Author: Vanda Scott
Position: Development Consultant
Institution: International Association for Suicide Prevention
E-mail: barade@aol.com
Additional Authors: Lakshmi Ratnayeke, Sri Lanka Sumithrayo
Submitted Date: March 06, 2008
Published Date: March 6, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

In his commentary on the survey of the impact of a new paraquat formulation on survival of self harm patients, Professor Bateman suggests that this approach may have been misguided and mentions a number of alternatives to prevent deaths from poisoning incidents. We would like to share with the readers some experiences and observations of the Sri Lanka Sumithrayo rural suicide prevention programme which operates in 60 villages in the North Western and Southern provinces. These communities are renowned for having a high risk of suicidal incidents and are therefore targeted by Sumithrayo for psychosocial support.

In visiting the villages in which smallholding farming families are living from hand to mouth the main concern is whether their land provides adequate crops to maintain the family. If the answer is negative there is an issue of pure and simple human survival. Remove their pesticides and their ability to farm in barren and tropical conditions is heavily affected. However, the public debate around removing pesticides or reducing their availability seems to be largely conducted by people who do not have to face poverty and starvation and it does not include those who are immediately affected, least of all subsistence farmers.

Talking to these farmers they recognise that the pesticide products are of potential danger to their children, possibly their wives but they would not necessarily consider themselves as at risk. On the whole they purchase only enough for current spraying activity for the obvious economic reason. Will they lock it away? Yes, although two schools of thought exist on where the safe storage should be maintained: lock away close to the farm land (inconvenient); lock adjacent to the home (focus on the poison close to domestics). Our fieldworkers report without exception that the compliance level for maintaining effective lockable storage is consistently high. Ask them to use an alternative products (organic, less toxic), or no product at all and the farmers respond negatively. What needs to be addressed are the underlying factors that bring this group of rural habitants to the edge of despair so that suicide becomes an option.

Health professionals, industry, non government organisations (NGOs) are beginning to work together in addressing these issues. An integrated approach to preventing rural suicide in low income countries is an essential component in a global strategy which includes reducing the availability of pesticides, public health campaigns, producing safer products, adding emetics or antidotes to pesticides, and improved management of pesticide poisoning. What is often missing however is the psychosocial support that is now a requirement in many national suicide prevention strategies. It is a facet in the preventive strategy that is firmly encouraged by the World Health Organisation which has formed a collaborative relationship with the International Association for Suicide Prevention on the basis of bringing science into best practice in the area of community action for safer access to pesticides. Representatives of the different sectors pooled information, knowledge and experience of high rate of suicide though the ingestion of pesticides and identified key issues in order to formulate a strategy. Three community interventions were identified: safer storage; education and psychosocial interventions.

More research is essential to determine the effectiveness and practical issues of the different prevention strategies by pesticide poisoning. Industry should be encouraged to contribute to this effort, not least by developing innovative products which are less toxic, rather than being criticised if their efforts do not produce instant solutions. Collaboration is essential across the sectors as there is enough evidence and experience to show a multi faceted approach to prevention of pesticide suicide is the way forward.