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Cablegate: Sri Lanka's High Suicide Rates: A Persistent Public

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ZNR UUUUU ZZH
R 151126Z JUN 06
FM AMEMBASSY COLOMBO
TO RUEHC/SECSTATE WASHDC 3674
INFO RUEHKA/AMEMBASSY DHAKA 9256
RUEHIL/AMEMBASSY ISLAMABAD 6150
RUEHKT/AMEMBASSY KATHMANDU 4185
RUEHNE/AMEMBASSY NEW DELHI 9722
RUEHCI/AMCONSUL CALCUTTA 0193
RUEHCG/AMCONSUL CHENNAI 6702
RUEHBI/AMCONSUL MUMBAI 4584

UNCLAS SECTION 01 OF 03 COLOMBO 001012

SIPDIS

SIPDIS, SENSITIVE

E.O. 12958: N/A
TAGS: SOCI PGOV TBIO EAGR ECON CE
SUBJECT: SRI LANKA'S HIGH SUICIDE RATES: A PERSISTENT PUBLIC
HEALTH PROBLEM


1. (SBU) Summary: Despite broad awareness of Sri Lanka's
high suicide rate, several factors inhibit the Sri Lankan
government's ability to address this public health problem.
Suicide and deliberate self-harm (DSH) pose a financial
burden on Sri Lanka's healthcare and police and negatively
affect the workforce and economy. Research to date
indicates that many who practice DSH do not intend to die,
but consume easily available, highly toxic pesticides that
result in fatalities. Other exacerbating factors include
poor data collection and an absence of social services or
mental health infrastructure. While there are some efforts
to move toward community-based mental health care, endemic
problems indicate that no immediate solution is in sight.
End summary.

DSH Continues Despite Pesticide Regulations
--------------------------------------------- --------------
2. (SBU) Steadily rising since the 1960s, Sri Lanka's
suicide rate peaked in 1995 with over 8,500 recorded deaths,
the world's highest suicide rate among women and the second
highest among men. In a May 5 meeting with emboff, the
director of the mental health non-governmental organization
(NGO) Sumithrayo said these high numbers led the president
to set up a special suicide task force in 1998. Reports that
the majority of suicides were due to pesticide poisonings
led the Government of Sri Lanka (GSL) to impose more
stringent regulations on pesticide sales, including a 1995
ban on highly hazardous World Health Organization (WHO)
class I organophosphates and a 1998 ban on highly toxic
class II endosulfan. However, a local government official in
Anuradhapura told emboff in a May 22 meeting that
shopkeepers in his district were unaware of the regulations.

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3. (SBU) Despite a steep drop in deaths from banned
pesticides in the 1990s, the pesticide research group South
Asian Clinical Toxicology Research Consortium (SACTRC) found
little difference in the total number of poisoning deaths
because villagers switched to new toxins. A doctor from the
Jaffna Teaching Hospital told emboff in a May 15 meeting
that eating indigenous yellow oleander seeds, a plant that
can cause heart failure, is becoming increasingly popular in
Sri Lanka's dry zones. According to the Sumithrayo
representative, around 23 suicide attempts occurred per day
in 1995. The number dropped to roughly 17 per day in
pursuant years, but has since risen to around 20 attempts
per day. The Sumithrayo official noted that while the number
of DSH deaths has decreased, possibly due to increased
access to care, the number of DSH attempts has actually
risen.

High Lethality of DSH Means Translates to High Suicide Rates
--------------------------------------------- --------------
4. (SBU) According to a SACTRC researcher who spoke to
emboff May 19, Sri Lanka's number of DSH attempts is
commensurate with the West's, but its mortality rate is much
higher due to greater toxicity in substances used and poorer
medical management. The researcher estimates Sri Lanka's DSH
fatality rate at 12-13 percent, compared to Australia's 1.5
percent. SACTRC's studies reveal that survival has little to
do with intent and that people choose a pesticide based on
availability with minimal awareness of the product's
lethality or of possible antidotes. The researcher reported
that suicide attempts were based on impulse during fits of
high emotion with few cases of premeditation.

Alcohol Abuse and Domestic Violence Predate DSH
--------------------------------------------- --------------
5. (SBU) According to SACTRC's researcher, limiting access
to pesticides would result in the most rapid drop-off in
suicide rates, but any long-term gains focused on underlying
causes would need to address the issue of alcohol abuse as
the largest factor driving DSH. In a May 25 meeting with
emboff, a WHO consultant concurred with that assessment. The
consultant also found domestic violence (often associated
with alcoholism) was a major risk factor in DSH, with one
study documenting that 1 in 11 women who suffer from it
attempt suicide.

