Nohan Baloch* survived a suicide attempt last year.

“I attempted suicide when I found out that I failed the entrance test for medical studies,” he says, adding that he felt he had adequately prepared for the exam. “But after failing, I felt frustrated and hopeless and I found myself in a bizarre situation where I wanted to end my life.”

But he survived.

Although, Nohan’s mother was devastated to learn her son had failed, she was grateful her child was alive.

His mother had supported Nohan’s education despite many financial challenges, which weighed heavily on him and exacerbated his depression too.

There’s a growing and largely unreported crisis of mental health in Balochistan, which is leading increasing numbers of young people to attempt suicide. Both the survivors and potential victims need urgent interventions from the state…

“It was very difficult for me getting an education in an expensive city like Quetta,” he says. “Financial hurdles were a bottleneck. The pressure of going for a medical career and the failure constantly made me feel worthless.”

Although Nohan is a medical student, he currently works on the Pak-Iran border as a driver and transports goods to provide for his family. He had to abandon his education plans even after reappearing in the medical exam.

Many people suffer mental health issues in Balochistan because of depression, harassment, financial and educational issues. Unemployment, too, can lead people to commit suicide. The Diagnostic Statistical Manual of Mental Disorders defines depression as a disorder in which an individual feels sad, hopeless and worthless, and therefore loses interest in things they used to enjoy. It severely affects individuals and interrupts their normal functioning.

However, attempting suicide is an extreme result of depression. “Suicidal ideation and behaviours mainly stimulate people to commit suicide,” says Mahan Baloch an MBBS doctor based in Turbat, Makran. “People are desperate — they choose suicide as the last option to provide succour for their pain and depression.”

According to a recent report of the website Balochistan Post, 45 cases of suicides have been reported in Balochistan province this year, among which seven were by women. Makran division in Balochistan is the latest hub of growing suicide cases. Unemployment, family pressure and toxic relationships are the core motives behind suicidal attempts among the youth.

According to a study by the Human Rights Commission of Pakistan, around 1,735 persons attempted suicide in 2020. Of this number, 1,086 were men and 649 were women. The issue impacts the entire country.

“Poverty, incomplete needs, lack of catharsis, unsupportive family or friends, comparison with one another, [widening gaps between] social strata such as the upper class and lower class, followed by a sadistic environment are some drivers that motivate people to attempt suicide,” says Mehreen Sheran, a clinical psychologist based in Turbat, Makran. Unfortunately, in Balochistan there is not enough psychiatric treatment available, she adds.

“The depressed individuals should be encouraged to share their viewpoints, and society must listen to them without being judgemental. Counseling and psychotherapy work better than drugs,” Sheran adds.

She stresses on the need for ‘cognitive restructuring’ in the treatment for people afflicted with mental health issues. Cognitive restructuring is a technique used to help people change the way they think.

When used for stress management, for example, the goal is to replace stress-producing thoughts — “cognitive distortions” — with more balanced thoughts that do not produce stress. Cognitive restructuring is a part of “cognitive behavioural therapy”, which is one of the most effective psychological treatments for issues such as depression, anxiety disorders and binge eating.

Techniques can be taught to patients who can then practise them at home to reduce stress. Cognitive restructuring can help in building new, healthy and positive thought patterns.

Nohan Baloch is not the only one who has suffered from depression while attempting to secure a medical seat. Many other students are also suffering.

“I tried to commit suicide when I was 23 by hanging myself from the fan of my room,” says Mehr Baloch*, a 25-year-old student from Khuzdar district.

Before I could ask her why, she says “I attempted suicide because I was suffering from depression. Secondly, I could not share with anyone what I was going through.”

In Balochistan many sad stories of suicides go unreported because of the culture and norms.

Dr Illyas, a psychiatrist working in City Hospital Quetta says, “Depressed youth must be given time to share how they feel. Receiving timely counselling, might help ease a mental pressure.” He believes the federal and provincial governments need to establish psychological clinics.

Although, many factors like depression motivate people to attempt suicide, family pressure can also play a role. “Being forced to marry a boy I do not like compelled me to attempt suicide,” says Sara Baloch*. “It was not only the decision of marriage but also my entire life. It is hard to live with a person one does not even like for one day. How can one live with a person they dislike for a lifetime?”

People who are mentally stressed or have suicidal thoughts should share them with a close friend or visit a therapist to help them through this difficult time. “Therapists’ work would be to align the distorted thoughts of persons who have suicidal ideation as they use different therapies like CBT, REBT or existential therapy.

“Drug therapy is also sometimes required in the first phase of psychotherapy,” says Aman Baloch, an MPhil scholar and lecturer at Government Atta Shad Degree College, Turbat.

Unfortunately, mental health is a largely ignored issue and, given the lack of basic infrastructure in the province, mental health hospitals are often low down on the list of priorities.

The Women’s Development Department’s launch of Helpline 1089 last year was a welcome step taken by the provincial government of Balochistan. It is a platform that aims to shrink gender-based violence, provides psychological services, shelter homes, medical, police and legal aid and supports the financially weak. Helpline 1089 is funded by the United Nations Population Fund (UNFPA) but is currently only accessible to residents in Quetta. The government should extend it to other districts.

People can call the helpline at any time of the day as it is manned round the clock by a dedicated team of operators who take calls and forward the complaints to the relevant department to follow up. A person dealing with financial issues, for example, will be referred to the Baitul Mal, medical cases to the Civil Hospital, cybercrime cases to the FIA, and mental health cases will be sent to psychologists.

The World Health Organisation reported in 2021 that suicide was the fourth leading cause of the worlds’ annual death toll. Researchers have found that both depression and suicidal behavior are interlinked to decrease serotonin in the brain. While a person’s impulses may drive one to such action, a suicide attempt should never be ignored as it is a warning.

“I attempted suicide when I could find no job despite holding a Master’s degree from one of the prestigious universities of Pakistan,” says Majid* who says he’s between 35 to 40 years of age. “I left no stone unturned in making my dream come true of becoming a government servant but, sadly, this degree neither works for me nor has it eased my sufferings and pains.”

Majid lives in a province where getting even basic rights have always been a cause of concern since the creation of the country. “My parents supported my education but I have done nothing awesome for them to be happy and live a comfortable life,” he says, and blames a corrupt system where connections stand in the way of merit based opportunities.”

*Name changed to protect privacy.

The writer holds an LLB degree from the Department of Law at the University of Turbat.

He has taught part-time as an English teacher.

He tweets @MunajGul

Published in Dawn, EOS, December 11th, 2022