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The Death of the Indian Farmer: India's Suicide Crisis

Hartej Gill, PhD(c)

Disclosures

September 13, 2021

The Indian agriculture industry is dying, and along with it, its farmers. A nearly three-decades-long suicide crisis has crippled India's farmers.

In November 2020, tens of thousands of farmers marched the streets and set up blockades along New Delhi's busiest highways. Ten months and nearly 500 deaths later, Indian farmers continue their sit-ins to protest three agricultural laws that threaten their financial stability and, for many, their livelihood.

Well before the largest protest in history, Indian farmers have struggled with insurmountable debt and a deteriorating quality of life. Approximately 300,000 farmers have died by suicide since 1995 and over 40 have died by suicide during the Indian farmer protests.

Agriculture accounts for 16% of India's total GDP. However, nearly 60% of India's labor force still depends on agriculture and farming for their livelihood. Over 80% of farmers are family operated with very minimal, and sometimes nonexistent, profit margins. This has led to decades of spiraling debt for over half of India's farm workers. The insurmountable debt combined with a shrinking agricultural economy has contributed to a growing suicide crisis. In 2019, it was reported that over 10,000 farmers and agriculture workers completed suicide. In a recent study on the mental health status of farmers in the state of Maharashtra, over 50% of farmers reported anxiety and insomnia. Nearly 4000 farmers had committed suicide in Maharashtra in the previous year.

The deregulation and privatization of the Indian agricultural sector threatens to worsen a suicide crisis that has seen a sharp increase in the past 5 years and has been compounded by government shutdowns due to the coronavirus pandemic. The suicide rate may be far higher due to the stigmatization of mental health disorders in India. Suicide was criminalized in India until as recently as 2017. The Indian Mental Healthcare Act aims to provide care, treatment, and rehabilitation for people at a higher risk for suicide. However, the policies have come up short as an effective prevention strategy for suicide. In Punjab, known as the bread basket of India, farmer suicide has increased 12-fold in the past 5 years. There are 28 farmer deaths by suicide reported every single day.

The Need for Reform

The need for mental health reform has existed for several decades. The social determinants of suicide behavior among Indian farmers has not been adequately addressed in the attempt to implement a national suicide prevention strategy. As such, the assurance of adequate intervention and medical support has never effectively materialized.

The decriminalization of suicide was an important first step. However, it is only a first step. It does not represent a comprehensive and multisectoral suicide prevention strategy, which will be essential to combat the overall mental health morbidity that contributes to the growing risk for suicide.

For example, Punjab's Malwa region accounts for approximately 97% of the farmer suicides in the state. Recent findings from a mental health survey revealed a lifetime prevalence of mental health disorders at approximately 18% in the Malwa region. However, community-based mental health support has been inaccessible and expensive for lower-income populations in rural regions, which are disproportionately affected by mental health disorders.

The region, with a population of approximately 19 million, has one accredited psychiatric rehabilitation hospital. Novel approaches have targeted the growing substance use problem as the root cause of financial instability and mental health comorbidity. However, recent reports have revealed that only 1.68% of household expenditure was toward drug use.

The financial instability and structural marginalization of farmers by large corporations is a root cause of agrarian anxiety and distress that has been ignored by the government. In fact, it is the reliance on noninstitutional borrowing and the resultant high debt-to-income ratio that is a primary risk factor for agrarian suicides.

Funding for mental health support and suicide prevention should account for these determinants when planning community-based interventions, particularly in low-income areas that are at higher risk for adverse events.

With ineffective and inaccessible mental health support, compounded with insufficient financial backing from the government, India's farmers are at the mercy of larger corporations and loan sharks.

Multisectoral changes are needed to reverse a decade-long trend. Immediate interventions are necessary that effectively account for social determinants of mental health morbidity and suicidal behavior. This includes alternative sources of income through skills training that will allow for employment versatility, loan waivers for agricultural workers, accessibility and development of non-agriculture employment in rural areas, market protection for various crop yields, and additional support for families previously affected by suicide.

As such, an effective framework for mental health support requires a synergistic effort from multiple sectors of society (eg, healthcare, education, business, and labor). Allocation of government funding to evidence-based strategies that account for the "treatment gaps" in vulnerable populations will be essential for improving mental health support for agricultural workers and help protect India's agricultural industry and its farmers.

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About Hartej Gill
Hartej Gill is a PhD candidate and researcher at the Canadian Rapid Treatment Center of Excellence and the Institute of Medical Science at the University of Toronto. He has expertise in mood disorders, investigating the etiology and pathophysiology of mental health disorders from both a clinical study and population health perspective, with over 50 peer-reviewed publications.

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