The country with the highest suicide rate in the world

Even in his darkest moments, as he resolved to kill himself, Lisema Pinyane could not ask for help.

Mental health was not something people talked about in Lesotho, and he was too proud to let others think he was weak.

“What kind of man cries? I was not able to talk to anyone about it, because I felt like I would be a cry baby,” he says.

Lisema had been orphaned in his teens and was struggling to find good work, his ambitions slipping out of reach. Life was leaving him behind, yet he preferred to isolate himself further – no good would come from seeking support, he told himself.

“I thought what kind of man would be crying, saying he’s going through these white people’s diseases: depression and stress.”

Now aged 24, he admits he came very close to suicide.

If he had killed himself, he would have been one of an estimated 700,000 people each year worldwide, in what the World Health Organisation (WHO) calls a “serious public health problem”.

Nowhere is it more serious than in Lesotho. This landlocked, mountainous kingdom of 2.3 million people encircled by South Africa has the highest suicide rate in the world, with 87.5 suicides per 100,000 people.

In the UK, this figure stands at 10.7, while Cyprus (3.5), Greece (4), Italy (5.6) and Slovakia (6.9) have among the lowest global rates.

Health workers caution that the reasons behind suicide are complicated. Factors include mental illness, addiction, loss, loneliness, financial woes, chronic pain and abuse.

But experts, mental health campaigners and the relatives of the dead in Lesotho told the Telegraph the country had a number of unique factors they felt were worsening its suicide crisis.

The nation’s poverty, its lack of prospects for the young, drug abuse, and strains on family life caused by migrant labour are all blamed for fuelling the high rate.

So too is the lack of treatment and the taboo around discussing mental health, or admitting to problems, particularly among men.

Liau Mochaba has spent 10 years working as a psychotherapist and counsellor in Lesotho’s capital, Maseru. He sees many cases of depression, anxiety, stress, drug addiction and domestic violence.

Suicidal thoughts are common among his patients, he adds, but very few people want to talk about mental health.

“The awareness is very low about mental health issues. When people have mental health problems, they would rather see traditional doctors.”

People are also afraid of being labelled mad. “That’s why some people hide when they have problems,” he says.

For decades, Lesotho’s men left their homes to work in neighbouring South Africa’s mines. This caused its own toll in broken families and marriages. But as that work has dried up, and as the country’s GDP has fallen in the past decade, the lack of money and prospects has added to the pressure on people.

The suicide rate is particularly high in men.

“Traditionally men are providers in our country, so if they don’t have a job, and they have a wife and children and they cannot provide for them, it causes psychological problems,” says Mr Mochaba.

For Lisema, who lost his mother at 10, followed by his father at 17, his suicidal thoughts began to emerge after he failed to secure the grades required to attend a good college.

Hopes of further education soon faded as the need to provide for himself took precedent. That his older brother had departed for work in South Africa, leaving him completely alone, made life harder.

As Lisema struggled to make ends meet, he saw his friends doing well, and, naturally competitive, felt they were leaving him behind.

“I started to say ‘What’s going on? I am trying to do things, but nothing works.’ I started to doubt myself: ‘You are nothing, you can’t do anything.’”

He admits he was too proud to ask for help.

“I thought nobody cared. I looked from side to side and saw that nobody was there for me.

“I thought I’m my only family right now. My brother is in South Africa, so why don’t I end this because I am suffering. I decided I am going to take my life.”

One night he posted of his desperation on Facebook, saying he had tried, but could not go on. “Whoever will be hurt, I am sorry,” he wrote.

He went to sleep in despair. To his surprise, the next morning he was woken by two worried friends.

“They were saying: ‘What are you doing?’ It was then I saw that these people still cared about me.”

This realisation, along with reading other people’s stories posted on social media, made him realise he was not alone and persuaded him to go on. He has since found a better job and his mood has lifted. He wants to encourage others going through the same thing.

