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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. 
 
¶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