Prevention in Psychiatry › Suicide prevention
No single person, programme or medicine prevents suicide on its own. What prevents suicide is a web of protection - families who ask, schools that teach, doctors who follow up, and laws that make the worst moments survivable. You can be part of that web.
About a 15-minute read · Part of the Prevention in Psychiatry series
Start with a story of survival
I want to begin not with statistics, but with someone who lived.
A few years ago, a woman in her thirties - I will call her Meena - was brought to a hospital in Bihar after a suicide attempt. She had been struggling for months: a failing marriage, mounting debt, a sense that her children would be better off without her. She told me later that, in the hours before, she felt completely certain there was no other way.
Today Meena runs a small tailoring business and walks her daughter to school every morning. What changed was not a single moment of rescue. It was a series of ordinary acts: a nurse who sat with her, a family that was told what to watch for, a treatment plan for her depression, a written safety plan she kept in her purse, and phone calls from our team in the weeks after she went home - the weeks when risk is often highest.15
"I still have bad days," she said at her last visit. "But now I know the feeling passes, and I know what to do while I wait."
Meena is a composite drawn from many patients' journeys, shared to illustrate recovery; she is not a real individual. Research shows that stories of people coping with suicidal crises can themselves be protective.20
The scale of the loss - and of the opportunity
Behind every number is a family. Behind many of them is a moment that could have gone differently.
700,000+people die by suicide worldwide every year; it is among the leading causes of death for people aged 15-29.1
1.7 lakhsuicides were recorded in India in 2022 - more than 460 every day.2
2030is the target year of India's first National Suicide Prevention Strategy, which aims to cut suicide deaths by 10%.3
India decriminalised suicide attempts in practice through the Mental Healthcare Act 2017, recognising that a person who attempts suicide needs care, not punishment.4
Five myths that cost lives
Silence around suicide is often built on beliefs that research has disproved. Tap each myth to see the evidence.
Myth:Asking someone about suicide puts the idea in their head.
Fact: Studies consistently show that asking directly does not increase suicidal thoughts, and may reduce distress.9 Asking tells a person that it is safe to talk.
Myth:People who talk about suicide are only seeking attention.
Fact: Many people who die by suicide have spoken about their feelings beforehand. Every such statement deserves to be taken seriously, gently and promptly.
Myth:Once someone is suicidal, they will always be at risk.
Fact: Suicidal crises are often temporary. With support and treatment, most people who survive a crisis do not go on to die by suicide.5,7
Why prevention needs many layers
Safety experts describe a "Swiss cheese" model: every layer of protection has gaps, but when enough layers line up, a crisis is much less likely to pass through all of them. Suicide prevention works the same way - and the major reviews agree that combining approaches works better than relying on any one.6,7,8
The 2021 World Psychiatry blueprint on preventive psychiatry, which I have drawn on throughout this series, makes exactly this point about young people: no single suicide-prevention strategy clearly stands above the others, and combinations of individual- and population-level approaches are recommended.8 The World Health Organization's LIVE LIFE guide names four that every country should prioritise: limiting access to means, responsible media reporting, life skills for adolescents, and early identification with follow-up care.5
Programmes that have saved lives
These are among the best-studied programmes worldwide. I include one that did not work as hoped, because honesty about failures is part of good science.
