National statistics, have shown a noticeable increase in the cases of suicide across Nigeria. People continue to jump off the Lagos Third Mainland Bridge into the Lagoon, or ingest ‘Sniper’, a disinfectant and all purpose cleaner, turned into a popular and easily available poison, to commit suicide. In a country where suicide is erroneously associated with spiritual causes, plus a paucity of psychiatric experts, curbing the malaise is undoubtedly challenging. Leading Psychiatric expert, Dr Maymunah Yusuf Kadiri, Onikepo Braithwaite, Kede Aihie and Abdul Ed Malik examine why both the young and the old are taking their lives, and possible solutions to curb the scourge Suicide: The Fourth Largest Cause of Death in the World
Dr Maymunah Yusuf Kadiri
Rising Number of Suicides
The recent deaths of Bimbo Ogbonna, Adetutu Adedokun, and Adedoyin Ayinde have raised the question: Why is suicide becoming more common in Nigeria? And what can be done to reverse the trends? Of course, these are a few cases known to the public due to their widely publicised deaths.
In addition to the 703 000 suicides per year, many more people attempt suicide.
Every suicide is a tragedy that has a lasting impact on the survivors, including the families, communities, and entire nations.
Suicide is a common cause of mortality, that affects people of all ages. It is the fourth largest cause of death worldwide, among those aged 15 to 29. This is a global issue that affects all parts of the world, not only high-income nations. In fact, low- and middle-income nations such as Nigeria, accounted for more than 77% of all suicides worldwide in 2019.
Mental Illness & Other Reasons for Suicide
Concern among stakeholders and officials regarding depression and the drive to kill oneself, which are becoming more widespread in Nigeria and are currently manifesting in a rise in the number of suicides, is growing.
Although there is a strong correlation between mental disorders and suicide in high-income countries, particularly depression and alcohol use disorders, many suicides occur impulsively in times of crisis due to a breakdown in coping mechanisms for life’s stresses, such as chronic pain and illness, financial difficulties, and relationship breakups.
The World Health Organisation’s findings in 2020, indicated that about 30% of Nigerians have one form of mental illness or the other. With the Covid-19 pandemic, the security situation in the country, and other social issues such as unemployment, economic issues, poverty, financial challenges, insecurity among others. it is believed that these figures have gone up significantly.
As a Psychiatrist, I have had to attend to patients who are suicidal, and one common thing they admit to as survivors, is the show of regret. This means they deserve to receive counselling, therapy, and other necessary support, because most people that tried to kill themselves never wanted to die; they just wanted the pain to go away.
Low Psychiatrist-to-Population Ratio in Nigeria
The population of Nigeria is currently estimated to be about 200 million people, but there are inadequate numbers of available medical professionals to cater to the health needs of the nation. The situation is even direr for mental health, with a psychiatrist-to-population ratio of 1:1,000,000 Nigerians. This roughly translates to one psychiatrist, for every one million people in Nigeria.
The psychiatrist-patient ratio in Nigeria is therefore, dismal, thereby widening the mental health treatment gap. Furthermore, the majority of available psychiatrists in the country are based in the urban and southern parts of Nigeria. There is a massive shortage of psychiatrists in the country, especially outside the aforementioned areas, and the psychiatrist-patient ratio is widely off the mark.
What Suicidal People Require
Indeed, what suicidal people really need is effective treatment, counselling, and assistance, not punishment, as attempting suicide is a criminal offence in Nigeria, under Section 327 of the Criminal Code Act, and carries a penalty of up to one year in prison.
In as much as we know that family members, relatives and religious leaders do help their loved ones when in distress, managing a suicidal patient requires techniques that those who are desirous of helping lack. For this, schools, government agencies such as LCC, religious and corporate organisations should have mental health first aid training for staff and Human Resources team members, to be better equipped to help is situations such as this.
Advice
As we prepare for the 2023 general elections, I strongly advocate that the National Assembly and the Presidency, where the Mental Health Bill lies now, should receive urgent attention to be passed into law as an Act. Also, we need to make sure that the integration of mental health into primary healthcare, is fully done and fully prosecuted. The National Health Authority Act needs to cover more mental health conditions, and include in their formulary the newer available medications in the country. This will also serve as a remedy. for universal mental health coverage investment.
