Mental Health and Suicide Prevention

According to WHO, globally, there are over 700,000 suicide deaths annually which translates to one suicide every 40 seconds. For every suicide, 20 people make a suicide attempt and many more have serious thoughts of suicide. Most suicides occur in low and middle-income countries where there are huge gaps in health systems and resources with limitation in early identification, treatment and support of people in need. Suicide is the fourth leading cause of death among 15–29-year-olds. In low- and middle-income countries the male-to-female suicide ratio is 1.5 men to woman. For each suicide, approximately 135 people suffer intense grief or are otherwise affected, translating to108 million people per year who are profoundly impacted by suicidal behavior.

The prevalence of suicidal behaviors—and of risk and protective factors for suicide—varies across groups and subgroups and changes over time. Suicide prevention efforts should focus on populations disproportionately impacted by suicide in different ways. Some groups may have high or increasing rates of suicidal thoughts and behaviors. Others may experience factors that can increase the risk for suicidal behaviors, such as social isolation and unemployment, or have fewer protective factors in their lives, such as access to effective mental health care. To develop and implement suicide prevention efforts tailored to each group’s unique needs and strengths, program planners must review the data available from existing sources and conduct their own data-gathering efforts, as needed.

Young people in Kenya are experiencing a mental health crisis. Although the mental health needs of children and adolescents were on the rise before 2020, the COVID-19 pandemic accelerated this trend and revealed how different communities experience disparities in stressors, outcomes, as well as in access. Mental illnesses are often associated with suicidal behavior and the prevalence of common mental illnesses in Kenya which include depression and anxiety disorders is about 10.3%. Additionally, 42% of those attending general medical facilities in Kenya have symptoms of severe depression. Suicidal thoughts associated with depression lifetime prevalence is estimated at 7.9%, and for other mental illness is estimated at 5-8%. Statistics from WHO estimates Kenya crude suicide rate at 6.1 per 100,000 population with age standardized suicide rate 11.0 per 100,000 population which translates to about 4 suicide deaths per day.

A recent study in Western Kenya among a sample of 4084 15-19-year-olds, found high prevalence of suicidal ideation among the samples.  Females and sexually active adolescents had higher odds of suicidal ideation and being categorised as moderate/high-risk. Adolescents with higher depression scores had higher odds of reporting ideation. Pregnancy was protective for females while impregnating a partner was a risk factor for males. Abuse from a family member, financial stress and health concerns were the most frequently mentioned precipitants of ideation. However, only abuse increased odds of suicide behaviour. The study recommended effective programmes to identify and support sexually active, pregnant, and distressed adolescents at risk for suicide in Western Kenya.

A population-based study conducted among adults in Kisumu County, located in the country’s high HIV prevalence Nyanza region, found that at one point in their lifetime, 24.1% of participants had thought that life was not worth living, 19.2% had wished they were dead, 7.9% had suicidal thoughts, and 1.9% had made a suicidal attempt. Another recent study in Kisumu County, Kenya among adolescents and young adults aged 15-19 years found that a total of 33 out of 4306 verbal autopsies confirmed suicide as the cause of death. Content analysis of a further 228 deaths originally attributed to accidents identified 39 additional likely suicides. The best estimate of suicide-specific mortality rate was 14.7 per 100,000 population per year (credibility window = 11.3 – 18.0). The most common reported method of death was self-poisoning (54%). From the case-control study interpersonal difficulties and stressful life events were associated with increased odds of suicide in both confirmed suicides and confirmed combined with suspected suicides. Suicide is common in Kisumu, and interventions are needed to address drivers. Any death by suicide is a deeply sad occasion. It is extremely painful for close family members and friends left behind who cannot understand why it happened. Inevitably, their sadness is multiplied as they ask themselves what they could have done to prevent the untimely death.

The Kenya Taskforce on Mental Health 2020, in their report, found that Kenya has a high burden of mental illness measured by numbers of years lost due to ill health, disability and premature mortality with huge gaps in access to care. There were high reported cases of depression, suicide and substance use in various epidemiological studies as well as by the media reporting. The huge treatment gap, stigma and discrimination worsen the burden of mental illness. There are many barriers and challenges which affects reporting of suicide and preventive measures; these include cultural beliefs, the Penal Code which criminalizes suicide and suicidal attempts. The Taskforce on Mental Health in Kenya, in their 2020 report, recommended that mental ill health be declared a National Public Health Emergency.

Kenya’s Ministry of Health’s Suicide Prevention Strategy 2021-2026 overall goal is to attain a 10% reduction in suicide mortality by the year 2026. The National Strategy calls for the creation of supportive environments that promote the general health of Kenyans and reduce the risk for suicidal behaviors and related problems. The National Suicide Prevention Strategy also calls for efforts and strategies aimed at reducing risk and increasing protection among all Kenyans. In particular, suicide prevention efforts must consider factors that influence the health of the population, including economic stability, education, social and community context, health care, and neighborhood and built environments.

