Suicide is no respecter of race, culture, religion, socio-economic status or professional standing in the SA context. Picture: STUART MILES/123RF
Suicide is no respecter of race, culture, religion, socio-economic status or professional standing in the SA context. Picture: STUART MILES/123RF

According to the international expert on suicide and author of Suicidal Behaviour in SA, Prof Lourens Schlebusch, in 2000 a World Health Organisation study found that about 1–million people committed suicide and up to 40 times more attempted suicide. It was predicted that by 2020, the figure would increase to 1.5–million.

The world appears to be on course to fulfil the prophecy.

Four times more men than women take their lives and the average age is getting younger: youth aged 15-29 are at high risk. Suicide is no respecter of race, culture, religion, socioeconomic status or professional standing in the SA context. Causes are multiple and multifaceted: from witnessing or experiencing violence, increased mental health disorders, relationship issues, socioeconomic challenges and substance abuse.

“In a way we’ve got a hotbed: we have an economic crisis, we have got incredibly high youth unemployment, we’ve got societies in transition and we’ve got a high rate of urbanisation and the total disruption of traditional systems,” Dr Lesley Robertson from the Wits psychiatry department said.

“In a society like ours, where things have changed very fast and culture has been fragmented and destroyed, people don’t have strong traditions or strong beliefs, which are shared and which people can rely upon,” Dr Alphonse Kanda, a logotherapist, said. This has led to “a crisis in personal values.”

In addition, care is lacking where it should be expected, according to Kanda. “Caring is missing in families, in the education system and in the health-care system.”

“Families are fragmented, either because of HIV and parents having died, or because parents are not present: they are working somewhere else, or running after money or they have their own problems,” Kanda said.

Dr Helen Clark, a child psychiatrist at the Chris Hani Baragwanath Hospital, said attempted suicides often don’t come to the attention of the parents. “Quite often kids come in with what we call a parasuicide, which is more a cry for help than an actual suicide and they will tell us: “I tried three times before and nobody knew.”

Parents don’t realise how stressed they are. They are left to cope on their own and they live in homes that are falling apart. Adolescents are accumulating stress and not learning coping skills, because their parents have no coping skills.

People don’t verbalise their distress and their struggles, according to Dr Faeeza Mohamed, a psychiatrist at the Charlotte Maxeke hospital in Johannesburg.

“We have parents who are extremely distressed. They themselves are unable to express their emotions. And because children internalise their difficulties and their stress and are unable to verbalise it, eventually this culminates in an emergency situation like a suicide attempt.” 

Education

“From crèche to university, I don’t think we consider educational institutions as places of caring,” Kanda said. “If children don’t’ feel cared for at school and they return to a home where parents are unavailable, we are in trouble.”

Bullying is pervasive in schools, Mohamed said. “The kind of bullying we are seeing is becoming more aggressive. There is also cyberbullying whereby a child is not only bullied in the playground but through their electronic devices in the home environment as well.”

Health-care system

“The other space where we expect care but we don’t get it is the health-care system,” Kanda said. “Not only mental health but the health system in general. I don’t think there are many clinics or hospitals where you go in and you come out feeling that they have taken care of you. We expect care but we don’t get it. And it is critical because that is where you can pick up people who might commit suicide. That is where you start prevention.”

Prevention should be the main focus, Schlebusch said. “That involves an awareness of mental health problems and how serious the problem of suicide is — and access to mental health treatment and suicide prevention.”

Robertson said, “Again and again, it is about having access. And it is no good if the primary care doctor that you see doesn’t understand and isn’t able to address the problem sufficiently because of lack of scope of practice and lack of skills. And it is no good if psychiatric expertise is in a stand-alone institution miles away from everybody. There has to be access to treatment.

“I think the department of health, and the country as a whole, is becoming more aware of the need for psychiatric care, but at present we are struggling to provide all the care we need to provide,” Mohamed said. “It is going to need a long-term plan to provide the resources we need to serve our population.”