The Conversation That Can Keep a Life Open Why Sri Lanka’s next suicide-prevention breakthrough may begin with one ordinary question

By Nimmi Dissanayake Udumalagala

There is a moment that often passes unnoticed in homes, classrooms and workplaces. Someone becomes quieter than usual. A young person stops replying to messages. A person who has always carried the family’s burdens begins to say that they are tired of everything. A friend cancels plans again. We may notice the change, but hesitate to ask the question that matters most: “Are you thinking about harming yourself?”

Many people fear that mentioning suicide will put the idea into someone’s mind. Evidence and clinical practice do not support that assumption. A respectful conversation can create an opening through which a person reaches help, feels less alone, and survives a dangerous moment. It does not need to be dramatic or perfect. It needs to be human, calm, and followed by practical support.

The Numbers Tell Two Stories

Worldwide, more than 720,000 people die by suicide each year. For every adult who dies by suicide, WHO notes that there may be more than 20 others who attempt suicide, although this ratio varies considerably across populations. In 2021, suicide was the third leading cause of death among people aged 15–29, and 73% of suicide deaths occurred in low- and middle-income countries.

Sri Lanka’s story is more complex than a simple headline. The country has made substantial progress since the 1990s. Research attributes much of the earlier decline to restrictions on highly hazardous pesticides, an important public-health lesson: changing the environment can save lives, even when individual distress remains. A recent analysis of police data found that the age-standardised suicide rate fell from 38 per 100,000 people in 1997 to 15 per 100,000 in 2022. The number of recorded deaths fell from 6,418 in 1997 to 3,406 in 2022.

Yet progress is not completion. In 2022, the age-standardised suicide rate was 27 per 100,000 among males compared with 5 per 100,000 among females ; more than five times higher among males. The same research identified a worrying recent pattern, particularly among older men and younger women, and called for continued monitoring rather than complacency. These figures are not labels for groups, and they do not tell us who will or will not be at risk. They tell us where services, listening, and prevention must become more responsive.

The situation among adolescents deserves urgent attention. Sri Lanka’s 2024 Global School-Based Student Health Survey found that 21.8% of students aged 13–17 reported feeling lonely most of the time or always during the previous 12 months. The survey also found that 15.4% had seriously considered attempting suicide during the previous 12 months, while 9.1% reported attempting suicide at least once during that period. Girls reported higher levels than boys for both seriously considering suicide (17.1% compared with 13.6%) and attempting suicide (10.5% compared with 7.7%). These findings should not be used to frighten young people or diagnose every unhappy student. They should prompt adults to take distress seriously and make help easier to reach.

Suicide Is Not One Problem with One Cause

There is no single explanation for suicide. A person may be struggling with depression, alcohol misuse, chronic pain, grief, violence, debt, unemployment, relationship conflict, discrimination, academic pressure, or an unbearable sense of isolation. Often, several pressures collide during a short period of crisis.

This is why simplistic explanations are dangerous. Saying that a person died “because of” one argument, one examination result, or one financial problem can create a false story and deepen a family’s guilt. Responsible prevention asks a broader question: What pressures were present, what support was missing, and what could have interrupted the crisis?

Mental illness matters, but suicide prevention cannot be left to psychiatrists and psychologists alone. Families, schools, religious communities, employers, agricultural officers, primary-care teams, journalists, and policy-makers all shape whether a struggling person encounters isolation or support. The WHO’s LIVE LIFE approach identifies four evidence-based priorities: reduce access to lethal means, report suicide responsibly, strengthen adolescents’ social and emotional skills, and identify, assess, support, and follow up people affected by suicidal behaviour.

What Prevention Looks Like in Everyday Life

• Replace guessing with compassionate curiosity. A person who appears withdrawn, hopeless, or unusually burdened deserves a private conversation. Listen without rushing to debate, lecture, or offer clichés. “You should be strong” may be intended as encouragement, but it can sound like a demand to hide pain. More useful words are: “I am glad you told me,” “I am taking this seriously,” and “We will look for help together.”
• Take immediate danger seriously. If someone says they are thinking about suicide, do not leave them alone if immediate danger is present. Involve a trusted person and contact urgent professional help. Do not promise to keep an imminent safety risk secret. Protection is more important than secrecy.
• Make belonging part of education. Social and emotional learning includes recognising emotions, managing conflict, seeking help, coping with failure, and building supportive relationships. Anti-bullying measures must include cyberbullying, because humiliation and exclusion can follow a child into the home through a phone.
• Make help-seeking ordinary at work and in the community. Men in particular may be taught to express responsibility through silence and endurance. A culture that praises people only for carrying burdens can miss the moment when they need someone to carry part of the burden with them. A supervisor asking, “How are you managing, really?” is not a substitute for clinical care, but it can be a bridge to it.
• Make dangerous moments less fatal. Research consistently identifies restriction of access to commonly used lethal means as one of the strongest population-level suicide-prevention measures. Sri Lanka’s experience with highly hazardous pesticide regulation demonstrates the potential of such action. There is also an important caution: restrictions should be planned as part of a wider strategy, monitored carefully, and combined with mental-health care, community support, and responsible communication.
• Continue support after the immediate crisis. A person may appear better after speaking to a professional, leaving hospital, or returning to school, while they may still feel unsafe. A written safety plan, a named support person, scheduled follow-up, and a clear route back to care can turn a single intervention into continuing protection. Recovery is not proved by one calm afternoon.

The Media Can Either Widen the Wound or Widen the Way Out

Journalism has a genuine public-health role. The WHO’s updated resource for media professionals notes that widely disseminated reports of suicide have often been followed by increases in suicide, while stories focused on overcoming a suicidal crisis can contribute to prevention.

This does not mean that newspapers should avoid the subject. It means they should report it with discipline. Coverage should avoid graphic descriptions, photographs of the scene, detailed descriptions of a method, romanticised or heroic language, speculation about motive, and repetition of a person’s final message. It should protect the privacy and dignity of families, avoid presenting suicide as an inevitable response to a problem, and include information about support.

The strongest article is not the one that creates shock. It is the one that leaves a distressed reader with recognition, a family with less blame, a community with practical knowledge, and a person at risk with one more reason to make contact. Alongside reporting a death, media organisations can publish prevention stories, interview trained professionals, highlight recovery, and make help-seeking visible.

A Small Question with a Large Reach

During this suicide prevention month, let us change the narrative from “Why did this person do it?” to “What pain was not met with enough support, and how can we respond earlier?” Let us stop treating emotional suffering as a private failure. Let us teach children that asking for help is a skill. Let us teach adults that listening is an intervention. Let us build services that are respectful, affordable, and available beyond major cities.

Most importantly, let us not wait for certainty before offering care. We do not need proof that someone is suicidal before we check in. We can say:

“I have noticed that you seem overwhelmed. I care about you. Are you thinking about harming yourself?”

Then listen. Stay. Help the person connect with professional support. If the answer is yes, or if there is immediate danger, treat it as urgent rather than as a private conversation that must be managed alone.

If You or Someone You Know Needs Support

• National Mental Health Helpline (Sri Lanka): 1926
  (24-hour, toll-free mental-health helpline)
• Sri Lanka Sumithrayo: 011 2 682 535

(Confidential emotional support and befriending)

• Emergency Services: Go to the nearest hospital casualty ward or contact local emergency medical services.

If you are worried about someone, do not leave them alone. Make the call with them and remain beside them while help is arranged.

---------------------------------

ABOUT THE WRITER

Nimmi Dissanayake Udumalagala is a Consultant Psychologist and Mental Health & Psychosocial Practitioner. She can be contacted at nimmiu@gmail.com.