Suicide is serious public health challenge

Suicide remains a global and national threat.

In Uganda, the only available statistics from Uganda National Institute of Public Health (UNIPH) Quarterly Epidemiological Bulletin, code suicide rates at 18 percent, with men standing at a higher risk than their female counterparts.

It is the above statistics gap that prompted the Transcultural Psychosocial Organization (TPO) Uganda, a local NGO to conduct a survey, focussing on the Acholi Sub-region to further digest and diagnose the problem.

For more than two decades, Acholi sub-region was one among those that were grossly affected by the Lord’s Resistance Army war and its related effects in Northern Uganda. During the survey, data was collected from police stations and health facilities in the districts of Gulu, Omoro, Amuru, Pader, Kitgum, Lamwo and Nwoya where many people continue to battle the long-term psychological effects from the war.

Results reveal that up to 368 individuals committed suicide in 2021, with 128 females and 240 males. These statistics only cover the cases that were reported and managed through the government health systems, leaving many unreported cases.

It is evident that suicide is more pronounced among men than women. This is reportedly due to the pursuit and access to psychosocial support by women as compared to men. Men are hesitant to seek psychosocial support for fear of drawing back on their patriarchy and superiority among peers.

Although there is no single most contributor to these high cases of suicide, persistent alcohol abuse and rampant poverty are common triggers in this sub-region. Health workers and other key stakeholders also acknowledge the easy access to deadly intoxicating substances, gender-based violence and lack of community support. Untreated mental illnesses especially psychological stress, depression and anxiety disorders is considered among other triggers with some of the highest records of alcohol consumption in Uganda. As a result, individuals are often disinhibited, impulsive and at times live with impaired judgment.  In other cases, experts relate suicide to other forms of injury and violence such as child abuse, sexual violence and bullying.

This social stigma attached to suicide survivors adds to complications occurring in the course of suicide bereavement. The practice of cleansing the family and community of suicide as a sinful act is equally stigmatizing.

Despite these nerve-wrecking trends, suicide is preventable. The findings recommend a holistic approach that incorporates restriction of access to potential lethal means such as poison. There is also need for mass sensitization in addition to more inclusive engagement of key stakeholders like the police, local leaders, Village Health Teams, religious and cultural leaders as well as family members who play a great role towards prevention.

Establishing protocols for treatment and management of attempted suicides and support to families of completed suicides with a comprehensive package, including clinical intervention, consistent counselling path (over a period of three months and not a one off) were also highlighted as key mitigators. For suicide cases that result from persistent alcohol abuse, linkages to Alcohol Anonymous groups and rehabilitation programs are recommended for addiction management, in addition to alternative counselling techniques.

From a technical perspective of a national organization whose major thematic offering is mental health and psychosocial support, there is need to integrate psychological or/and psychiatric care into general healthcare especially for people with severe mental health disorders whenever their needs exceed the capacities of existing primary/general health services.

Suicide as a serious public health threat is preventable. Addressing it will therefore considerably reduce or even put an end to the lasting harmful effects on individuals, families and communities. This is only possible through strengthening integration of supportive mental health services into the general healthcare system. It is crucial for all stakeholders to be familiar and watchful of the risk factors and warning signs of suicidal behaviours by looking at mental health as a public health challenge rather than a curse or witch craft driven challenge.

Mr Reagan Rwabambari,  Project Manager-TPO Uganda