Poor Data But Emerging Trends
--------------------------------------------- ----------
6. (SBU) The GSL collects national statistics on suicide
through both the Health Department and the Police
Department, but in a study on suicide among rural young
women, researcher Jeanne Marecek claimed DSH numbers are
skewed because the act is stigmatized and not reported

COLOMBO 00001012 002 OF 003


unless medical treatment is necessary. The Police
Department collects suicide statistics including method
used, victim's occupation, ethnicity, religion, age, and
gender. Police records only cover fatalities, however, so
the actual number of DSH cases from them can only be an
extrapolated estimate. As for medical records, data
collection is hampered because until 2002, hospitals did not
segregate numbers by age, and until 2004, gender was not
taken into account. Furthermore, on medical forms, no
separate category exists for suicide, so cases fall under
the listing of poisonings or burnings. Officially, it is
unknown whether these cases are accidental or deliberate,
but in his research, the SACTRC researcher found almost all
adult poisoning cases to be deliberate.

7. (SBU) Despite incomplete statistics, Marecek noted some
patterns in DSH, namely its high concentration in rural
areas, and in particular among women aged 16-29 years of
age. In contrast, some communities face much lower DSH
rates. Islamic leaders from the Mohideen Jummah Grand
Mosque in Anaradhapura told emboff in a May 22 meeting that
suicides are rare in their community, an assertion district
statistics support. Yet people living in Internally
Displaced Persons' welfare centers face up to three times
higher DSH numbers than those in surrounding areas,
according to a Doctors Without Borders study in Vavuniya.
The December 2004 tsunami also affected the suicide rate,
according to the WHO consultant, with an initial drop in DSH
immediately after the event followed by increasing DSH rates
to greater than pre-tsunami levels in tsunami-affected
areas.

DSH Decimating Workforce and Straining Health Sector
--------------------------------------------- --------------
8. (U) A 1998 study by the Sri Lanka Medical Association
calculated that with an estimated 6000 suicides annually,
broken down by age, gender, and location, the economic cost
from lost earnings across 7 provinces was approximately
904,000 USD in 1996 alone. A SACTRC study also noted the
large strain placed on the health sector by pesticide
poisonings, cases of which occupied 41 percent of the beds
in Anaradhapura Hospital.

Mental Health Provision: Little Professional Counseling
--------------------------------------------- --------------
9. (SBU) In all of Sri Lanka, fewer than 30 psychiatrists
and 12 clinical psychologists trained beyond a bachelor's
level serve 20 million people, and 90 percent of these
mental health resources are concentrated in Colombo. One
clinical psychologist at the General Hospital in Colombo,
told emboff in a May 20 meeting that he sees 3-4 new
patients a week following their DSH attempts. According to
the Sumithrayo representative, her organization's trained
counselors visit the hospital's wards each week to provide
counseling. Yet Colombo General Hospital's psychologist
assessed Sumithrayo's "befriending" techniques as
ineffective, stressing that DSH patients require
psychological treatment methods such as behavioral and
cognitive therapies.

Moving Towards Community-Based Mental Health Care
--------------------------------------------- --------------
10. (SBU) In 2005, Parliament finally revised mental health
legislation in effect since 1873. In collaboration with the
WHO, the GSL drafted and passed a new ten-year Mental Health
Policy that called for a community-based model rather than
the previous focus on institutionalizing patients. More a
strategy plan than operational policy, the 2005 Mental
Health Policy also recommends new national and provincial
management structures, a reorganization and decentralization
of services, human resources development, greater research
into mental health, the establishment of a National
Institute of Mental Health, and the need to address stigma.
In a June 1 meeting with emboff, the Director of Health
Services reported the World Bank's interest in bolstering
suicide prevention, but she felt any programs would first
require a move towards more community-based mental
healthcare models.

11. (SBU) The Health Services Director was unable to cite
any concrete progress made in the sectors cited in the 2005
Mental Health Policy Plan. Instead, she mentioned the need
for districts to prepare action plans and the need to
receive approval from ministries such as planning,
management, and finance before any new psychosocial workers

COLOMBO 00001012 003 OF 003


or psychiatric nurses could be recruited or trained. The
Director noted the Health Ministry has no separate budget to
implement the new policy. The WHO consultant reported that
he had received funding from Ireland, Finland, and Australia
to continue developing community-based mental health
services in 6 of Sri Lanka's 27 districts, and he is
currently circulating a proposal to develop country-wide
services over the next ten years in line with the new
policy.

Comment
--------

12. (SBU) Comment: The Sri Lankan government's focus on
limiting access to pesticides as its response to the high
suicide rate in Sri Lanka at the expense of addressing
alcohol abuse and familial dysfunction has resulted in
little headway in reducing the practice of DSH. The high
lethality of the means used for DSH, poor medical
management, and minimal information on the role of social
and psychological factors in DSH behavior means that Sri
Lankan youth, and in particular young rural females, will
likely continue to die in high numbers. Funding shortages
and slow bureaucracy that limit burgeoning efforts to
develop community-based mental health services indicate it
will remain difficult for the government to address this
public health burden in the future. End comment.
LUNSTEAD

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