Evolving ‘good practice’ for responding to attempted suicide at the hospital

Dilaasa’s experience has demonstrated that women admitted in public hospitals after an attempt to suicide are often facing domestic violence, the underlying reason for the attempt being that they are unable to bear the abuse at home. Based on this experience, Dilaasa evolved a suicide prevention counselling strategy, which is operational in two hospitals in Mumbai, where Dilaasa is located. In order to broad base this model and encourage other hospitals to respond to this issue CEHAT decided to embark upon a consultative process so as to evolve a consensus on a ‘good practice’ for responding to attempted suicide among women facing domestic violence. We began with undertaking an exercise of understanding the suicide prevention models of other big hospitals in Mumbai. Based on the ground work carried out in Mumbai a consultation of renowned psychiatrists and representatives of the civil society across India was called to present these findings and also evolve comprehensive ways of responding to the issue of attempted suicide amongst women living in abusive relationships.

The consultation was held on the 28th April 2012. Several delegates from the discipline of psychiatry agreed to the fact that practices highlighted through our assessment are rampant, but also stated the need for classifying failed suicide attempts. Consultation brought to light that psychiatry education doesn’t have any mention of classifying violence against women, thus psychiatry falls in to using the DSM/ICD classification. The consultation ended on a positive note of developing a gender sensitive methodology for interviewing domestic violence survivors attempting suicide. We aim to put together a set of indicators in the interview guide of the psychiatry departments that would include probes related to history of violence. A draft documentation of the consultation with mental health experts has been prepared. Currently efforts are underway to build alliances with interested hospitals to develop such a model.

Research

Assessment of Practices for Responding to Attempted Suicide among women facing domestic violence

A study was conducted in collaboration with the KEM hospital to understand the psychiatric response at Sion, JJ, KEM and Rajawadi hospitals. This exercise brought to light the fact that “abuse” is not understood as a violation but as “altercations”, differences of opinion amongst the couple, problems in adjusting to new environment after marriage” and the like . Further there was a tendency amongst psychiatrist to assign a label for the failed attempt to suicide as para-suicide due to adjustment disorder, impulsive deliberate self harm and the like. Though patients were sent invariably for mental status examination to the clinical psychologists, the results of the MSE were not always factored in the future plan of recovery of the woman from her situation of distress. Thus the current model was restricted to a more bio medical approach. Based on this study a consultation of renowned psychiatrists and representatives of the civil society across India was called to present these findings and also evolve comprehensive ways of responding to the issue of attempted suicide amongst women living in abusive relationships.