Rising suicide rates: Scarcity of economic resources, lack of awareness, and stigma

During the pandemic, numerous reports emerged in the media concerning the rising suicide rates. Most people trest suicide in their conversation with pity, but only a few emphasize on its root cause. 

Suicide rates have risen among youth and adults of both genders with disregard to their marital status. Although national statistics on incremental suicide rates is not yet available, extreme cases, such as that of a young poverty-stricken couple's case, has drawn nationwide media attention: the couple (Shamin and Rokeya) had left behind a three-year-old child when they took their lives together.

Aaron Reeves's research sums it up well. With increased uncertainty about future in all aspects of life and depression during the pandemic, the Oxford University sociologist claims that in Europe and the United States, suicide rates rose by about 1% for every one percentage point increase in unemployment. 

This might be considered one methodology to determine Bangladesh's rising suicide rates during the Covid-19 pandemic, in addition to various other factors such as blackmail, provocation, unreported suicide attempts and undiagnosed suicide cases.

In Bangladesh, when a person tries to take his or her own life and fails in the first attempt, his or her loved ones are faced with social stigma and financial pressure, along with the obvious emotional scarring. Moreover, in the eyes of the law, suicide is considered a felony under Section 309 of the Bangladesh Penal Code, 1860. 

Three key factors – social stigma, financial pressure, a felony – along with the lack of knowledge of the importance of mental health may be a reason for a person to attempt suicide. Statistics show that one-third of all the people who fail in their first attempt are bound to try again.

Whenever someone independently realises the need for external professional help, he or she will be faced with financial challenges. An average lower middle class Bangladeshi employee earns around Tk15,000 per month. Whereas, the minimum cost of one session at Mansuba's counselling (a Dhaka based counselling centre) is Tk1,500. This means an average bread earner will have to spend 40% of their income for four sessions a month. 

If a family overcomes social stigma and comes forward to report a suicide attempt, they would still face difficulties. This is because, under Section 309, the attempt to commit suicide is punishable by fine and/or up-to one year of imprisonment. 

Does mental health problems deserve the same "punishment" as that of someone who voluntarily wants to hurt someone (Section 319 Penal Code 1860)? These unjustified laws should be replaced with the collaborative work of legal policymakers, with expert counselling research teams, to incorporate more developed solutions such as court-mandated therapy. 

Simultaneously, the Bangladesh government should prioritise, fund and encourage citizens to pursue more national psychiatrist degrees and training, to reduce the distribution and demand gap of mental health assistance evenly throughout Bangladesh.

Logo of Bangladesh Forum for Legal and Humanitarian Affairs (BFLHA). Photo: Collected

The worst-case-scenario, but a very common one is when the family of the patient does not come forward due to social stigma. Rural families, as well as many urban ones too, believe mental health problems disgrace them in the community. Many fear name-calling, such as "mad-man", by people in society. 

The National Mental Health Survey (2018-19) reported that patients with mental illness are highly stigmatised, where the average stigma score is 4.5 out of 7 on the stigma scale. To overcome the social stigmatisation the government needs to fund and prioritize awareness programs with special emphasis on rural health care centres, since 74% of Bangladesh's population lives in the rural area.

Blackmailing is one of the biggest reasons for suicide. Uninformed and unaware people of Bangladesh, especially females, in very rare cases file a report under Section 504. Under this act, any party or individual who intentionally insults with the intent to provoke the breach of one's peace is subject to up to two years of imprisonment and/or subject to fine. The victims of blackmail are always cornered with the thought of bringing "shame" upon their family, over their mental health. 

Consequently, many families are aware of their children's, husband's or wife's mistreatment by others. Conversely, if family members are knowingly aiding and abetting someone who has provoked a suicide or have committed suicide, they will be subject to a fine and/or to life sentence extending up to 10 years, under Section 305 and 306. 

We do know how to effectively reduce suicide rates in the long term. 'Knowledge is power' is a powerful statement. Today, 86% of Bangladesh's population remain unaware of mental health's importance and the government's mental health expenditure stands at less than 0.5% (of which 67% is devoted to mental hospitals, not mental health care). 

Overall, we have only 0.49 human resource per 100,000 population. The uneven distribution of psychiatrist and psychiatric degree holders, especially in the primary health care level, raises the hour rates for private therapy. 

Let us raise our voices and focus on reforming our culture, and advocate for a modest increase of our national budget on mental health, because our laws will neither reduce unreported suicide attempts and undiagnosed suicides, nor will they make counselling cheaper and widely available. Our country's bureaucrats must seek human and capital resource assistance from the World Health Organization (WHO) to break the social stigma and formulate a large-scale plan to address this growing concern.

Sabreen Saeed is Head of Human Resource at Bangladesh Forum for Legal and Humanitarian Affairs (BFLHA)

Disclaimer: The views and opinions expressed in this article are those of the author's and do not necessarily reflect the opinions and views of The Business Standard.