Suicide due to mental illness is emerging as a major public health concern in India. Among all Indian states, Punjab has recorded the highest rate of suicides linked to illness. Every second suicide in the state is attributed to health issues.
Down To Earth spoke with Zimi Angad Singh, senior psychologist (Doctor of Psychoanalysis) and head of Mental Health First India, Bengaluru about the situation in Punjab. Excerpts:
Bhagirath: Over the past few years, Punjab has recorded the highest rate of suicides linked to illness; every second suicide in the state is attributed to health issues. What does this situation indicate?
Zimi Angad Singh (ZAS): A suicide every second means silent invisible depression is going undiagnosed and unnoticed. This situation exposes a deep systemic failure. It should be viewed as a medical crisis and a socio-economic collapse masking itself as a health statistic.
In Punjab, the intersection of agrarian distress and health failure is absolute. The intensive chemical-heavy farming model born from the Green Revolution has left behind a toxic legacy of contaminated groundwater and a severe surge in chronic illnesses most notably cancer, leading to entire areas being colloquially mapped as being part of a “cancer belt.”
Suicide is often misconstrued as an act of economic self-preservation to spare the family from further ruin. But most people miss the deep psychological angle.
The situation suggests that we are not merely dealing with disease, we are witnessing the psychological consequences of the disease.
Let me explain. Growing rate of suicides tell us about the changing nature of suffering in Punjab. We often think of illness as just a medical problem and suicide as a psychological problem. In reality, the two are intertwined.
As the National Crime Records Bureau (NCRB) data notes, Punjab has consistently reported one of the highest proportions of suicides attributed to illness. In 2021, nearly 45 per cent of suicides in the state were linked to disease, roughly 2.5 times the national average at that time. That also means that mental illness accounted for the overwhelming majority of illness related suicides in Punjab.
When someone develops health problems like cancer, chronic kidney disease, paralysis, severe neurological illness or another prolonged condition, the diagnosis affects far more than the body. It changes the identity first, then employment status, family roles, finances and hope for the future. The illness, terminal or not, often becomes a social and psychological burden.
When a family member in a rural household drops into chronic illness, the socio-economic domino effect is rapid.
First there is the debt spiral. Out-of-pocket health expenditures in Punjab are among the highest in India. Private healthcare is predatory and a single major illness can increase a family’s debt burden by an estimated 40 per cent, instantly pushing a vulnerable or marginal family below the poverty line.
Then, there is the finality of choice. That is when a farmer or an agricultural labourer realises that keeping themselves alive means selling their remaining fragmented land holding, the sole source of identity and survival for their children.
Punjab also has a relatively high burden of chronic non-communicable diseases and in some regions, there have long been concerns about environmental exposures and lifestyle-related illnesses. When chronic illness is combined with high treatment costs, loss of livelihood and fear about the future, emotional distress can become overwhelming for the person and the family.
What concerns me most is, ‘The healthcare system often treats the disease but not the distress.’ A patient may receive chemotherapy, dialysis or cardiac treatment, but very rarely is someone asking, “How are you coping emotionally?” Depression and anxiety frequently go unnoticed.
Therefore, I see this statistic as a signal that Punjab needs to move beyond a purely biomedical model. Every patient with a serious illness should be viewed as someone who may also need psychological support. Mental health cannot remain an optional add-on to healthcare. It has to become part of routine clinical care to save lives.
Bhagirath: Mental illnesses play a major role in suicides caused by health issues in Punjab. Based on your experience, what are the reasons behind the rise in suicides due to mental illness?
ZAS: We have already established from NCRB data that suicides are rising. But mental illnesses rarely develop because of one reason. It is usually the outcome of an interaction between biology, psychology and society. That means it is multifaceted.
From my clinical experience, one of the biggest problems is delayed recognition. Depression is often mistaken for weakness. Anxiety is dismissed as overthinking. Many families seek help only when functioning has deteriorated significantly or suicidal behaviour has already emerged.
While the bureaucratic books often classify these deaths under “physical illness,” our clinical realities show that chronic physical ailments and severe psychiatric morbidity are deeply intertwined.
Let’s understand the primary drivers.
One is the socio-cultural hyper-masculinity. Punjabi culture places an immense structural burden on men to present as providers who are physically and economically invincible (Anakh or honour). Admitting to a mental illness or a debilitating physical condition feels like a complete forfeiture of identity.
Then these is the co-morbidity of substance use. Drug and alcohol dependence do not exist in a vacuum. They are often forms of dysfunctional self-medication for untreated trauma, unemployment blues and depression. When substance/drug abuse intersects with chronic health issues, impulse control drops sharply, causing situational distress to turn fatal.
There is also the neurochemical undercurrent. There is emerging neuropsychological concern regarding long-term, low-dose exposure to organophosphates (pesticides). Growing research suggests these chemicals act as neurotoxins that alter acetylcholinesterase levels, which directly correlates with higher baseline rates of severe clinical depression and suicidal behaviour in heavy farming zones.
Also, it should be understood in this social media age that Punjab is undergoing a rapid social transformation. Traditional joint families are shrinking. Migration has become a defining aspiration for many young people. Expectations regarding education, employment and financial success have increased dramatically. At the same time, social support systems have weakened.
There is another aspect that deserves attention, ‘Chronic stress has become normalised.’ We celebrate resilience but often ignore emotional exhaustion.
