A debt of ₹5,000 pushed a 28-year-old garment factory worker from rural Karnataka into one of the darkest moments of her life.

Unable to repay money borrowed from her mother for a chit fund payment, she was reprimanded at home. Hurt, angry, and overwhelmed, she consumed a disinfectant lying in the house. Within minutes, she began vomiting and was rushed to hospital by her husband.

Today, she does not describe the incident as a planned attempt to end her life. Instead, she remembers it as the result of mounting financial stress, family tensions, and a feeling that nobody understood what she was going through. “I felt like nobody understood my tension,” she recalls.

At the hospital, she was connected to counsellors associated with Project SURAKSHA, a community-based suicide prevention initiative led by NIMHANS with support from the Karnataka government and corporate social responsibility funds. Through counselling, follow-up calls and family support, she gradually regained confidence.

“They listened patiently and helped me understand that family and money problems can be solved slowly and that I should not harm myself because of temporary stress,” she says.

Multiple reasons

Her experience is far from unique. A 33-year-old homemaker struggling with debt and family disputes. A 16-year-old boy grieving the loss of both parents who reacted after a friend insulted them. A 57-year-old government school teacher devastated by a family conflict that spilled into her workplace.

Circumstances differ, but the emotions are similar — grief, loneliness, shame, financial stress, family conflict and a sense of having nowhere to turn.

These stories illustrate a reality long emphasised by mental health professionals: suicide and self-harm rarely stem from a single event. More often, they emerge from accumulated distress that remains unrecognised, unsupported or untreated until a crisis occurs.

This understanding has shaped Karnataka’s evolving approach to suicide prevention — one that increasingly seeks to move beyond hospitals and specialist psychiatric services into communities.

Beyond clinical settings

“Community-based interventions are integral to suicide prevention. Engaging panchayat functionaries, schoolteachers, and other community influencers ensures that suicide is not hidden in the shadows,” says NIMHANS director Prabha S. Chandra. “When stigma decreases, people seek help and gatekeepers become more effective in preventing self-harm.”

Dr. Chandra says evidence from Karnataka indicates that psychological interventions in emergency settings, followed by regular low-intensity follow-up contacts, can significantly reduce repeat attempts.

“We now need to use this evidence to build scalable solutions. Suicide prevention is everybody’s business,” she says.

Anish V. Cherian, Principal Investigator of Project SURAKSHA and Lead of the NIMHANS Suicide Prevention, Research, Implementation Training and Engagement Centre (N-SPRITE), says the programme has shown that suicide prevention can be woven into everyday community life.

“SURAKSHA involves collaborations between community members, government agencies, the private sector and non-government organisations. It incorporates several elements of India’s National Suicide Prevention Strategy and is the first long-term community-based suicide prevention programme developed and implemented in India,” he says.

According to Dr. Cherian, the programme offers a model that can be adapted across the country and incorporated into State-level suicide prevention plans.

Karnataka’s burden

The need for interventions becomes clear when viewed against Karnataka’s suicide burden.

According to the National Crime Records Bureau (NCRB), 1,70,746 people died by suicide in India in 2024. Karnataka remained among the five States reporting the highest numbers, accounting for 13,151 deaths, or 7.7% of the national total.

Bengaluru recorded the country’s highest suicide rate among major metros. NCRB data showed over 2,313 suicides in 2022, 2,370 in 2023, and 2,430 in 2024, with the city’s suicide rate remaining close to 20 per lakh population through the three-year period..

Yet, suicide deaths represent only the visible part of a much larger problem. Behind every death are many more individuals experiencing suicidal thoughts, emotional distress, self-harm, and suicide attempts.

Data generated through the Urban Self-Harm Study (USHAS), another NIMHANS-led initiative, provides a glimpse into this wider picture.

Between 2022 and May 2026, USHAS recorded 32,712 cases of self-harm and suicide attempts across 16 hospitals in Karnataka. Of these, 30,217 survived, representing 92.4% of all reported cases.

Among survivors, 24,361 people, or 80.6%, received psychosocial interventions, including brief counselling and structured telephone follow-up.

Rate of repeat attempts

Only 381 individuals, or 1.5% of those who received interventions, went on to make another suicide attempt. International studies estimate repeat-attempt rates among survivors at 15% to 25%.

Among the 381 who re-attempted suicide, 78 died, representing just 0.32% of all those who had received psychosocial support.

Rajani Parthasarathy, Karnataka’s Deputy Director (Mental Health), says the findings highlight the importance of continued support after a suicide attempt.

“Individuals who survive a suicide attempt are at a high risk of re-attempting it. Hence, their early identification, management and follow-up are crucial for suicide prevention,” she says.

“By equipping public health facilities to record details of survivors and linking them to referral services, we ensure that no survivor falls through the cracks. The brief interventions and long-term follow-up have resulted in significantly lower re-attempt rates.”

Understanding vulnerability

The USHAS data also sheds light on the factors driving suicidal behaviour. Nearly half of all reported cases had a previous history of suicide attempts, while more than 43% had engaged in self-harm earlier.

Young adults emerged as the most affected group. People aged 25 to 39 accounted for 44.4% of all reported cases, followed by those aged 18 to 24.

