In a country known for its policy of Gross National Happiness, the high rate of suicide in Bhutan often surprises people. The country is in the beginning stages of collecting meaningful data regarding this trend. In this post, I’ve written about the information I was able to find online and some anecdotal data, too.
Talking about suicide is new for the Bhutanese, medical providers included. This is a culture where saving face, maintaining dignity, and avoiding conflict is important. Add to that a stigma regarding mental health. How do you talk about something as taboo as suicide?
There are some providers here who are quite skilled and confident regarding talking to patients about mental health. Others are avoidant. They may have their own discomfort or not recognize risk factors and warning signs. They may feel that the conversation would be needlessly upsetting to the patient. Or they may not believe that mental health, and even suicidality, can be treated.
In my experience here, the initial resistance to talking about suicide often drops away when you start the conversation. I remember telling some medical interns that I wanted to train them how to assess for suicidal ideation. They said “ok.” Then I said that I expected them to do this the next time someone came for admission so that we could talk about it later. They looked shocked and horrified.
The training went really well. They seemed so eager to learn more, and the importance of the topic was clear to them. The interns had a friend who had committed suicide, and they recognized some of the warning signs on the handouts. Another intern talked about a time when he wished he would have more fully assessed his patient. After the training, one of the interns gave my handouts to the Dean of Students at the college and arranged for me to come and give a talk.
I’ve been learning a lot of suicide in Bhutan, too. The clinical picture is often different than in the US. The victims here are usually young, with the incidence decreasing with age. Also, it’s often done impulsively in someone who didn’t have any outward signs of mental illness. That has made safety planning difficult. The triggering event is often something related to school, arguments with the family, or a relationship.
The little data that does exist about suicide has been gathered by police and medical reports (following a death) and by the government survey that measures factors related to Gross National Happiness. They are doing the best they can, but many question the accuracy of the data.
- Bhutan is ranked #22 among all countries for number of deaths by suicide. For comparison, the US is #47 and the UK #103.
- Between 2009 and 2013 there were 371 deaths by suicide. That’s 6 per month. The population in Bhutan is 767,250 as of October 2015 as determined by the Bhutanese National Statistics Bureau.
- 58% of those who had completed a suicide also met criteria for alcohol dependence.
- 91% of those who completed a suicide did so by hanging.
- 64% of those who attempted suicide did so by intentional overdose. (I have also noticed many people who attempted by jumping off a building.)
- For every 2 males who complete a suicide, 1 female completes.
- The rate of suicide decreases as age increases, and half of the deaths by suicide occur in people under 30.
- There is a positive correlation between suicide and poverty.
In a future post I talk more in-depth about school-related stress, a common trigger, and how suicide is viewed in the context of Tantric Buddhism.
World Health Rankings: Suicide by Country [website] Retrieved from http://www.worldlifeexpectancy.com/cause-of-death/suicide/by-country/
Lhadon, K. (2014). Suicide Trends in Bhutan from 2009 to 2013 [pdf] Retrieved from http://www.bhutanstudies.org.bt/publicationFiles/JBS/JBS_Vol30/v30-2.pdf
Tashi, T. (2015, October 1). Bhutan Focuses on Preventing Suicides [news article] Retrieved from http://www.thebhutanese.bt/?p=948