On World Suicide Prevention Day, we need to ask a difficult question: Are we trying to prevent suicide too late?
India has built important mechanisms for responding when someone is in crisis. Helplines, emergency services and crisis intervention can save lives, and they remain essential. But prevention cannot begin only when a person reaches the point of crisis.
By then, months of warning signs may already have been missed.
A person may have been living with persistent low mood, anxiety, social withdrawal, hopelessness, changes in behaviour, substance use or thoughts of self-harm long before anyone recognised the seriousness of what was happening.
A person should not have to become suicidal to qualify for mental-health care.
That is where India’s suicide-prevention conversation needs to move next: from responding to crisis alone to identifying psychological distress earlier and connecting people to appropriate care before the situation escalates.
India cannot afford to intervene only at the point of crisis
The latest National Crime Records Bureau data recorded 171,418 suicides in India in 2023, with a suicide rate of 12.3 per 100,000 population. While the rate was marginally lower than in 2022, it remains exceptionally high and underscores the scale of the challenge.
At the same time, India’s mental-health treatment gap remains substantial. The National Mental Health Survey found treatment gaps ranging from 70% to 92% across different mental disorders.
These numbers tell us something important: the problem is not simply what happens when someone reaches a suicidal crisis. The larger challenge is how many people are struggling before they ever reach a mental-health service.
Stigma remains one of the biggest barriers. Individuals and families may hesitate to seek psychiatric help because of fear of judgement, social stigma or the belief that the problem will resolve on its own. Persistent low mood may be dismissed as stress. Withdrawal may be seen as a personality change. Anxiety may be normalised. Self-harm may be hidden.
By the time professional help is sought, the illness may have progressed significantly.
The missing layer between “at risk” and “in crisis”
At Athena, we believe this is where a critical layer of care is needed: early identification, clinical risk assessment and continuous follow-up.
Our intake process includes structured psychiatric assessment, with suicide risk forming an important part of the evaluation. Assessment of depressive symptoms and suicidal ideation may be supported by standardised tools such as the PHQ-9, including its suicide/self-harm item. Where clinically indicated, a more detailed structured suicide-risk assessment may also be undertaken using tools such as the Columbia-Suicide Severity Rating Scale (C-SSRS).
These tools are not used in isolation.
Clinical judgement remains central. The treating psychiatrist considers suicidal thoughts and intent, previous attempts or self-harm, psychiatric symptoms, substance use, psychosocial stressors, protective factors and family support.
The objective is simple: understand the level of risk and match the patient to the right level of care.
For one patient, that may mean outpatient treatment with monitoring and follow-up. For another, it may require more intensive psychiatric intervention or inpatient care. When there is an immediate safety concern, urgent stabilisation and emergency intervention may be necessary.
Most importantly, risk is not a static label. A patient’s mental state can change, which means risk must be reassessed over time.
Care cannot end after the consultation
Early identification only works if there is continuity after the initial assessment.
At Athena, a dedicated Care Continuum team supports structured follow-up after clinical assessment and treatment. The team coordinates scheduled follow-ups, tracks patient progress and maintains relevant clinical data, while facilitating communication with families and caregivers where appropriate.
The frequency and nature of follow-up are individualised according to the patient’s clinical condition and risk level. If suicidal thoughts, self-harm behaviour or other indicators of deterioration emerge, the patient’s care can be escalated accordingly.
This creates an important layer between “identified as at risk” and “in crisis.”
A patient should not simply disappear from the care system after the immediate consultation or treatment episode. Continuity matters because recovery is rarely a single event. It is a process.
Families can be an early-warning system
Families are often the first people to notice that something has changed.
A person may stop participating in activities they once enjoyed. Their sleep or routine may change. They may become increasingly withdrawn, anxious or hopeless. Their behaviour may become markedly different. They may begin expressing thoughts of self-harm or that life is no longer worth living.
Families need to know that these changes should not simply be dismissed as a phase, stress or a personality issue.
At Athena, caregiver involvement focuses on helping families recognise these warning signs and respond with empathy rather than judgement. They are also guided on when to involve the clinical team and which changes should prompt urgent escalation.
The goal is to make the family a partner in early identification and continuity of care, not simply someone who is contacted when a crisis has already occurred.
A helpline can start the conversation. Care must continue beyond it.
Helplines such as KIRAN and iCALL play an important role in suicide prevention by providing immediate emotional support and crisis counselling.
But a crisis conversation is not the same as a clinical care pathway.
Some people need psychiatric assessment, treatment, family involvement, safety planning, monitoring and continued follow-up. That is the gap Athena seeks to address.