SRI LANKA · NATIONAL POLICY
Banning highly hazardous pesticides
Step-by-step bans on the most toxic agricultural chemicals were followed by a dramatic fall in suicides, without harming crop yields.17,18
Suicide rates roughly halved over a decade
RURAL ASIA · TRIAL
Lockable storage boxes at home
A large trial tested giving families locked boxes for storing pesticides at home. It did not reduce self-poisoning - suggesting that national regulation achieves what household measures alone cannot.19
No significant effect
EUROPE · 10 COUNTRIES
SEYLE - Youth Aware of Mental Health
Five interactive classroom sessions helped teenagers talk about stress, crisis and emotions.10
About half as many new suicide attempts and severe suicidal thoughts at 12 months
USA · PRIMARY SCHOOLS
The Good Behavior Game
A simple classroom game teaching cooperation and self-control to six-year-olds was linked, years later, with fewer suicidal thoughts and attempts in young adulthood.11
Benefits seen in young adulthood
GERMANY · COMMUNITY
Nuremberg Alliance Against Depression
Training GPs, a public awareness campaign, support for at-risk groups and community gatekeepers, all at once.16
About 24% fewer suicidal acts over two years
USA · EMERGENCY DEPARTMENTS
Safety Planning Intervention
A short, written plan made with the patient, followed by phone check-ins after discharge.12
About 45% fewer suicidal behaviours over six months
SWITZERLAND · AFTER AN ATTEMPT
ASSIP
Three therapy sessions to understand the crisis, plus regular letters over two years.13
Repeat attempts reduced by about 80%
USA · THE ORIGINAL STUDY
Caring letters
People who had declined ongoing treatment received brief, kind letters for five years - simply to show someone cared.14
Fewer suicides in the first two years
GUJARAT, INDIA · ONGOING
SPIRIT
An Indian trial combining school programmes, trained community volunteers and safer storage of pesticides in rural villages.25
Results awaited - a model for states like Bihar
Two medicines deserve mention too. Lithium reduces suicide risk in people with mood disorders,23 and clozapine reduces suicidal behaviour in schizophrenia.24 Treating the underlying illness well is itself suicide prevention. And telephone crisis lines help: in a large US study, callers' distress and hopelessness fell during and after the call.22
The words we print and post
One of the most robust findings in this field concerns the media. When news reports of a celebrity's suicide are sensational or detailed, suicides in the population rise afterwards - by about 13% in one meta-analysis.21 This is known as the Werther effect. But the opposite also happens: stories of people who overcame a suicidal crisis are linked with fewer suicides - the Papageno effect.20
This applies to WhatsApp forwards and Instagram reels as much as to newspapers. Before you share anything about a suicide, ask: does this describe the method? Does it present suicide as a solution? Does it include where to find help? If in doubt, share a story of hope instead.
What you can do: ask, listen, stay, connect
You do not need to be a professional to help. Training ordinary people to recognise and respond to distress improves their confidence and helping behaviour.27
Ask
Choose a private moment. Ask directly and calmly.
"Sometimes when people feel this low, they think about ending their life. Are you having thoughts like that?"
Listen
Do not argue, lecture or rush to solutions. Let them speak.
"Thank you for telling me. That must be so painful."
Stay
If they may be in danger, do not leave them alone. Keep harmful things out of reach.
"I'm going to stay with you. We will get through tonight together."
Connect
Help them reach a doctor, counsellor or helpline - today. Follow up tomorrow.
"Let's call Tele-MANAS together. I'll check on you in the morning."
Your personal safety plan
A safety plan is a short list you write before a crisis, so that you do not have to think clearly during one. It is one of the simplest tools with good evidence behind it.12 Fill it in for yourself, or together with someone you care about, then print it or copy it into your phone. Nothing you type here is saved or sent anywhere.
My safety plan
Keep a copy in your wallet and share it with someone you trust.
Adapted from the Safety Planning Intervention developed by Barbara Stanley and Gregory Brown. A safety plan supports, but does not replace, professional care.
What it would take in Bihar
India's National Suicide Prevention Strategy and the Supreme Court's 2025 student mental-health guidelines give us a framework.3,26 What remains is the everyday work of putting the layers in place. Here is how each of us can contribute.
As families
- Ask directly when someone seems hopeless
- Keep medicines and agricultural chemicals locked away and out of reach
- Never shame a person for a failed exam, debt or relationship
- Stay close after a crisis - the following weeks matter most
As schools and coaching centres
As clinicians
A note to anyone who has lost someone
If you have lost a family member or friend to suicide, I want to say this clearly: it was not your fault. Suicide arises from a complex mix of illness, pain and circumstance, and no single person can carry the responsibility for it. Grief after suicide is often tangled with guilt, anger and silence. You deserve support too, and talking to a professional or a support group can help.
And to anyone reading this in pain
If you have read this far while carrying thoughts of ending your life, thank you for staying with these words. The feeling that nothing will change is a symptom, not a fact - and it often passes, especially with help. Please tell one person today, or call Tele-MANAS on 14416. People like Meena are proof that the darkest night is not the whole story.
Dr. Saurabh Kumar
MD (Psychiatry) AIIMS New Delhi · Associate Professor & HOD, RDJM Medical College · Ex-Assistant Professor, PMCH Patna · Consultant, Healthy Minds Clinic, Patna
Help you can reach right now
Talk to us
Healthy Minds Clinic, House No. 46/B, Sahdeo Mahto Marg, near Sri Krishna Puri Park (Children's Park), Patna 800001. Open Monday, Tuesday, Wednesday, Friday and Sunday, 9 a.m. to 7 p.m. For appointments only - if someone is in immediate danger, call 112 or go to the nearest emergency department.
