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The Economic Cost of Suicides

Rohit Harlalka

Suicidal and non-fatal suicide behaviour are serious concerns facing many countries. They take an 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 affects 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

              (Source: Kinchin and Doran (2017))

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


Postvention

Postvention

Zero

Postvention


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

Cost Category

Average

Total

NFSB Resulting in Short Absence



Production Disturbance Cost

331

3721911

Human Capital Costs

0

0

Medical Costs

820

9218440

Administrative Costs

33

270986

Other

0

0

Transfer Costs

0

0

Subtotal

1184

13311337

NFSB Resulting in Full Incapacity



Production Disturbance Cost

38001

87517077

Human Capital Costs

2012011

4635964426

Medical Costs

12515

28822045

Administrative Costs

2634

6066102

Other

80158

184604324

Transfer Costs

109449

252061909

Subtotal

2255769

5195035883

Suicide



Production Disturbance Cost

38001

34315206

Human Capital Costs

1413325

1276232047

Medical Costs

2430

2194290

Administrative Costs

7030

6348090

Other

116100

104838300

Transfer Costs

109449

98832785

Subtotal

1686335

1522760718

Total

3943288

6731107938

                                  (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



 

2014

2018

Cost Category

Average

Total

Average

Total

Production Disturbance Cost

38001

34315206

44674.89

136079707.7

Human Capital Costs

1413325

1276232047

1661539

5061047154

Medical Costs

2430

2194290

2856.766

8701710.211

Administrative Costs

7030

6348090

8264.637

25174083.45

Other

116100

104838300

136489.9

415748376.7

Transfer Costs

109449

98832785

128670.9

391931473.6

Total

1686335

1522760718

1982496

6038682505


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

 

Cost Category

Methodology

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

Head

Gains/Savings

Expenditure /Loss




2014

2018

2014

2018

Medical Expenses

 

 

223.9

346.8533

Police Investigation, post mortem &transportation expenses

 

 

6583.3

10198.48

Funeral expenses

 

 

65833

101984.8

Recurrent death related expenses

 

 

28588.2

44287.23

Compensation paid by insurers

 

 

148.73

230.4042

Compensation paid by Government

 

 

37080

57442.25

Lost income/wages

 

 

151854.35

235244.2

Lost productivity

 

 

131438.21

203616.7

Lost assets

 

 

444

687.8199

Lost taxes

 

 

2599.91

4027.635

Education

28238

43744.7232

 

 

Routine Medical expenses

5778.21

8951.27831

 

 

Routine maintenance expenses

41934.74

64962.9433

 

 

Sub-total

75950.95

117658.945

424793.6

658066.4

 

 

 

 

 

Total Cost =

348842.65

540407.435

 

 

Expenditure

424793.6

658066.38

 

 

Less: Savings

75950.95

117658.945

 

 

 (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

Short Absence

102.3

1184

121163

24%

Full Incapacity

21

2255769

47277964

98%

Fatality

8.2

1686335

13860149

96%

Total

131.5

 

 

97%

                       (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.


 

References


  1. 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/ 


  2. 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/


  3. 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/


  4. 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.


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