LIFESTYLE

Despite Severe Handicaps, Suicide Prevention Helplines In India Are Trying Their Best To Make A Difference

Emotional first-aid.

09/09/2016 6:03 PM IST | Updated 10/09/2016 12:00 PM IST
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It has been 27 years since Varsha started volunteering at the suicide prevention helpline Sumaitri in Delhi, but she remembers most of her callers. Every week, the 50-something educationist, takes out time from her day job to visit the basement office of the helpline in central Delhi's Aradhana Hostel. Her job as a volunteer she says, is just to listen.

"I think it is easier to talk to a stranger," Varsha said. " A lot of people don't talk to their family because they may judge them, or don't understand or they don't want to stress them out. So that's why its important for us not to judge or give advice, but just listen."

Opened in 1988, Sumaitri runs one of the 16 helplines that are affiliated to the Indian branch of Befrienders, an international volunteer-based suicide prevention organisation. It operates from 2 to 10 pm on weekdays and 10 am to 10 pm on weekends, receives between 6-10 calls a day. It is also the only such helpline in north India.

Varsha, who is now in her 50s, joined the NGO in 1989, after a college friend committed suicide. "I felt that there was a communication gap, and she was unable to convey her suffering to her parents," Varsha recalled. "I felt very strongly about it. When I got to know about Sumaitri, I thought that this was my way of helping people."

"Every call is a challenge and every word can make a huge difference."

Inside the centre, two volunteers work in shifts, one answering a landline telephone, and the other responding to emails or counselling visitors. "It is a journey. Even today, when the phone rings, my hand still shakes a little," Varsha said. "Every call is a challenge and every word can make a huge difference."

Like Varsha, it was an early encounter with a string of suicides that led Johnson Thomas to co-found the Mumbai-based helpline Aasra in 1998, when he was still in college. In the previous year, there were numerous suicides among students in Navi Mumbai. Thomas had also heard about numerous suicides among the workers living his residential neighbourhood. "It was a closed community. I would hear about suicides, but it never came out in the newspapers -– it was always hushed up," Thomas recalled. There were also two suicides in a children's home where was volunteering.

The first such helpline in the region, Aasra is also one of the first 24-hour suicide prevention helplines in India. It is manned by a team of 28 volunteers, who devote 4-6 hours a week in one or two shifts. Aasra operates two telephone lines, which receive an average of 150-170 calls coming in everyday. Thomas himself spends 10-15 hours on the helpline each week.

Christophe Lehenaff

"How are you feeling today?"

A typical call begins with the volunteer introducing the NGO and explaining the nature of the service. Often, callers start the conversation by talking about their troubles themselves. At other times, the volunteer has to prompt them with questions on how they are feeling and tries to earn the caller's trust. Often, volunteers ask questions to determine their degree of risk and intent to harm themselves, but the key is being non-judgemental.

"We don't give counselling," Varsha said. "We listen to their problems. We work like a pressure cooker whistle -– to relieve their pressure and help them ventilate."

Besides serving as an emergency support for those suffering from chronic risk of suicide, the helplines also receive calls people are distressed, depressed or lonely. The largest number of callers are concerned with relationship problems, but there are others linked to nuclear families and career goals. There's also an increase in calls due to financial troubles, especially the inability to achieve a certain lifestyle. "Earlier people weren't that ambitious," she said. There are also numerous calls from elderly people, who call because of loneliness after their retirement or a spouse's death.

The age group of the callers varies according to each centre. The bulk of Aasra's callers are between 15 and 45 years, with those above 60 years forming the second largest chunk. In comparison, most of the callers at Sumaitri are between 25 and 55 years.

However, both helplines see a sharp spike in calls from students or their parents before exams in March-April and after the results come out in June and July. "Many of the emails we get are from kids as young as 14, who write about the troubles they have with studies," Varsha said.

"If I can make a person talk, ventilate and save a life or even support someone, it is worth it. I am just giving my time."

Some of the calls can last for hours -- one of Varsha's longest was for five hours, from a drunk man who was taking sleeping pills. "Throughout the call, we requested him not to take more pills. After five hours, he said I am sleepy, I'll call after a few hours," Varsha recalled. "And he did. He called after three hours at night, just as the centre was about to close, and talked to us again.

Other callers find it difficult to open up, but Varsha says that the important part of the job to keep listening, even when the other person on the line is silent. "If somebody has called but is not talking, it means that there is still a wish to talk," Varsha said. "We make them feel comfortable, express our concern and ask if something is bothering them to help them open up."

There is also a fair number of callers who just want to speak to a female counsellor or say something sexual or nasty, but volunteers still proceed with the conversation, and sometimes the prank turns into an actual grievance.

"In extreme cases, it is important not to get shocked to panicky," Thomas said. "Instead, we need to stay calm and to convince them to talk about it. Once they start talking, most of the job is done."

Yet, there are also conversations where the caller says they will harm themselves and then ends the call abruptly. "There was a girl who said she'd taken pills and was sinking. She said if I wake up, I'll call," Varsha's colleague and current Sumaitri director Aparna said. "But it hasn't happened till date."

"There was a girl who said she'd taken pills and was sinking. She said if I wake up, I'll call," Varsha's colleague and current Sumaitri director Aparna said. "But it hasn't happened till date."

