Friend in need

With World Suicide Prevention Day falling tomorrow, Renuka Raj looks at Sri Lanka Sumithrayo’s contribution

In 1995, a study by the University of Harvard estimated that Sri Lanka had the world’s highest rate of suicides – an estimated 47 out of 100,000. In terms of numbers, this amounted to 8,519 persons, mainly in the rural areas that year. The situation seems brighter today. Figures for 2006 indicate that these statistics have fallen by as much as 50%, to 4,503 persons, or 22 out of 100,000.

“We can’t afford to relax, however. Statistics from hospitals, especially rural hospitals, indicate that suicidal behaviour has not changed. The number of suicide attempts remains at the earlier high levels,” warns Lakshmi Ratnayeke, Director of the Sri Lanka Sumithrayo Rural Programme.

Lakshmi attributes this reduction in the number of suicides over the past decade as being probably due to the availability of better transport facilities in rural areas, as well as greatly improved treatment facilities in rural hospitals. Earlier, bullock carts and tractors were the sole means of transportation to hospital, so many victims would die before arrival. Now, however, the network and frequency of buses have improved, and even most rural townships have three-wheelers so treatment is more readily available.

About 75% of suicides in Sri Lanka as well as in India and China are in rural communities, especially farming communities, mainly due to the fact that they have high levels of stress because they live, most often, without even the barest necessities of life. These stress levels differ from those living in urban environments, “We can’t just say that they have no coping capacity. They do have the capacity to cope but just one incident could be the ‘straw that broke the camel’s back’,” states Lakshmi.

Although depression is a main causal factor of suicides in developed countries, the situation in Asia is different. “Especially in Sri Lanka, India, China and Malaysia suicides are more due to the onset of sudden uncontrollable feelings stemming from a ‘loss of face’ caused by the “I’ll show them” syndrome,” says Lakshmi. She explains that the loss of face is a phenomenon of the Asian culture that plays a major role in suicide: the suicidal person may at first merely threaten suicide as a means of getting attention, but he or she would then feel compelled to carry out the threat rather than ‘lose face’ with those before whom they threatened to take their own lives.

The age group of 15 to 25 year olds are the most vulnerable. Hormonal changes taking place in their bodies don’t enable them to control their feelings. Emotions are, consequently, high in this group. This would not happen if there was a support system, but, unfortunately rural communities rarely have safety nets. “You don’t have to be mentally ill to commit suicide,” says Lakshmi.

Despair, anxiety, loneliness, sometimes leading to suicide, have no geographical boundaries, racial or class distinctions. “Suicidal feelings come to 99.9% of people but these feelings don’t last forever. Get help. If you feel you can’t cope, talk to someone, a trusted friend who will listen and understand, or talk to organisations like the Sri Lanka Sumithrayo. Don’t take your life,” she pleads.

The Sri Lanka Sumithrayo, a voluntary organisation, incorporated by Act of Parliament No. 10 of 1986 has, as its primary aim, suicide prevention through befriending potential suicides. Sumithrayo is affiliated to Befrienders International, (Samaritans Worldwide) which was founded in England by Chad Varah in 1952. The first branch of Sri Lanka Sumithrayo was founded in June 1974.

The service of the organisation is delivered through trained volunteers known as ‘Befrienders’. The technique of befriending, as defined by the organisation, is described as ‘the skill of listening to a stranger and helping him/her to unburden troubled feelings, thereby setting in motion a cathartic process’. Befrienders are trained to diffuse the tension and pent-up emotions of the caller, and help the caller to think clearly, examine all options and cope with the situation in a positive manner.

Confidentiality is one of the cardinal principles of Sumithrayo. Lakshmi explains that the power of befriending has to be experienced to be believed, and the success of the befriending process is proven by greatly reduced suicide figures in the areas in which Sumithrayo operates. Sri Lanka Sumithrayo has branches at Horton Place – Colombo, Pitakotte – Colombo South, Kandy, Bandarewela, Panadura, Matale, Mawanella, Katunayake and Kurunegala.