The Road to Suicide
Onikepo Braithwaite
Definition of Suicide
Suicide is “the action of killing oneself intentionally”. Black’s Law Dictionary defines suicide as “the wilful and voluntary act of a person who understands the physical nature of the act, and intends by it to accomplish the result of self-destruction”, “the deliberate termination of one’s existence while in the possession and enjoyment of his mental faculties”. It seems that two of the key elements of suicide in this definition, are the voluntariness and being in one’s right mind. However, the argument is that, a person in their right mind, who isn’t suffering from one mental health issue or the other like Depression, is unlikely to intentionally or voluntarily kill themselves. Self-killing by an insane person, a person not of sound mind, is not suicide. Insurance Co. v Moore, 34 Mich 41.
My Friend’s Older Sister
One of the most common reasons why people commit suicide, is Depression, a mental illness which comes in various forms, some of its causes may be unknown, or due to heartbreak, bereavement, financial crisis, and so on. A person can get so depressed and feels so helpless, that he/she starts to lose the will to live, and sees death as a better option.
As a child, suicide did not seem to be a common occurrence. The only person whom I ever knew that committed suicide, was my friend’s older sister. I will never forget the unfortunate incident. She ingested the disinfectant cleaner, ‘Izal’ (which today now seems to have been replaced by ‘Sniper’, a powerful disinfectant and all purpose cleaner), and by the time assistance reached her, it was too late. She had successfully killed herself. I’m not quite sure, whether anyone knew the reason why she took such a drastic step and ended her life in her teens. No one was really encouraged to talk about it.
Sniper & Third Mainland Bridge
However, today, in Nigeria, suicide seems to be becoming rather commonplace. These days, Third Mainland Bridge, from where people plunge themselves into the Lagos Lagoon, is apparently the choice location for this dastardly act. There was the case of Dr Allwell Orji, a medical doctor. He had instructed his driver to park the car on the Bridge. He then jumped into the Lagoon. His body was found a few days later. Though the reason for his suicide may be connected with depression, several others, including two ladies who were unsuccessful in their suicide attempts on the Bridge (one of the ladies was 51 years old in 2017 when she made the attempt), were pushed to this point by indebtedness. The two unsuccessful ladies were upset that they were fished out of the Lagoon and were rescued in the nick of time, as they knew that their financial problems would still persist. The 51 year old lady was instructed by the Magistrate whom she appeared before, to submit herself for psychiatric tests.
A couple of weeks ago, purportedly after a heated argument with her fiancée, a young lady jumped off third mainland bridge and successfully committed suicide, while a young mother of two was said to have ingested Sniper and killed herself, as a result of marital problems. It is a known fact that, in Nigeria, many married women are going through hell; they are ill-treated, emotionally abused and disrespected by their husbands, some even beaten to death by abusive husbands. They are however, sometimes encouraged to stay on in horrible marriages by their families members, possibly because the husbands are good financial providers, or by their churches/pastors who tell them that God hates divorce, so, they should endure and keep praying to God for their husbands to change; all this while the women get progressively depressed! Suicide has become so commonplace these days, with the young and not-so-young, that most of us can say that we personally know people who have killed themselves. Why should it be so?
With the youngsters who commit suicide, they may also suffer from mental health issues. But, could it also be the permissiveness of the world today, that people can do pretty much whatever they like to be happy, including take their own lives to be free, that has spurred them on? I do not have an answer. As youngsters, we were taught that suicide was a sin that God would not forgive, and those who killed themselves would surely go to hell. That position doesn’t seem to hold any water today.
Nigerians are Depressed: Some Causes & Statistics
It is obvious that today, the reasons for suicide in Nigeria may not only be love or heartbreak; but, mental illness, drug use, and financial difficulties/crisis – not being able to meet up with one’s basic responsibilities, indebtedness, the prevailing harsh economic conditions that exist in the country. At least three of my friends confessed to me that they contemplated suicide at some point in time of their lives, due to the financial crisis they were facing at the time.
In 2016, the World Happiness Report, showed that Nigeria had dropped drastically from its 78th position to 103 in the world happiness ranking. In 2022, we are now in 118th position out of 146 countries, meaning that as the years have gone by, we have become progressively unhappy. As of 2015, Nigerians were the 2nd happiest people in Africa, by 2017 we had dropped to the 6th position; today, Nigeria does not feature among the first ten happiest countries in Africa!
