By Margaret Uddin-Ojeahere
The World Mental Health Day is marked every 10th of October. This year’s theme revolves around suicide ― the taking of one’s life, with this fatal outcome being a deliberate intention. Unsurprisingly, domestic media reports of each incident of suicide border on the sensational. Different reasons account for this. From pure naivete and the shock of learning of an event perceived to be alien to our culture, it may seem appropriate to report such a seemingly interesting event. Against the widely reported “fact” that Nigerians are regarded as some of the happiest and resilient people on earth, these reports raise questions about how much is myth, misconception or the consequence of changing dynamics. For others, it is an opportunity to draw attention on a social media platform. Usually just a click on the ‘send’ button is all that is needed to disseminate information. There is also the possibility of a trained professional eager to carve a niche for herself in the field of journalism, regardless of the consequences.
So, why should the consequences of suicide coverage be an issue of concern, when all the disseminator wants to do is to inform? What readily comes to mind is the “Werther effect”. A phenomenon where there occurs an increase in the imitation of a widely publicised suicide. This concept was coined from the novel The Sorrows of Young Werther by the German writer Johann Wolfgang von Goethe, where the leading character dies by suicide in the name of love. Sequel to the book’s publication in 1774, over three dozen young men took their own lives in circumstances similar to that of the protagonist. This phenomenon is synonymous to suicide contagion or copycat suicide. It has been established over the years that the more sensational the portrayal of a suicidal act, wherein the details such as the method, the location and the events that surrounded the act are well elaborated, especially when a renowned individual is involved, a spike in occurrence is observed. This imitative behaviour has been observed to spread quickly and spontaneously, among young adults usually. It has also been suggested that the glamorisation of suicide by the media may influence and motivate similar actions in susceptible individuals to contemplate or outrightly complete it.
There is the question of why so much hullabaloo over reportage of suicide plagues the mind. After all people die daily and it is not reported with so much fuss. What then makes the topic of discuss spectacular, such that each one discovered results in people going through pain to ensure it gets some degree of review? Could it be its intentional nature that makes it uncanny and sensational? Howbeit, a life is lost and people are bereaved, and just as we are sensitive to the demise of others, which occurred from a gamut of causes, we should also consider the families and loved ones of individuals who died from suicide when reporting the event. It is bad enough that they have lost someone. To be constantly reminded and stigmatised consequent upon the demise of their loved one might just be a pain too much.
Some might say this suicide thing is starting to sound like a cliché, however for a doctor or a mental health practitioner, suicide or attempt at the act is an emergency that results in the mobilisation of resources to ensure that the individual gets appropriate care, and this involves the collaborative effort of both professionals and non-professionals. It is therefore not surprising that the World Suicide Prevention Day on September 10 and The World Mental Health Day chose the same theme this year, of “Working Together to Prevent Suicide”. It is no longer news that suicide is among the top-20 leading causes of death globally across all ages and the second leading cause of death among youth aged 15-29 years, or that over 800,000 people worldwide die by suicide annually. Every 40 seconds, one person will die by suicide and for every suicide, an estimated 20-25 people would have attempted it. One wonders how many more people have entertained suicidal ideas or thoughts. Mental illness is one of the most important causes of suicide, and depression, a major contributor to these. Perhaps what may be news to some is that for every act of suicide, about 135 people are affected by their death, which makes an estimated 108 million people who have lost someone to suicide worldwide. It is important to note that people bereaved by suicide are referred to as suicide survivors. These data, in my opinion, are conservative, considering the fact that suicide is under-reported in countries like Nigeria, where stigma greatly affects survivors’ willingness to admit to death by suicide in the family. Thus, this phenomenon is mostly concealed, but for the advent of social media.
In recent times, the print and electronic media have ensured that incidences of suicide are reported at such rapid speed, with the gory details splashed all over on an almost daily basis, making it difficult to ignore. Pictures are splattered over social media as statistics for suicide jingles or seminars. Mouths wag and judgmental statements are made in loud whispers. Beyond the increased number of cases consequent upon the sensational reportage, empathy and the feelings of the survivors should be taken into cognisance. We need to remind ourselves that a tragedy has occurred and family, friends and loved ones are affected by an acute loss. It is bad enough that these folks must deal with the guilt of not being able to prevent it and questions plague their minds. Where did they go wrong? This is made worse by the media denying them the opportunity to mourn their dead appropriately, as would have been the case if this had occurred from other causes.
