Suicide prevention goes further than just putting up grilles

This past week, the Daily Nation featured a story about the increasing number of suicides at the Kenyatta National Hospital (KNH).

Apparently, patients admitted with medical ailments have been jumping to their deaths from the hospital’s tower. According to doctors at the hospital, many of those killing themselves at the facility have undiagnosed mental illnesses that only come to light after they decide to end their lives.

In an accompanying editorial, the Nation suggested that the solution to this problem was simple – putting up grilles on the higher floors of the hospital complex. The Nation editorial averred: “It does not require a lot of money to put grilles on the windows, deploy adequate security guards and secure corridors especially on the upper floors.”

Clinicians and management at the hospital seem to be in agreement that this would be a solution to the problem of suicides at KNH, and the only hurdle cited is the structural instability that would ensue should such grilles be put up.

As a result, the hospital indicated that they needed money to put up new structures, preferably with wards in lower floors, in order to “prevent suicides” at the facility.

What is the problem with this kind of thinking?

Wider society
The problem is that it focuses on suicide as a problem at the KNH, rather than seeing these hospital suicides as a sign of deeper problems in our society.

Many more Kenyans are attempting and committing suicide daily, and most are not able to reach any health facility, let alone KNH. Unfortunately, all we have to go by are anecdotal reports, since we have not carried out a national survey that would uncover such information. However, it is clear that almost any Kenyan you meet knows of someone close to them who has attempted or committed suicide.

This large number of suicides is indicative of the magnitude of mental ill-health in our country. A majority of people who attempt and commit suicide have at least one mental illness requiring emergency medical attention.

Unfortunately, as cited in the Nation report, mental health services continue to be relegated to the backburner in this country, even within the Health ministry where relatively clueless functionaries made a decision to scrap the Division of Mental Health.

The solution to the problem of suicides in this country lies in a multi-pronged approach that can only be implemented in the context of a well-organised and funded mental health programme. Such a programme would bring in clinicians, public health workers, educators, social scientists and even religious and political leaders to confront the problem on all fronts.

It would include mental health education, highlighting the factors that promote good mental health and those that increase risks of mental ill-health.

A second component would involve actively preventing mental illnesses by targeting risk factors such as unhealthy lifestyles, interpersonal and social conflict, poor pregnancy care, and substance use.

Finally, provision of curative and rehabilitative services would go a long way in reducing the burden of mental illnesses, and this would in turn significantly reduce suicides in the community and in hospitals such as KNH.

Without tackling the systemic weaknesses inherent in our health sector, barring the windows and improving security will only change the mode of suicide, but will not reduce suicides either at the hospital or in the community.

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. [email protected]