'Build up on family units, train more paraprofessionals to combat mental health challenges'

There is an urgent need for building up on the unit of family and relationships, adopting more community-based initiatives such as training paraprofessionals supervised by psychologists to combat struggles surrounding mental health and suicide prevention, said experts of the BRAC Institute of Educational Development (IED).

On the occasion of World Mental Health Day, BRAC IED Executive Director Dr Erum Mariam and the institute's senior psychologist Taifur Islam delved into a discussion with an overview of the current situation surrounding deaths by suicide in Bangladesh and shared insights on key factors contributing to this, such as societal stigma and conflicts throughout interpersonal relationships.

In an Interview with The Business Standard, Dr Erum [EM] and Taifur [TI] shed light on the shadows of suicide, unmasking the factors contributing to people's pain and sufferings, as well as underlining solutions for prevention and treatment.

Can you provide an overview of the current suicide rate and trends in Bangladesh? What are some of the key factors contributing to these trends?

TI: People aged 15-29, or below 40, have more suicidal tendencies. Suicide is the 4th leading cause of death amongst young people. Death by suicide is prevalent among about 39.6% of 1 lakh people in the country. In fact, the suicide trend is such that the deaths have been increasing quite drastically. Studies have shown that attempt is more prevalent among men while the ideation of suicide is more common in women.

Recent data reports have shown that in Jhenaidah, there is a high rate of deaths by suicide; of which, 80% are house wives. During the first 10 months of the Covid-19 pandemic, approximately 11,000 people died of suicide, while, let's say 5,000 died from coronavirus. Anchal Foundation's findings in 2023 showed that in the first 8 months, 361 college, school, and madrasa students died from suicide.

EM: In terms of key factors, adolescents may feel a lot of pressure living up to others' expectations or that of the society, may face relationship issues which can induce a huge amount of stress.  Society can be quite cruel. We tend to put everyone into a mold. We are so quick to judge, label and give unsolicited advice that it becomes quite painful for young adults. Following norms or conforming to them creates a lot of distress, anxiety and can lead to more serious mental health problems.

Illustration: BRAC IED

How does the stigma surrounding suicide impact individuals seeking help?

EM: Everyone has felt pain and vulnerability at some point in their lives. We may adopt help seeking behaviours, such as simply asking to have a conversation with someone we can trust. But in our society, seeking counselling can have us labelled as mentally unstable or people may say we are seeking attention for no good reason. This sort of negative attitude towards mental health keeps individuals from seeking the help they need. We have to build trust amongst ourselves. A lack of compassion and openness, at the very core, largely contributes to the stigma.

TI: If we speak up, we can be perceived as weak or that we don't have the strength to manage ourselves. Close ones undermining our problems might prevent us from seeking help. If someone is being aloof, our society would force them into taking up responsibilities to keep them busy and getting them married as a solution. This may burden them more. People may lose a sense of belonging, feel isolated and alienated. Their mental health continues to deteriorate and thus, gives rise to suicidal tendencies. There is a huge understanding gap in terms of seeing people as human. We tend to stay in packs and communities. While this strengthens some people, it ostracises others who are different.

What are some of the common warning signs and risk factors associated with suicide in Bangladesh's context? How can friends, family, and communities better recognise and respond to these signs?

TI: When someone's unhappiness keeps piling on, they may lose their sense of a meaningful life which may lead to an existential crisis. We need to observe behaviour patterns – the first step to pick up on the signs and symptoms which vary from person to person.

EM: In terms of major warning signs, we see a change in the way they function and perform their daily life activities. When someone is isolated and withdrawn, they may stop interacting and continue living inside their head. This doesn't happen overnight. It builds up.

However, in our society, family, child rearing, and familial responsibilities are areas of love, attachment, affection and compassion. These are the saving, protecting factors. When a mother, the first caregiver of a child, is doing well, her interaction with her children is naturally a reflection of that. When that child steps into the community, they exhibit the same healthy emotional responses.

What are some approaches or interventions that have shown promising results in providing support and treatment to individuals struggling with suicidal thoughts? What further improvements can be made?

EM: Building up on the unit of family and compassion in society – even at work or school settings is very important. Training paraprofessionals in every sector and at the community level to implement psychosocial support models can help build awareness.

We can't afford to work with mental health slowly. We need to really give it a push and step up the game; it is urgent. Fortunately, the government already has strategies in regards to providing mental healthcare in the country. A collective effort from NGOs, corporate organisations, schools and media can further contribute to better awareness.

We can implement various interventions such as connecting people with psychologists. Kaan Pete Roi, Shojon, and such organisations work with providing therapy and necessary help. More of such organisations are needed.

TI: While working with mental health, we found that it is not a tangible issue. People only open up after building a certain rapport, trust and connectedness with psychologists and therapists. Parenting, creating a safe environment at home and other avenues of life can bring much improvement in dealing with suicide intervention, especially for young adults.

What more can be done through education and awareness campaigns for reducing suicide rates and promoting mental well-being?

TI: Training teachers to create a conducive and healthy environment can help children grow and contribute to society. Utilising the voice of the youth can help reach more people, even at grassroots levels, through campaigning. Even public figures and influencers can contribute in reaching more people. Technology can be further leveraged for campaigns through social media, apps and other platforms.

EM: More segmented campaigns targeting various age groups – children, youth, men and women – can bring about more of a difference.  Work regarding the impact of climate change on mental health is also urgent and needs more focus.