Summary

Suggestions for future research in the UK

Theme 1. Self-harm and Stages of Suicide Ideation

Theme 2. Psychological First Aid and Selfcare Plans

Theme 3. The Importance of a Holistic Childhood

Theme 4. Post-Immigration Care

Theme 5. Connecting Globally: A Gender Issue 

• We have the need to collect suicidology data specific to the current Punjabi Sikh generation

• We have the need to ascertain a position recognising suicide ideation as a health issue in Punjabi communities and to share how we are impacted by it and how to implement effective interventions 

• We have the need to modify Gatekeeper Training resources accessible in both Punjabi and English languages

• We have the need to create and share suicide ideation management & prevention tools

• We have the need to empathetically address and understand generational trauma patterns

• We have the need to develop support systems to recognise the importance of self-preservation

• We have the need to encourage Punjabi women and girls to forge spaces within healthcare practices

Next Steps

Next steps in working with Punjabi women and girls 

The recommendations for a move forward would include:

• The setting up of a suicidology support network for Punjabi Sikh communities

• A holistically designed approach in dealing with trauma

• Suicide prevention training with language and age appropriate delivery

• Acknowledging the lived experiences of suicide from Punjabi communities

• Working with representatives in Punjab and globally with mental health researchers

• Working on improving life longevity for Punjabi women and girls in the UK

• Fundraising for future Sikh-led charitable events 

Summary

Discussion & Conclusion

This section discusses and summarises my Churchill Fellowship research journey. I attained knowledge of a range of suicide interventions aiding diaspora communities living in India and Canada. I discovered approaches that may be beneficial for British, Punjabi Sikh women in the form of self-care and have a greater understanding of the stages of ideation. I now recognise that some Punjabi born women struggle with the transition from their homeland of Punjab to another country and overwhelmingly encounter stressors. These may be from study, marital union and the adaptation of culture and systems within the new country.

The interviewees in the places I visited conveyed some of their life experiences of suicidology giving an insight into stressors. From the experts' feedback, I gained further insight into interventions that have been developed over time throughout their professional careers. I was less concerned with comparing interventions from different regions, and more interested to know how Punjabi Sikhs approach suicide ideation through cultural attitudes and shared learning.

I learned that in the UK, psychotherapeutic services do not always meet the needs of Punjabi women who require informed suicide ideation support. Issues of unrelatability and unaffordability dissuade them from utilising these services. In the regions I visited in India there were equally inequalities within psychotherapy and linked healthcare. However, systemically in comparison to the National Health Service, the attitude towards the use of holistic and alternative therapies combined with allopathic medicine were much more favourable.

We hear from Case A where she was limited in accessing support from Sikh voluntary groups based in her UK university in comparison to a different university which was functionally inclusive. This demonstrates that inconsistencies occur within support structures with possible reasons linking to underfunding or ineffective leadership. We know that peer-organized support in preventing isolation and sharing ideation experiences online in anonymity is advantageous. Offering opportunities to young people to become ambassadors within their neighbourhoods and educational spaces helps enable lifesaving actions. The promotion of mental health dialogue energises community relations and provides future generations with readily available support tools and knowledge that can be further built on. 

Gatekeeper Training as an intervention is beneficial if Punjabi women in rural areas are able to communicate effectively in regional language. A level of confidence and literacy is required in providing psychological first aid to others. We risk excluding some women who do not have these personal skills and digital services. In summary, a simplified form of training would be appropriate for those who do not speak English as a first language. The Sikh identity Census UK (2021) revealed that a high percentage of Sikh elders are less likely to converse in English therefore, we should be mindful of this demographic. The digital divide between Punjabi generations requires acknowledgement. In fast-changing societies a collective approach is recommended in constructing effective intervention planning.

We learn that religion serves its own forms of intervention support and the recommendation of reconnecting with Sikh principles was raised by most of the interviewees. The concept of volunteering and maintaining focus in the present by engaging in prayers was said to be beneficial for re-establishing spiritual equilibrium. Barriers to participation, as raised by one case study, revealed that she was often not permitted to attend any place of prayer on her own. There are some restrictions placed by family particularly on younger women impacting on their ability to access social spaces. Notably, it is the youth-aged demographic who are at risk of suicide the most, as seen from data collected by Outlive. The need to address emotional regulation during childhood was explained by football coach Vikram Singh via his coaching ethos. In the UK we see emerging diversity within Punjabi Sikh communities, and consequently a rise in younger non-Punjabi speaking populations. Therefore, the association of traditional cultural spaces as being accommodating for all has to be disputed due to changing societies. 

We are informed by interviewee feedback and from researchers Currie and Bedi (2019), that Homeopathy, Cognitive Behavioural Therapy (CBT), Somatic Therapy and other alternative therapies are effective in treating anxiety and depression. Furthermore, the benefits of physical massage therapies specifically for trauma recognition in Punjabi communities was explained by Kulpreet Singh. Research also reveals that "massage therapy lowers depression and anxiety levels, and lowers cortisol stress hormone levels" (Hart et al, 2010).

We know that during 2020 touch therapies were not permitted during social distancing restrictions resulting in disruption of human connection. Consequently, the absence of nerve calming sensations of 'touch' as physical comfort would have led to increased anxieties. Dr Jahnvi Sharma detailed the importance of a psychosomatic approach in treating her most anxious clients. She prescribed nerve calming rescue remedies as an emergency approach before proceeding with actual treatment. We are told that suicide rates overall in India are of the highest in the world, and that Punjabi communities are at risk of suicide in the UK. Suicide ideation is universally recognised as 'a clear and present danger-sign of worsening mental health' (Quinnett, 2021). 

Fellowship journey

Acknowledgements   

References 

Gallery