Unpacking the Silent Epidemic: Self-Harm, Injury, Accidents, and Suicide Among Adolescents in India

Introduction

Adolescence represents a critical period of growth and self-discovery, often referred to as the "second window of opportunity" for shaping an individual's future. During this phase, young people undergo significant physical, emotional, and cognitive changes that can set the course for their adult lives. However, it is also a time when they are particularly vulnerable to a range of challenges, including self-harm, injuries, accidents, and suicide, which have tragically become leading causes of death in this age group.

Background

The mental, emotional, and physical well-being of adolescents often shapes their future prospects and overall life trajectory. However, societal pressures, academic stress, changing social environments, and other factors can significantly impact their mental health and safety. In India, various studies and reports have pointed out a growing trend in the number of adolescent deaths due to self-harm, accidents, and suicide. Many of these causes are preventable, highlighting the need for targeted interventions and greater awareness.

The Silent Epidemic

Self-harm, suicide, and accidental injuries have become a silent epidemic among Indian adolescents. Often hidden behind a veil of societal stigma and insufficient mental health services, these issues tend to escalate unnoticed. They represent not only a health challenge but a social issue that requires urgent action.

The interconnectedness of these problems—mental health struggles leading to self-harm, which may then result in suicidal behavior, or risky actions that lead to accidents—paints a grim picture of adolescent well-being in India. By recognizing these as a silent epidemic, there’s an opportunity to prioritize adolescent mental health and safety through national policy and public health interventions.

Causes of Deaths Among Adolescents

The leading causes of adolescent deaths in India are multifaceted, but key contributors include:

1. Self-Harm: Adolescents who engage in self-harm are often trying to cope with overwhelming feelings of stress, anxiety, or depression. Studies show that nearly 12-14% of adolescents in India have engaged in self-harm behavior at some point.
2. Injuries and Accidents: Accidental injuries, particularly road accidents, are a significant cause of death among adolescents. According to the Ministry of Road Transport and Highways, adolescents make up 14% of all road traffic fatalities in India.
3. Suicide: Suicide is the leading cause of death among adolescents in India, with over 10,000 adolescent deaths recorded annually by the National Crime Records Bureau (NCRB). Contributing factors include academic pressure, family conflicts, and undiagnosed or untreated mental health issues.

The Gender Dimension

Gender plays a significant role in the prevalence and nature of these causes of death among adolescents:

• Self-Harm and Suicide: Studies have shown that adolescent girls are more likely to engage in self-harm, often due to societal pressures, body image issues, and emotional distress. However, boys are more likely to die by suicide, possibly due to the societal expectation to suppress emotions and the tendency to use more lethal means.
• Injuries and Accidents: Boys are more prone to risky behaviors, which increases their likelihood of being involved in accidents. Gender norms that encourage risk-taking and the pursuit of adrenaline-fueled activities contribute to the higher incidence of accidents among male adolescents.

These gender-specific differences highlight the need for targeted interventions that address the unique challenges faced by boys and girls during adolescence.

Global and Indian Perspective

Globally, adolescent deaths due to self-harm, suicide, and accidents are rising. According to the World Health Organization , suicide is the fourth leading cause of death in young people aged 15-19 worldwide. In India, the situation is even more alarming:

• Overall statistics: In India, suicide accounts for nearly 8% of deaths among adolescents aged 15-19 years.
• Road accidents: Data from the Ministry of Road Transport and Highways shows that nearly 14% of road traffic fatalities in the country involve adolescents.
• Mental health: The National Mental Health Survey (2015-16) found that nearly 7.3% of adolescents in India suffer from mental health conditions, with a significant portion of these adolescents going undiagnosed and untreated.

Government of India Programs and Initiatives

• Rashtriya Kishor Swasthya Karyakram (RKSK) The RKSK is a comprehensive adolescent health program launched in 2014. It addresses the health and development needs of adolescents, including mental health, substance abuse, injuries, and sexual and reproductive health. Through peer educators (Saathiyas) and school-based activities, the program is working to spread awareness about mental health and reduce stigma among young people. RKSK also provides essential mental health services, including counseling, for adolescents.
• School Health Program (SHP) under Ayushman Bharat The SHP, as part of the Ayushman Bharat initiative, focuses on promoting health and well-being among school children and adolescents. Through Health and Wellness Ambassadors (HWAs) and regular health check-ups, the program seeks to educate students about mental health, road safety, and the importance of well-being. Its holistic approach also covers the prevention of anemia and other adolescent health concerns, with the aim of reducing deaths related to health and safety.
• District Mental Health Program (DMHP) A part of the National Mental Health Programme (NMHP), the DMHP seeks to provide mental health services at the district level, ensuring early diagnosis, community-based rehabilitation, and awareness generation. The program is crucial in addressing adolescent mental health challenges by providing local and accessible care for issues like depression, anxiety, and suicidal ideation.
• Mankaksh Mankaksh is a state-level initiative aimed at promoting mental health awareness and providing support in schools and communities. Through workshops, counseling, and awareness campaigns, Mankaksh aims to create a supportive environment for adolescents struggling with mental health challenges. It helps reduce the stigma associated with mental health issues and provides a safe space for adolescents to seek help.
• Tele-MANAS (Tele Mental Health Assistance and Networking Across States) Launched in 2022, Tele-MANAS provides free, accessible, and confidential tele-counseling services across India by dialing 14416. This initiative bridges the gap in mental health services, especially in rural areas, where access is limited. Adolescents can access mental health support from trained professionals, making it easier to seek help for issues like self-harm, depression, and suicidal thoughts. Tele-MANAS ensures mental health services are available to all, irrespective of geographical location.

Way Forward

It is essential to:

• Strengthen Mental Health Services: Expanding programs like Tele-MANAS, RKSK, and DMHP will help ensure mental health services are available and accessible to adolescents in every part of India.
• Increase Awareness: Mental health education should be promoted at the school level through programs like SHP and Mankaksh. Road safety education should also be emphasized to reduce traffic-related deaths.
• Open Dialogue on Mental Health: Breaking the stigma around mental health is key to preventing self-harm and suicide. Government programs must continue to support conversations around mental health issues, ensuring adolescents feel safe to seek help.
• Gender-Sensitive Approaches: Interventions should be designed with gender differences in mind, ensuring that both boys and girls receive the appropriate support and education to reduce their specific risks.
• Collaborative Efforts: Government bodies, NGOs, schools, and communities must collaborate to create a supportive ecosystem for adolescents, promoting mental well-being and reducing risky behaviors that lead to accidents or self-harm.

Conclusion

The rising number of deaths among adolescents due to self-harm, injuries, accidents, and suicide in India is alarming but preventable. With the right programs, policies, and awareness initiatives in place, we can address the underlying causes and protect our adolescents during this vulnerable stage of their lives. The Government of India’s initiatives, if expanded and strengthened, hold the key to reducing these preventable tragedies and ensuring a brighter, healthier future for the country’s youth.