Consultant Psychiatrist and Medical Director, Dr. Tomi Haven, Dr. Tomi Imarah shares her thoughts on the rising incidence of suicide in Nigeria:
Last week a famous Lagos DJ, (DJ XGee) committed suicide by drinking an insecticide (Sniper), and that’s one too many suicides in Nigeria, in past couple of years; what do you think is going on?
There are almost 800,000 suicides in the world every year, with another 16 million suicide attempts. Almost 80% of these suicides occur in low- and middle-income countries like Nigeria. So, suicide is an actual epidemic that has been with us for a long while. What is new is the rise in reportage due to social media explosion in Africa in the last decade. Regardless, we need to combat it head on.
Whatever do you think happened to the once celebrated ‘World happiest People’ who hardly ever give up?
We are still happy people. We are still persevering people. We are still resilient people.
However, one of the many reasons suicide rate is increasing is that the world around us is rapidly changing. Social Media has revolutionized our hopes and dreams in such a way that it takes a lot more than good food, shelter, a stable job, and loved ones around the table to foster satisfaction with one's life. People are aware that they can have lots more than their forefathers had.
Now, the challenge is this: those dreams and aspirations are often not backed up with the knowledge, skills, and resources to actualize them.
Hence, when things don't add up...when you don't have thirty billion in your bank account and you don't have the pomp and pageantry you see on all social media platforms and in entertainment news every minute of every day… chronic dissatisfaction may set in.
That happy-go-lucky persona we reputedly have as a nation will be eroded gradually, replaced by an angry and perpetually displeased generation. Obviously, it is time we educate our young ones to develop a contented heart and focus on seeing every day as a gift to be enjoyed.
What do you think we, collectively, can do to stem the tide?
We can reduce the rising trend of suicide by focusing on mental health awareness nationwide. Religious leaders can lead the efforts by educating their followers when they present to them with symptoms of mental illnesses. Let people know they are not under spiritual attack. Help them get the needed help. Stir them in the direction of the available services.
As a people, let's be more open about our mental health struggles and recovery journeys. Let's inspire hope with our stories. When the lungs are ill, asthma may occur. When the pancreas is ill, diabetes may occur. When the brain is ill, depression may occur.
We need to see mental illnesses for what they really are...the body struggling with maintaining good health. All body organs require treatment in the course of our lives. There is no shame in it.
How does an individual even realise that he or she is having suicidal thoughts and what steps should someone in that position take immediately?
It’s simple. When the thought of ending one's life begins to be a welcome development and one begins to give consideration to a final escape from one's life, suicidality is already present. Planning the act is a step further. It's not where the process starts from.
Suicidality is a universally recognised psychiatric emergency. Professionals don't take it lightly and neither should anyone going through it. Book an assessment session with a Psychiatrist right away and embrace treatment modalities promptly, please.
Substance use antagonises clarity of thoughts, causing people to be prone to making decisions they would not have normally executed. Suicide is one of these unintended situations.
How can a non-expert distinguish between when someone is being dramatic and truly suicidal?
To be candid, it's better to never assume someone is being dramatic about suicide. If anyone ever mentions thoughts of self harm or suicide, it should be taken as a call for help and not just an attention grabbing gesture.
It is better to get them to see a Psychiatrist right away. Let the specialist decipher true intentions and implement a treatment plan promptly.
What group is at the greatest risk of suicide in Nigeria?
There have been too many shocking and unexpected suicides around the world that one may not be able to be so bold as to declare that a group is at great risk of suicide. Suicide cuts across all demographics.
However, there are conventional lists of groups at risk of suicide. These include people with Depression, previous attempt of suicide, substance abuse disorder, other major mental disorders, family history of suicide, financial problems, chronic medical illnesses, relationship breakups e.t.c.
Regardless of what statistics on suicide risk shows, we need to make concerted efforts to safeguard our nation from this rising incidence of suicides.
Social Media has revolutionised our hopes and dreams in such a way that it takes a lot more than good food, shelter, a stable job, and loved ones around the table to foster satisfaction with one's life. People are aware that they can have lots more than their forefathers had.
