’ works in conflict zones in far flung poor countries in extremely trying conditions. We cannot justifiably tell doctors elsewhere that this is our problem, we got it, thank you. Because we havent’. I do not know of any efforts by our governments or by the IPS to have set up out- reach trauma clinics in Kashmir. Whatever efforts have been done are by local mental health professionals with limited resources at their disposal. You will understand if I do not count the IPS conferences held in sylvian surroundings of Kashmir as efforts to that end.
 
“How can commenting about something be interference or intrusion into another country’s affairs? Also, if that is interference, why is the IPS president commenting on Pakistan’s health care? And if students and doctors are going to carry unpleasant memories of an editorial, what must the Kashmiris be carrying?
 
“I am no longer a member of IPS since I resigned some years back on the issue of IPS refusing to acknowledge at that time that homosexuality is not a disease to be treated. So, technically you would be within your rights to tell me this is none of my concern, this is a society matter.
 
To which my sincere reply would be I am raising concerns as a fellow Indian psychiatrist about possibility of even more PTSD in Kashmir after August 5.
 
Dr. Anirudh Kala is a psychiatrist and author based in Ludhiana. He was a member of the Policy Group appointed by government of India which wrote the first ever Mental Health Policy for the country in 2014.A collection of short stories by him entitled ” Unsafe Asylum: Stories of Partition and Madness” was published by Speaking Tiger Books last year. 
 
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By Moin Qazi*

Particularly worrying is the intensity of mental disorders in the adolescents. Half of all mental illness starts by the age of 14, but most cases go undetected and untreated. Suicide is the second leading cause of death among 15-29-year-olds.depression is the third leading item in  the burden of   disease among adolescents Fortunately, there is a growing from the earliest ages, in order to cope with the challenges of today’s world

The pathetic state of mental health care in the country coupled with government’s apathy is a cause of great concern. A plausible reason is the sheer scale of the problem. Hence, nobody wants to discuss the elephant in the room. However, the nation cannot afford to ignore the stark reality. There are only about 43 mental hospitals in the country, and most of them are in disarray. Six states, mainly in the northern and eastern regions with a combined population of 56 million people, do not have a single mental hospital. Most government –run mental hospitals lack essential infrastructure, treatment facilities and have a sickening ambience. Visiting private clinics and sustaining the treatment, which is usually a long, drawn-out affair, is an expensive proposition for most families.
 

The Key facts
 

• One in six people are aged 10–19 years.
• Mental health conditions account for 16% of the global burden of disease and injury in people aged 10–19 years.
• Half of all mental health conditions start by 14 years of age but most cases are undetected and untreated.
• Globally, depression is one of the leading causes of illness and disability among adolescents.
• Suicide is the third leading cause of death in 15–19 year olds.
• The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.
• Mental health promotion and prevention are key to helping adolescents thrive.

According to a Ministry of Health and Family Welfare report, India faces a treatment gap of 50-70 percent for mental health care. The government data highlights the dismal number of mental healthcare professionals in India; 3,800 psychiatrists and just 898 clinical psychologists. A large number of them are situated in urban areas. The WHO reports that there are only three psychiatrists per million people in India, while in other Commonwealth countries, the ratio is 5.6 psychiatrists for the same. By this estimate, India is short of 66,200 psychiatrists.

Mental health care accounts for 0.16 percent of the total Union Health Budget, which is less than that of Bangladesh, which spends 0.44 percent. A developed nation’s expenditure on the same amounts to an average of 4 percent. India must find better ways to parlay its impressive economic growth into faster progress in this critical area as maintaining an ignorant stance on the issue will not help in its resolve.

A survey conducted by the All India Institute of Medical Sciences (AIIMS) in collaboration with WHO across 11 centres in the country, involving 3,000 people from each city found that 95 percent of those with mental-health problems remain deprived of treatment due to stigma, shame and getting shunned from societies. Three age groups are particularly vulnerable to depression: pregnant or post-partum women, the youth and the elderly.

With resources tight an effective method for successfully tackling mental illness is a major expansion of online psychiatric resources such as virtual clinics and web-based psychotherapies. The economic consequences of poor mental health are quite significant. The cognitive symptoms of depression like difficulties in concentrating, making decisions and remembering cause significant impairment in work function and productivity.