For patients who are at risk but not in immediate crisis, this may involve early assessment, treatment, caregiver involvement and structured follow-up through the Care Continuum team.
For patients experiencing an acute crisis requiring urgent intervention, Athena also has 24×7 patient-retrieval support, with a psychologist as part of the response team, helping facilitate safe transfer to the appropriate level of clinical care.
The distinction is important.
A helpline can be the first lifeline. But someone in distress may still need a clinical system that stays with them after the call ends.
One night, a crisis call changed a trajectory
One Athena case illustrates why rapid intervention and continuity of care need to work together.
A young person experiencing significant psychological distress while navigating a gender transition was at immediate risk of jumping from the second floor of her home. At around 2 a.m., her mother contacted Athena’s crisis support line seeking urgent help.
The crisis team established contact, helped calm the young person and mobilised a response team to the family’s home. She was subsequently brought safely to Athena for psychiatric assessment and treatment.
Her mother remained involved throughout the treatment process, providing an important source of support and continuity.
With clinical care, family involvement and ongoing support, the patient was eventually able to return home and resume her life.
That night, rapid intervention created something critical: time.
Time for the immediate danger to pass. Time for clinical assessment and treatment to begin. Time for the family to become part of the recovery process.
Suicide prevention is not only about preventing the final act. It is also about creating enough opportunity for treatment to change the trajectory.
Prevention has to move upstream
Suicide prevention cannot remain confined to hospitals and crisis services.
Athena has also been involved in mental-health camps in rural and underserved communities, school-based initiatives and corporate mental-health workshops. These programmes focus on mental-health literacy, recognising early warning signs, reducing stigma and encouraging people to seek professional help earlier.
Athena has conducted workplace mental-health workshops for organisations including Tata Steel, with sessions addressing stress, its impact on mental health and practical approaches to managing stress.
Stress alone does not explain suicide, which is a complex and multifactorial phenomenon. But for some individuals, significant or prolonged stress can contribute to worsening mental health and may form part of the pathway towards self-harm or suicidal thinking.
This is why prevention needs to begin where people live, study and work — not only when they arrive at a psychiatric facility.
What needs to change at the system level
India needs to move from a predominantly crisis-response framework towards a system of early identification, accessible treatment and continuity of care.
First, implementation of the Mental Healthcare Act, 2017 needs to translate into accessible services on the ground, particularly outside major urban centres.
Second, mental-health insurance coverage needs to become more meaningful at the point of care. While mental illness is recognised within India’s insurance framework, there can still be a gap between having coverage and accessing it seamlessly. At Athena, we continue to see instances where cashless authorisation for mental-health treatment is not approved even when a policy provides mental-health coverage, while reimbursement claims may subsequently be considered and paid depending on the policy terms.
There is therefore a need for greater clarity and consistency around cashless access and reimbursement, particularly so that financial barriers do not discourage people from seeking treatment early.
Third, early mental-health support needs to become more routine in schools, colleges and workplaces. Schools should have access to trained counsellors and clear referral pathways. Workplaces should move beyond one-time wellness sessions towards sustained mental-health support and professional referral mechanisms.
Finally, India needs stronger community-based mental-health services, regional-language resources and better links between primary care and specialist psychiatric services. India’s existing National Mental Health Programme already recognises early detection and treatment as important components of community mental-health care. The challenge is to make that principle more consistently accessible in everyday healthcare.
The real measure of prevention
We often ask whether a crisis was successfully managed.
We should also ask a different question:
Could we have reached this person earlier?
Could someone have recognised the persistent withdrawal? Could a family member have understood that the behaviour change was more than ordinary stress? Could a workplace or school have provided a referral? Could a person have accessed psychiatric care without first reaching a crisis?
These are the questions that should shape the next phase of India’s suicide-prevention strategy.
As Dr. Shradha Malik says:
“A person should not have to become suicidal to qualify for mental-health care. By the time someone reaches a crisis, we may already have missed months of opportunities to intervene.”
The real test of a mental-health system is not only how well it responds when someone is in danger. It is how early it can recognise suffering, how quickly it can connect a person to appropriate care, and whether it can remain connected through recovery.
Prevention begins much before the emergency room.
About Athena Behavioural Health
Athena Behavioural Health is a specialised mental-health and behavioural healthcare provider with centres across India. Athena provides psychiatric assessment, inpatient and outpatient treatment, crisis intervention, family involvement and structured follow-up through its Care Continuum team.
By Dr. Shradha Malik, Founder & CEO, Athena Behavioural Health
On World Suicide Prevention Day, September 10, 2026
Website : https://www.athenabhs.com/
