Towards the end of a cul-de-sac, to the left, is a cream-colored building, two-storied, unpretentious. A simple white board above the doorway informs that this is the office of Sneha Center for Suicide Prevention, in the South Indian city of Chennai. When it opened, Sneha was the first such center in South India — and at present, is the only one in the country open around the clock.
The clinic opened in 1986, soon after a psychiatrist couple, Drs. Vijaykumar and Lakshmi Vijaykumar, went to Vienna to attend the conference of the International Association for Suicide Prevention. Dr. Lakshmi was presenting a paper at the conference about the pattern of suicides in India. “The victims portrayed in textbooks at that time were elderly white males, living alone, depressed,” she observed, “while we were seeing young females, married, not alone but living with families, and not necessarily depressed, taking this extreme step.”
At the conference, the couple met delegates from other countries working on suicide prevention, and soon had the opportunity to visit many clinics around the world.
“I was amazed at the amount of work being done for the prevention of suicide,” Lakshmi said. “I liked the concept of the Samaritans in the UK, where they used volunteers to rescue people thinking of taking their own lives. I thought it would be an appropriate model to follow.”
In the 1980s, Chennai — then known by its British-given name of Madras — was a conservative city with an orthodox mindset. People did not confide in strangers easily, especially on sensitive topics. “We encountered a lot of objections,” Lakshmi recalled of the organization’s inception. “‘Why would people thinking of suicide come and talk to you? You cannot run an organization only with volunteers, it would not be sustainable.’”
But she and her husband persisted and started Sneha, modeled after the Samaritan Centers in London and Manchester. Dr. Vijaykumar lent his support as a member of the board of trustees while Dr. Lakshmi became the face of the organization. A leading businessman in the city, Nalli Kuppuswamy, made a contribution of Rs. 25,000 (US $375 with today’s exchange rate), and film star Rajnikanth contributed a similar amount.
Thirty years later, the clinic operates 24 hours a day and 365 days a year, and was even open during Chennai’s infamous cyclones and floods and the tsunami. To date, the organization has received more than 350,000 calls, fielded entirely by volunteers.
For a long time, Sneha did not have enough funds to advertise their services, but help came from unexpected sources. Lakshmi recalled how the organization scored its first bit of publicity: “A person had been calling us for about four months; she had lost her husband and was in great distress. Talking to us helped her a lot. We had no clue who she was, but…she happened to be the resident editor of a popular magazine.”
In addition, the General Manager of Southern Railways allowed them to hang their posters in all of the city’s trains, and the Autorickshaw Association helped by putting up the posters behind the driver’s seat in all the rickshaws in the city. They also teamed up with another NGO, Nalamdama, to conduct shows and street plays in lower-income neighborhoods.
In the early days, people dropped in to the office to talk, while others sent postcards. As telephone services improved across the city, the number of callers increased. Today, people seek help using all of those methods, as well as Skype and email.
SSneha places great emphasis on anonymity and confidentiality. In addition to this being good medical practice, it’s helped gain trust among Chennai’s population. “What we do is listen, offering our callers the anonymity and the confidentiality required to talk about anything that is distressing them,” said Anamika, a volunteer at Sneha. “We give them the space and time so that they can talk about whatever they are going through. We do not judge or criticize any of their actions, we do not tell them to do this or that, we just allow them to talk, without any bias, any judgment.”
Most of the callers fall between the ages of 20 to 50, though there have been callers as young as seven and as old as 80. According to Dr. Lakshmi, the most common problem that comes up are those relating to interpersonal ones — such as between mother-in-laws and daughter-in-laws, friends, lovers, or families. Calls typically last for 45 minutes, though some take up to three hours.
A friend of mine, who would prefer to remain anonymous, used to call the Sneha helpline.“I have called at all times, even in the middle of the night,” he said. “They always picked the phone, were always patient, willing to talk, to listen, and never disconnected a call. I was encouraged to think from different angles, to identify the triggers. Many times, they turned my thoughts towards new possibilities. They asked about my sleep cycle, food cycles, and never ended a call without providing some kind of reassurance.”
TThe volunteers at Sneha come from all walks of life — but aren’t mental health professionals themselves. “When we hire volunteers we look for people who can provide unconditional acceptance, warmth, empathy, and are non-judgmental,” Lakshmi said. Each year, she said, they choose 8 or 9 volunteers from a pool of about 200 applications. The role of the volunteer is explained in more depth in a handbook they released earlier this year:
“If we were to pick one word to describe the role of a Sneha volunteer, it would be the Tamil word Sumaithangi, which literally means ‘load-bearing.’ Sumaithangi in earlier times was a stone platform at shoulder height; just outside every village, travelers could lay down any load they were carrying and refresh themselves before moving on.”
Volunteers not being medical professionals has downsides. When calls come in from people with mental health issues, instead of offering medical advice, Sneha volunteers act as a bridge between the callers and the health system. Lakshmi sees advantages to this approach. “The taboo and fear attached to mental health disorders make people hesitate in consulting a doctor and instead they prefer to make a call to an organization like ours,” she said. “From the very beginning, our volunteers are trained to identify people with such disorders and to slowly but surely refer them to professionals.”
Since there are very few people costs, Sneha’s operating budget remains low; one of the highest ticket items is, not surprisingly, telephone charges. The organization works with just enough funds to meet running expenses. Any major funding needs, like posters for World Suicide Prevention Day, are raised individually.
“From very modest beginnings, I have seen Sneha attain a stature of national and international eminence,” said Rangaswami Thara, the director of the Schizophrenia Research Foundation. “What stands out in the case of Sneha is the fact that in a resource poor setting, it is run only with unpaid volunteers and run professionally. I have individually known some of the Trustees and volunteers, and seen their passion for the cause of suicide and saving lives.”
IIn addition to running Sneha, Dr. Lakshmi was an editor of the WHO’s World Suicide Report in 2014.
According to the report, every 40 seconds a person commits suicide somewhere in the world — and India has the unfortunate distinction of having the highest estimated number of suicides.
“Suicide is an impulsive act,” said Lakshmi. “Even when it is a planned one, it is an impulsive act. Research has shown that a majority of people who die by suicide have spoken to someone, have communicated the intention. If you are able to listen, you are able to prevent it. The wish to live and wish to die is like a seesaw. If support is given at that moment of ambivalence, the will to live prevails over the will to die.”