A World Economic Forum-Harvard School of Public Health study estimated that the cumulative global impact of mental disorders in terms of lost economic output will amount to $16.3 trillion between 2011 and 2030. In India, mental illness is estimated to cost $1.03 trillion (22 percent of the economic output) during 2012-2030. Estimates suggest that by 2025,38.1m  years of healthy life will be lost to mental illness  in India (23% increase).

The fact is that poor mental health is just as bad as or maybe even worse than any kind of physical injury. Left untreated, it can lead to debili­tating, life-altering conditions. Medical science has progressed enough to be able to cure, or at least control, nearly all of the mental-health problems with a combination of drugs, therapy and community support. Individuals can lead fulfilling and productive lives while performing day-to-day activities such as going to school, raising a family and pursuing a career.

Although mental illness is experienced by a significant portion of the population, it is still seen as a taboo. Depression is so deeply stigmatised that people adopt enforced silence and social isolation. In villages, there are dreadful, recorded cases of patients being locked up in homes during the day, being tied to trees or even being flogged to exorcise evil spirits. Stories of extreme barbarity abound in tribal cultures. In some societies, family honour is so paramount that the notion of seeking psychiatric help more regularly is considered to be anathema to them. Recognition and acknowledgement, rather than denial and ignorance are the need of the hour.

Many a time, mental-health problems are either looked down upon or trivialised. These man-made barriers deprive people of their dignity. We need to shift the paradigm of how we view and address mental illness at a systemic level. Tragically, support networks for the mentally ill are woefully inadequate. There is an urgent need for an ambience of empathy, awareness and acceptance of these people so that prejudices dissipate and patients are able to overcome the stigma and shame.

India’s Mental Health Care Act is a very progressive legislation, and   is the equivalent of a bill of rights for people with mental disorders. Fundamentally, the Act treats mental disorders on the same plane =as    physical health problems thus stripping it of all stigmatizations. Mental health issues get the same priority as physical disorders Conceptually, it transforms the focus of mental health legislations from supposedly protecting society and families by relegating people with mental disorders to second-class citizens, to emphasizing the provision of affordable and quality  care,  , financed by the government, through the primary care system

There have been some encouraging innovations in India, led by voluntary organisations that are both impactful and replicable. Dr Vikram Patel, who is a professor at the London School of Hygiene and Tropical Medicine and co-founder of the Goa-based mental health research non-profit ‘Sangath’, has been at the forefront of community mental health programmes in central India.

It deploys health workers, some with no background in mental health.  The mission tasks community-based workers to provide low intensity psychosocial interventions and raise mental health awareness and provide “psychological first-aid.” Since they are drawn from the same community, they are able to empathise with the patients. The next stage consists of mental health professionals. The programme uses Primary Health Centres for screening people with mental illnesses.

According to Patel, mental-health support workers can be trained at a modest cost. Given the limited availability of mental-health professionals, such first-aid approaches can be suitably and successfully adapted to community needs with limited resources. The senior therapists can be given basic training in general medicine, psychology, psychiatry, psychopharmacology, social work and patient management.

His model envisages the involvement of primary care based counsellors and community based workers to reduce the burden of depression in the population. There is no longer any doubt about whether community health workers can be trained and supervised to deliver clinically effective psychosocial interventions. The challenge before us now is how to go beyond pilots and research studies and scale these innovations up in routine health care. Involvement of the social, health and education sectors in comprehensive, integrated, evidence-based programmes for the mental health of young people is vital for strneghtening the overall healthcare framework at the grassroots level.

Mental healthcare initiatives are presently focused on a narrow biomedical approach that tends to ignore socio-cultural contexts.Community mental-health services can offer a mix of clinical, psychological and social services to people with severe, moderate and mild mental illnesses. Also, counselling can make a profound difference and build resilience to cope with despair. Providing psychoeducation to the patients’ families can also help. Unfortunately, in recent decades, academic psychologists have largely forsaken psychoanalysis and made themselves over as biologists. There is need for strengthening the cadre of behavioral health therapists.

