As suicide cases spike, how accessible are government and non-profit mental health helplines?

India witnesses almost 14% of the world’s suicide deaths and yet its government-run suicide prevention helpline fails people seeking help. FactChecker called KIRAN, a 24X7 mental health helpline under the Ministry of Social Justice and Empowerment, more than 40 times over five days from seven states and three Union territories.

Guess how many times did we actually get through to a human voice: Thrice.

FactChecker also contacted eight other non-governmental hotlines and all of them answered our calls. Although, they too had a long list of roadblocks they face in helping those experiencing suicidal thoughts. Shortage of funds, lack of volunteers, bad telecommunication network, technical glitches and burnout are some of those many problems.

This is when the rate of suicide in India stood at 12 (per one lakh population) in 2021, highest ever in the last two decades, according to FactChecker’s analysis of Accidental Deaths & Suicides in India 2021 and reports of previous years. Moreover, 21 states crossed this national average of 12.

The suicide rate was declining between 2011 (11.2) and 2017 (9.9). But, in the last five years, the number of deaths by suicide is on a continuous rise. The total number of deaths by suicide shot up by 26.2% — from 1.29 lakh in 2017 to 1.64 lakh in 2021.

With 11.3 suicides for every one lakh population, the year 2020 saw the highest rate of suicide after 2021, indicating that most deaths by suicide were related to COVID-19, doctors told FactChecker.

What is KIRAN’s problem

Over a period of five days, FactChecker called up the KIRAN helpline from Andaman and Nicobar Islands, Sikkim, Chhattisgarh, Puducherry, Kerala, Tamil Nadu, Tripura, Goa, Maharashtra and Delhi. Some of these states have high suicide rates in the country.

While Andaman and Nicobar Islands (39.7), Sikkim (39.2) and Chhattisgarh (31.8) have the highest suicide rates in India, the greatest number of suicide deaths were reported in Maharashtra (22,207), Tamil Nadu (18,925) and Madhya Pradesh (14,965).

The three KIRAN helpline calls that were answered were from Maharashtra, Chhattisgarh and Telangana. The rest either did not connect, were busy, or went unanswered.

Moreover, the KIRAN suicide prevention helpline is a long toll number (1800-599-0019), which makes it highly inconvenient for an emergency call. The call begins to ring only after around 1:48 minutes.

“A short dialling code (3-4 digits) for a national suicide prevention helpline will be easier to disseminate and advertise as people are more likely to remember it in an emergency. It should also be a free call number,” Soumitra Pathare, Director, Mental Health Law and Policy, Indian Law Society, Pune, told FactChecker.

Since the government’s lone suicide helpline could only be reached three of the over 40 times it was called, we asked for a reason for this unavailability from those who picked up.

While the volunteer from Telangana refused to respond to FactChecker’s questions, the volunteers from Maharashtra and Chhattisgarh listed shortage of workforce and technical glitches as reasons for the helpline being unresponsive.

The volunteer from Maharashtra, while requesting anonymity, said that they are just social workers under the Union Ministry of Social Justice and Empowerment, and have to attend calls at odd hours since there are only 10-15 of them for the entire state.

“We are not psychologists, but rehabilitation officers. We are assigned by the government to work as helpline officers as additional duty alongside our regular work. We find it most challenging to attend calls during the night and early morning hours,” said the Maharashtra volunteer.

Similarly, the volunteer from Chhattisgarh, an occupational therapist under the ministry, said they were facing an acute shortage of volunteers. The central state has only four volunteers including a clinical psychologist, said the volunteer.

“I have been answering calls round the clock for the past 15 days. I take calls while travelling and driving. I have also answered calls after midnight because the traffic of calls is high during that time. It’s a 24X7 duty and there’s no fixed time,” said the Chhattisgarh volunteer, while adding that poor network connectivity and lack of a better technical system are major roadblocks. “During some distress calls, clients ask us for medical advice or prescriptions. We are advised to immediately connect the call to a senior medical officer or psychologist. But there is no facility to connect the call further to a professional.”

FactChecker contacted officials from the Ministry of Social Justice and Empowerment to ask them about the roadblocks the helpline was facing, but we had not yet received a response. When we called Rajeev Kumar, Additional PS to the Union Social Justice and Empowerment Minister, another official received our call and asked us to email our queries.