Section 327 of the Criminal Code Act provides that “Any person who attempts to kill himself is guilty of a misdemeanour, and is liable to imprisonment”. Those who fail in their suicide attempts, may therefore face prosecution, and a 1 year stay in a vile Nigerian prison, if convicted (which will only worsen their mental health, since prison conditions in Nigeria are deplorable, one of the worst in the world). As if imprisonment/punishment is what they need! A person that is desperate enough to attempt to end their lives, obviously needs help, not imprisonment. Personally, I find the provision to be rather ludicrous; it evinces the fact that the Nigerian State itself, does not really understand mental health issues and how to deal with them.
Furthermore, in these parts, talking about mental health issues is almost a taboo, let alone admitting to suffering from depression, schizophrenia or being bipolar; people are ashamed to admit to any form of mental ill-health, unless it’s a headache or migraine! Therefore, many suffer in silence, under so much pressure and go untreated until they explode. We only recognise that all is not well with an individual when things become extreme, when we see them running around the streets in a state of undress, looking rough or talking gibberish.
Some Suicidal Signs
Though suicidal people may keep their intention to themselves, a few of the warning signs may be mood swings, isolation at home and general withdrawal from society, change of habits like eating and sleeping (some may begin to stay up through the night while the world is asleep, thinking all sorts of bad thoughts and giving them the opportunity to fester, with no one around to disabuse their minds), talk of feelings of hopelessness, increase in alcohol consumption or drug taking, saying things like “Gbogbo nkan ma ti su mi” (I am tired of everything), “I wish I was never born”, putting their affairs in order, and contacting people to say goodbye. A person contemplating suicide may also talk about death a lot, about heaven and hell, sound cynical and pessimistic, and give away prized possessions, which under normal circumstances they would not consider parting with.
How to Assist a Suicidal Person
Once you may have recognised suicidal signs in an individual, take them seriously. Be a good listener, especially in order to try to discover as much as possible, what is going on in the mind of such an individual, and what actions they may be planning to take. Let the suicidal party know that you care, and you want to help and support them. Let such a person know that the feelings of hopelessness and committing suicide, can pass, and advice them to seek professional help, even though here in Nigeria there is a paucity of mental health professionals. Try to point out better alternatives to suicide. Unfortunately, Nigeria does not seem to have proper infrastructure set up for psychiatric counselling, though in 2017, Lagos State Government recognising that there is an increase in the rate of suicide, established some help lines, so that people can seek assistance. I do not know whether these lines are still functional, and if they are, how successful they have been in curbing suicide in Lagos.
Conclusion
Can someone in their right mind, just decide that they are tired of life and just decide to end it? Or are such decisions taken as a result of stress, desperation or mental illness, which precludes a person from being rational? I do not have the answers. But, I know that Mental Health Illness like Depression, is simply a sickness of the mind, just as Malaria or Cancer is a sickness of the body. Americans visit their therapists on a regular basis, to talk things through. The sooner Africans stop attaching a stigma to mental health issues, the easier it will be for sufferers to seek proper professional help, instead of living in unending emotional pain which may eventually push them to suicide. This could save many lives. Maybe it is even the fact that most people are ashamed or unwilling to seek professional help, that has discouraged many of our medical practitioners from choosing to specialise in psychiatry and psychology.
Onikepo Braithwaite, Editor, This Day Lawyer
Suicide, Now a National Scourge
Kede Aihie
The number of suicide cases reported in Nigeria are getting a bit high, and therefore, require national attention. The death of a young lady, who tragically jumped into the Lagos lagoon about two weeks ago, should make mental health issues a topic for regular discussion and conversation in Nigeria.
What is driving people to take their lives, especially young people? I am not a psychiatrist or psychologist, so my article is geared towards having a conversation on this issue, which seems to be a taboo subject among Nigerians, indeed, among Africans.
Sweden & Statistics
The cause of suicide vary from one society to another. For example, Sweden has a high suicide rate, studies have shown that “suicide-bereaved individuals may suffer increased risk of suicidal thoughts and behaviors (STBs) due to traumatic grief”.
In Sweden, suicide is one of the most common single causes of death. With a population of 10 million people, approximately 1,500 individuals die by suicide every year (National Centre for Suicide Research and Prevention, 2019). Every death to suicide has a ripple effect, and is estimated to deeply affect at least 6 to 14 relatives and close friends (Clark and Goldney, 2000; Jones and Meier, 2011; Jordan and McIntosh, 2011).
According to World Health Organisation (WHO), suicide is the fourth leading cause of death in people aged 15 to 19 years (male and female). It also stated that, over 700,000 people die due to suicide annually.
