Suicide rate drops, but more people using poison

After decades of having one of the highest suicide rates in the world, Sri Lanka now has a declining trend, but health professionals are concerned about the growing numbers who end their lives with poison.



Police records show a plunge in the number of suicides over the past few years, from a peak of 8,449 in 1995 to 4,504 in 2006 and 4,225 in 2007. However, police figures also reveal that of the deaths recorded as suicides in 2006, more than half were due to poison, with some 2,268 men and 519 women consuming toxic substances.



State hospitals have seen a 300 percent increase in the number of patients being admitted with symptoms of poisoning in the last 20 years, but health professionals believe the figure could be much higher.



The seeds of the yellow oleander tree, the yam of the gloriosa superba plant, agricultural chemicals and over-the-counter drugs were some of the poisons ingested by the 93,773 people treated in government hospitals in 2006, according to the National Poisons Information Centre (NPIC).



"But the figure is definitely much higher," said Ravindra Fernando, senior professor of forensic medicine and toxicology at the University of Colombo and founder of the NPIC. "We don't have information about hospital admissions in the north and east and it's likely that we are missing about one-third of cases."



Social, economic and other statistics from the conflict zones in the north and east are hard to come by. A 2008 WHO report, Suicide and Suicide Prevention in Asia states: "Civil war resulting in large numbers of refugees is believed to contribute to the suicide rate (Berger, 1988), but has also made it impossible to collect suicide data from the north-eastern region of Sri Lanka, which is known to have the highest suicide rate in the country."



Admissions to private hospitals are also not included in the official tally, said Fernando, who calls poisoning "a modern epidemic in Sri Lanka".



Medical experts are disturbed at the steadily increasing number of people, most between 19 and 30, going to hospital to be treated for intentional or inadvertent poisoning. Countless cases also go unreported, according to health experts.



"There is cause for concern at the number of poisoning cases increasing because these are socio-economic issues," said Fernando. "Mostly young people are being affected and that results in a loss of productivity, a loss of young lives and the enormous costs of managing a man-made disaster."



The WHO report ranks Sri Lanka among the four Asian countries with estimated suicide rates at over 20 self-inflicted deaths per 100,000 people.



The island nation in 2007 had a rate of about 21 suicides per 100,000 people, said Sudath Samaraweera, a medical doctor with the Institute for Research and Development, a local non-profit forum of professionals and academics.



"Although the rate has dropped since 1995, when it was a peak figure of 46.6 suicides per 100,000 people, the figure still remains high," said Samaraweera, pointing out that anything over 15 suicides per 100,000 is considered excessive.



Sri Lanka's recent decreasing suicide trend is the result of national strategies instigated in the mid-1990s, Samaraweera said. Chief among them was the de-criminalising of suicide. Until then, "attempted suicide" was an offence under the penal code and people who tried and failed to end their lives were arrested and hauled up before court, usually after being taken to hospital for emergency treatment. Changing the law eliminated the stigma attached to the psychological condition.



The NPIC also lobbied to have the import of highly toxic pesticides banned by the government and to restrict access to poisonous chemicals. More medical officers with mental health training have also been assigned to provincial hospitals to provide psychiatric support.



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