Apart from chemical imbalance in the brain what are the other factors that can lead to depression and what can be done about them?
There are many other biological causes of depression, such as hormonal imbalances, genetic vulnerabilities, faulty mood regulation by the brain. There are psychological issues involved as well. One’s view of self and the world may contribute to a process to depression. We call them cognitive distortions. Social issues such as stressful life events have a pivotal role in the causation of Depression as well.
With regards to what we can do about them, it is of utmost importance to know that Depression is treatable. There are millions of people around the world who have had at least one episode of major depression and had great response to treatment.
The most important step is to make a proper diagnosis and determine the severity of the illness. Psychiatrists are trained to use diagnostic tools to determine if the episode is mild, moderate, or severe. Subsequently, treatment will be tailored to the assessment they make.
Antidepressants and other medications have shown established high efficacy as treatment modalities. Also, Depression responds well to Psychotherapy (such as Cognitive Behavioral Therapy). Strategic efforts will also be made to resolve identifiable social triggers of Depression.
Suicide cuts across all demographics.
Where does alcohol and drug abuse come in when it comes to suicide; is it also a factor?
Yes, it's a vital risk factor for a number of reasons. Many people (especially men) take these substances as self-medication. They are going through unimaginable anguish and find transient relief when they take these things. Of course, the troubles await when the alcohol or other drugs wears off.
Meanwhile, these substances are isolated risk factors for mental illnesses. Therefore, there is a cumulative effect that further drives one closer to the cliff edge.
Another dimension is that substance use antagonize clarity of thoughts, causing people to be prone to making decisions they would not have normally executed. Suicide is one of these unintended situations.
I’m aware that there are a couple of suicide hotlines in Nigeria; how effective have they been?
Yes, there are suicide hotlines available nationwide. Their effectiveness can only be determined if we collate the data they have generated so far. I am not aware of such aggregates.
However, that doesn't mean they are not functional. Their efforts may not be apparent like Fire Services. People who access the hotlines may not readily give reviews about their experience because of the stigma surrounding mental illnesses.
The purpose of a suicide hotline is to provide suicide first aid and serve as referral guide. So, the focus should be on ensuring that people are made aware of available services.
That is why the mental health awareness arm of Dr Tomi's Haven is currently curating a directory of psychiatric facilities and suicide prevention initiatives in Nigeria. Our goal is to improve the accessibility of mental health care for everyone.
It's better to never assume someone is being dramatic about suicide. If anyone ever mentions thoughts of self-harm or suicide, it should be taken as a call for help and not just an attention grabbing gesture.
Can every suicide really be prevented or are some cases where it becomes inevitable?
Every suicide cannot be prevented. The best suicide prevention initiatives around the world have not totally eliminated suicides in those countries. However, the efforts have yielded significant reductions in the rates of attempts and completions of suicide. That's why we have to keep forging ahead with all our efforts.
What, specifically, do you think the government can do to reduce suicide rate in the country?
The government is doing a lot already. They have established mental health facilities around the country. They have provided paid training for psychiatrists through the residency programmes in these facilities. Also, they have provided highly subsidized health care in these psychiatric facilities. You can see that the issue does not lie with the government.
Of course, there is always room for improvement. An important step will be to train more Psychiatrists. Currently, there are less than a thousand Psychiatrists in the entire nation of at least 190 million people.
However, the issue is with us, the populace. Stigmatization and misconceptions about the causes of mental illnesses are keeping people from speaking up about their struggles. That's what we need to tackle. We need to create awareness about mental health, as exemplified by your media house.
When the thought of ending one's life begins to be a welcome development and one begins to give consideration to a final escape from one's life, suicidality is already present.
What are last words for anyone with suicidal thoughts?
My last words will be this: Fight for yourself. Others may not be able or willing to fight for you. You owe it to yourself to fight. You may be in a dark, dark tunnel and can't seem to muster the will to go on living. Can you at least reach out and grab the hands extended by psychiatrists across the nation?
I know you want to throw in the towel but there is no harm in exploring the option of mental health care. Don't consider what people will say about you. Their opinions are irrelevant in the light of the finality of suicide.