(If you feel suicidal or know someone in distress, please reach out to them with kindness and call these numbers of local emergency services, helplines, and mental health NGOs)
(6 to 11 September is suicide prevention week. FIT is republishing this story in light of it, and the immense burden of mental health issues that has been weighing on our frontline workers in the pandemic.)
“There is an expectation that a doctor is a superhero. They’re supposed to do a 100 things, work for 100 hours and still be alert and function at 100 percent. That’s unfair and impractical!”Dr Soumitra Pathare
Recently, a psychiatry resident at AIIMS died from suicide. Right now especially, doctors across the world are being hailed as frontline warriors, but the risks of burnout and depression are less talked about.
A study in the Indian Journal of Psychiatry revealed that 30% of Indian doctors and physicians go through depression, while 17% have experienced suicidal thoughts.
The word suicide often throws us. It’s shrouded in shame and misinformation. For example, globally, one of the most persistent myths is that suicide is not preventable. Another myth is that suicide is always linked to a mental health disorder.
So how much do we really know about suicide? And what do we know of suicide among Indian doctors?
FIT speaks to Dr Sumedha Tiwari, a psychiatrist in a Mumbai COVID ward Dr Soumitra Pathare, a consultant psychiatrist and Director of Centre for Mental Health Law and Policy at ILS, and someone who helped draft India’s new mental health law, and Dr Samir Parikh, a psychiatrist in Fortis Hospitals, Delhi.
Understanding Suicide
Before we get into the link between doctors and suicide, Dr Pathare clears up a few misconceptions about suicide itself.
“All suicides, even suicides among doctors, are never because of just one thing.” So, there are many reasons and problems that can trigger these thoughts.
“Suicide is not a rational decision. It is emotional,” he adds.
Suicide is a desperate cry for help.
So how do we prevent suicides? First, let’s see if the medical profession has a suicide problem. In 2018, the Indian Medical Association said that suicides among doctors was a “public health crisis.”
Understanding Medical Suicides
The life of a doctor is hard. We knew that already - not many other jobs have to deal with death and illness on a daily basis.
“There is a sense of guilt since the job deals with a patient's life. There is often a sense of failure if the patient does die,” says Dr Pathare.
Dr Parikh, however, adds that every job has its own issues, “It’s not right to say a doctors life is more or less stressful.”
Still, there is no doubt that the long-hard journey to become a doctor is riddled with stones. “There is a lot of pressure and bullying in medical school. Residents are constantly overworked,” adds Dr Pathare.
Psychiatrists have one of the highest suicide rates among the profession. Is there a reason behind this?
Dr Sumedha, a psychiatrist in a Mumbai COVID ward tells me that the people that choose the field are often very empathetic but “empathy is a double-edged sword.”
“I remember when I was in another hospital as a resident, I was dealing with a rape accused. It took a toll on me, seeing the depravity. Luckily my supervisor advised that I take a short break and re-orient my outlook and look at them as patients in need of tests.”Dr Sumedha Tiwari
Dr Pathare also says that there is a suggestion that people who take up psychiatry have some sort of a personal connect with the subject - either they have a mental health issue or someone in their family usually does. This of course is not always the case.
A field like psychiatry must be uniquely aware of mental healthcare, so I asked about how this field has the highest number of suicides. “But suicide is not a rational decision,” reminded Dr Pathare, “which means that increased knowledge is not always helpful.”
What does help is systemic changes - the answer to reducing suicides lies beyond the individual and through societal, institutional changes.
Mental healthcare isn’t seen as a priority, even in the medical field. “Even with certain things like depression which is a neurobiological illness, there is a stigma around medication.”
Would you go to a sick doctor?
Dr Pathare says that many medical professionals may not acknowledge a problem or seek help or take medication as that would be seen as a sign of weakness, and they would lose the trust of their patients.
“Doctors always put themselves second.”Dr Sumedha Tiwari
How Can We Prevent Medical Suicides?
Suicide is not inevitable. While we are far from a 100 per cent suicide free country, we need to re-orient our framework of suicide prevention, says Dr Pathare.
“Suicide is not caused by just one thing. Therefore the solution is also not just one thing - it needs a multi-pronged, multi-sectoral approach.”
Education and awareness has a great impact on sensitising us towards mental healthcare. “People have identified medical training as an issue, as there is nothing about mental health, nothing to help you deal with the psychological impacts of facing life and death every day.”
“Think of suicide prevention as multiple safety nets. If someone is falling they need many things that can catch them at every step.”
We can start with institutional reactions - ragging, bullying needs to be curbed and doctors need to be encouraged to have a work-life balance.
However, in a country like India where there is one doctor for every 1,145 patients (lesser than WHO recommended standards), this becomes difficult. We need to understand the humanity of doctors as well, and for this the medical fraternity needs to publicly speak up to change their ‘superhero’ image.
On addressing the stigma of doctors asking for help, Dr Pathare suggests a confidential number just for healthcare workers. “Another safety net.”
“We have a pan-India helpline and it is so important to also cater to vernacular languages,” says Dr Parikh who is one of the counsellors for the Fortis helpline.
On a positive note, general awareness about mental healthcare has risen. Has this seeped into any action?
“The medical community is speaking out but they are not supported by institutional representatives yet,” says Dr Pathare. HCWs have faced immense backlash from their administrations for speaking up for various issues in the pandemic. “There is a lack of willingness to understand the HCWs issues.”
“But we are making progress. It is possible to reduce suicides - it just needs persistent efforts.”Dr Pathare
Dr Parikh adds that we need a national mental healthcare policy that outlines changes in curriculums for all fields, policies for corporate mental healthcare packages, insurance and more.
“It’s not just an issue for doctors, this is important for everyone,” says Dr Parikh.
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