Suicidal and non-fatal suicide behaviour are serious concerns facing many countries. They take immense emotional toll on the friends and family of the victims and especially on those who have survived such attempts. A suicide is a purposeful act of self-harm undertaken with the expectation that it would be fatal. Non-fatal suicide behaviour (NFSB), on the other hand, is defined as suicidal thoughts, plans and attempts to inflict bodily harm or even die. NFSB is far more prevalent than suicides and it was believed that for every suicide, there were 10 to 20 attempted suicides in 2014. According to the World Health Organisation, over 800,000 people die out of suicides every year and hence, as many as 16 million people attempt to kill themselves. Both suicides and NFSBs have follow on effects that impact the livelihoods of many individuals including friends, family, clinicians, colleagues, coronial staffs, first responders, volunteers etc. These people undergo the inevitable emotional distress in response to such behaviour. Moreover, there are significant economic impacts of suicides. Financially, it effects the individuals, families, states and the nation as a whole. The costs include the lost income and productivity for the victim and its families, among many others. The cost of suicidal behaviours and the savings that can emanate out of the preventive policies can convince the governments and policy makers to implement necessary steps. Therefore, this article summarises the findings of Poduri (2016) and Kinchin and Doran (2017) and revises their estimates for India and Australia, respectively with the latest data available, i.e., for the year 2018.
According to the annual reports published by the National Crime Records Bureau, India’s suicide rate has increased from 6.3 per 100,000 in 1978 to 8.9 in 1990. The reported number of cases then fluctuated between 2006 and 2011, when it reached 11.2. The rates among the males ranged around 14 per 100,000 while for the females, it decreased from 9 to 7 per 100,000 in 2013. In 2018, the total number of suicides reported in India was 134,516 and compared to 131,666 in 2014.
In Australia, suicide has remained one of the primary reasons for most of the deaths. In 2014, it was the leading cause of fatality for males aging between 25-44 and females aged 25-34. In 2018, 3,046 deaths were caused by suicides and the rate stood at 12.2 per 100,000. This attributed to 1.9% of all deaths in the country.
Costing Methodology and Estimates for Australia
Kinchin and Doran (2017) use the methodology developed by Industry Commission of Australia that identifies the direct and indirect costs of suicides and NFSBs for various economic agents including employers, workers and the government. The costs have been segregated as per the severity of the cases as shown in Table 1. Further, there were six groups that were used to derive the total cost of suicides and NFSBs, namely the production
disturbance costs, human capital costs, medical costs, transfer costs, administrative costs and others. The costs, their description and the actual incidence point of them between the employer, the worker and the government have been summarised in Table 2.
Table 1: Severity of the Suicides or NFSBs
|Category Label||Severity||Category Definition|
|Short Absence||Less than five days off work||A minor work-related injury or illness, involving less than five working days absence from normal duties, where the worker was able to return to full duties|
|Long absence||Five days or more off work and return to work on full duties||A minor work-related injury or illness, involving five or more working days and less than six months off work, where the worker was able to return to full duties|
|Partial incapacity||Five days or more off work and return to work on reduced duties or lower income||A work-related injury or illness which results in the worker returning to work more than six months after first leaving work|
|Full incapacity||Permanently incapacitated with no return to work||A work-related injury or disease, which results in the individual being permanently unable to return to work|
|Fatality||Fatality||A work-related injury or disease, which results in death|
|Conceptual Group||Cost Item||Employer||Worker||Government|
|Production disturbance costs||Value of lost production||Overtime premium and value of wages paid while away from work||Zero||Zero|
|Staff turnover costs||Staff turnover costs||Zero||Zero|
|Human capital costs||Net present value of lost earnings||Zero||Zero||Loss of income and welfare payments transferred to worker for loss of wage minus deadweight loss associated with tax revenue forgone|
|Medical cost||Medical and rehabilitation costs||Threshold medical payments||Gap payments||Medical payments not covered by employer or worker|
|Admin. costs||Investigation costs||Employer investigation costs||Zero||Costs of running the compensation system (including investigation claims)|
|Travel costs||Zero||Out of pocket expenses||Compensation for travel costs|
|Funeral costs||Zero||Out of pocket expenses||Zero|
|Other||Carers||Zero||Zero||Payments to carers|
|Aids, equipment, and modifications||Zero||Zero||Reimbursements for aids, equipment, and modifications|
|Transfer costs||Deadweight costs of tax revenue foregone||Zero||Zero||Deadweight costs of tax revenue foregone|
Table 2: Cost Categories
(Source: Kinchin and Doran (2017))
In 2014, the death of 2,419 Australians from suicides implied an age adjusted death rate of 10.3 per 100,000 people. Among these, 903 people were employed at the time of death. Therefore, employing the relationship between suicide and NFSB, as established by the WHO, it can be expected that a total of 13,545 non-fatal suicide attempts took place yielding 2,303 cases of full incapacity and 11,242 cases of short absence from work. Table 3 summarises the average and total costs of suicides and NFSB as estimated by Kinchin and Doran (2017) for the year 2014. The results show that the average cost of short-term absence is around $1,184 per incident whereas a full incapacity costs as much as $2.25 million per case. A fatality, on the other hand, leads to expenses worth $1.69 million. Among these, it is fair to note that that the key contributions to these costs are made by lost income and taxes for full incapacity and fatality. The total cost, at the same time, stands at $6.73 billion for both NFSB and suicide, combined. 77.33% of this is contributed by NFSB resulting in full incapacity, followed by fatality that amounts to 22.5% of the total cost. NFSB
resulting in short absence from work contributed only 0.2% or $13.31 million to the total cost.
