[ Dr Leeyir Ete ]

Every year on 10 September, the World Suicide Prevention Day reminds us that suicide is preventable. This year, the World Health Organisation continues its 2024-2026 theme, 'Changing the Narrative on Suicide', with the call to action, 'Start the Conversation'. The need to start these conversations is of special relevance in Arunachal Pradesh, as open conversations around mental health and suicide are still relatively new.

Over the course of my work as a mental health researcher and Research Scientist-II with an Indian Council of Medical Research-supported suicide prevention initiative, I have had the opportunity to interact with over 3,000 stakeholders, including students, teachers and principals across more than 70 educational institutions in the Itanagar Capital Region and Papum Pare district. One common observation across these interactions has been that our conversations around mental health are still at a very early stage.

Mental health awareness remains limited, and many people continue to struggle with emotional distress while feeling uncomfortable speaking openly about it. This may partly be because, for generations, our communities have understood psychological distress through socio-cultural and traditional belief systems, with causes being attributed primarily to physical illness, substance use, or supernatural or spiritual explanations.

These cultural understandings of health undoubtedly offer invaluable insights, but our vocabulary must also expand with time. Suicidal behaviour is complex and can arise through an interaction of psychological, social, economic, health-related, and situational factors. Yet, seeking professional help is still associated with being 'mad', and expressing suicidal thoughts is still seen as a sign that a person is beyond recovery. This has indirectly fuelled existing stigma and made conversations around mental health difficult and uncomfortable.

Awareness without infrastructure is not enough

It is important to acknowledge the encouraging efforts being made through mental health awareness campaigns and outreach programmes. However, greater awareness does not necessarily translate into improved help-seeking or reliable access to care. Even as people gain greater mental health literacy and recognise signs of distress, they may still be unsure of where or how to seek help.

The need to bridge this gap becomes all the more important when we look at the numbers. According to the National Crime Records Bureau, India recorded 1,71,418 deaths by suicide in 2023, with a national suicide rate of 12.3 per lakh population. Arunachal recorded 128 deaths by suicide in the same year, corresponding to a rate of 8.2 per lakh population. These figures, however, reflect only officially reported cases and may tell only part of the story, as incidents of suicide continue to surface regularly in the media.

Beyond awareness, access to professional support remains another significant challenge. The country continues to face a severe shortage of mental health professionals, with fewer than one mental health professional available per lakh population. This shortage has also been recognised in Arunachal, with the head of psychiatry at the TRIHMS highlighting the shortage of psychiatrists in the state during preparations for the second National Mental Health Survey in 2024.

The educational system presents a similar gap, with many institutions in the state lacking dedicated counselling services and trained psychologists, despite increasing policy and regulatory emphasis from the Supreme Court, UGC, and NCERT on strengthening mental health support within educational settings.

So, when someone realises that they need help and is ready to seek it, where do they go?

This highlights why creating awareness without building clear pathways to care remains insufficient and, at times, even meaningless. We can encourage a person to seek help. But suppose a student tells a teacher, "I don't want to live anymore," does that teacher know whom to contact? Is there a counsellor in the institution? Is there a clear referral protocol? Can the student be connected quickly to a psychologist, psychiatrist, or appropriate service? Does the family understand why professional support is necessary? And after the immediate crisis has passed, who follows up? Suicide prevention cannot depend upon individuals improvising these answers during a crisis.

This is not to suggest that mental health resources are absent in Arunachal. The state does have important services and initiatives, including the TRIHMS, the State Mental Hospital in Midpu, Tele-MANAS, the District Mental Health Programme, NGOs, and professionals working across health, education, child protection, substance-use treatment, and community settings.

But the need of the hour is stronger coordination and greater manpower. We need clearly mapped referral pathways at district and state levels, designated points of contact, trained gatekeepers in educational and community settings, accessible counselling services, mechanisms for follow-up, and stronger linkages among the education, health, social welfare, child protection, and community sectors.

Tele-MANAS, India's 24-hour free tele-mental-health service, accessible through 14416, is an important resource, particularly for a geographically dispersed state such as ours. But helplines must form part of a wider continuum of care, particularly when individuals require face-to-face assessment and continued psychological or psychiatric intervention.This is also consistent with India's National Suicide Prevention Strategy, which calls for multi-sectoral action and aims to reduce suicide mortality by 10 percent by 2030. Such efforts should also extend beyond educational institutions to include government departments, workplaces, and larger organisations. But for these measures to make a real difference, awareness must be backed by support that people can actually access.

We cannot tell people to 'speak up', unless we also build places where they can be heard. We cannot repeatedly conduct awareness programmes without simultaneously investing in psychologists, counsellors, psychiatrists, referral mechanisms, and accessible services. And we cannot treat suicide as an isolated tragedy after every death while neglecting the emotional, relational, and social distress that may have existed long before the crisis.

The 2026 World Suicide Prevention Day message asks us to change the narrative and start the conversation. For Arunachal, changing the narrative could mean creating a community where people feel safe to seek help about their struggles, and a system that is ready to support them when they do.

Note: The observations in this article reflect recurring experiences during field interactions and training programmes, and are not presented as findings of a prevalence study. (The contributor is a psychologist and Project Research Scientist-II, ICMR-AITS Project, Rajiv Gandhi University, Rono Hills.)