As discussed before, substance (drug) use and abuse complicate the picture as Punjab geographically is located on major ‘drug routes’. Addiction is both a cause and a consequence of mental illness. Recent Punjab government data show that more than 90,000 people received treatment through the state’s de-addiction and opioid-assisted treatment programmes during the state’s anti-drug campaign, reflecting both the scale of the challenge and the importance of expanding treatment services.
Among young people, I increasingly see anxiety disorders, panic symptoms, social comparison, digital addiction and loneliness. Among middle-aged adults, prolonged caregiving, financial pressures, chronic illness and occupational stress are major contributors.
An important misconception is that suicide occurs because someone “wanted to die.” In most cases, individuals do not want death. They want relief from unbearable psychological pain. That distinction is extremely important because psychological pain is treatable.
Bhagirath: As a psychologist, what trends in mental illnesses are you observing? Please highlight the causes of mental illness.
ZAS: The emerging psychiatric trends that I see as a psychologist are noticeable changes happening over the last decade. That mental health problems are becoming more complex and are appearing at younger ages in India, especially Punjab.
Anomic depression and despair are occurring due to a stagnant agrarian economy, high youth underemployment and the breakdown of traditional joint-family safety nets. Therefore, impact is felt on young adults (18-35 years) who try to migrate abroad, often by fraudulent means.
Intense systemic pressure to migrate abroad is leading to massive debt (to fund travel) and profound grief for those left behind. Suburban and rural youth are mostly impacted.
The mass migration of youth leaves elderly parents behind to manage farms and suffer chronic health conditions alone. They suffer from geriatric loneliness and psychosis. The elderly population (60+ years) are most impacted.
The root causes of mental illness in the region are multi-layered. Structurally, the state is dealing with an identity vacuum. The pride of being the nation’s breadbasket has faded into an ecological and financial bottleneck.
Mechanisation has reduced the need for manual farm labour, leaving a generation of youth with high aspirations but very few viable local economic opportunities. This structural stagnation breeds chronic feelings of worthlessness and existential despair.
Earlier, we commonly saw depression or anxiety in isolation. Today, many individuals present with combinations of problems: anxiety with insomnia, depression with substance misuse, burnout with panic attacks or social media addiction alongside low self-esteem.
Among adolescents and young adults, I observe several emerging themes.
The first is perfectionism. Young people increasingly feel they must excel academically, professionally and socially while maintaining an ideal online image.
The second is loneliness despite hyper-connectivity. We have more digital communication than ever before, yet many people report fewer meaningful emotional relationships.
The third is uncertainty. Whether it is career prospects, migration, employment or financial stability, uncertainty itself has become a chronic psychological stressor.
In simple terms, in Punjab specifically, psychosocial stress cannot be separated from broader social realities. Migration, changing family structures, agricultural uncertainty in some regions, drug use and chronic disease all influence mental wellbeing.
The important message is, ‘Mental illness is neither a character flaw nor simply a biochemical disorder. It emerges from the interaction between biology, lived experience and the social environment.’ Effective prevention therefore requires action not only in hospitals but also in schools, workplaces, families and communities.
Bhagirath: What are the shortcomings in the diagnosis and treatment of mental illnesses and what improvements could address these gaps?
ZAS: The current institutional mechanism for diagnosing and treating mental health in Punjab and India at large, is severely under-equipped. To turn the tide, we must identify these structural gaps and implement targeted interventions.
No doubt, India has made important progress through initiatives such as the District Mental Health Programme and the National Tele Mental Health Programme (Tele-MANAS). However, the treatment gap remains substantial, particularly for common mental disorders.
So, our healthcare system continues to separate physical and mental health. A patient receiving treatment for cancer, stroke or kidney disease should automatically receive psychological assessment because emotional distress significantly affects recovery, treatment adherence and quality of life.
Punjab requires practical interventions.
Mental healthcare must be completely integrated into standard primary care. A farmer shouldn’t have to visit a psychiatrist to get help. Their local community health officer or general physician at an Aam Aadmi Clinic should be fully trained to screen for depression and dispense basic SSRIs (antidepressants) during a routine checkup.
We need to train structural intermediaries such as ASHA workers, auxiliary nurse midwives and local granthis (Sikh priests) in psychological first aid. They can spot the early behavioural signs of withdrawal, substance abuse, or severe depression right at the village level.
Establishing dedicated, well-staffed crisis hotlines that speak the local dialect and understand rural socio-economic stressors is essential to providing immediate, anonymous intervention when an individual hits a breaking point.
In simple words, I believe these five priorities deserve attention immediately and can address the suicide issue in Punjab urgently:
Integrate routine mental health screening into primary care and specialty clinics, especially oncology, nephrology, cardiology and diabetes services.
Strengthen district-level mental health teams with more psychologists, counsellors and psychiatric social workers with psychiatrists.
Expand school and college based mental health programmes, since many mental disorders begin before the age of 25.
Improve training for general physicians and frontline health workers so they can identify depression, anxiety and suicide risk early.
Shift public awareness campaigns from crisis response to early intervention. We should normalise seeking help before distress becomes overwhelming.
Ultimately, suicide prevention is not solely a mental health issue, it is a public health, social and developmental issue. If Punjab wants to reduce illness-related suicides, we must treat the person not just the disease. That means combining medical care with psychological support, social protection and compassionate community engagement.
This interview is part of the article “What suicide statistics conceal”, published in July 1-15 print edition of Down To Earth