Table 3: Costs of Suicides and NFSBS
|NFSB Resulting in Short Absence|
|Production Disturbance Cost||331||3721911|
|Human Capital Costs||0||0|
|NFSB Resulting in Full Incapacity|
|Production Disturbance Cost||38001||87517077|
|Human Capital Costs||2012011||4635964426|
|Production Disturbance Cost||38001||34315206|
|Human Capital Costs||1413325||1276232047|
(Source: Kinchin and Doran (2017))
Table 4 shows our estimates of the costs of suicides for 2018. In 2018, 3,046 deaths were caused by suicides and the rate stood at 12.2 per 100,000. This attributed to 1.9% of all deaths in the country. Therefore, adjusting for the number of suicide cases and inflation, the revised figures for 2018 were estimated. It is seen that, given the assumptions used in the study, the cost of suicides for 2018 stood at $6.03 billion as compared to $1.52 billion in
2014. If we add the costs of NFSB, this figure would be way more than what was estimated for 2014.
Table 4: Revised Estimate for Cost of Suicides
|Production Disturbance Cost||38001||34315206||44674.89||136079707.7|
|Human Capital Costs||1413325||1276232047||1661539||5061047154|
Costing Methodology and Estimates for India
Poduri (2016) estimates the short-term costs of suicides in India for the year 2014. Short- term costs within the first year of a suicide attempt includes hospital expenses, autopsy expense, family counselling, recurrent religious expenses, lost taxes and wages, compensation and potential organs lost for transplant. In the log-term, it is the lost income till retirement, tax rebates, etc. that are lost. Other costs include the emotional distress, stigma and in some cases, even PTSDs. However, alongside these, there are also some monetary savings in terms savings from education expenses, medical expenses and personal maintenance. Table 5 summarises the various costs and savings category and their computation methodology.
Table 5: Cost Category and Computation
|COSTS||Medical expenses||based on 20% consulting, at least one time before committing suicide and cost of one visit|
|Compensation paid by insurers||Proportionate claim amount was computed from insurance average coverage and settlement of claims from official statistics of insurers|
|Compensation paid by government||half the amount given by Telangana Government was taken|
|Lost income/wages||National per capita income and income given by the suicide statistics were taken for computation of lost wages.|
|Lost productivity||World Bank statistics for per capita gross domestic product (GDP) and average dollar value for the year were taken to compute the lost production.|
|Lost assets (potential organ transplants)||The parts that can be of use for transplantation that are lost were computed depending on the market rate and rate of these occurring in general population.|
|Lost taxes||Lost taxes were computed based on the income bracket and relevant years’ tax structure.|
|SAVINGS||Education||The annual cost, including living, food, transport, and education|
|Routine medical expenses||Proportion amount was calculated using the fact that Public and private care system spent 4% of the GDP|
|Routine maintenance expenses||The income computed was taken for this purpose and one-third was taken for personal maintenance expenses.|
|Others||Police investigation, post mortem and transport expenses, funeral expenses, and recurrent death-related expenses in the first year were computed basing on local inquiries and prevailing rates|
(Source: Poduri (2016))
In 2014, there were a total of 131,666 suicides in India and the adjusted male and female numbers were 89,139 and 42,527 respectively. Table 6 depicts the total costs and savings caused due to suicides. Whereas the former amounts to Rs. 424,793.6 lakhs, the latter computes to merely Rs. 75,950.95 lakhs, thereby leading to the overall cost being Rs. 34,8842.7 lakhs, for the year 2014. When these numbers are adjusted for the number of suicides and inflation, the cost rises even further. In 2018, 134,516 fatalities were caused due to suicides. Whereas, the total expenditure from the same stood at Rs. 658,066 lakhs, the savings amounted to Rs.117,659 lakhs, yielding an overall cost of Rs. 5404,07 lakhs.
