The epidemic of suicides
The last few academic years would be remembered for the alarming number of reported suicides among school- going children. It almost appeared like the outbreak of an epidemic. There was a flurry of programmes on TV channels, in the community and in schools and colleges immediately following this outbreak. Theories were postulated. Blame games were played. Helplessness was voiced on different levels. Mental health authorities were interviewed by the media.Tall claims were made by school authorities regarding the status of mental health of their schools. Concern was showered on children. The media glorified the issue as usual. The wave seems to be over now. The same indifferent silence will prevail among people until some other disaster gets reported in the media.
Cause, or just a precipitating factor?
Most of these suicides, though seemingly a result of some incident in the child’s life, were not “because of” that incident. Not getting to participate in a competition, failure in an examination, being denied some materialistic thing such as a cell phone, being scolded by a parent or a teacher cannot be “causes” of successful suicides in a child. They can, at the most, precipitate the disaster in a child who is predisposed. The crux of the issue is how to identify these children who are prone to suicidal attempts so that they can be helped in time.
Some facts and figures
It is widely believed that childhood is a time which confers a relative immunity from the risk of suicidal behaviours. This belief is based on two notions: childhood is largely free of problems, and that children lack the developmental maturity to think of or act upon suicidal thoughts. However, recent research has shown that by std III (age 8-9) children have a good understanding of suicide. A Canadian study indicates that 229 children between ages 5- 14 committed suicide during the period 1993-1997. Two of these suicides were by boys under 10. Of the remaining 227 children, 155 were boys and 72 were girls. Highly lethal methods like hanging and firearms were used by 90% of children. There are no adequate Indian studies regarding suicides among children. However, the typical Indian scenario reveals an increasing competition among students, undue importance laid on examinations, a rise in the number of overanxious parents and unempathetic teachers, increasing commercialisation in the field of education, devastating influence of media on children and thoroughly inadequate facilities for help towards children in distress.
Who is at a high risk of suicide?
Factors which may place children at increased risk of suicidal behaviours are psychiatric disorders such as depression, poor social adjustment, emotional, sexual and/ or physical abuse, problems in the family, chronic health problems and poor coping strategies in general. The basic difference between adults and children with respect to their emotional problems is their ability to express them. Children cannot express their emotions in words, unlike adults. Very often they get expressed through their behaviours which can be picked up by sensitive adults who deal with children.
Case 1–
Asha (name changed for the purpose of confidentiality), a 12 year old girl, basically a chirpy, talkative child, was remaining quiet for the past one month. She had stopped answering questions in the class, had stopped mixing with her friends and would be found to be lost in her own thoughts. She would keep drawing black clouds in her books. One fine day she did not report to school. The school received a news that she was hopitalised in a nursing home because she tried to kill herself by consuming some sleeping tablets (which her mother used to take). A note was found on her bed which said, “ If I am the cause of problems in my mother’s life let me leave this world.” Further probing into her family background revealed that there was severe disharmony between her parents. Her father was an alcoholic and used to beat up his wife when drunk. Her mother had left the house with Asha twice before but had returned after a few days “for the sake of Asha”. The mother would often remark that she was staying with her husband just because Asha needed “a family” to stay in. Asha would often wonder how she could help the situation. That day the father assaulted his wife once again. Asha could not see her mother in a distressed state any longer. She persuaded her mother to leave the house and go to her parents’ house. But the mother kept saying, “I don’t want to do it just because you will be in trouble.” Asha took the blame on to herself which finally resulted into a suicidal attempt.
Case 2–
Anmol (name changed for the purpose of confidentiality), an eleven year old boy was found missing from home after his father refused to give him a mobile phone. After about 20 hours he was found sleeping on a railway platform. He was reluctant to come home and had to be coaxed into coming back. When he came into treatment some details of his background became evident. He was average in studies. However, both his parents were highly educated and would expect a higher percentage of marks, a target which he was not able to achieve. His parents would pressurise him for studies, would criticise him for his low marks, would keep demanding a good performance from him. They had drastically cut down his hours of play. They showed no appreciation for his talent in music. He had lost interest in studies. His work in school would remain incomplete for which he would get punished by teachers. His parents used to be called to school very often for the same complaint. Anmol was feeling sad and he had lost interest even in activities he liked, such as music and sports. He did voice his feelings to his elder sister but she also could not help him much. He was contemplating for a long time to run away from home and end his life. One day he asked for a mobile phone from his father. His father not only scolded him but also beat him mercilessly. In a frustrated state of mind Anmol left home.
Early detection is the key
It is very clear from the above cases that children who have suicidal ideas are generally depressed for a long time and see no hope for further improvement in their condition and resort to a suicidal attempt as a way to escape from their suffering. If their depression is detected early and if help is provided they come out of their depressive state.
How to detect depression in a child?
Persistent sadness of mood, loss of sleep at night leading to daytime drowsiness, lack of interest in work and play, loss of appetite with loss of weight, deterioration in scholastic performance, lethargy, retardation of the child’s physical and mental functioning are observable signs of depression in a child. Sometimes, there can be vague physical symptoms off and on, such as headache, abdominal pain, bodyache etc. for which there is no physical basis. A change in a child’s mood which is persistent for more than two weeks is an alerting signal and may indicate depression. If such symptoms are present the teacher should communicate with the child and find out what is wrong and what the child attributes it to. If there is a definite likelihood of depression, the school counsellor needs to be informed, who can take up the case and follow up the matter with the child’s parents and refer the child to a psychiatrist. In case there is no counsellor available the teacher needs to get in touch with the child’s parents and suggest a referral to a psychiatrist and follow up the matter further.
Communicate with children
It is important for teachers to communicate with their students as a group about difficulties in life and healthy strategies to deal with them. It is helpful to discuss with children about various aspects of life. Children can express themselves beautifully when given an opportunity. A sensitive, empathetic teacher can effectively communicate about almost anything with his or her students. I can say this with confidence because I have seen such teachers.
Teachers, it is high time..!
Teachers, it is high time you take a pause to find honest answers to some of these questions for yourselves….How often do I talk to my students apart from the subject that I teach? Do I know my students well? Do I have a good rapport with them? Do my students ever approach me with their difficulties? Do I understand the “child’s point of view” in a given situation? Do I consider referring a child to a mental health professional important? Do I feel that my students are a burdensome responsibility on me? Do I lack time…. or the inclination…..or the understanding…. or the sensitivity….or something else?
TEACHERS, PLEASE TRUST THAT YOU CAN MAKE A DIFFERENCE! IT DOES NOT NEED GREAT EFFORT, JUST A LITTLE SENSITIVITY.