We then tried to contact Anjali Bhawra, Secretary in the Department of Disability under which the scheme is placed, but her office too asked us to write to them. Calls to a few other officials in the ministry went unanswered. If and when Fact Checker receive a response, this story will be updated.

Burnout, poor funding

FactChecker contacted eight non-governmental helplines: Vandrevala Foundation, Samaritans Mumbai, iCALL, AASRA, Sahai, Parivarthan Counselling Training and Research Centre, SNEHA, and Roshni.

Acute shortage of manpower, lack of funding and burnout were the common challenges highlighted by these suicide helplines.

Johnson Thomas, Director of Navi Mumbai-based AASRA, said they had to give up their office owing to financial constraints. “Our main challenge currently is that we do not have an office. We’re around 16 volunteers and we all attend calls from our homes,” he said.

Similarly, Malini Sridhar, Executive Director at Parivarthan, said, “As Parivarthan is not a for-profit centre, one of our major challenges is meeting the expenses of running a helpline, which is a totally free service.”

Sailing in the same boat is Samaritans Mumbai, a suicide prevention helpline, that has seen an attrition rate of nearly 40% in the last two years. The organisation is also finding it increasingly difficult to pay the rent and other expenses of their Mumbai office which costs around Rs 50,000 a month, said Manohar Rangnekar, assistant director of the helpline.

“During the lockdown, our volunteers answered most of the calls from their homes. This was really trying for them because after they attend a call they would have to engage with their family members. When they were at the helpline centre, they were coming purely to take the calls and the stress after a particular call was immediately attended to by other volunteers at the centre,” explained Rangnekar. “Many of our volunteers experience burnout because of the calls’ intensity. After a while, they take a break and finally leave the organisation.”

Another issue that stems from these challenges is helpline timings. Barring AASRA, Vandrevala Foundation and KIRAN, the other six helplines are only available during certain hours of the day.

The organisations running these helplines said the most common reasons for people calling suicide prevention helplines were examination-related stress, romantic relationship and family issues, and debt.

Low budget

The central government allocated Rs 86,200 crore to the Union Ministry of Health and Family Welfare in the 2022-’23 budget. From this, Rs 3,200.65 crore is the budget estimate for health research.Of the remaining Rs 83,000 crore, only 0.8% or Rs 670 crore are funds for direct expenditure on mental health.

A major chunk of this money goes in to two institutions: National Institute of Mental Health and Neuro Sciences, NIMHANS, Bengaluru (84% or Rs 560 crore) and Lokpriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur (10% or Rs 70 crore), according to an analysis by the India Mental Health Observatory and Centre for Mental Health Law and Policy.

“In most countries, about 5%-15% of the health budget is allocated to mental health services. In India, this is approximately 1% per cent. We allocate no specific budget to suicide prevention,” said Dr Pathare.

Just 6% of the total mental health budget or Rs 40 crore goes to the National Mental Health Programme and this amount has remained unchanged since 2021-’22. “The main problem is that our union government budget is too low to support social endeavours. But the government alone can’t do it. It should come forward to help organisations and people who are motivated and committed,” said Vinay Kumar, Vice-President, Indian Psychiatric Society.

Pathare echoed his views and suggested a national fund for such helplines. “Until now, India has largely relied on volunteers and efforts of non-governmental organisations, which are poorly funded. There is a need to properly fund these suicide prevention helplines – we could possibly set up a national fund to fund such helplines in different states in local languages,” he said.

However, the experts also highlighted that just allocation of funds will not work in the absence of an effective and coordinated strategy to utilise these funds.

No national strategy

The World Health Organization recommends four evidence-based suicide prevention strategies to governments – reduce access to lethal means of suicide, improve media reporting of suicides, foster life skill development for adolescents and early identification, treatment and follow up of those exhibiting suicidal behaviours.

Pathare opined that a national suicide prevention policy may be useful in setting a broad policy direction for suicide prevention, and specific strategies must be framed at state level.

“There is an immediate need for a National Suicide Prevention Agency modelled on the lines of National AIDS Control Organization. This agency can not only collect the suicide and attempted suicide data, but also help state governments in designing and implementing suicide prevention strategies that are locally relevant. Most importantly a national agency will be able to bring inter-sectoral coordination between departments like health, education, agriculture, social justice, women and children department,” suggested Pathare.

Some helpline numbers

This article first appeared on FactChecker.in, a fact-checking initiative, scrutinising for veracity and context statements made by individuals and organisations in public life.