This underscores the pivotal role the media plays in suicide prevention, regardless of the competence of the disseminator of the news, be it the trained journalist or the inculpable greenhorn. If we intend to curb this growing menace, then it is high time responsible portrayal of suicide is ensured by regulatory bodies for traditional media organisations and the encouragement of sensitive reportage by self-made journalists who are oblivious to the adverse impact on family and loved ones. However, one cannot blame the apparently simple-minded phone user who seizes that opportunity to share a shocking event, not realising that detailed portrayal of the act may perpetuate other suicides.
However, it is necessary to educate the general public on how important suicide reporting is. While I cannot claim to be an expert on the regulation of news reporting, I can state that talking about it, or directly asking someone with identified warning signs of suicide does not translate into the action being carried out. While this may sound somewhat contradictory, it helps to clarify the type of discussions. Conversation where direct questions are asked, with a view to listen and proffer help, whether directly or indirectly, is the preferred path. It employs a non-judgmental, supportive discussion, while being truthful and not offering false hope. A need to recognise that the person’s feelings and concerns are serious and germane. No matter how seemingly ridiculous it may sound to you the listener, don’t rubbish it, and don’t promise what cannot be achieved. After the person has opened up, it is not the time to flee and give them a wide berth. Encourage and help the person access appropriate health care. The importance of suicide crisis resources being easily accessible cannot be overemphasised and psychiatrists across Nigeria have taken the initiative to ensure that these resources are becoming readily accessible.
While it is important to inform and disseminate news, we ought to be mindful of the impact that these have on the general public, particularly on suicide survivors and susceptible individuals. Suicide should not be glamorised, nor painted as a quasi-answer to a phase of seeming impasse in one’s life or an escape route for a troubled individual. Avoid the gory details of the act, methods and locations; avoid repeated use of images which display the means or faces of the affected individual. Preferably report the consequent trauma and emotional devastation felt by their survivors, the vacuum left behind and probably the attendant hardship that ensues in some instances. The reportage of suicide should underscore the fact that suicide can be prevented, recognition of warning signs, where and how to access help and available prevention resources. The World Health Organisation endorses the use of extreme restraints in reporting suicide deaths, involving the exclusion of the word ‘suicide’ from headlines and limitation of the number of stories on suicide. Perhaps, now might be a good time to perfect our national guidelines for the coverage of suicide, that is assuming one is already in existence. There is need for journalist training on reporting suicide and the enactment of laws and policies by the appropriate regulatory bodies to ensure reduction in the access to lethal means. Accessible and affordable mental health facilities and machinery, which will serve as impediments to the act should be put in place. Training of professionals and non-professionals right from the grassroots communities all the way to the national government where mental health should be prioritised in a national agenda and the establishment of favourable policies and abolishment of archaic ones.
This may seem like a long shot, considering a government that appears to disregard the importance of health care and the impact on its populace. We can each help to rid the world of this menace by ending the discrimination, reducing the stigma we display towards individuals living with mental illness and their caregivers, dare I say even their health care providers. Thankfully it is not all talk. Psychiatrists in their own way across the nation are raising the awareness and being innovative, despite the limitations that exist. One of these is the Suicide Prevention Initiative in Nigeria (SURPIN), an initiative initially birthed by psychiatrists in the Lagos University Teaching Hospital and which has spread across 51 institutions in 28 states of the country, involving a multidisciplinary team. The initiative collaborates with other bodies, such as legal outfits and civil society groups to address this menace. It is involved in raising awareness, trainings of the media and other significant partners with subsequent development of referral systems. Suicide hotlines are available and when contacted, linkages are made to the nearest mental health care centre or service provider. SURPIN has stepped in several times to rescue persons in distress across the country whether directly contacted via the hotlines or discovery on social media. Hopefully, the federal government will key into this initiative and empower it better or convert it to a national one soon. This menace cannot be handled alone, it involves everyone; family, significant others and health care providers all the way up to the highest level of government. Indeed, a concerted and collaborative effort is required if we are to make any progress at all. Therefore, the theme adapted this year is so apt. We are all part of a community. Let us reach out. Let us work together to prevent this growing menace.
Margaret Uddin-Ojeahere, is a psychiatrist and Fellow of the West African College of Physicians.