TW: Mention of suicide

“I am sick and tired” were the final words of Anil Mehta to his daughters, Bollywood actors Malaika Arora and Amrita Arora, before his death by alleged suicide. Reports say that he switched off his mobile phone after the call and was found dead below his building. Deputy Commissioner of Police, Mumbai, Raj Tilak Roshan told media that prima facie, it was death by suicide, and further investigation is underway. The alleged suicide of the 72-year-old has brought to the fore the state of geriatric mental healthcare, especially as India’s elderly population is expanding at an unprecedented rate and is expected to surpass the population of children by 2050.

Data available from the National Crime Records Bureau (NCRB) show that of the 1,70,924 cases of suicide reported in 2022, those aged above 60 made up 15,339.

The issue becomes alarming when the data of NCRB is juxtaposed with that of the data projected by the India Ageing Report 2023. The report prepared by the International Institute for Population Sciences and United Nations Population Fund (UNPF) states that India’s population above 60 years is set to double from 10.5% in 2022 to 20.8% in 2050. This means that by 2050, one in five persons in India will be a senior citizen, that is, aged above 60. 

Further, a report by the Longitudinal Ageing Study of India (LASI) states that nearly 30% of elderly persons have depressive symptoms.

Identification of problem precedes seeking help

Dr Steve Paul Manjaly, consultant geriatrician at Apollo Hospital, Bengaluru, says that identification of a mental health problem in elderly persons is the crucial step in getting them the help they need. “Only when identification happens can we ask for help. Especially in a country like India, we need to know how and whom to approach for help. First, we need to make sure that family caregivers of elderly persons have the necessary tools to identify a problem,” he says.

Further, he suggests that social workers can also be involved in identifying elderly persons in need of mental health care. “We need to help the family caregivers to realise the problem. Then there is the question of whom to approach. There is stigma surrounding visits to the psychiatry department itself,” he says. This is where psychiatry social workers can step in, to talk to family members and assess the extent of help required. “It is more [socially] acceptable to talk to a social worker than a psychiatrist. But once they realise the need for [professional] help and learn who can help them, social workers can convince the [families to avail help],” he says.

He continues, “If they need only counselling, they can be referred to psychologists or counsellors. If not, they can be taken to a psychiatrist. By then, both the patient and their caretakers would be open to discussing their problems with someone else. This makes the process easy and reduces the stigma.”

Causes of suicide among elderly persons

According to the NCRB data, the top reason for suicides among the elderly is illness (6,402), which has been further divided into five subcategories. The second biggest reason cited is family problems (3,951). 

Steve adds that elderly abuse is as much a cause for concern as financial issues and family problems when it comes to the mental and physical health of the elderly. According to HelpAge India, which is a non-profit organisation that works for ‘the cause and care of disadvantaged older persons to improve their quality of life’, 25% of elders face abuse, especially from their own kin. Disrespect (45.6%) and beating/slapping (23.1%) were the main forms of abuse.

Dr Steve points out that another major concern is that of physical health. “Elders worry about becoming a burden to their families in their old age. They often refuse to take medicines in an attempt to fall sick and die soon. Being a burden, both in terms of health care and financially pushes them into an abyss where they often think the unthinkable. Partition related disputes and discord with sons and daughters can be avoided to a large extent if a will execution is planned well earlier.

Dr Aravinda GM, an Internal Medicine consultant in Manipal hospital, says that migration of their young caretakers also affects elderly people in the family. “The family might have the resources to arrange external caretakers, but there are also instances where the elderly persons will have to visit hospitals. Not having a family member at such times might impact their mental health.” 

While experts say that the outmigration of children might cause loneliness and mental health issues among the elderly, there must be systemic changes to handle their issues, including a safe community and accessible healthcare. A study points out that financial assistance from children who have migrated has helped parents engage better in social activities.

Aravinda suggests that in residential areas and complexes, volunteers who are aware of mental health related issues and the symptoms should be made available, so that those in need can get timely help. The volunteers can, if needed, refer them to a counsellor or psychiatrist. 

Symptoms to look out for

Experts say that symptoms of depression and stress among the elderly, as in any other age group, are the same. This includes insomnia, loss of interest in activities, and loss of appetite. Apart from this, writing a will, giving away prized possessions, skipping medicines, and being preoccupied with the idea of death are some other signs to look out for. Doctors also suggest that having a direct conversation with the person and asking them what support they need might be a timely intervention.

If you are aware of anyone facing mental health issues or feeling suicidal, please provide help. Here are some helpline numbers of suicide-prevention organisations that can offer emotional support to individuals and families.

Kerala

Maithri: 0484 2540530

Chaithram: 0484 2361161

Both are 24-hour helpline numbers.

Tamil Nadu

State health department's suicide helpline: 104

Sneha Suicide Prevention Centre - 044-24640050 (listed as the sole suicide prevention helpline in Tamil Nadu)

Andhra Pradesh

Life Suicide Prevention: 78930 78930

Roshni: 9166202000, 9127848584

Karnataka

Sahai (24-hour): 080 65000111, 080 65000222

Telangana

State government's suicide prevention (tollfree): 104

Roshni: 040 66202000, 6620200

SEVA: 09441778290, 040 27504682 (between 9 am and 7 pm

Aasara offers support to individuals and families during an emotional crisis, for those dealing with mental health issues and suicidal ideation, and to those undergoing trauma after the suicide of a loved one.    

24x7 Helpline: 9820466726 

Click here for working helplines across India.