#22 - Dr Leah Utyasheva on the non-profit that figured out how to massively cut suicide rates

Problem Scope and Severity

• Approximately 150,000 people die annually from pesticide self-poisoning, accounting for roughly 20% of all global suicides (out of ~800,000 total suicide deaths).
• The issue is severely underreported due to social stigma surrounding suicide, particularly in low-income agricultural communities in Southeast Asia and parts of Africa.
• Case fatality rates for pesticide poisoning range from 40% to 70%, compared to less than 1% for methods common in the West (e.g., analgesic overdose).
• For example, ingesting just 20ml of paraquat has a fatality rate of 60-70%.
• Suicide attempts involving pesticides are typically impulsive events with less than 30 minutes of premeditation.
• Less than 10% of individuals who attempt suicide via pesticides repeat the attempt if the primary means are removed.
• Pesticide suicides often function as a "cry for help" or a mechanism to cope with immediate stressors (e.g., family conflict, financial struggle, gender violence) rather than a premeditated desire to die.

Intervention Strategy: Means Reduction

• The Centre for Pesticide Suicide Prevention advocates for "means reduction," specifically banning or restricting access to Class 1A and highly toxic Class 2 pesticides, rather than attempting to change global suicide rates through mental health awareness alone.
• This strategy relies on the premise that if lethal means are inaccessible during a crisis, suicidal impulses often pass before alternative, less lethal means can be accessed.
• The organization rejects "safe storage" (e.g., locking pesticides in boxes) as ineffective, citing evidence that boxes are easily broken into, keys are forgotten, or pesticides are purchased specifically for the act of poisoning.
• Alternatives to highly hazardous pesticides exist and are supported by WHO and UN guidelines, though the older, more toxic pesticides are sometimes slightly cheaper.
• Highly hazardous pesticides also cause incidental harm, including occupational exposure for workers and accidental poisoning of children and non-target individuals (e.g., children eating food cooked in pesticide containers).

Evidence of Efficacy and Cost-Effectiveness

• In Sri Lanka, a sustained ban on five highly hazardous pesticides (1998–2011) correlated with a 70% reduction in the national suicide rate, dropping from 57 per 100,000 (1995) to 17 per 100,000.
• This intervention in Sri Lanka is estimated to have saved approximately 93,000 lives.
• Similar significant reductions in suicide rates were observed in Bangladesh and South Korea following the banning of highly hazardous pesticides.
• Estimated cost-effectiveness of the intervention ranges from $2 to $7 per life saved in Sri Lanka, with broader estimates up to $400 per life saved when accounting for implementation costs like monitoring and research.
• The intervention is projected to be more cost-effective than many other global health interventions, including malaria prevention.

Organizational Launch and Funding

• The Centre for Pesticide Suicide Prevention was founded in 2016 by Leah Utyasheva (legal/policy expert) and Professor Michael Eddleston (toxicologist/physician).
• The charity recently received an incubation grant from GiveWell to initiate work in India and Nepal.
• The organization is initially affiliated with the University of Edinburgh to utilize its legal infrastructure and reduce operational overhead, allowing resources to be directed toward field work.
• The team plans to collect data from 20 hospitals in India and 10 hospitals in Nepal to identify specific pesticides used for suicide and present evidence-based policy choices to local decision-makers.
• They intend to partner with local pesticide registrars, civil society, and UN agencies (WHO, FAO) rather than operating solely as an external entity.
• The GiveWell grant is for a two-year period, with goals to demonstrate cost-effectiveness and secure renewed funding from organizations like Open Philanthropy.

Policy Implementation Challenges and Strategy

• Implementation costs involve researching country-specific pesticide brands and active ingredients, as there is no universal list of banned substances.
• Policymakers are generally receptive to the intervention due to low budget requirements, alignment with UN Sustainable Development Goals (SDGs), and the potential to relieve strain on overburdened health systems.
• Current health systems in affected countries are often overwhelmed by pesticide poisoning cases, with some hospitals dedicating 60% of resources to such patients.
• Success relies on demonstrating that the government fulfills its human rights obligation to protect citizens' health and life, countering arguments regarding limited resources.
• The team acknowledges that means reduction is a necessary but not sufficient intervention; long-term goals include improving general mental health infrastructure and ensuring ethical media reporting on suicide.

Founder's Background and Motivation

• Leah Utyasheva brings extensive experience in drafting legislation for human rights, gender equality, and anti-discrimination in Europe, Canada, and Russia.
• She has previously succeeded in repealing visa restrictions for people living with HIV and improving domestic violence legislation in the former Soviet Union.
• The founders chose to establish a new charity rather than joining existing NGOs because the specific issue of pesticide suicide was neglected by all major organizations, which focused instead on environmental or occupational toxicity.
• The decision to create a dedicated entity allowed for a specialized focus on "harm reduction" and "means control," a strategy distinct from the industry's historical advocacy for safe storage.
• Utyasheva recommends starting new non-profits for problems with demonstrated solutions that are currently unaddressed, noting that while registration is straightforward in the West, it can be challenging in jurisdictions with restrictive views on civil society.