In today’s society, people have to contend with numerous problems such as marital problems and family issues, grief, loneliness low self-esteem, and harassment sometimes leading to grave problems and causing them to even take their own lives. We interviewed Jomo Uduman  Volunteer at Sumithrayo to discuss some of these issues.

Q What can a caller expect, and what type of concerns do they walk in with?
People of all ages seek to befriend someone from Sumithrayo for concerns that include marital, family, domestic violence, sexual abuse and harassment, relationship issues, mental health, grief, loneliness and low self-esteem. Sumithrayo is where they will find empathy instead of sympathy, empowerment instead of advice, and a nonjudgmental friend who will listen with the assurance of confidentiality and anonymity (if desired). People who have been through crisis, trauma and stress will confirm that it was a huge relief to unburden their feelings and discover options that they had never seen before. The Caller unburdens while the volunteer listens and accepts the Caller unconditionally.
The Caller is encouraged to explore and identify the feelings that have caused despair and distress.
When a rapport is thus established and the Caller is more rational (with a better balance of head and heart), options are explored and discussed. The Caller is finally empowered to consider one or more of these options to seek relief from their present feelings. The goal of befriending is to empower the Caller to make life-enhancing choices.

Q What are some of the common issues that you deal with such as suicide and the background to Suicidal thoughts?
Suicidal ideation or suicidal thoughts, is thinking about, considering, or planning suicide. The range of suicidal ideation varies from fleeting thoughts to extensive thoughts, to detailed planning. Most people who have suicidal thoughts do not go on to make suicide attempts, but suicidal thoughts are considered a risk factor. Suicide contagion is the exposure to suicide or suicidal behaviours within one’s family, one’s peer group, or through media reports of suicide and can increase suicide and suicidal behaviours. Three factors believed to be closely associated with suicidal behaviour are depression, misuse of alcohol and other drugs, and previous suicide attempts. Of these, previous attempts at self-harm are one of the strongest risk factors for subsequent suicide and that is why a high standard of aftercare from the community is so important.

Q Who are the people who would be predisposed or vulnerable to Suicidal behaviour?
Suicidal behaviour has a large number of underlying causes, which are complex and interact with one another. Identifying these factors and understanding their role in both fatal and non-fatal suicidal behaviour is central to preventing suicide. Factors such as living in poverty, unemployment, loss of loved ones, arguments with family or friends, a breakdown in relationships and legal or work-related problems are all acknowledged as risk factors when affecting those who are predisposed or otherwise especially vulnerable to self-harm. A family history of suicide is a recognised risk factor with both social and genetic correlates. Other predisposing factors include alcohol and drug abuse, a history of physical or sexual abuse in childhood, and social isolation. Psychiatric problems, such as depression and other mood disorders, schizophrenia and a general sense of hopelessness also play a central role. Physical illnesses, particularly those that are painful or disabling, are also important factors. Having access to means to kill oneself is both an important risk factor in itself and an important determinant of whether an attempt will be successful or not. Having made a previous suicide attempt is a powerful predictor of subsequent fatal suicidal behaviour, particularly in the first 6 months after the first attempt.

Q Are Suicides Preventable?
Suicides can be prevented. In most instances, it is only a desire to end the current torment and painful situation. A person who is suicidal feels isolated and alone with his or her problem, which seems beyond their capacity to cope with because their pain exceeds their resources for coping with it.

At times like these, talking about their stressful situation with a non-judgmental, accepting, understanding and caring person can throw a different light on the situation and help diffuse the suicidal impulse.

Q Can you share with our readers some statistics in Sri Lanka?
The highest number of suicides are recorded within the North, Central Province and the Puttalam district. Colombo and the Western Province have consistently shown the lowest suicide rate. It is seen that 80% of those who suicide are males and around 70% are married. Interestingly 65% are employed while 35% are unemployed. Education wise 60 % are educated up to grade 8 30% up to O/L and 10% AL/Uni. Age-wise we see 35% up to 35 years, 25% from 36-50 years, 30% from 50-70 years and 10% above 70 years.

