(1) Youth Suicide Crisis in India: the Problem Landscape
To map the problem, we conducted an extensive literature review, and identified a departure we wanted to explore further. Literature showed a strong correlation between psychiatric disorders and suicide deaths in high-income countries but this was less clear in Low and Middle-income Countries (LMIC), such as India, Bangladesh, Nepal, etc. (Knipe et al., 2019). In the context of LMIC, however, there exists a strong correlation between various social determinants of health and psycho-social factors. We realized, therefore, the need to understand suicides as a complex psycho-social phenomenon, and design interventions that address both, psychological and social determinants (Jacob, 2008).
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.
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