Suicide prevention among adolescents: Why educational institutions must take the lead
In February 2022, a 15-year-old student at a school in Haryana died by suicide. The student’s mother mentioned in police reports and in conversation with the media that he was being bullied at the school over his sexuality. Police reports also mentioned the boy was sexually harassed within the school premises, which prompted his mother to complain to the school authorities, initially in March 2021, and later in September 2021. The school authorities did not provide any support to the student and took only preliminary action against those involved in the bullying, with some of the students named in the complaint being removed from the school and other students denying their involvement with no evidence to be found. The school further threatened the boy that he would not be promoted to the next year by claiming that “he was taking advantage of having dyslexia.” Arguably, the school and its lack of support only led to more distress to the student.
While such discrimination and bullying may be first experienced in a school setting, such instances often follow individuals into higher education settings. A recent example of this is of an 18-year-old student at IIT-Bombay, who died by suicide within three months of moving to campus. Belonging to a marginalised community, his death has raised concerns of caste discrimination within India’s elite institutions. Investigations are presently ongoing, though IIT Bombay has issued a public statement denying that the cause of death was caste discrimination.
Both these incidents are deeply distressing and highlight how educational institutions can be oppressive, both by the nature of the institution themselves and the sentiments and actions of the communities within them. These incidents reflect the rising number of deaths by suicide amongst adolescents and young adults in India that occur everyday, where only a few are deemed newsworthy.
Research indicates suicide is the leading cause of death amongst 15–18-year-olds. According to the National Crime Records Bureau (NCRB), while the total number of deaths by suicide showed a 10% increase from the year 2019 to 2020, the number of deaths by suicide of children below 18 years of age increased by 18.5%, almost twice the national average. In 2021 there were 10,730 deaths by suicide of children below 18 years of age, a small decrease from the 11,396 deaths by suicide in the year 2020. While these numbers are staggering, it is important to keep in mind that the NCRB is widely known to underreport the number of suicides. The rate of suicide in India is likely worse than indicated by the NCRB data.
What are the stressors faced during adolescence?
Adolescence is a phase of change. This time is marked by physical, psychological, and interpersonal changes, as adolescents navigate through several challenges including forming an identity and working towards emotional regulation. Seeking guidance in challenging situations can be difficult for adolescents, and as a way to cope with challenges, some may turn to self-harm.
While NCRB records “family problems”, “love affairs” and “illness” as the main reasons for deaths by suicide in children, it is important for us to draw upon specific stressors that adolescents face in their educational institutions. Risk factors or stressors are aspects or situations in an adolescent’s life and their environment, which can cause distress and lead to thoughts or feelings of suicide. A common misconception held by people is that suicide is due to one specific reason. However, research shows that it is a combination of several stressors in a vulnerable individual that leads to suicidal ideation or death by suicide. The above incidents highlight how several stressors such as bullying or harassment due to social, cultural or sexual identity and a learning disability, coupled with a lack of support from the educational institutes could have led to extreme distress.
Adolescents spend much of their time in an educational institution, interacting with teachers, and school authorities daily. As they go through adolescence, they face several stressors in both their home environment as well as in educational institutes. A few stressors, unveiled through focus group discussions held with students in Chhattisgarh, are highlighted below:
Discussing career aspirations, one student mentioned, “Had a passion for cricket. When I got older, told my mother I wanted to enrol at a cricket club. She told me I cannot play and that I shouldn’t do something in which there is no career. Now I am doing B. Com.”
Another student mentioned how relationships can also affect adolescents, “Recently heard that a 9th standard student died by suicide after a break-up with his girlfriend.”
When discussing pressures related to education, a student expressed, “Online classes were not effective, (there was) uncertainty with exams.”
And finally, in the context of an individual’s social surroundings, a student indicated the significance of identity factors, “Caste-based discrimination can lead to bullying, harassment, ragging in school. Teachers can also ridicule, punish or lower the student's confidence and self-esteem through casteist behaviour.”
In an educational institute, each of these risk factors can play out differently.
• Individual risk factors include inability to follow their dreams due to parental pressure, academic performance/exam stress, failure in exams, learning disabilities (such as dyslexia or ADHD).
• Relationship risk factors can include relationship issues, bullying by classmates, a strained relationship with teachers, humiliation or insult by classmates or teachers.
• Community risk factors include discrimination in a school setting based on one’s caste, socio-economic status, gender, religion, sexuality, or disability.
