One afternoon in Feb 1986, when suicide was still spoken of in hushed tones, psychiatrist Dr Lakshmi Vijayakumar rented a building, with borrowed furniture and a rotary phone, and started Sneha, one of India’s first volunteer-led crisis helplines.“No one thought it was necessary. No one believed we could stop suicides, and that too by training volunteers to listen to those in distress,” says Dr Lakshmi. “But seeing ads in the newspapers and through word of mouth, someone reached out every day for the first week. That has not stopped in the past 40 years.”Over the years, Sneha has handled more than 1.5 million calls and expanded beyond a helpline into work spanning research, advocacy and public health reform. What began as a small listening service gradually became part of a wider effort to address suicide prevention in India.The turning point that set her on this path came years earlier, when she was an intern. A man in his late 20s was wheeled into Madras Medical College. “He had ingested cyanide,” says the 70-year-old. “Most doctors had given up hope, but I remembered reading that sodium thiosulfate could act as an antidote. We tried it and the man survived. Soon after, I, still an intern, was asked to present the case before a panel of senior medical experts.”Months later, the man met her on Marina Beach. He was married, expecting a child, and full of gratitude. “That’s when I realised how much timely care can change a life. I decided to pursue psychiatry,” she says.At the time, psychiatry, suicide prevention, in particular, received little focus in India. Medical textbooks described older white men, especially those who were lonely, socially isolated, or widowed, as being at high risk of suicide. But in hospital wards, students were seeing something quite different: young, often married individuals whose distress was due to social pressure rather than clear mental illness. “What we saw did not match what we were taught,” she says.“Only three or four NGOS were working on mental health at the time,” says Chennai-based psychiatrist Dr R Thara. “People didn’t think mental health required professional care. Suicide prevention was virtually uncharted territory. It was a punishable offence and dealing with it was a struggle for Dr Lakshmi and team.”In 1983, a conference in Vienna exposed Dr Lakshmi to a different way of thinking about suicide, one that framed it as a social issue as much as a medical one. Guided by Vanda Scott, who was chairman of Defenders International, an organization that trained volunteers to support people, insights from that visit became Sneha’s founding philosophy – getting volunteers to speak to listen to people in distress.Sneha did not have to pay salaries, but it still needed money to cover rent and basic expenses. Philanthropists stepped in at this stage. “We were losing young people to suicide. I felt we needed to support this effort,” says industrialist Nalli Kuppuswami Chetti, among the organisation’s earliest patrons. “Some of us contributed. I was a board member then and continue to be associated because of the difference the institution has made,” he says.In the early years, nearly three-fourths of those seeking help walked in to speak to volunteers, who worked in two shifts. As telephone access increased over the next decade, more people chose to call instead.“Phones help maintain anonymity,” says Sita, a volunteer since 2012. “I walked into the office wanting to volunteer after seeing a newspaper advertisement. I thought we were going to be sitting next to each other and convincing people not to commit suicide. It was just the opposite.”She and many others made it to the team after long interviews – called discussions – to assess empathy, attitude and ability to handle a crisis without being judgmental. “We never asked people their story. We dealt only with their emotions,” says Sita. “We observed that callers were getting younger,” says Dr Lakshmi. “During the exam results season each May, calls surged, most from anxious teenagers, often girls, worried about disappointing their families.”In 2003, a small study by Sneha revealed that several students who died by suicide had missed top grades by just a few marks. Dr Lakshmi took the findings to then chief minister J Jayalalithaa. “The following academic year, the Tamil Nadu govt introduced a supplementary exam programme that allowed Class X and Class XII students to reattempt exams within a month. Over time, suicides linked to exam failure dropped by 70% across Tamil Nadu and by 82% in Chennai.”In 2023, 1,27,622 students appeared for the supplementary exams in the state, and 60,551 of them — about 40% — passed. “The simple policy change saved many young lives,” she says. Several states across India have since introduced a similar model.As its work expanded, Sneha began contributing to mental health policy discussions at state and national levels. The organisation served on advisory committees of leading educational institutions, including the IITs, and later extended its engagement to other sectors such as agriculture.“In Tamil Nadu’s rural areas, pesticide ingestion had long been a common and impulsive method of suicide among farmers. We piloted the use of central pesticide storage sheds, community-managed lockers that restricted access and encouraged safer alternatives. A decade later, suicide rates in those villages remain lower,” she says.Sneha’s community-based model also travelled beyond Tamil Nadu. When rising suicide rates were reported among Sri Lankan Tamil refugees, the organisation trained volunteers from within the camps to provide peer support. The emphasis on empowering insiders rather than external counsellors was later replicated elsewhere. The UNHCR adapted the approach for refugee camps in Lebanon and Turkey.One of her longest efforts was the campaign to decriminalise attempted suicide. “A woman who survived a suicide attempt was publicly named and shamed in a criminal case. That night, she took her life. We were punishing people for being in pain,” says Dr Lakshmi. She consistently argued that people who attempted suicide needed medical care, not prosecution. After nearly 15 years of advocacy, the Mental Health Care Act of 2017 included a clause recognising this principle.In 2023, India launched its National Suicide Prevention Policy. While Dr Lakshmi had long pushed for such a framework, she says implementation is still an issue. “We treat suicide as a private tragedy, not a public health issue. We are still looking for partners,” she says. From Sneha’s offices, she and her team now train religious leaders and traditional healers, often the first point of contact for people in distress, to recognise warning signs and refer serious cases.The Covid pandemic upended the helpline’s round-the-clock volunteer shifts, forcing a retreat to 8am-10pm phone hours (with chat from 7pm to 1am and 24-hour email support). “Volunteers adapted, and so did callers,” says Sita. “Most young people prefer texting over talking, reaching out via social media.”Profiles stay anonymous — volunteers rarely push for real identities. In high-risk cases, they offer callbacks, though refusals are common. “We’ve hung up, unsure if we helped,” she says. “But Dr Lakshmi reminds us, just being there matters.Sneha Suicide Prevention Centre can be reached at 04424640050
