Trigger Warning: Mention of suicideMore number of people die as a result of suicide than Human Immunodeficiency Virus (HIV), malaria, breast cancer or war and homicide, each year, states the World Health Organisation (WHO).In India, more than 1,50,000 people died by suicide in 2021, according to the latest data released by the National Crime Records Bureau (NCRB).As per the NCRB data, 82.1% of all deaths by suicide is from hanging (69,917) and consuming poison (29,408) – the top two means by which people die of suicide.In India, the number of deaths by suicide caused by consuming poison has increased in direct proportion to the total number of deaths.Tamil Nadu reported the second highest number of deaths by suicide in the country with 18,295 deaths in 2021.Out of this, 7,041 cases were caused by poison – making it the second highest means of suicide in Tamil Nadu.What did the Tamil Nadu government do about this?The Tamil Nadu government recently announced that there would be a blanket ban on the sale of cowdung powder and rodenticides (also known as rat poison).
This announcement came in the backdrop of reports regarding increasing number of suicides due to rat poison.Although, the move was ridiculed by social media users, the WHO has stated that “restricting access to commonly used, high-lethality suicide methods” is one of the few effective approaches to preventing suicideCountries like Bangladesh, the Republic of Korea and Sri Lanka, which had banned a few highly hazardous pesticides, saw sharp reductions in overall suicide rates because communities had access to less toxic pesticides.Mariwala Health Initiative’s (MHI) recent report on suicide prevention looks at how Sri Lanka’s suicide rates declined because of strategic policy measures to regulate access to pesticides.The report states that while four measures were introduced by the island nation, “evidence suggests that of all the measures introduced, it was the comprehensive ban on the import and sales of WHO Class I toxicity pesticides in 1995, and endosulfan in 1998, that ultimately created the most impact on reducing the overall suicide rate.”To understand why a ban on rat poison was imposed, TNM spoke to experts on the matter.Dr CE Eapen, Professor in the Hepatology Department at Christian Medical College, Vellore, says that while the ban is a welcome move, we need multiple levels of intervention to address the root cause of suicides.Dr Eapen was part of a team that conducted a study about how consuming rat poison was one of the important reasons causing acute liver disease in Tamil Nadu.“There are concerns if such a ban is actually possible.The fact is it isn’t because we need the pesticides for other purposes.In schools, the children will not be allowed to touch chemicals.But, rat poison, one of the most severe forms of poison in the state, can be easily purchased by anyone.
While all other poisons are highly regulated and graded, there is nothing of that sort concerning rat poisonThere is a need to regulate the sale,” he says.But whether this will really help in suicide prevention is worth pondering, he says.“While we can regulate and reduce the access of the poison, what happens to a person in distress? Suicide happens due to conflicts, acute distress, and many other reasons.Here we need multiple levels of intervention on removing the distress or handling them,” Dr Eapen adds.Dr Eapen says that rat poison is one of the biggest killers of young people in Tamil Nadu, and adds that there are two levels of intervention.One is, how to rescue those who consumed the poison and two is, how to ban or reduce the availability and access to the poison.On the treatment side, Tamil Nadu Chapter of Indian Society of Gastroenterology (TNISG) has released guidelines on the Management of Rodenticide Poisoning, which prescribes that no sedation should be given to the patient and plasma exchange as effective and cost-effective means of treating poisoning.“Further, each district is given specialised equipment.Doctors, nurses and technicians are also given training in the treatment method under Tamil Nadu Accident and Emergency Care Initiative (TAEI),” he says.Why is rat poison more lethal than other poisons?“Rat poison affects the liver.Even consumption of a small amount of the poison leads to dangerous outcomes.The patient’s liver may be affected and they may die two days after consumption of the poison.We can also see that rampant rat poison consumption is happening in peripheral regions of TN, as there is no regulation.
Any roadside shop can sell them and people can take it along with food or waterA study was conducted by TNISG in 2019, which showed that the mortality rate of those consuming poison was 60-70%,” says Dr Ubaldhus, Secretary of TNISG.The study was conducted by TNISG in 15 hospitals in six districts of Tamil Nadu between January 1, 2019 and June 30, 2019.It concluded that “Rodenticide ingestion was an important cause of acute hepatotoxicity in Tamil Nadu” and public health interventions are needed to address it.Need data for focused interventionHowever, while the TNISG, doctors and researchers state that interventions are needed, they also seek good quality data to do so.Dr Soumitra Pathare, Director, Centre for Mental Health Law and Policy, says that one can only draw limited conclusions from the NCRB data.“NCRB data is highly unreliable, and their total numbers are grossly underestimated.However, the underestimation is not uniform across categories.For example, the number of deaths by hanging incidents cannot be included in accidental deaths, but poisoning can be done so,” he says.He further adds that the data by NCRB is consistently under-reported and neither their methodology nor their categories change.“The only thing we can see is the trend.Though the numbers are underreported, there is a trend of increasing deaths each year, which is something we can look into.But their categories make no sense at all.
What is this categorisation ‘profession’ based on? Say if a woman is married and works in a field with her husband, will she be called a housewife or unemployed or an agriculture worker? And who decides it?” he asks and explains that NCRB data is basically data collected by local police, which is aggregated nationally.To plan an intervention it is necessary to know which subgroups are most likely to die by consuming rat poison, says Dr Pathare“However, as of now, we don’t even know exactly how many persons died by consuming rat poison,” he says.Dr Eapen also says rat poison is a major problem in southern and western parts of India, but there is a deficiency of data.Suicide is a public health issue“My major question is why is the NCRB collecting data on suicides? This is a public health issue.Why is the police collecting data and not a public health agency?” Dr Soumitra asks and adds that the focus of NCRB data is not to make any policy changes.He also elaborates on the importance of raw data.“NCRB doesn’t release raw data.Now, if it is done, researchers like us could analyse it in multiple ways even if only a limited data set is available, and plan interventions,” he says.Further, stating that data for data’s sake is pointless unless there is a national suicide prevention policy or strategy, he says that we should focus our energy on our plan of action to improve the situation next year rather than focusing on numbers, which are underestimated.“If we are to move the needle on suicide prevention, we have to have a different conversation focusing on good quality data and policy changes,” he adds.If you are aware of anyone facing mental health issues or feeling suicidal, please provide help.Here are some helpline numbers of suicide prevention organisations that can offer emotional support to individuals and families.Tamil NaduState health department’s suicide helpline: 104Sneha Suicide Prevention Centre – 044-24640050 (listed as the sole suicide prevention helpline in Tamil Nadu)Andhra PradeshLife Suicide Prevention: 78930 78930Roshni: 9166202000, 9127848584KarnatakaSahai (24-hour): 080 65000111, 080 65000222KeralaMaithri: 0484 2540530Chaithram: 0484 2361161Both are 24-hour helpline numbers.TelanganaState government’s suicide prevention (tollfree): 104Roshni: 040 66202000, 6620200SEVA: 09441778290, 040 27504682 (between 9 am and 7 pm)Aasara offers support to individuals and families during an emotional crisis, for those dealing with mental health issues and suicidal ideation, and to those undergoing trauma after the suicide of a loved one.24×7 Helpline: 9820466726