In 2008, a patient found himself admitted to Ward 11 of the Psychiatric Disease Hospital in Srinagar, now known as the Institute of Mental Health and Neurosciences (IMHANS). It was his fifth day of admission when he appeared conscious and oriented. During the conversation with the doctors, he revealed it was his 13th attempt to end his life within three years. The doctors took a deep dive into the patient’s history. "The 13th attempt was serious, and he seemed to have lost all hope," recalls a doctor who attended to the patient.
Till his 13th attempt, it was assumed that he wanted to end his life because of his poor economic conditions. However, his psychiatric profile revealed a different story. Having lost his father at a young age, he shouldered the responsibility of providing for his family. There came a day when he stopped going to work and was overwhelmed by sadness. He remained unconcerned about the economic hardships of his household. He was not stepping out of his house as his family plunged into poverty.
It was during this time that he made his first suicide attempt. Though his neighbours came to his family’s help, it was the prologue to 12 more suicide attempts. After every suicide attempt, he got medical attention with doctors prescribing medicine. And every attempt was attributed to his economic condition. But on his 13th attempt, he was diagnosed with a severe recurrent depressive disorder. The doctors advised a modified electrotherapy regimen which lasted for three weeks. He showed significant improvement, and within six months, he found love and was married. He embraced his passion for singing. Today, he is among the celebrated singers in Kashmir.
However, throughout all these years, he has been counselling patients with depression, imploring them to visit the IMHANS. Only this week he was in the IMHANS with a patient. “He advises patients to visit the hospital and at times he brings patients to the hospital having depressive disorders. He is saving lives,” says a doctor.
Cut to 2023, doctors say the situation in the Valley has worsened. As per the National Crime Record Bureau (NCRB) report of 2021, the suicide rate in Jammu and Kashmir has surged, experiencing a twenty-six-fold increase from 0.5 per hundred thousand population. The doctors blame live coverage of self-harm or suicide attempts by the media as one of the causes of the spread of these incidents.
The government medical college in Baramulla has alone recorded 278 cases of self-harm attempts between January 1 and August 31 this year. Of 278 attempts, 271 had taken oral substances to end their lives.
In January this year, panic gripped the district when girls started jumping into the river. “Many of the attempters would first make videos and then circulate them before trying to go for self-harm. The district administration ensured such videos did not get circulated. The district administration also warned anyone on social media not to do live or delayed telecasts of such attempts and subsequent rescue operations. This helped a great deal to halt further such attempts,” a doctor says.
Dr. Parvaiz Masoodi, Medical Superintendent at GMC Baramulla, says live or delayed coverage of self-harm attempts on social media or any other media has consequences as it prompts other depressive persons having self-harm thoughts to take such extreme steps in the same fashion. He says there are World Health Organisation guidelines on the prevention of suicide that say “sensationalist portrayals of suicide in the media, news stories, can lead to increase in suicides due to imitation. “What we did in Baramulla stopped the imitation effect or copycat effect,” Dr Masoodi says.
Last year, due to low attendance, a student was not allowed to sit in the examination at one of the colleges in North Kashmir. She tried to end her life. She was rushed to the hospital immediately by her teachers and fellow students. “We informed her parents, who were at that time in Delhi about the incident. They behaved as if nothing had happened and told us she does it off and on. We were shocked,” says one of her teachers. He says a lack of awareness among parents is dangerous.
“I feel that a large section of teenagers are living a life of sadness due to various reasons, personal and professional. They get into depression and have mood swings,” Dr Masoodi says.
According to the Doctors Association Kashmir president Dr Nisar ul Hassan, there has been an increase in suicide attempts in Kashmir with people adopting different means to end their lives, and the availability of pesticides at home comes in handy. Dr Hassan, who is a consultant at the government medical college in Srinagar, says the decades-long conflict has led to a series of depressive disorders and most of the self-harm attempts have been from those with severe depressive disorders.
A 2015 study called ‘Kashmir Mental Health Survey’, conducted by Médecins Sans Frontières revealed that on average, an adult living in the Kashmir Valley has witnessed or experienced 7.7 traumatic events during their lifetime. The survey showed that nearly 1.8 million adults (45% of the adult population) in the Kashmir Valley were experiencing symptoms of mental distress, with 41% exhibiting signs of probable depression, 26% probable anxiety, and 19% probable PTSD.