Interpersonal relationship issues emerged as the most common trigger, accounting for 46% of all cases. Financial and property-related concerns contributed to 9.3% of cases, while physical illness and mental health conditions accounted for 5.4% and 5.3%, respectively.

The findings reinforce a pattern often observed by mental health professionals: suicidal behaviour is frequently linked to everyday challenges, strained relationships, family conflict, debt, illness and emotional distress.

Such problems may not appear extraordinary in isolation, but when combined with a lack of support, they can become overwhelming.

Taking prevention into communities

Recognising that suicide prevention cannot rely solely on hospitals, NIMHANS launched Project SURAKSHA in Channapatna taluk in 2023.

Developed in line with India’s National Suicide Prevention Strategy and the World Health Organization’s LIVE LIFE framework, the initiative sought to bring suicide prevention into communities.

Instead of depending exclusively on psychiatrists and psychologists, it focused on building local networks capable of identifying distress early and connecting vulnerable individuals with help.

Teachers, panchayat representatives, Accredited Social Health Activists, anganwadi workers, healthcare staff, self-help group members and police personnel were trained as gatekeepers.

The idea was straightforward: people experiencing emotional distress often interact with community members long before they reach a mental health professional. By strengthening those connections, the programme sought to create opportunities for earlier intervention. Three years later, the programme has begun to demonstrate what such a approach can achieve.

Initially implemented across 32 gram panchayats in Channapatna, SURAKSHA is now being extended to all five taluks of Bengaluru South. The Karnataka government has also approved its first phase in Ballari district, another region that reports high suicide numbers..

Changing conversations

One of the most visible outcomes has been a shift in how communities talk about mental health.

Leelavathi, Panchayat Development Officer of Nagavara Gram Panchayat in Channapatna taluk, says, “Earlier, people were afraid to openly speak about stress, depression or suicide. Many families suffered silently without knowing where to seek help.”

Former Nagavara Gram Panchayat president Harish Kumar C.S. says emotional distress often remains hidden because of social stigma. “People openly discuss physical illness but often hide mental health problems because of shame or fear. Awareness programmes helped people understand that seeking help is not a weakness,” he says.

Mental health professionals view such shifts as significant because they create opportunities for intervention before a crisis develops.

For many people, the first conversation about emotional distress occurs not in a psychiatrist’s clinic but during a school interaction, community meeting, visit by a frontline worker or conversation with a trusted local leader.

Strengthening primary healthcare

Another important aspect of SURAKSHA has been its effort to integrate suicide prevention into routine healthcare services.

Sahana Sitharam P., Medical Officer at Nagavara Primary Health Centre, says self-harm and emotional distress often went undetected in primary healthcare settings.

“Earlier, we focused more on emergencies and physical illness. Through training, staff became more confident in identifying vulnerable individuals and providing timely referrals,” she says.

The programme introduced systems to record self-harm cases and ensure follow-up support. Such registries are important because previous suicide attempts remain among the strongest predictors of future suicide risk.

Alongside support for survivors, family-based postvention services have been delivered to 26,387 families affected by suicide attempts or deaths. These interventions focus on helping families cope with grief, reducing stigma and connecting them to available support systems.

Building evidence for policy

Experts say Karnataka’s experience is important because it generates evidence on what works in suicide prevention.

Lakshmi Vijayakumar, member of the WHO Network on Suicide Prevention and Research, points out that India accounts for more than a fifth of global suicide deaths. The National Suicide Prevention Strategy, announced in 2022, aims to reduce suicide deaths by 10% by 2030.

“Community-level interventions are an important component of the strategy. These include gatekeeper training, integrating suicide prevention services into primary healthcare, providing crisis services, promoting school mental health programmes and restricting access to means of suicide,” she says.

Pointing out that suicide patterns vary considerably across States, Dr. Vijayakumar argues that local strategies are essential. “Suicide rates vary widely across India. Each State needs a strategy that takes its culture and context into consideration. Suicide is a preventable public health crisis and the time to act is now.”

The role of partnerships

The Karnataka experience has also highlighted the role of collaboration.

K.G. Umesh, Director-Human Resources, Himalaya Wellness Company, the CSR partner for the projects, says suicide prevention requires long-term collaboration.

“Beyond funding programmes, CSR can help bring together institutions, expertise and communities to address complex public health challenges in a sustained manner,” he says.

Looking ahead

Beginning in July, the USHAS programme will expand to all districts of Karnataka, operating through five hospitals in Bengaluru and district hospitals across the State.

For public health experts, the significance of these initiatives extends beyond statistics. The programmes demonstrate that suicide prevention need not remain confined to specialist psychiatric services. It can be integrated into schools, primary healthcare centres, panchayats, community organisations and families.

The stories of the garment worker, homemaker, teenager and school teacher illustrate that point. None were facing extraordinary circumstances. Financial stress, grief, family conflict and social humiliation are experiences encountered by countless people.

What transformed those experiences into crises was a temporary absence of support and an inability to see alternatives in moments of overwhelming emotional distress.

The interventions that helped them recover did not always begin with specialised treatment. More often, they began with something simpler — a conversation, a follow-up call, a teacher who noticed, a health worker who listened, or a community member who reached out.