Since the helplines promise anonymity for the callers and do not record their phone numbers, the volunteers are unable to reach out to them even during emergencies. The only exception to this is when a caller specifically asks them to contact their relatives or the police and is unable to do so himself. If not, the volunteer can often be left wondering. The burden of lending their ears to the miseries of strangers brings with it the anxiety of possibly failing someone who badly needs help.

And then there are memories of callers that still unsettle Varsha and her colleagues. Several years ago, a caller's mother called Sumaitri to inform them that her daughter had taken her life. The caller had been speaking to Sumaitri volunteers regularly for a few weeks about being abused and raped by her alcoholic husband. "The hardest part of the work is the failures that you get to know about. She was afraid for her daughter," Varsha recalled."She had tried everything but failed."

This a drawback that ails most of these Indian helplines. They can only lend their ears to a person who is willing to speak about their troubles and can try to console them, but they cannot get them any more help than that.

This a drawback that ails most of these Indian helplines. They can only lend their ears to a person who is willing to speak about their troubles and can try to console them, but they cannot get them any more help than that.

"The purpose is to convince them to give up that attempt. If someone is in that process already, we give them instructions on seeking help, first aid, or calling relatives and friends," Aasra's Thomas explained. "If it is a third party calling about a suicidal person, we suggest they call the local police and ask them to help the person in question."

The bigger picture

Unlike countries like the US, where the government funds the National Suicide Prevention Helpline, Indian helplines are mostly run by independent NGOs and colleges on limited financial resources, and sustained through independent donations and volunteers like Varsha.

According to a 2014 World Health Organisation report, India had the highest number of suicides in the world in 2012. However, in the absence of a central national suicide prevention policy, most suicidal people are left to their own devices, with the helplines being a convenient emergency support service.

"It is emotional first aid. Our immediate goal is to get them out of the ideation phase," Aasra's Thomas explained. "If that is successful, we are not looking at curing them or giving therapy."

With limited resources and no governmental support, helplines like Aasra and Sumaitri are unable to offer an active rescue policy like in the US.

With limited resources and no governmental support, helplines like Aasra and Sumaitri are unable to offer an active rescue policy like in the US. The focus is instead on providing emotional support. For this reason, Indian helplines keep the identity of the caller anonymous to make them more comfortable in stepping forward.

All the 16 centres that are a part of the Befrienders India network together get about 35-40,000 calls a year, a number which is significantly lower than the 1.1-1.2 million calls received by the National Suicide Prevention Lifeline in the US. Rajesh Pillai, president of Befrienders India, attributes the problem both to a lack of awareness as well as the fact that these are not toll-free numbers. In addition, many helplines are unable to increase their capacity because finding volunteers who are willing to devote time and effort for the training and weekly sessions is equally difficult.

"It is emotional first aid. Our immediate goal is to get them out of the ideation phase."

In the US, telephone-based hotlines are now accompanied by suicide prevention services offered through instant messaging and even texting. However in India, most helplines continue to use landlines.

Dr Samir Parikh, who heads the psychiatry department at Fortis Hospitals, says that helplines are only a small part of suicide prevention methods. "The idea behind a helpline is crisis intervention," Parikh said. "We cannot look at them in isolation. If a person calls a helpline, they are likely to not attempt a suicide that time. Yet, even if they are able to postpone that impulse, it will come back. That's where a medical follow-up and sensitisation is important."

Parikh argues for the need for a suicide prevention policy like in the US, which involves increasing acceptance of mental illness, sensitisation towards signs and symptoms, and ensuring that help reaches the person at the right time. "Helplines lose their impact unless looked at in a holistic manner," Parikh said.

Do they make a difference?

One way of assessing the 'success' rate is through the number of returning callers. While 20-30% of the callers at Aasra dial in again, the figure is around 70% for Sumaitri.

Thomas hopes that even if people don't call back, the callers may have been able to make a difference and helped ease some anxiety. But there's no way to verify that. "People call with varying degrees of suicidality, but by the end of most conversations, the caller would have ventilated a lot of negative emotions," Thomas said.

For volunteers, the job can be emotionally stressful and draining. At the end of a session, each volunteer like Varsha and Thomas, goes through a process of debriefing with a co-worker, which helps them ventilate their feelings before leaving the centre. They also have the option to adopt pseudonyms while taking calls or just use their first names, which also ensures that callers do not become dependent on one particular volunteer.

Despite these checks, some conversations can linger in their minds. "Yes, we do remember them. After all, you develop a connect with that person," Varsha said. "And that stays on as a memory."

Though Thomas says that he has trained himself to let go of "emotional baggage" that comes with the job, there are a couple of calls that have stayed with him. He recalls a female caller who was being abused by her alcoholic husband, and felt alone because her grown-up children were already married and lived apart.

"Even though it was 15 years ago, I remember the calls because she was a poet and recited beautiful poetry," Thomas said. "She spoke of wanting to end her life, but after several conversations, she said she has found purpose in her poetry and planned to leave her husband to live independently. And I think that's what happened."

If you struggle with suicidal thoughts or attempts, call any of these helplines: Aasra (Mumbai) 022-27546669, Sneha (Chennai) 044-24640050, Sumaitri (Delhi) 011-23389090, Cooj (Goa) 0832- 2252525, Jeevan (Jamshedpur) 065-76453841, Pratheeksha (Kochi) 048-42448830, Maithri (Kochi) 0484-2540530, Roshni (Hyderabad) 040-66202000, Lifeline 033-64643267 (Kolkata).

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