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The Uncared Carers: An Urgent Need for Action

Prekshya Thapa

It’s so much difficult over here.We are feeling like whether to live or die because our sibling had attempted suicide. No worse can happen to person than this. At times we had to hold her hand, at times had to snatch rope from her hand and other times had to snatch her shawl; we could not leave her even for a second. Stress?There can be no stress more than this.We did not tell about her admission here in the hospital even to a close relative of mine whose wife had delivered in this hospital only and I had gone to visit them as well because people talk a lot of negative not only about people who try to commit suicidebut also the whole family. And this hurts us more.

A caregiver expressed her traumatic experiences of caregiving a suicidal sister whowas admitted in the psychiatric ward.
Suicide is a tragic global health problem. With more than 8lakhs people ending their life by suicidal attempt and many millions attempting to commit suicide, this global health problem is not receiving as much priority as it needs. Every suicide directly affects manypeople around, at least 135 people and many more indirectly. Caregivers, who are directly involved in providing the care to these suicidal people or those who attempt suicide are affected and traumatized even more. Most often, in the developing countries like ours, where formal or paid caregivers are not available, the major task for caring the suicidal individuals goes to the family members.

The role of family members and caregivers in suicide prevention and caring for those suicidal people is immense. However they go through lots of stress. Caring for the suicidal people and those who have committed suicidal attempt itself is a very challenging task. These caregivers are further overburdened by the stigma conferred upon the suicidal person and family by the society. The family caregivers feel the impending burnout as they have to be constantly vigilant about their suicidal relatives and also because of the tremendous stigma the suicide carries in the developing countries.

More than 90 percent of people who commit suicide have been found to have one or other mental illness like depression, schizophrenia, substance abuse and others. Some severe cases of mental illnessrequire prolonged hospital stay and the caregivers has to facemultiples stressors. They could face tremendous financial burden as the expenditure for the treatment is totally out of pocket leading to the catastrophic expenditure. They have to manage the medicines, look after the suicidal relatives, manage finances, manage food;attend the doctors round and many more. Even they may not be able to do self-care, have food timely, sleep properly, fulfill own job responsibilities and other household responsibilities.There is a lack of appropriate physical facilities in hospitals like separate room, pantry, laundry services, proper restroom facilities etc. All these are likely to further add to the burden they are already facing while caring for the suicidal relative.

Constant worry, tension, stress of having to be vigilant all the time to prevent suicidal attempt are likely to compromise the mental health of caregivers. They may feel sad, irritable, anxious, overburdened, overwhelmed, guilt, shamed. The physical health also gets hampered as they can get cough and cold, headaches, backache, fatigue etc. due to overexertion and burden.

All these factors that compromise the physical and mental health of caregivers in turn directly affect their ability to take care of their suicidal relative and thus increase the risk of suicide. So, any suicide prevention policy and programs should take care of this immense aspect. The society has a vital role in supporting the caregivers and suicidal individuals. This includes developing a positive attitude towards mental illness and suicide, helping them identify appropriate health services providers and resources, improving the hospital facilities, and advocating for the national level policies and programs to cater the specific needs of caregivers. Understanding and caring attitude of society towards toward suicidal persons and relatives could also unveil many other mental illnesses that could be managed with timely intervention. As the caregivers are the one who spend most of the time with the suicidal persons, the specific training/ awareness programs for the caregivers could also make the caregiving task easier. It could also help the caregivers to cope with distress of caregiving and preserve their own mental as well as physical health.

(Thapa is a Senior Instructor at Department of Psychiatric Nursing, College of Nursing, B.P.Koirala Institute of Health Sciences, Dharan.)

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