Deliberate self harm in Sri Lanka: an overlooked tragedy in the developing world

Abstract

The World Health Organisation's definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” clearly relates social and mental wellbeing to physical health.1 For many years, however, attempts to improve health in the developing world concentrated on physical illness—mental health was relegated to the bottom of the list of priorities.2 Only recently has it begun to appear at the forefront of international public health.3 #### Summary points Fig 1 Bed occupancy in relation to diagnosis in the medical intensive care unit of Anuradhapura General Hospital, Sri Lanka, 1995-6 Sri Lanka has a high incidence of suicide—at least 40 suicides per 100 000 population each year compared with 8 per 100 000 in the United Kingdom. 4 5 As part of a collaboration between the universities of Colombo and Oxford, we have been studying new treatments for self poisoning in Anuradhapura General Hospital, a secondary referral centre for 900 000 people living in the North Central Province of Sri Lanka. Our work there has allowed us to observe at first hand the tragic consequences of these deaths for the families and the community. During 1995 and 1996, 2559 adults (age range 12-73 years; 1443 men and 1116 women) were admitted to the …