“It is a pressure. I think it happens to almost everybody, but then it will pressurise you more if you come from such a family [like mine]. When you have no back-up it is too much.”

Yet Lisema is a rare case. Many men, if they do admit to problems, won’t seek support among fellow sufferers; instead, they often turn to individuals like Malefetsane Liau. As a traditional healer, he dispenses advice from a small shop in a Maseru market.

He admits those who come to him often say they are suicidal.

“Some have even shown me the gun they intend to use to take their lives,” he says.

His treatments include talking, steaming, purging, and bathing in different herbs.

Much of the anguish suffered by his patients can be put down to them losing touch with their cultural traditions, he believes.

“There should be a culture of mental health clinics, where people can be treated culturally. Conventional and traditional medicine must work together.”

The belief that mental health problems should be treated by traditional methods, or by churches, is commonplace, says Nthati Phakoe, a Maseru resident in her late 30s.

When she was diagnosed with bi-polar disorder more than 25 years ago, no one had heard of it, she says. Mental illness was either a white man’s disease, seen only in television dramas, or caused by demons.

Her church believed her own illness was caused by possession and she was tied up during an exorcism. She tried to kill herself five times.

Ultimately it has been medication and psychotherapy that have helped her. So has blogging about her experiences, which has attracted a devoted online following, and she has since founded a self-help group called Tunasafiri to raise the profile of mental health issues. Things are changing, she believes, but slowly.

Men in particular find it hard to talk, she says.

“From when they are born, their fathers, their fathers’ fathers, their peers in the street, the church pastor, the village elders, even your mother says: you do not bleat, you are a man. Nothing supersedes you, nothing is beyond you, you can do anything.”

This wall of silence means that Sekake Mohale has only been able to piece together his son Potsane’s torment after his death. He gave no clue he was about to kill himself in December, aged 17.

His last WhatsApp message to his father, replying to congratulations that he had passed exams, said: “Thank you Dad. I always want to make you proud.” He killed himself the next morning.

Mr Mohale says his son was badly bullied at a prestigious Lesotho school, where the boys appeared to resent him for being moved up a year because he was bright.

One day he was pounced on and kicked so badly he needed to have a testicle removed. His injury just gave the bullies another reason to taunt him.

His father knew there was bullying at the school; it had been an issue when he was a student there 30 years earlier.

Potsane went to counselling after his injury, but was reluctant to discuss it with his father. The bullying went on.

“I tried to talk to him, get him to talk, but it was difficult,” says Mr Mohale, a former ambassador and politician.

It is only by talking to friends and classmates that he has managed to get a glimpse of his son’s situation.

“He was happy, the results were out. But to my thinking, he was again afraid that the results would lead to more bullying. He has been mocked and bullied whenever he has done well.”

He went on: “You are told as a man you must be tough, you don’t have to go around sharing your problems – it’s how we grew up. He was a strong person, he was someone proud of himself who always wanted to be excellent in everything.

“It’s a very, very terrible loss for me. If I knew that this was continuing, I could have talked to people to help him get over this. I could have taken other measures to protect him.”

For those who do come forward seeking help with mental health problems, there is little support from the country’s under-resourced health system.

The government last year said it had one just mental health hospital, with three doctors, two clinical psychologists and two psychotherapists.

Staff at the hospital told the Telegraph it was badly overcrowded and understaffed. Some wards had twice as many patients as capacity. Drug addiction was one of the biggest problems for patients.

Across town at Lerotholi Polytechnic, students gathered to remember a quiet young classmate with a ready smile who had killed herself in early January.

Teboho Mokati always sat near the door, so she could dash out after class.

The polytechnic’s lecture theatre was filled with fellow students from the construction engineering department where she studied. Many of her classmates, mainly young men, wore work overalls.

Recollections from friends and classmates were interspersed with hymns.

At the end, the dean of student affairs pleaded with the students not to make the same choice as Teboho.

“You should not be ashamed to share with your challenges,” she told them. “You can come and see us at any time.”

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