PART 2 – Breaking the Silence: We say Suicide is NOT a crime.

This blog has 2 parts. Read Part 1 here. 

“People will find alternate means of suicide if you remove one.”

“We cannot disregard agricultural incomes for suicide prevention”

“What is the economic impact of such suicide prevention policies?”

These phrases are commonplace when discussing pesticide regulation for suicide prevention, as it is not widely known that farm pesticides are responsible for more than 140,000 suicide deaths each year!  Most of these deaths are in low-and middle-income countries (LMICs). Means restriction for suicide prevention, especially banning of lethal pesticides, is one of the most cost-effective interventions for suicide prevention. 

The World Health Organisation (WHO) recommends that effective policy changes such as pesticide bans can positively impact suicide prevention efforts. This blog will discuss commonly asked questions about banning of highly hazardous pesticides (HHPs) to prevent pesticide suicides. 

What is means restriction? Means restriction is limiting access to lethal means of suicide such as putting up barriers near bridges or other high points, guardrails on subway platforms, restricting weapon ownership, or banning drugs and lethal poisons. 

Why are pesticide suicides a matter of concern? Pesticide ingestion using HHPs ranks as one of the top three methods of suicide globally, responsible for nearly 15-20% of all suicide cases. This also disproportionately affects young people, especially women, as self-poisoning is used as a means of suicide by more women as compared to men. 

What are HHPs? According to WHO guidelines, pesticides that cause acute harm to health and the environment due to their extreme toxicity are classified as ‘highly hazardous’. Most international regulatory bodies recommend phasing them out and they are now banned for usage in many countries, especially high income nations. 

How are HHPs related to suicides? Research shows that pesticides are used as a means of self-harm or are an impulsive response to distress. HHPs are frequently employed in small-scale farming as they are relatively inexpensive, easily obtainable from local stores, and commonly stored in households. Nearly 95% of pesticide poisoning deaths have occurred in low and middle income countries (LMICs) which are predominantly agrarian economies. These pesticides are available to everyone in the community, not just agricultural workers, regardless of age or occupation, and this easy access poses a suicide risk in moments of distress or vulnerability. 

How will banning HHPs reduce deaths? Use of less lethal poisons can reduce mortality. This is evidenced by the fact that self-poisoning cases in high income countries lead to fewer deaths simply because such lethal poisons are not freely available. HHP poisoning is difficult to treat which leads to increased mortality, especially in LMICs where treatment facilities are not easily accessible in many areas. In some commonly used HHPs, there’s no effective antidote which is a direct violation of international usage guidelines. 

Won’t people simply replace pesticides with other means of suicide? The WHO reports that many pesticide-related self-harm incidents are impulsive rather than premeditated. If these means were not as readily available, individuals might have to go through additional steps to access them, which could offer them an opportunity to reconsider their decision to harm themselves. This is similar to the phasing out of carbon monoxide ovens in the 1950s-60s led that to suicide deaths in the UK falling by a quarter. 

Have HHP bans been successful anywhere in the world? Yes, in Sri Lanka the suicide rate dropped by 70%, and an estimated 93,000 lives were saved over a decade due to responsible regulation of HHPs! In South Korea, there was a clear decline of 37-48% after the ban of certain HHPs. Similar reductions in suicide rates were observed in Bangladesh, proving that individuals did not replace pesticides with other means. 

What about the effects of such bans on agricultural yield and the economy of LMICs (most of which are primarily agrarian)? There is clear research evidence that shows that HHP bans in countries such as Sri Lanka, Bangladesh, and South Korea did not have any significant impact on yields or agricultural incomes as they can be easily replaced with safer and cleaner alternatives. Moreover, WHO reports that pesticide bans are one of the most cost effective interventions for suicide prevention. 

Industries recommend using locker facilities away from homes to safely store pesticides. Why don’t we promote ‘safe usage?’  Research has found that safe usage and storage techniques tend to be ineffective in the long run as they are expensive to maintain, and bans are the only permanent solution. 

Isn’t pesticide suicide an individual level problem? Why should we go through all this effort to ban highly hazardous pesticides?  Most pesticide poisoning suicides occur in LMICs, especially among rural and marginalised communities that don’t have access to modern means of agriculture, protective gear, and advanced treatment facilities. Usage of these HHPs also have devastating impacts on the environment and they are completely banned in many high income countries. 

Thus, pesticide suicides are not just an individual-level problem, it is a larger human rights and public health challenge as one’s right to safety and a clean environment is disregarded. 

Pesticide regulation seems to be a surface level solution, what about addressing social and cultural issues that affect mental health?  

Means restriction is not a stand-alone solution for preventing suicides. It is a way to prevent the occurrence of impulsive self-harm incidents. Suicide is a wider public health challenge and it is essential to address social, emotional, and/ or cultural determinants of suicide. There is a definite need of investing in reducing stigma and increasing awareness about mental health and wellbeing, along with promoting community mental health outreach programmes and improving mental health services. Further, these efforts need to be complemented by implementing legislation that upholds human rights, safeguards dignity, and saves lives. 

This 2-part blog series tackled two major legislative changes that impact suicide prevention efforts. While legislative changes alone are not the panacea to solving the challenge of suicide, these are a step in the right direction. Decriminalisation of suicide creates an enabling environment for strengthening suicide prevention efforts, while banning HHPs reduces suicide mortality which enables individuals to seek help, leading to fewer fatalities and a decline in suicide rates over time.