It is worth appreciating that the Kerala government has taken up a study on a serious mental health issue and brought out a report in a record time, especially when there are numerous challenges to also contend with on account of the ongoing pandemic.
(This refers to the report on Child Suicides in Kerala – Causes & Possible interventions for prevention — An analysis based on cases reported from January 1 to July 31, 2020)
This report has raised several important questions and led to a range of conclusions on the nature of death by suicide of children which need to be more closely examined and understood. Understanding the nature of neurodevelopmental and social issues being faced by children in the context of the ongoing pandemic is also crucial before arriving at any conclusions based on this analysis report.
Children must be distinguished from adolescents
To start with, there is a need to distinguish children from adolescents when it comes to death by suicide, as several studies, including this one has shown that in general, the rate of death by suicide among children less than 12 years is relatively less common when compared to that of adolescents from 13 to 18 years.
Adolescence is an often confusing and anxious period with so many neurobiological, psychological and sexual changes, as teenagers struggle to understand their own bodies, their relationship with others and their place in the world. Physical appearance, friends, peers, romantic relationships, worry about academic performance, future career, popularity and acceptability on social media – these are the issues that become very important at this stage and take up a lot of mind space for most teenagers. Adolescents thrive through social interactions, discussions with friends and peers and popular media.
Frustration, hopelessness, fear, helplessness to do anything about the situation can all come together in a tragic way to make a young person believe that suicide is a way out.
It is heartening to note that death by suicides of children and adolescents is being widely discussed today, and rightly so. However, the analysis report does appear to make certain sweeping assumptions and arrive at some quick conclusions.
The report states, “As per the statistics of the State Crime Records Bureau (SCRB), the number of children who committed suicide during the lockdown period from March 25 to July 10 in 2020 is 66. The number of child suicides in the corresponding period of the previous year is 83. Hence, we may have to infer that lockdown due to Covid-19 as well as online classes have not caused undue stress to the children. Although, the figure is lesser this year in comparison to the previous year, the fact that so many children died committed suicide while remaining at home under their parental/family’s care during the lockdown period is alarming and this beats the popular notion that better parental presence and care are deterrents to children committing suicide.”
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Suicide is a complex and layered issue and is often the outcome of combination of long-standing psychological problems that might be triggered by a recent stressful event. Adverse childhood experiences like death or divorce of parent(s), physical or sexual abuse, emotional neglect, exposure to violence in the family, substance abuse, mental illness of self or someone in the family, etc. are some of the reasons that increase the risk of suicidal behaviour among adolescents. The ability, resources, and support systems available to adolescents to cope with some of these adverse experiences can also impact the suicidal behaviour of adolescents. Deriving direct inferences such as these on a cause-effect relationship between parental presence at home during the COVID pandemic or that online classes have not caused stress to children would be an ill-advised and limited approach to understanding the complexity of this issue.
Again, the report states that “Nowadays children are unable to cope up with even minor forms of stress and often struggle to handle failures and rejection, unlike in the past and this has led many of them to take the grave decision of ending their lives” (Para 3, Page 3 in Introduction). This displays a sad lack of empathy and understanding of children’s lives and realities. What might be a “major” enough reason for a child to consider death by suicide? It is important to understand that suicide is a combination of multiple factors in an individual’s life and what seems like a ‘minor stress’ to an adult, may in fact, be the last straw that triggers a total collapse of the child’s ability to cope with the situation.
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Children even a decade ago did not face the kind of pressures that children today are facing because of the explosion of technology and all-pervasive nature of social media. The pandemic has only deepened and highlighted already existing social divides and further marginalised many already vulnerable communities. Children who are still in the process of developing their capacities to understand themselves and the world around them have been forced to face situations beyond their coping abilities. Even as adults, we are struggling to cope with the numerous fallouts of the pandemic because we simply don’t have any reference points on how to cope with a pandemic. How then, do we expect children to make sense of this changed, scary, disordered world that has suddenly become their reality?
The reasons for suicide in 41 cases are stated as ‘únknown’ and this must be explored further in follow-up studies. Eliciting information about death by suicide of a child in the family from grieving family members is a very difficult task and it is understandable if they would not want to share that information. Also, the stigma and sensationalism surrounding death by suicide makes it hard for families to talk or even grieve about the death of their child or their loss.
Referring to the death by suicides by as a “crime” ( page 9 section 11.4) and use of the words ‘committed’ suicide throughout the report, as well as many other media reports on suicide, are sadly indicative of a widely pervasive mindset among society and unfortunately also among many professionals across law, medicine and mental health – of looking at suicide as a crime. These are young children in distress, for god’s sake. Children need education, treatment, support, counselling, safe schools, loving families, positive parenting, safe neighbourhoods, governments that care about them even though they are not a vote-bank and the hope of a positive and possible future. Not sanctimonious sermons on how they should abstain from ‘love affairs’ or being labelled as “criminals” for being unable to cope with the high, unreal expectations of society and apathy of the State.
The reality of the psychological impact of the COVID pandemic on children and adolescents
The social isolation of adolescents due to the lockdown and restrictions imposed due to the ongoing pandemic has deprived many adolescents of the emotional and social support that they earlier received from friends and peers. Adolescents are grappling with long hours of staying indoors, absence of physical activities, prolonged exposure to screens, social media and online activities, limited social interactions, repeated and reinforced messages of disease, death and crime on media, etc. which are causing them to experience self-doubt, loneliness, emotional disconnection, social withdrawal, fear and uncertainty over the future. A majority of the children and adolescents in distress in these COVID times do not have access to counsellors or trusted adults with whom they can share or talk about issues bothering them.