Q Can you talk to us about suicide bereavement and how they cope with their loss?
Suicide bereavement is very different from the mourning that occurs after the natural loss of life. The mourning process, which is already an overwhelmingly distressful time, is further upset by the presence of stigmatisation. Survivors suffer greatly from the building of what is called the “wall of silence” by family, friends and the community at large. Because of the nature of the death, there may also be an absence of caring and interest or, conversely, an unwelcome shower of unhelpful and awkward advice.

The majority of us just do not know how to broach the subject of suicide with the bereaved - so we try not to. Some survivors may choose to deal with this painful situation through avoidance or denial. This is sometimes done through suppression and outright refusal to accept that the death has occurred. In this case, although the death was a suicide, it might never be accepted as such by the survivor. Other possible reactions include a “geographical" solution, where remaining family members or other survivors may move to a new area to try and erase the memory of the death by starting life afresh.

The bereaved must seek out assistance if needed, but, unfortunately, the barrier of stigma can cause a reluctance to seek this vital help.

Q How can the media help prevent suicidal behaviour?
The media also needs to reduce or eliminate the sensationalism associated with suicide reporting. They must avoid giving graphic details of the method used and avoid using words like “commit”(which makes it sound like a crime). Using phrases like “died by suicide” is a better way to express and convey the news. Providing details of the mechanism and procedure used to carry out a suicide may lead to the imitation of suicidal behaviour by other people at risk.

Avoid simplistic explanations for suicide. Encourage public understanding of the complexity of suicide. Avoid labelling places as suicide ‘hotspots’. Above all, if a suicide helpline is given at the end of the report it will help other vulnerable people with suicidal thoughts to reach out for help.

Q Is it true that while women tend to experience more suicidal thinking, men are far more likely to die by suicide?
Traditional male gender roles discourage emotional expression. Men are told they need to be tough and that they should not need to ask for help. Such rigid gender norms may make it difficult for men to reach out and ask for support when they need it. Having mental health issues is a major predictor for suicide – almost everyone who dies from suicide has an underlying mental health problem. Most people who die by suicide are experiencing some sort of mental illness or addiction, most often depression. However, depression may be underdiagnosed in men. Men often do not disclose feelings of depression to their doctors. When they do, it is often described in terms of having problems at work or in relationships. Men also tend to describe their feelings as stress rather than sadness or hopelessness.

Men are less likely to seek help for emotional problems. Researchers suggest that depression may be diagnosed less frequently in men because of the tendency to deny illness, self-monitor symptoms, and self-treat. Men may be more likely to self-treat symptoms of depression with alcohol and other substances. If a guy says, 'Well my sense of being a man means that I can’t disclose any vulnerabilities because that will make me look weak if something [like depression] does come up, what do I do with that? I have to keep it to myself.' Reframing help-seeking is also important.

Men may avoid asking for help because they fear it is a sign of weakness. Finding ways to change this perspective is a critical aspect of reducing male suicide rates. Reframing help-seeking as masculine behaviour increases the likelihood that men will ask for help when they need it. Suicide prevention programmes should recognise that men are a high-risk group and tailor messaging and programming to them. Identifying feelings, building coping skills, resilience, decision-making skills and conflict management.

Q Talk to us about your Addiction Centre which adjoins your building.
The unit assists those who are experiencing difficulties arising from harmful substance use (including alcohol). While helping ‘users’ to overcome these harmful habits, they also help family members who may be experiencing difficulties in coping with the situation. Services are rendered by a competent and scientifically trained staff which makes no distinctions as to age, creed, wealth or other particulars of the client. Programmes are conducted under the guidance and supervision of an Honorary Consultant Clinical Psychologist and people from all walks of life drop in for confidential support. At Mel Medura, trained befrienders work with the substance user in a relaxed and friendly setting. His or her purpose is to find the root of the addiction and help them progress into sobriety.

Depending on the underlying cause of the addiction discovered, the befriender develops an individual plan for each user. To help them work past the addiction, befrienders educate them about addiction and teach them how to move on through life without substance abuse. The main goal of the befriender is to guide the drug user or abuser into sobriety and a healthier lifestyle. Mel Medura is also dedicated to helping people with Behavioral Addictions – like Smart Phones, Gaming, Gambling, and Pornography.

By Kshalini Nonis