Table 6: Expenditure, Saving and Total Cost of Suicides in India
|Police Investigation, post mortem &transportation expenses||6583.3||10198.48|
|Recurrent death related expenses||28588.2||44287.23|
|Compensation paid by insurers||148.73||230.4042|
|Compensation paid by Government||37080||57442.25|
|Routine Medical expenses||5778.21||8951.27831|
|Routine maintenance expenses||41934.74||64962.9433|
|Total Cost =||348842.65||540407.435|
(Source: Poduri (2016))
Potential Impact of Implementing a Workplace Suicide Prevention Scheme
An example of a suicide prevention scheme that Kinchin and Doran (2017) use is Australia’s Mates in Construction (MIC). It is an early intervention and multimodal prevention scheme and has three main components: General Awareness Training (GAT), Connector Training (CT) and Applied Suicide Intervention Skills Training (ASIST). While the GAT involves training sessions given by accredited trainers to raise awareness against suicides, the CT involves appointing a connector to keep the co-workers safe and connecting them to an ASIST trained worker. Therefore, given these aspects, the cost of implementing the MIC in Queensland was estimated to be $37.46 per worker per year. Using the employment figure of 11,582,797 in 2014 and a 9.4% rate of exposition to the scheme, it is estimated that there would be 0.91% reduction in the number of suicides. This, in turn, would lead to economic benefits amounting to $61.23 million each year. The majority of these benefits were estimated to flow to the government totalling up to $61.25 million each year. With the total cost of implementing such a program being $40.94 million, the benefit cost ratio computes to approximately 1.5:1, making the program a profitable economic investment from the public funds.
Table 7: Potential Savings from a Scheme like the MIC
|Type of Incident||No. of Incidents Reduced by MIC Each Year||Average Cost per Incident||Total Cost Savings||% Savings to Government|
(Source: Poduri (2016))
It must be noted that the cost of death is a notional concept and any methodology adopted cannot be perfect. Moreover, the costs and benefits associated with suicides and the prevention schemes will vary from age, sex, capacity, economic status, etc. The computations used by Poduri (2016) and Kinchin and Doran (2017) are based on many assumptions that are inevitable in such an analysis and hence, gives only an approximate estimate of the costs of suicides.
In conclusion, it is important to note that the rates of suicides and non- fatal suicide behaviour are extremely high in the entire world. Although being employed does help in reducing the same, over one-third of the fatalities caused by suicides were among the employed people. Therefore, using the above analysis, it can be concluded that the economic burden of $6.73 billion in Australia Rs. 54 billion in India can be avoided with intervention schemes like the MIC. Other measures like proper treatment facilities at affordable rates should be complemented with public education and awareness campaigns. Suicide is a multifaceted issue requiring the prevention schemes to be multidimensional. Cooperation, collaboration, coordination and commitment are needed to establish and develop nation-wide plans which should not only be cost effective but also sensitive to the needs of the community. Today, suicide prevention is a public and social health objective, alongside being a traditional exercise in the mental health sector. Therefore, the time is apt for everyone to undertake active roles in suicide prevention so that the lives of thousands of people can be saved.
- Kinchin, I. and Doran, C. (2017). The Economic Cost of Suicide and Non- Fatal Suicide Behavior in the Australian Workforce and the Potential Impact of a Workplace Suicide Prevention Strategy. International Journal of Environmental Research and Public Health. Available at SSRN: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409548/
- Poduri, G. (2019). Short-term Cost of Suicides in India. Indian Journal of Psychological Medicine. Vol: 38(6), pp: 524-528. Available at SSRN: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178035/
- Snowdon, J. Indian Suicide data: What do they mean? Indian Journal of Medical Research, Vol 150(4), pp. 315-320. Available at SSRN: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902359/
- Suicide Facts and Stats. Life in Mind. Available at SSRN: https://lifeinmind.org.au/about-suicide/suicide-data/suicide-facts-and-stats#:~:text=In%202018%2C%20preliminary%20data%20showed,suicide%20rate%2012.2%20per%20100%2C000).&text=In%202018%2C%20preliminary%20data%20showed%20an%20average%20of%208.3%20deaths,attributed%20to%20suicide%20in%202018.