Oleh Melati Mohd Ariff
This is the second of a three-part series on suicide
KUALA LUMPUR, March 18 (Bernama) -- Suicidal crisis may happen to individuals who feel emotional or physical pain that they believe is intolerable, inescapable or interminable, according to the National Suicide Registry Malaysia (NSRM) principal investigator Dr Nor Hayati Ali.
The consultant psychiatrist and head of Kajang Hospital's Department of Psychiatry and Mental Health said 'intolerable' means when the emotional or physical pain exceeds the person's threshold while 'inescapable' is when the person believes that there is no way out to solve the particular problem that is producing the pain.
As for 'interminable', it means the individual expects that the situation producing the intense pain will not change on its own accord.
This reflects on the attitude of 'hopelessness', which is a strong predictor of suicidal risk, she said in an interview with Bernama here.
Dr Nor Hayati said religion and spiritual faith appears to have a protective effect on possible suicide cases.
"Religion promotes righteous conducts and the belief that God will not forsake us, which acts as an antidote towards hopelessness. However if a patient is inflicted by mental disorders or an overwhelming life event, this might affect the person's ability to make a choice," she said.
According to Dr Nor Hayati, at this stage the role of family members, close friends and the society is of utmost importance to ensure that the person does not feel isolated and given assistance.
GATEKEEPER TRAINING
Dr Nor Hayati further explained that studies had shown that one of the most promising methods of suicide prevention is what is called as the 'gatekeeper' training.
Gatekeepers are people who may come into contact with suicidal individuals in their daily work, such as police officers, religious officers, custodial (prison officers) personnel, teachers and school staff, social workers and doctors.
Very often, these individuals receive little or no specific training in the identification of suicide risk and how to help suicidal individuals.
Gatekeeper training involves not only information about assessing risk and intervening with suicidal people, but generally provides information on referral and help available from other services within their community, including treatment for depression, alcoholism and drug abuse.
Dr Nor Hayati also said the Health Ministry has taken measures towards suicide prevention, one of which is to encourage responsible reporting by the media.
"Individuals who may have previously contemplated suicide but rejected it as a course of action on the grounds of its negative consequences, might be inclined to inhibit the behaviour if they witnessed a model whose suicide was presented as acceptable by the media," she said.
This phenomenon is called "copycat suicide" or the "contagion effect."
According to her, it is pertinent for the newspapers to refrain from making sensational or too-detailed reports on cases of attempted or committed suicides.
YOUR MIND YOUR HEALTH
World Health Organisation (WHO) defines health as a state of complete physical, mental and social well being and not merely the absence of disease.
Hence, Dr Nor Hayati said mental health, which refers to the function of the mind, is a vital component of an individual's health. "
"Individuals with good mental health always feel good about themselves. They also feel comfortable with others including in their personal relationships and are able to meet the demands of life," she explained.
She explained that individuals with poor mental health tend to be unhappy, vulnerable, and uncertain about their present life or future and have low self-esteem apart from feeling isolated from the society.
Such individuals also have feelings of being overwhelmed by adverse life events and often feel that life pressures are uncontrollable.
"Depression is a physical disease that affect the brain, causing chemical imbalance in areas controlling our biological and social functions," she said.
According to her, studies in "quality of life" showed that depression has a more serious impact on one's ability to function, namely remembering things, making decisions or going to work when compared to other chronic diseases.
Dr Nor Hayati said if a person is too ill to recognise his or her difficulties, the individual's family and friends are encouraged to assist in getting the necessary treatment.
ACCESS TO TREATMENT
Dr Nor Hayati also acknowledged that the negative perception on people with mental health difficulties might cause them to be reluctant to ask for help.
However the situation is expected to change gradually as more scientific evidences have shown that mental disorders have a biological basis in the brain, and is not just 'spiritual weakness'.
"In most cases, they can be diagnosed and treated. And there is a wide range of medications that are available in health facilities in Malaysia that can be used to treat depression. Left untreated, it can cause suffering to the individual, family and community," she said.
Dr Nor Hayati said: "If a suicidal person turns to you for help, it is likely that the person believes that you are more caring, more informed about coping with misfortune, and more willing to protect the individual's confidentiality. No matter how negative the manner and content of the talk, the person has a positive view of you.
"There are hundreds of modest steps we can take to improve our response to suicidal people and to make it easier for them to seek help. Taking these modest steps can save many lives and reduce a great deal of human suffering," said Dr Nor Hayati.
EVERYONE HAS A ROLE
Dr Nor Hayati believes that everyone has a role to play and she supports the Health Ministry's efforts in collaborating with other agencies that offer help to suicidal people such as the 'Befrienders'.
"With more data produced by the NSRM, hopefully we can disseminate a basic understanding of the factors that heighten a person's risk of becoming mentally ill and factors that increase a person's risk of attempting suicide in Malaysia', she said.
She said specific knowledge must also be provided on where to send people who are at high risk for further assessment and treatment, and the importance of the follow-up.
Helping people to learn skills in problem solving, conflict resolution and non-violent handling of disputes also contributes towards preventing suicide bids.
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