Michael Eddleston is a professor of Clinical Toxicology at the University of Edinburgh with over two decades of experience in suicide by ingesting pesticide. He is also the director of Centre for Pesticide Suicide Prevention and was recently in Nepal as a principal investigator of a research analysing self-poisoning in the country. Excerpts of his conversation with Nepali Times.
Nepali Times: What is pesticide suicide?
Michael Eddleston: All of us feel suicidal from time to time. Unless you are very depressed or have a mental illness, you survive the feeling and move on with your life. The green revolution brought highly toxic pesticides into homes that people drank in the moment of impulse without a second thought.
Suicide rates went up massively in Asia because spontaneous acts of self-harm became lethal. These are accidental suicides, people don’t really want to die, drinking pesticide or a poison in many parts of Asia is an expression of anger or frustration.
What is the burden of pesticide suicide in the region?
Pesticide suicides have killed some 15 million people, mostly in this region of South and East Asia since the 1960s. The numbers have come down to about 150,000 people a year. China alone used to have 180,000 pesticide suicides per year back in the 1990s and it has come down to 50,000, partly due to mechanisation and restriction of Highly Hazardous Pesticides (HHP). In Nepal, 15-20% of suicides are from ingesting pesticides and about 1,000 people die every year.
Read also: Suicide by pesticide in Nepal, Sonia Awale
Nepal's suicide rate vastly underestimated, Sewa Bhattarai
Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:
TUTH Suicide Hotline: 9840021600
Transcultural Psychosocial Organization-Nepal Crisis Hotline: 1660 0102005
Mental Health Helpline Nepal: 1660 0133666
What can we do about it?
Ideally we could move away from all pesticides like Sikkim has done with natural farming. But this might take time so for now the simplest answer is to ban HHPs and replace them with less toxic chemicals. So when people take poison, it’s not toxic and they don’t die.
There’s a clear data from Sri Lanka, Bangladesh and South Korea showing that when you ban just a few particular pesticides which people are commonly using for self-harm, the suicide rate falls rapidly and remarkably without affecting agriculture output. Sri Lanka banned Monocrotophos and Methamidophos in 1995 and in the next 20 years there was 70% reduction in all suicides saving around 93,000 lives at a cost of $50 per lives saved. This is one of the most effective public interventions from anywhere in the world. So legislation does work.
What are the most toxic pesticides in Nepal?
Dichlorvos and 3g tablets of Aluminium phosphide are the most hazardous pesticides in Nepal and the good news is that both of these have been addressed by the government already, they were recently banned. We are also identifying another toxic compound, a combination of Chlorpyrifos and Cypermethrin. What we have seen from case studies elsewhere is that after each ban something new always comes up but we have also found that they always kill less than those prior pesticides.https://www.youtube.com/watch?v=Dy5SX0RnYhA&feature=youtu.be
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.