In 2011, a Kashmir-based report by Mercy Corps stated that risks associated with high youth unemployment included feelings of failure, isolation, lack of social status, delayed marriages, and an increase in tensions among young people. Expressions of disappointment, anger, and hopelessness, in addition to conflict-related stress, mental illness, suicide, and drug addiction are prevalent in Kashmir's youth, the Mercy Corps report said.
In the wake of a decline in violence over the past few years, the police say they have observed a shift in the patterns of suicide attempts within the region. According to the most recent data from January to June 2023, incidents of self-harm are more common among married people due to their marital discord and family issues. A senior police official pleading anonymity says serious suicide attempts are made at three places, and in all three places, most of the attempts result in fatalities.
There are other ways. In July at midnight, a Srinagar teenager, already undergoing treatment for depression and having overdosed on antidepressants, hit her head in her home. The situation left the family in a state of panic, as they were unsure how to respond. “We were unaware of the severity until her head began bleeding,” the girl’s mother says. Although they managed to save her, they remained deeply troubled by her tendency for self-harm. “She can repeat it. We are always distressed about her.” The mental health counsellors at the Institute of IMHANS say that people have different reasons for self-harm. While many have mental health issues, cases of self-harm are also found among drug addicts and people struggling with family conflicts.
Take the case of a 55-year-old mother residing in uptown Srinagar. She is wailing for her 32-year-old son with whom she shared their last dinner together an evening of January 2022 before he hanged himself to death, leaving behind his 3-year-old son and young wife. “We don’t know what happened to him. We are yet to come to terms with it,” the mother says. “He was sitting with us, then went to his room, locked the door, and within 20 minutes, he was gone, leaving countless unanswered questions and a devastated family.”
In another incident in June, a 30-year-old domestic worker in Srinagar found himself wielding a kitchen knife, his desperate act causing a profuse wrist wound. He was fortunate to survive as his friend, who lived nearby, arrived on time and made him cover his wound with a cloth.
During his conversation with the psychologist over the phone, he was diagnosed with a life-changing illness – severe mental health issues. The psychologist at a Telemans helpline at IMHANS encouraged him to visit the hospital and seek proper treatment for his underlying mental health problems.
“We calmed him down on the phone and made him get his treatment the next day from the hospital and he was put on medications.”
Originally from north Kashmir, the person lives alone in Srinagar and frequently grapples with self-harm thoughts. However, it was only when he reached out to mental health caregivers that he began to experience genuine improvement in his mental health well-being. Psychologists who attended him say the transformative power of seeking help and professional intervention set him on the path to proper treatment.
“He lived alone in an outhouse; fortunately, his friend, another domestic worker, was there to help him and encourage him to seek help. We were able to calm him. The patient had already tried to commit suicide three times before, but it was good he sought help,” the psychologist who attended his call at the helpline of IMHANS says.
Police say from January to July this year, 236 persons have attempted self-harm and when they were analysed, 62 per cent of the individuals who attempted suicide cited domestic issues and family problems as the driving factors behind their extreme decisions.
The police data also indicate that females account for 61 per cent of the total, whereas males constitute 39 per cent of attempts. The data reveals that self-harm attempts predominantly occur among females aged 16 to 35. However, even an eleven-year-old girl was found involved in one such incident. Among males, the age spectrum ranges from 15 to 50, with an instance of a 15-year-old boy attempting self-harm. Of 236, 15 males and 14 women died.
“When we see patients brought to the hospital after suicide attempts they show they suffer from underlying causes like mental health issues, borderline personality, depression, mood swings and family disputes,” says a Dr Insha of the IMHANS Srinagar. “Suicide is behaviour and method of suicide depends upon what is available,” the doctor says.
“Hence media persons should show restraint while reporting on self-harm attempts. The narrative about self-harm or suicides should be of hope and media should never narrate what was the method used by someone to end his life because some other person having such thoughts would adopt the same means,” says Dr Insha.
“Suicides are a public health problem which is largely preventable with the right support and right resources. And suicides are not chronic. If the right intervention is made at the time of crisis by talking to a person having such thoughts, his life could be saved,” says Dr Insha.