Causes of Suicide in Nigeria
The major cause of suicide in Nigeria, seems to be tied to mental health issues and depression. Why will a young man or woman end their lives over issues like rejection, broken hearts, poor academic performance or some unexplained reasons? The challenge here is that not many studies have been done in Nigeria, to give accurate data on the number of deaths. The law is also punitive in Nigeria, people who attempt suicides are criminalised, charged to court for attempted suicide.
In Nigeria, suicide is not a crime (no brainer), but attempted suicide is. Section 327 in the Criminal Code Act (which applies to Southern Nigeria) states that:
“Any person who attempts to kill himself is guilty of a misdemeanour, and is liable to imprisonment for one year.”
Similarly, Section 231 of the Penal Code Act (applicable to Northern Nigeria) asserts that:
“Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with imprisonment for a term which may extend to one year or with fine or with both”. I think these laws should either be removed, or amended to reflect the social impact it has on survivors, who shouldn’t be stigmatised or punished, but require professional help instead.
Suggestions
My suggestion for solutions is that, when in difficulty seek help, talk to a professional, trusted friend or family member or even your clergy. They will, in most cases, show compassion. In my book Rising Above Challenges, I dealt with the issue of Wellbeing (Chapter 8) and shared my conversation with medical doctors on the mental health issues facing the African and Black people in the UK, and by extension Africa/Nigeria. The major take away, is creating awareness
Hopefully, this conversation can be taken forward, as a national discourse.
Kede Aihie, Lawyer, Author, Publisher of The Nigerian Magazine in London
Rising Incidences of Suicide: The Monsters Within
Abdul Ed Malik
In recent times, the plethora of mysterious deaths and suicides has taken a macabre lead in the worry of health and social challenges faced by the nation.
The ascendancy of suicide and suicidal thoughts, as a welcome shortcut to personal problems faced by both young and old people, is cause for studied analysis by psychologists, psychiatrist professionals and even faith-based organisations like Churches, Mosques and community centres.
Causes
Look at even our military personnel, suffering from PTSD. They have seen too much human misery and deaths, that go into their brains. Endless insurgency and military campaigns, without the corresponding needed holidays to break the cycle of violence that they witness daily are some of the things they grapple with.
This unfortunate and worrisome scenario, can be rightly compartmentalised into medical and society. I mean or rather, I’m talking about clinical depression caused by inadequate medical attention and pressures built up by the demands of the society.
Generally, a cursory layman appropriation of the problem would reveal that, with more advance in technology, there’s a concomitant pressure build-up that many people are not able to handle within their limited means of access and mental capacity. It’s a multi-faceted malaise.
Many people are struggling with drug addiction, especially overdoses on common OTC sleeping pills after suffering emotional or marital disappointment. Others are suffering intense financial pressures due to rising costs of daily living, peer pressure and all kinds of disillusionment.
The foregoing scenario is a really gloomy picture, when one looks at the attention and concerted efforts required to reverse or slow down the trend, in the context of the resources that the Government allocates to undertake a comprehensive study and proffer solution, or even provide more safety nets for the vulnerable.
But, from a non-medical point of view, I think society is growing too far apart, due to the influence of social media. You find out that many people have large social media followership, but, in real life, have no real friends. So, everything is just surreal, with no reality of any form.
Let me tell you something, traditionally, there were many avenues for fellowship such as churches, mosques, town’s meetings and events, and just a communal spirit. People looked out for their family members and others. But, do you know that, nowadays, that many do not even know their neighbour has been sick for months until they see the corpse being moved out, that’s when they ask what happened. It’s become a conglomeration of fake life and me, me, me with no care for others.
Suggestion
Not to take much of your time or space, I think or rather, I want to canvass that the religious bodies and faith-based organisations do more outreach programs to discourage the idea of anyone taking his own life, no matter the degree of disappointment or disillusionment. People should be encouraged to build real relationships, check on each other from time to time. Believe it or not, a simple ‘Hi’ or ‘Hey, Buddy I was thinking of you’ is enough sometimes, to change the course of a person’s negative thoughts.
Sometime ago, I read that a Psychiatrist shot himself because of pressure of the job. Think of that. It’s pressure everywhere. It’s time the health professionals and religious bodies, and even lifestyle consultants, enlighten us on more safe means to let off the pressures.
The parents have a lot to do too, by taking time to bond with their children and wards, to understand their crowded vision of life and help them to make good choices. See, there’s blowing up everywhere. May God help us.
Abdul Ed Malik, Abuja
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