Suicide Prevention: Gatekeeper Training for India’s youth

The median age of India’s population is 28 years. That amounts to half a billion people at the prime of their lives juggling the demands of their education, careers, families and relationships. Every life stage comes with its own set of stressors, young adulthood being no different. However, it’s here that the statistics cause one to pause.

In a study published in The Lancet in 2018, suicide was found to be the leading cause of death among those aged 15-29. The latest report from the National Crime Records Bureau (NCRB, 2016) backs it up with the youth population (18-30) forming the largest chunk of all national suicides (34.1%). According to data submitted by the Union Ministry of Home Affairs in Parliament, approximately one Indian student dies by suicide every hour and 9474 students annually. The actual number of deaths by suicide are likely to be much higher as many go unreported due to the attached stigma.

Suicide was decriminalised only as recently as 2017 in India. Suicide killed more people in India (approx. 230,000) than AIDS (approx. 62,000) in 2016, yet is not treated as a public health crisis in need of urgent intervention. Mental health care infrastructure is woefully inadequate. At present, India has only 1 psychiatrist for every 400,000 people and mental health expenditure accounts for 0.06% of the total health budget. Against this backdrop, mental health professionals in the country are rallying around community led preventative measures as it is low-cost, not very resource intensive and can be implemented at scale .

Suicide Prevention India Foundation

We at Suicide Prevention India Foundation (SPIF) based out of Bangalore aim to use Gatekeeper Training, a community led initiative, for suicide prevention in India. Gatekeeper Training is a WHO recommended suicide prevention strategy. We aim to equip individuals with skills to be a first responder for someone in emotional distress and potentially suicidal. In a country where 9474 students die by suicide annually (2016), there is  currently no large-scale, evidence-based intervention addressing mental health amongst young students. This is the gap we hope to bridge and we follow a three-pronged approach of “Advocacy” “Action” and “Research” in our work with suicide prevention. We use the QPR Gatekeeper Training Model (Question, Persuade Refer) in our training with students, which is an evidence-based, research backed intervention developed by the QPR Institute based out of Spokane, Washington and is present across 800 colleges in the US, in addition to several other countries.

Working with India’s youth

The youth act as the foot soldiers in the mental health movement in India. Organising Gatekeeper trainings at educational institutes have been only half as challenging, as students lobby to have greater institutional support for mental health awareness programs. They are often the ones initiating contact across various platforms to arrange for gatekeeper trainings and related events. There is considerable insight in terms of understanding what their challenges are, insights that help us customize the training sessions for them. Their experience of mental health issues and healing, has been rather isolating due to lack of institutional and societal support that foster conversations, aid identification and recovery.

Lack of familial support also deprive economically dependent groups like students of several options for quality help. Friends then become all the more crucial for timely identification and intervention before the situation worsens. This comes through in our trainings where almost all discussions revolve around real-life instances brought forward by students. We found many young people act as primary caregivers for their friends whose parents stay in the dark about their condition. This places considerable pressure and demands exceptional emotional labour of individuals who don’t have the skills or the knowledge. The main reason for why gatekeeper training is requested by students is because of the need to be able to identify warning signs and being able to handle the crisis points more effectively. We have also identified two other frequent requests:

1. Network. Help with establishing contact with affordable but reliable therapists/mental health professionals in the city.
2. Self-care. Understanding when to step back from situations and not become overwhelmed by what is happening with our friend.

Our sessions have grown to include conversations incorporating this feedback and these questions. In the last three months of our work with students, our gatekeeper training programs have evolved considerably to include various aspects that need urgent addressal like basic skills in interventions (active listening, reflecting etc), and drawing boundaries for self-care. We also strive to develop in all the cities we go to, an eco-system of help and support for those who find themselves in crises. This could be in the form of other trained gatekeepers, new instructors who in turn are licensed to train more gatekeepers, reliable mental health professionals, clinics, hospitals and NGOs. Developing this network might serve to make this journey a more community oriented endeavour and give hope to those who need it the most.

Related links:

• Suicide Prevention Foundation India
• Give Subtitles to Suicide
• WHO Preventing suicide: a community engagement toolkit (2018)

Image credit: Light Up