Gatekeepers: The volunteers who work day and night to save Kenyans from suicide

In 2010, 75 Kenyans took their own lives, and the numbers have been going up, peaking at 421 deaths by suicide in 2017. The deaths are mainly a result of mental illnesses, but Kenya still does not have an active suicide prevention plan to stem the tide. Volunteers are doing their best to keep Kenyans away from suicide. Their rallying call is that everyone should join hands to save the people who are most at risk.

Hiram Chomba starts his day answering distress calls from people from every corner of Kenya, who are on the verge of giving up their lives.

In their darkest hour, many of them type “I want to die” or “I want to kill myself” in a search engine, and the first thing that pops up is the Befrienders Kenya website, where Hiram works.

The message is simple: Feeling suicidal? You don’t have to make a decision today. You don’t have to act on your thoughts right now. And then a lifeline – a phone number to call.

“Wanting to die is the last reason why people end their lives. A person with thoughts of suicide is in great distress and they don’t have a mechanism to cope or deal with it. They have run out solutions and the only thing they can think of is that ending their life will bring an end to the pain,” Hiram, the lead counsellor at Befriender’s Kenya, explains.

On the other end, the caller talks to Hiram, or one of the other counsellors, all volunteers whose aim is to relieve the mental suffering of Kenyans at no cost to the caller. The last time Hiram received such a call was yesterday, one of 30 or more calls that come through from Kenyans who are contemplating suicide every week.

CALL FOR HELP

“I was searching for ways to die when I saw your website. I feel empty,” the caller says, amid sobs.

“Would you like to share? How long have you been feeling this way? Are you thinking of killing yourself?” Hiram prods gently. The goal is to find out the severity of the threat and whether the person has an immediate plan to kill themselves.

“I’m staring at a knife as we speak,” the caller answers.

This is a clear and imminent threat that has to be acted on immediately, or the caller will be one of the tens of Kenyans who end their lives every year. In August alone, police reported that 80 people died by suicide and last year 421 deaths by suicide were reported. Suicide numbers have been going up over the years, from a low of 75 deaths in 2010.

Yesterday, Kenya marked World Suicide Prevention Day along with other countries, to create awareness that such deaths can be prevented.

To do this, Hiram says that the first thing when handling a person with an imminent threat of suicide is to ask them if there are people they trust close to them they can talk to. The goal is to get them help and out of harm’s way, and to get them to a health facility as soon as possible.

If there is no imminent harm, the person can be screened for depression, which is one of the major contributors to suicide, and if the person is diagnosed with depression or any other mental illness, they can be put on treatment. 

“However, suicide is not always a result of mental illness. People who have difficulties with basic living standards can be suicidal, even though they may not be depressed,” explains Hiram.

“It doesn’t help that when one attempts suicide, they are seen as an outcast or a sinner or even a criminal. These ideologies and the stigma attached to suicide do not help reduce the number of cases,” he adds, noting that such notions only exacerbate the situation, because the underlying problems are not resolved, and therefore, the person is likely to attempt suicide again.

AWARENESS

To challenge these views, Hiram engages religious leaders and police officers, who often come face-to-face with people who have attempted suicide. Many are the times he has gone to police stations to create awareness on suicide prevention, and the newly enlightened officers hand him a “suspect” who was to be charged with attempted suicide, with a new understanding that the solution for the problem is mental health services rather than a jail term.

“We need to address the law that says suicide is an offence so that the affected can get interventions instead of being charged in court. Taking someone to court or jailing them aggravates the likelihood that they will attempt suicide again,” he says. “Instead of being in a police cell, the person needs to receive treatment and medication and to see a therapist.”

The situation is no better in churches, where members who attempt suicide are denied privileges that are accorded to other members of the congregation. Those who complete suicide are not buried by a pastor and no cross is put on their grave.

“This is open discrimination, and it doesn’t help anyone. In any case, the bereaved family is affected and denied the support they need to cope with the death. If you won’t bury a person who succumbed to suicide, you shouldn’t bury a person who succumbed to malaria. We have to take mental illness as seriously as physical illness,” says Hiram, who has made inroads with some churches in Kikuyu, and recruited pastors as gatekeepers to identify members of their congregation who might be at risk of attempting suicide, and refer them to professional counsellors or mental health units. 

A gatekeeper is a person in the community who comes into contact with many people as part of their daily routine and therefore can be recruited as a first point of contact for people who need mental health services. The gatekeepers are trained to identify people in their communities at risk of suicide and refer them for treatment or other appropriate support services.

GATEKEEPERS

Rosemary Nyambura is one such person. Known as Nyambura Msafiri, in Kikuyu Sub-county, she is a politician, community leader and mobiliser, mother, grandmother and most importantly, a gatekeeper.

“People are suffering,” Nyambura says pensively, when we meet in Kikuyu Town in Kiambu County.