• Societal risk factors include lack of opportunities for education, COVID-19 pandemic and its effects, lack of technological devices/access to the internet leading to inability to attend schools.
What measures can be adopted to protect students?
As we outline risk factors, it is necessary to highlight the protective role educational institutes can play in preventing adolescent suicides. Protective factors are factors that help in reducing the risk or preventing adolescent suicides. Similar to risk factors, protective factors are broadly classified as individual, relationship, community, and societal. In an educational institute, individual protective factors include problem-solving skills, an ability to cope with distressing feelings, and experiences of success. Relationship protective factors include social support, and acceptance from friends and peers. Community protective factors include anti-bullying/anti-discriminatory policies at school, and support from teachers and school authorities. Societal protective factors include educational opportunities and financial aid.
Knowing the various risk and protective factors leads us to one question - what is the role of a school/teacher in preventing adolescent suicides? Schools play a role in ensuring the students are provided with an open, safe, and inclusive environment. The Suicide Prevention Resource Centre, USA highlights that schools can help the adolescent suicide prevention movement comprehensively by promoting and enhancing students’ wellbeing, identifying students at risk of suicide, and providing support. Apart from prevention, it is necessary that schools are prepared with effective postvention strategies as an adolescent suicide can lead to suicide contagion and affect other students as well as the wider community.
As teachers have direct contact with students, and are respected community members, they are in a position to understand their students and context. Teachers are able to build a trusting relationship, boost students’ motivation, lead by example, communicate with students beyond academics and provide them with emotional support. At the same time, teachers can act as gatekeepers and be trained to identify and assess risk of suicide amongst students, and provide a referral to mental health professionals, as well as follow up with the adolescent’s family. They also can inform and advocate for schoolwide policies that affect student wellbeing, raise awareness on mental health and suicide and psychoeducate parents, students, and other members of the community.
Keeping the key role teachers play in mind, the Centre for Mental Health Law & Policy, ILS is currently co-designing, implementing & evaluating an e-learning gatekeeper training course for public school teachers of secondary & higher secondary schools across three rural districts of Chhattisgarh as part of Project ENGAGE (Enabling School Teachers as Gatekeepers for Preventing Adolescent Suicides in Chhattisgarh).
To aid suicide prevention efforts for adolescents, schools can adopt the following actions:
- Ensure the school has a suicide prevention strategy in place, as well as a protocol for an immediate response to a suicide attempt.
- Train teachers to be gatekeepers to identify, provide support, refer and follow-up with at-risk adolescents with the help of school counsellors or school psychologists
- Have a comprehensive approach to suicide prevention with anti-bullying and anti-discriminatory policies, workshops for parents, school staff, and students on mental health awareness building, addressing risk factors through policy changes, or life skill training for students
As best-case practices, schools can consider introducing structural changes such as offering supplementary exams to reduce the risk of suicides associated with fear of examination failure. In India, to reduce deaths by suicide, the state of Tamil Nadu offered students supplementary examinations, which allowed students who failed an exam to re-sit it within the same month as the declaration of results. Evidence suggests that this single change led to a nearly 50% reduction in the number of deaths by suicides in more than a decade. Other successful practices include the Youth Aware of Mental Health or YAM program, which promotes positive mental health practices amongst adolescents aged 13 to 17, who learn and engage with the topic of mental health through roleplays and discussions. While we list best-case practices and policies which can be adopted by schools and how they can engage with the suicide prevention movement, it is important for us to note that these practices are adaptable to higher educational institutes such as colleges and universities.
While community and family systems are an important source of support, educational institutes and teachers play a critical role in creating awareness, reducing stigma and providing emotional support to adolescents through policy changes and teacher training. The role of a teacher also helps in bridging the gap between mental health problems and formal healthcare services, especially in low-resource settings like India. As a young country, with over 31% of the population being under the age of 18, it is imperative that India seeks to address this looming threat on our young people.
Swetha Ranganathan is a Research Associate; and Soumitra Pathare is a Consultant Psychiatrist and Director; at the Centre for Mental Health Law & Policy, Indian Law Society, Pune
Discussing suicides can be triggering for some. However, suicides are preventable. In case you feel distressed by the content or know someone in distress, call Sneha Foundation - 04424640050 (available 24x7) or iCall, the Tata Institute of Social Sciences' helpline - 02225521111, which is available Monday to Saturday from 8 am to 10 pm