Part of the reason why suicide issues have not been addressed in Kenya is because of lack of awareness as to why people actually opt to end their own lives. Adequate information on suicide plays a significant role in preventing suicide and mitigating stigma against affected individuals, families and communities. The National Suicide Prevention Strategy calls for urgent interventions to equip stakeholders with knowledge and skills on responsible case reporting and how to identify persons at risk of suicide, offer brief interventions and refer them for appropriate treatment.

Suicide prevention theory and research have long identified the social context as crucial to protecting individuals and populations from suicide. Theories of suicide suggest that social factors, such as isolation and the feeling of being a burden to others, may increase suicide risk. Opportunities to contribute—through gainful employment that pays a living wage, or by volunteering or mentoring—may help reduce suicide risk by fostering supportive relationships and a sense of meaning and purpose. These theories suggest that young people need to be connected to one another and need to believe that they are making a meaningful contribution to society. Schools, workplaces, places of worship, and many other organizations in the community help provide opportunities for vulnerable and at-risk adolescents and youth to develop these positive connections and be of service in meaningful ways.

Better Futures for Children works with donors, foundations, the private sector, Governments and communities to contribute to suicide prevention by implementing LIVE LIFE – WHO’s approach, at the community level. LIVE LIFE is WHO’s approach to suicide prevention. It details the practical aspects of implementing four evidence-based interventions for preventing suicide, plus six cross-cutting pillars which are fundamental for implementation. The WHO strongly community stakeholders with a vested interest or who may already be engaged in implementing suicide prevention activities to support the implementation of the LIVE LIFE. Better Futures for Children is  the first community based organization in Kisumu  committed to LIVE LIFE.

Better Futures for Children is committed to preventing suicide and suicidal ideations among adolescents and youth in Kisumu.  To better understand the drivers and facilitators of suicidal ideas, we participatorily undertake targeted research particularly with adolescents and youth with lived experience—and organizations already working with this population, not only as key informants but also as leaders, experts, and partners. This approach helps us ensure that suicide prevention efforts are grounded in a thorough understanding of the relevant risk and protective factors, consider local strengths and assets, and are tailored to address the unique factors that may contribute to suicide prevention in the most effective and sustainable ways.  We believe that suicide prevention among vulnerable and at-risk adolescents and youth must go beyond identifying and addressing risk factors to charting a course toward building a purposeful, engaged life.  While Better Futures for Children needs to continue to increase understanding of why some adolescents and youth experience suicidal thoughts and behaviors, we also need to better understand the factors that help vulnerable young people overcome a crisis and recover, including key supports and reasons for living.

Better Futures for Children’s strategy is a broad-based public health response to suicide that engages all societal sectors—including government, health care systems and providers, businesses, educational institutions, community-based organizations, family members, and friends— in suicide prevention. We infuse suicide prevention into schools, workplaces, faith-based organizations, corrections, and other diverse settings and systems.  We strongly believe that integrating suicide prevention into the work of all sectors will help create a network of community-wide supports to reduce risk, enhance protection, and support the implementation of culturally appropriate suicide prevention efforts that are tailored to young peoples’ unique needs and strengths.

Better Futures for Children’s Social and Behavior Change Communication (SBCC) efforts help activate a broad-based response to suicide by changing young people’s knowledge, attitudes, and behaviors to support prevention. Our SBCC efforts increase help-seeking by publicizing available care and supports for adolescents and youth at suicide risk; help teach and mobilize families, friends, communities, and others how best to support young people who are struggling; and strengthen suicide prevention efforts by educating decision-makers about effective policy and systems change for prevention. Our SBCC efforts are research based and reflect safe messaging recommendations specific to suicide.  Suicide prevention communications are tied to Kenya’s Ministry of Health Suicide Prevention Strategy 2021-2026 and connects to other programmatic efforts, such as girls’ education programs, menstrual health and hygiene, financial literacy and education, climate literacy and education, etc. Credible and culturally appropriate messages are developed and conveyed through multi method channels most likely to reach and be trusted by the intended audience. Our SBBC tea engages with vulnerable and at-risk adolescents and youth   to co-design suicide prevention efforts from the beginning, thereby informing choice of language, channels, and platforms—and helping to ensure that the call to action is accessible and realistic for them.

 In addition, Better Futures for Children identifies strategic ways to strengthen the protective factors among vulnerable and at-risk adolescents and youth in Kisumu that promote strength and resilience (the ability to endure, respond to, and recover from stress and adversity), thereby reducing suicide risk. Research suggests that efforts aimed at increasing protective factors can have long-lasting effects.  School and community-based suicide prevention programs that build life skills and resilience have also been found to have long-term positive effects in supporting various health outcomes. In addition, family-based prevention programs, conducted with diverse groups, have been found to have long-term effects on decreasing suicide risk and providing other related benefits (e.g., prevention of mental health problems). We utilize insights from such research build life skills and resilience for adolescents and youth in Kisumu.