Prevention must begin with people being made aware of    the early warning signs and symptoms of mental illness. Parents and teachers can help build life skills of children and adolescents to help them cope with everyday challenges at home and at school. Psychosocial support can be provided in schools and other community settings

Training for health workers to enable them to detect and manage mental health disorders can be put in place, improved or expanded. Such programmes should also cover   peers, parents and teachers so that they know how to support their friends, children and students overcome mental stress and neurotic problems.

There is a need for more open discussion and dialogue on this subject with the general public, and not just expert’s .this can help create a more inclusive environment for people with mental illness.

Lewis Carroll very succinctly summed up the plight of today’s human beings in the conversation between the Queen and Alice in her classic .Alice in Wonderland. Here’s the paraphrase: Alice tells the queen that one has to run at the top of one’s speed to excel in a competitive race. The queen disagrees and we see the essence of competitive existence when she tells Alice that in her country one has to do all the running at the top most speed to retain one’s position. But if you want to get somewhere you have to run twice as fast. This is the paradox. Everyone wants to go somewhere. But where no one knows. This is the reason for the growing incidence of depression in   society.

With simple yet effective steps, we can turn the situation around and build a more accommodating environment for those struggling with mental distress.
—
*Contact: moinqazi123@gmail.com

Courtesy: Counter View
 

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Cartoons often have scenes of physical or verbal violence. Chris Beckett/Flickr

With more access, children are more likely to be exposed to violent content – like real-life or cartoons where force is being used and harm is being done to a person or character. Studies show that 37% of media aimed at children have scenes of physical or verbal violence. What’s more, 90% of movies 68% of video games, 60% of TV shows, and 15% of music videos have some form of violence. In some cases, it’s rising – the amount of violence in mainstream movies has been growing steadily over the past 50 years.

Evidence shows that this can be detrimental to young children. Around the ages of three and four children begin to develop perceptions and expectations about the world around them. These views are strongly influenced by their daily experiences. If children are often exposed to scenes of violence, they may develop a view of the world as a more dangerous place than it actually is.

To investigate this further, and predict the types of mental health outcomes this has, my colleagues and I examined the potential long-term risks associated with exposure to violent media on children’s development. We found that those exposed to violence become more antisocial and emotionally distressed.
 

Exposed to violence

Through parent reports, we measured children’s exposure to violent movies and programmes in 1,800 preschool aged children between the ages of three and four. Four years later, second grade teachers rated the same childrens’ classroom behaviour using a social behaviour questionnaire – which covers behaviour such as physical aggression, inattentiveness and emotional distress over the course of the school year. Teachers were unaware of which children had been exposed to violent media.

To rule out the impact of the home environment on the development of these behaviours, we controlled for the contribution of early childhood aggression, parenting quality, maternal education, parent antisocial behaviour and family structure.

According to our results, teachers rated exposed children as more antisocial. Antisocial behaviours include; a lack of remorse, lying, insensitivity to the emotions of others, and manipulating others.

Our results also reveal significant associations between exposure to violent media and classroom attention problems. Furthermore, exposed children were reported to show more signs of emotional distress; in terms of sadness and a lack of enthusiasm.
The results were similar for boys and girls.
 

Child development

The content of media to which young children are exposed is closely related to child outcomes.

Age-appropriate programmes – like sesame street for kindergarteners– which aim to help children understand words or ideas, are known to help them develop language and mental skills.

New technology can be useful too. Video chat technologies – like Skype or Facetime – which give children an interactive, two-way live exchange with adults facilitate language learning.

On the other hand, violent films and video games often feature attractive protagonists that engage in a disproportionate number of aggressive actions. Children exposed to this type of content can develop a deformed perception of violence and its actual frequency in real life.
Eventually, this can give rise to the impression that the world is an overly dangerous place filled with ill-intentioned people. People that have such a worldview are more likely to interpret an ambiguous or accidental gesture as hostile or as a personal attack.

There are steps that parents can take. By modelling, positive non-violent behaviour – like using respectful communication to solve problems rather than aggression – and having conversations about the violent images their children are exposed to, parents can reduce the negative effects of violent media on their child’s development.

Parents should also keep bedrooms free from screens, closely monitoring children’s media usage, and shutting off the internet at night.
 

Caroline Fitzpatrick, Researcher at Concordia’s PERFORM center and Assistant Professor of Psychology, Université Sainte-Anne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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