We must first acknowledge our role as adults in having created a world that a child is unable to cope with, a world that offers him/her/them no hope or foreseeable future, and feels compelled to end his/her/their life. Even as we look at the statistics of such reports, we need to reflect on our mindset as a society and State to blame the vulnerable while absolving itself of the responsibility to care for, protect and ensure the rights and well-being of its children, without investing the effort to understand issues relating to children in-depth, acknowledge intersectionality of class, caste, poverty, gender, sexuality and politics that decides the trajectory of the lives of the children in our country.
Is sexual abuse also a causal factor for suicide?
I was recently asked by a journalist whether sexual abuse during the pandemic is a factor that is pushing children, especially girls, to suicide?
Well, the link between child sexual abuse and poor mental health outcomes, including risk of suicide, is well established.
Of course, with strong family and social support systems, counselling and treatment options, life skills training, social acknowledgement of the harm caused to victims / survivors of child sexual abuse, etc. many of these risks can be mitigated and many children do go on to become psychologically resilient adults in later life.
It has been well established that majority of the sexual abuse of children in India happens in the home and by persons known to the child. The pandemic has caused women and children, especially girls, to be confined indoors and in close proximity to male members of family and extended family, much more than they were before the pandemic. This has created conditions for greater sexual abuse and domestic violence against women and children. Access to help and support are also limited when women and children are not allowed outside the home. Whether girls are more vulnerable than boys to sexual abuse during the pandemic is hard to say, as we don’t yet have data on this. But the heightened risk of child sexual abuse of all children, across genders, and children with disabilities, due to the conditions created by the pandemic, cannot be overlooked.
With specific reference to girls, studies show the methods chosen by boys like hanging, use of weapons, firearms etc. are often more lethal and result in death by suicide, while those attempted by girls (like drug overdose or cutting themselves) are often less effective / successful.
There are no one-size fits all kind of solutions
Each child, family and circumstance is different. But there are several measures that are worth considering in addressing the issue of death by suicide by children, and that this must be seen within the larger context of the health psychosocial well-being of children.
Parents, teachers, governments, health professionals – each of us have the responsibility to ensure that we create a just society where our children are not compelled to take their own lives.
Early warning systems and psychological first aid
Observing the children whom we are close to/responsible for, whether at home or at work – identifying any changes in mood, behaviour, sleep, appetite, interactions, irritability, unexplained crying, lack of interest, etc. forms the first line of defence. Teachers can play a crucial role in identifying and flagging behaviour, at least among school going children, that could be indicative of suicidal inclinations. But for this, teachers need to take an active interest in the lives of their students beyond academic performance. Teachers themselves also need support systems to help them perform this role as they are also facing multiple challenges in their personal and professional roles on account of the pandemic. For this, training teachers in psychological first aid and providing access to mental health services for teachers would help create a virtuous cycle of mutual support.
Having a daily routine, including exercise, play or some physical activity at least for a few minutes daily, scheduling time away from screen activities, limiting news feeds, making time for hobbies and recreational activities like gardening, music, dance, painting, etc., maintaining contact with extended family and friends through online channels, getting involved in community volunteering activities to help others, etc. are all practical measures that can promote psychological immunity for children.
A culture of listening and empathy – The need of the hour
We need to create a culture of listening to and communicating with children that includes actively engaging with them as individuals, asking for their opinions, encouraging them, appreciating their efforts and involving them in decisions that affect their lives. This also means looking at children and adolescents as individuals in their own right and not merely passive recipients in their own lives. Encouraging children to talk about their issues and seek help for them, letting them know that it is a sign of strength to seek help.
As a society, emphasising on building empathy, communication, emotional connections and social responsiveness as key skills that must be taught in schools, colleges and insisted upon in workplaces, public spaces and governance. Life skills education for children as well as parenting education for parents must become a part of what is considered education in our society. Investment and support for mental health care services, counselling, community health services, addiction treatment, family counselling, must become part of public health policy.
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Parents, families, civil society, governments – all of us have to invest in learning these skills. They are just as important to resolve and heal the issues facing the world today as are technology and management. Justice, education, health and healing, equality and equity, human dignity – these are the real subjects that we must focus on learning about in schools and colleges. We as adults have to lead the way in showing how to live healthy, meaningful, socially connected lives, before we expect our children to do so. It is our duty to create a world where children are not forced to take their own lives because they cannot cope with the messy world that we have created for them.
These are unprecedented times for us as a society and we need to approach the issue of death by suicide of children as a holistic issue – at the family as well as public health issue – as the State of Kerala has rightly made a good beginning with this study.
There is a saying that people who die by suicide don’t want to end their lives, they want to end their pain. We must remember this especially in the context of death by suicide of children and act before it is too late to help them.
(Kalpana Purushothaman is an Adjunct Professor at the Indian Institute of Psychology & Research, Bangalore and member, Juvenile Justice Board, Bangalore (Urban), Bangalore)
(The Federal seeks to present views and opinions from all sides of the spectrum. The information, ideas or opinions in the articles are of the author and do not necessarily reflect the views of The Federal)
(Please reach out to a mental health specialist if you need support or know someone who does. Helplines: AASRA: +91 98204 66726; SAHAI: 080 25497777)