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FINAL REPORT: Suicide in Sri Lanka: Past, Present and Future Transformations, University of Colombo, 21-22 March 2013

FINAL REPORT

Suicide in Sri Lanka: Past, Present and Future Transformations, University of Colombo, 21-22 March 2013

Introduction

Since the middle of the 20th century, rates of suicide and self-harm rose to ‘epidemic’ proportions in Sri Lanka. From the mid-1990s a series of restrictions placed on the import and sale of the most toxic agrochemicals led to a substantial decreased in the suicide rate. However, emerging evidence – much of it presented at this symposium – suggests that the rate of self-harm has increased exponentially since then. The objective of this symposium was to engage academic researchers and policy makers and intervention practitioners in a dialog concerning the socio-cultural causes and meanings of self-harm and suicide in Sri Lanka, and the implications of this for the development and delivery of effective interventions.

Methodology

The symposium was organised by Dr Tom Widger (University of Sussex) and Ms Tharindi Udalagama (University of Colombo). In February 2013 a Call for Papers (CfP) was announced via academic and policy/practice channels. The CfP attracted twelve abstracts from local and international researchers and interventionists. The resulting programme spread across two days and included five sessions, including a final roundtable debate seeking to integrate the results of discussions from the previous sessions:

Opening session:         Welcome & Plenary Address

Session 1:                    Reading Sri Lanka’s suicide rate

Session 2:                    Self-harm and suicide in ethnographic contexts

Session 3:                    Interventions: transforming suicidalities in Sri Lanka

Session 4:                    Roundtable debate

Formal invitations were sent to a list of academic and policy/practice stakeholders, including representatives of the Ministry of Health, Ministry of Social Services, and local and international NGOs. A few days before the symposium feature stories were published in the Sri Lankan press, which elicited requests for further information and/or requests for an invitation to attend. The symposium was also publicised on the website of the Forum for Suicide & Culture Research (FSCR), and via FSCR Twitter feeds. This helped to raise the profile of the symposium among local researchers.

Results of the sessions

Welcome & Plenary Address

The symposium was introduced by Dr S.M.K. Herath (Head, Department of Sociology, University of Colombo). Dr Herath reminded the audience of the importance of social scientific studies of suicide, especially in Sri Lanka where suicide rates are so high. Next to speak was Dr F.R. Metha (country representative, WHO), who pointed out the heavy psychological and social burden represented by, and caused by, Sri Lanka’s suicide and self-harm epidemic. The plenary address was given by Professor N. Fernando (National Institute of Mental Health). Professor Fernando’s talk provided a general introduction to self-harm and suicide from a global perspective. A lively debate followed concerning the relationship between suicide and mental illness, with one side arguing for a strong relationship with depression and the other suggesting only a weak correlation.

Session 1: Reading Sri Lanka’s suicide rate

The aim of this session was to establish the quantitative framework of suicide and self-harm in Sri Lanka. Three papers were presented, each exploring the rise and fall of the suicide rate from, broadly, medical epidemiological, sociological, and anthropological perspectives. Results of the session included an increased awareness that even though suicide rates have fallen, the rate of self-harm is increasing. A consensus was reached that self-harm remains a major health and social problem and renewed commitments to prevention should be made.

Session 2: Self-harm and suicide in ethnographic contexts

The aim of this session was to provide context to the quantitative picture. Three papers were presented, including two concerned with self-harm and suicide in southern Sri Lanka and one with suicide in northern Sri Lanka. The papers included discussions of suicide and gender, suicide and kinship, and suicide and war. The papers showed how acts of self-harm and self-inflicted death are caused by relational disputes and accusations of shame, and exist as a social practice rather than the consequence of deep-seated psychopathology.

Session 3: Interventions

The aim of this session was to provide an overview of suicide interventions in Sri Lanka and to assess their effectiveness. Five papers were presented, including a review of government policies and in particular the national suicide prevention strategy published in 1997. While the GoSL was lauded for being the first government in Asia to produce such a document, consensus was reached that a new policy is urgently needed and that this should include an implementing body. Building on the findings of the previous sessions, it was also generally agreed that interventions based on Euro-American approaches were unlikely to be effective in the Sri Lankan socio-cultural context.

Session 4: Roundtable debate

The aim of the debate was to address the theme of the conference – what are the social and cultural challenges of suicide prevention in Sri Lanka, and how might they be overcome? – by building of the results of the past two days’ discussions. Six panelists took part, representing the GoSL, local and international suicide prevention organisations, and academia. Results of the debate included calls for greater communication and collaboration between academic researchers and interventionists, and for greater commitments to research targeting the needs of policy and practice experts. It was also expressed that interventionists rely too much on Euro-American approaches to understanding suicide and suicide prevention, and that greater attempts should be made to engage with socio-cultural approaches relevant to the Sri Lankan context.

Outcomes of the symposium

The symposium generated a large amount of interest. Among those who presented at or attended the symposium, there was keen enthusiasm to maintain the momentum started and to forge lasting networks of researchers and prevention experts. To facilitate this, the presentations were made available on the FSCR website. Selected papers will be published in English, Sinhala, and Tamil as part of a special issue of the University of Colombo’s sociology journal.

Among policy/practice stakeholders the symposium provided further impetus to start new projects. The World Bank, in particular, has showed a strong interest to build on the results of the symposium. The Development Partners Secretariat requested a one-page brief to distribute amongst donor organisations and INGOs in order to raise further awareness of the issue. A few days later, the organisers and WHO met with the World Bank’s Senior Health Specialist to discuss how intervention programmes could be taken forward and these meetings are still continuing.

Overall the symposium demonstrated that a large network of researchers and policy/practice experts exists in Sri Lanka, which until the event had not met or had the chance to hear about each other’s work. The symposium suggested that there is significant potential to develop a consortium of experts to conduct policy/practice orientated research studies and develop socio-culturally relevant suicide interventions. As a direct result of the symposium several stakeholders are now in discussions about how this might happen.

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