She has been at that place when she felt it might be best to end it all, lost close friends to suicide and listened to people in distress.

Her lowest moment, the one that drove her to the edge, was when her property was auctioned due to financial difficulties, something she says, put her under a lot of stress.

To get through the ordeal, she started Extra Mile, a group for women who were struggling with stress.

It attracted 100 members, and exposed her to people who were considering taking their lives to end the pain of marital problems or the distress of financial difficulties.

They sought solace in the fact that women talk things out to release mental burdens, which offers them some protection from attempting suicide. Men, on the other hand, are more likely to isolate themselves, suffer alone, and use lethal methods to end their lives. This contributes to higher number of suicides in men than women.

In 2016, Nyambura joined the Kikuyu Mutuini Suicide Prevention group (KIMWA), which thrust her right in the middle of suicide prevention. Through activities to create awareness, people came to know her and the other KIMWA members as people they could turn to when they were feeling overwhelmed.

“Suicide can affect anybody, not just those who are struggling financially,” she says, starting a conversation on the death of a close friend last year.

Nyambura’s friend had dinner at home and retired to bed. No one, not even her only child, a daughter, knew that it was the last time she would be seen alive. No one knew about the pills she would gulp down in the middle of the night. Her daughter found her in the morning. Lifeless. “My God! It was devastating!” she exclaims, a pained look on her face.

“She was a single mother like me, so we had similar struggles, but she had a stable job, while I was dabbling in politics (she was vying for party nomination to be a Member of the County Assembly).”

PSYCHOLOGICAL FIRST AID

Such deaths are often devastating for the community and gatekeepers like Nyambura strive to prevent them as much as they can. Having a reliable person in the community whom people can talk to goes a long way.

But Nyambura says more needs to be done and that the government needs to be more aggressive in promoting mental health and active suicide prevention in schools, colleges, churches and community groups.

Hiram concurs, saying that health workers, who are the first point of contact for most patients, should be trained on screening people who might be at risk of suicide, trained on how to offer psychological first aid, and then refer the patients to a specialist or other facility is necessary.

He adds that we need to get to a point where everyone acts as a gatekeeper in line with this year’s theme “Working together to prevent suicide”. To prevent suicide one has to note the risk factors and tell-tale signs. After identifying a person who might be suicidal, engage them because giving them an opportunity to talk out their feelings helps to unburden them. Say something like: I have noticed you have isolated yourself or you have a depressed mood or you stopped going to the gym.

If someone has mentioned suicide, ask them directly if they are thinking of killing themselves, find out if they have an actual or imminent plan and means to kill themselves and get them help by taking them to see a therapist.

“Keep checking on them to find out how they are faring and show that you care. What they need is a trusting, non-judgmental atmosphere and intervention to save their lives,” says Hiram, adding that though many people see suicide threats as manipulative, or attention-seeking or a joke, it is a cry for help that must be taken seriously and the problem addressed.

MEDICAL HELP

If a person attempts suicide, the first stop should be a hospital, where they can get the intervention they need. According to Peter Owuor, a clinical psychologist who is in charge of Dove International Treatment Centre in Kikuyu, the first step is usually to put the person on medication and sedate them to neutralise the irrational feelings and bring down the intense feeling of overwhelm.

“When they wake up, they are not as overwhelmed and the feelings have subsided, but they still cry a lot. Some of the patients will have gone without food before attempting suicide, so they need to be fed. Once they are stable, they continue to be monitored because they might still want to die, and if we are not careful we can lose them. They also receive psychiatric care and get psychotherapy to help them deal with the underlying issues,” says Mr Owuor.

Preventing a repeated attempt at suicide calls for teaching the patient about their condition. Many who attempt suicide are suffering from mental illness like depression, bipolar disorder or schizophrenia and get overwhelming episodes that push them towards suicide. They need to be counselled to accept the diagnosis, adhere to medication and prescribed treatment, and manage their condition. Their families are also taught how to support them, the red flags to look for and how to respond to them.

“If poorly managed or not taken seriously, the condition can get worse and the person might end their life. But when the person gets the medical intervention he or she needs, they recover and live full lives,” says the clinical psychologist.

However, as Hiram points out, treatment does not come cheap, and many who need it cannot afford it.

“Help is available, but the cost is too high. Therapy alone costs Sh2,000 to Sh5,000 per session on average, and not many people can afford it, and insurance might not even cover it. At Befrienders we offer free counselling and listening services, but people who need medication should be able to get it at affordable prices,” he says.

Mr Owuor, who says that a treatment session for a person who attempted suicide can cost something like Sh36,000, agrees that the cost is often out of reach for many patients, especially those in rural areas.

“There is no health without mental health, so we must make treatment affordable if we are serious about preventing suicides,” says Mr Owuor.

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