(3) Youth Suicide Crisis in India: Gaps and Levers
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).
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