When we hear of a suicide, we are quick to attribute it to a single factor: the person committed suicide because of a failed relationship, because they had huge financial problems, or because they were not promoted at work.
The truth is that suicide is a complex phenomenon that is based on several factors. A person may contemplate suicide because of several challenging situations that they may be facing: stress at work, lack of job satisfaction, problems with relationships or family, self-image issues, financial loss, anxiety, depression, or other mental health issues. The combined stress of these challenges could make the person consider suicide.
Suicides are usually a hidden problem, as employees rarely want to speak about it. There are several fears that keep people from reaching out for help: “What if my boss finds out?”, “Will I lose my promotion and bonus?”, “How will my colleagues and employer treat me once they find out?”, “Will I lose my job?”
Due to these fears, an employee may not share their thoughts of suicide. Lack of knowledge about the services offered may also decrease the person’s trust, and make it less likely that they will reach out for help; in several organizations, employees with mental health issues are asked to take leave (sometimes unpaid) and referred to a hospital where they may or may not receive the support they need.
But we don’t have a problem!
Most organisations dismiss the idea of a structured suicide prevention programme due to the belief that there has been just that one suicide. There are several myths and beliefs: “It’s just one person who committed suicide,” or “the suicide may not even have been work-related,” or “I know my employees can handle this.”
Even one suicide, when it occurs, can have long-term effects, harming not only the person who committed suicide, but other employees and the organisation too. Colleagues and fellow employees may think that the suicide was due to work-related causes; they may assume that the same factors will affect them in the future. This may create a general mistrust in the management or the system.
One suicide is usually just the tip of the iceberg. There are possibly several other employees who are contemplating suicide, due to factors that may or may not be related to the workplace. These vulnerable employees may see suicide as an easy way out of their difficult situation.
Employees may develop a negative image of the organisation and leave. This leads to a loss of manpower, productivity, earnings and goodwill.
The tip of the iceberg
The number of suicides that have occurred in a certain setting – even if there has been just one suicide over several years – is always the tip of the iceberg.
Experts use the idea of a spectrum to explain how suicide occurs. “Suicide is always a spectrum, and what we see as an attempted or completed suicide is at the end. For every person who commits suicide, there are at least 10 to 20 who have attempted suicide, hundreds who are thinking of suicide, and many more who are at risk,” says Dr Gururaj Gopalakrishna, Professor and Head, Department of Epidemiology, NIMHANS.
An employee has just been promoted to a job that he’s not trained for, and is not able to deliver. He experiences enormous stress, and finds outlets in drinking and smoking, and spends most of his money on cigarettes and alcohol. This leads to him developing a gambling habit – which puts him deeper into debt.
He is unable to support his family. The family is unhappy; he fights with his wife regularly. He drinks more and becomes depressed. He feels lonely, loses interest in all activities, and wonders whether life is worth living. This thought process becomes more repetitive and intense. At this point, he moves beyond thinking about suicide to actually planning it.
(This fictional narrative has been constructed to aid the understanding of this phenomenon by placing it in a real life situation.)
Suicides are caused by several social, cultural, biological, work-related and system-related factors, all of which affect each other and can have a cumulative effect. These factors can accumulate over a period of time and cause great distress, making a person consider ending their life.
Why is it important to have a suicide prevention program?
Mental health and suicide prevention programs are essential in any workplace in order to accomplish the following:
- Improving employee health and wellness
- Identify those at risk of developing a mental health disorder (and offer support to them)
- Identify those who are in critical situations (i.e. employees who have attempted suicide, or are contemplating it), offer them timely support and follow-up services.
- Improve the quality of life for those who are affected by mental health issues or suicidal thoughts, and support them in returning to productivity.
From the employer’s point of view, having a proactive suicide prevention programme ensures that the employees are mentally healthy. If an employee has suicidal thoughts, they can receive support, which helps them cope better with work, and improves their level of productivity.
An outreach programme gives the employees a sense of being taken care of, and improves their comfort level. Overall, the organisation benefits by having a more mentally healthy and productive workforce.
For the employee, the existence of a mental health and suicide prevention programme tells them that the organisation is interested in their health and welfare; this can increase their confidence in the management. The employee also benefits from the opportunity to discuss their challenges with a dedicated team of experts – they can receive help for themselves, or seek it on behalf of their colleagues or family.
This access is a crucial element in the prevention of suicide. A person who has access to help and is able to tackle their problems with professional support is likely to come out of the suicidal ideation phase.
A suicide prevention programme is also a form of long-term care and support, and can help employees contribute optimally to the organization.
In short, having an effective mental health and suicide prevention program benefits both the employer as well as the employee.
Setting up a system
“When we say just one suicide, we are focusing only on the tip of the iceberg. Any such incident has to be taken seriously. Some organisations function in a reactive way, by trying to control damage when an employee commits suicide. Ideally, an organization has to take a proactive role in ensuring that no crisis reaches the stage of desperation,” says Dr Gururaj Gopalakrishna.
There are two ways in which an organization can take a proactive approach to preventing employee suicide:
- By having an overall mental health program that addresses common mental health disorders such as depression, anxiety and substance use.
- By having a suicide prevention program independent or as part of the workplace program on mental health.
There is a need to recognise suicide prevention and mental health as a part of the larger employee wellness programme. At the same time, it is also essential to recognise suicide as an issue, assess its impact on an organisation, and create a structured plan to deal with it.
Any suicide prevention plan requires that the organization make sure that the services are available to all employees who may need them, and that there is support from the management for employees who wish to seek help. Due to the sensitivity and complexity of the issues, the programme needs to be well-structured and thought out. The employers and the employees need to recognise each other’s needs and be supportive of the offer to help.
This series has been curated by White Swan Foundation with inputs from Dr Gururaj Gopalakrishna, head of the department (epidemiology), NIMHANS; Dr Prabha Chandra, professor of psychiatry, NIMHANS; Dr Seema Mehrotra, additional professor of clinical psychology, NIMHANS; Dr Poornima Bhola, associate professor, department of clinical psychology, NIMHANS; and Dr Senthil Kumar Reddi, associate professor of psychiatry, NIMHANS.
(This article first appeared on White Swan Foundation. You can read more on workplace mental health here.)