The Sumithrayo Rural Programme has as its vision and mission; assistance to rural communities, in enhancing self worth and self respect with the aim of reducing suicides in the areas that Sumithrayo functions, through helping them improve both their skills in dealing with negative feelings and urges in a more positive manner, as well as their skills in decision making and in selecting healthy alternatives in life, thus empowering them to make better choices in life.

The Sumithrayo Rural Programme which celebrated ten years of service to rural communities last year has gone to the grassroots level to actively prevent suicides. The success of the programme was endorsed this year by the International Association for Sucide Prevention (IAS), which presented the coveted Ringel Service Award for innovative programmes on suicide prevention on a national level, to Lakshmi at the IAS Biennial Congress held in Dublin recently.

Work carried out by field officers includes regular visits to the selected villages, making contact with those who are potentially suicidal, when alerted, and giving them support during their emotional crisis. They also conduct a range of programmes that include programmes on improving interpersonal relationships and life skills, and suicide awareness programmes, coupled with support programmes for the depressed and suicidal and on mental illness and suicide. Life skills programmes and suicide awareness programmes are conducted in village schools in the area and in nearby towns, as well as art competitions for school children, aimed at helping children express their hidden or suppressed feelings of sadness and trauma.

The Sumithrayo Rural Programme was set up in 1996 in a small room on the premises of the temple in Hettipola and has, over the past decade, grown to cover over 90 villages in the North Western, North Central and Southern provinces of Sri Lanka. Today, the Sumithrayo runs a Befriending and Crisis Prevention Centre in Lunugamvehera and helps operate a befriending centre in Panduwasnuwara. Presently, the Sumithrayo works in 30 selected villages in the Panduwasnuwara, Bingiriya and Katupola divisional areas comprising about 1416 families. The Sumithrayo also works in about 30 chosen villages in Thanamalwilla, Lunugamvehera and Tissamaharama areas in the South, but not on the scale that it operates in Panduwasnuwara, due to a dearth of suitable volunteers and field officers. In May 2006 however, the Sumithrayo had to temporarily withdraw from the villages in Kebbittigollawa and Padaviya in the North Central province due to the adverse security situation in the area.

In 2006, an important part of the Sumithrayo Southern Rural programme was in befriending and helping the traumatised survivors of the tsunami in Kirinda. Within a year of the disaster, however, most of the survivors were back on their feet. Two years later, despite the tragedy, there have been no suicides in Kirinda.

In farming communities in particular, easy access to agricultural pesticides in many cases, gives speedy release from a bleak existence, and is the most common method used. The ingestion of kaneru (Yellow Oleander) seeds is another means of suicide in rural communities. A two year experimental pilot study that commenced in December 2004 on the ‘Secure storage of pesticides to reduce suicide’ was carried out in various villages in which Sumithrayo functions, funded by CIC and Syngenta. Findings indicate that there have been appreciable reductions in the numbers of suicides in those villages in which Sumithrayo works, with suicides in several villages decreasing by as much as 100 %.

In 2006, the Sumithrayo embarked on another similar pilot study, in collaboration with the Centre for Suicide Research, Oxford University. The study was financed by Syngenta through CIC, and its findings will be available soon.

Lakshmi advocates one solution for reducing the numbers of suicides, namely to address a root cause: to increase the earning capacities of rural communities, through teaching them cottage industries like handicraft making, for instance, and finding them a market for the finished products. Setting up labour intensive industries is another permanent solution. This is where the support of the private sector is an urgent necessity. In the North Western province, for instance, the prevalence of garment and packaging industries has improved rural lifestyles and succeeded in lowering the number of suicides.

A dearth of field officers is a main drawback in successfully implementing the rural programme. For instance, only four field officers function among the 30 villages in the south. In Panduwasnuwara too, there are only 4 field officers. Scarce funds are a reason for this dearth of support staff. Although the mercantile sector does support the programme, these funds are negligible when considering that it costs about Rs. 100,000 per year to employ just one field officer, not taking into account his travelling and supervisory expenses.