How can we be sure people won’t go for another method after the ban?
Yes, people often argue that pesticide bans don’t work, they will simply do something else. But that something else is often further away. I can walk to a tree to hang myself or to jump off a bridge but by that time I get there I might get bored, meet a friend on the way or get distracted one way of the other. Pesticides have high toxicity because they are hazardous and close by but if you switch to something else it will always be less toxic. And what we have seen in Sri Lanka is that when you ban pesticides, people don’t switch to other things and don’t attempt suicide again because they are not intended to begin with.
But are you not treating a symptom rather than a disease, which is mental illness?
Yes I accept that we are not dealing with the cause, but with the symptom but I want people to live. If you don’t live, you can’t see your psychiatrist. And it is not purely mental health. It’s also about culture and communication.
If I have no other way of telling people how angry or upset I am, then I will stand in front of you and drink a bottle of pesticide to tell you how I feel. It is the same in the UK, Nepal and Sri Lanka. The only difference is the lethality of method. So I can’t stop suicide or self-harm as an individual but I can stop people from dying after self-harm, which means they get a chance to seek help if necessary.
It’s a concept of harm minimisation, it’s not stopping people from self-harm because it’s difficult to change human behaviour and how people direct their anger and violence towards themselves or other people but we can make it safe.
Which groups are more vulnerable?
When we look at the patterns of self-harm, it’s found among young women between 15-20 years of age more than in anybody else. Women are generally sober and take a very small dose of poison. If you get rid of HHPs, these women suicides fall away and that was the case in China and Sri Lanka. Middle-aged men have more deaths because they tend to be intoxicated when they take poison and they take it in a higher dose so even if it’s a less toxic poison, the higher dose is enough to kill them. Suicide is a combination of people harming themselves and lethality of the method.
How has the progress been in Nepal so far?
Pesticide suicide in Nepal is comparatively smaller but that is also probably due to the number of bans the government has implemented over the last 15 years. Methyl parathion was a huge problem here in the 1990s and 2000s until it was banned and now there are no cases of suicides using this pesticide. It has been replaced more recently by Dichlorvos but that was also recently banned and will be out of shops in couple of years. There has been a remarkable changes going on here in Nepal to remove the most toxic pesticides and replace them with less hazardous alternatives.
Tell us about your work here in Nepal.
What we are trying to do in Nepal is work with our clinical colleagues, Nepal Public Health Foundation and the police laboratories to identify the most problematic pesticides that are killing people in Nepal and once we identify those, we will take that information to the concerned authorities and see how they want to move with that.
Nepal has made a success and has thought about pesticide suicide carefully. What we are doing is bringing the focus on suicide and showing how to get rid of accidental suicides.