The Small African Country with the Highest Suicide Rate in the World

It’s a steep climb from the main road to 79-year-old Matlohan Molloy’s home in Lesotho, one of the highest countries in the world.

The mother of 10 welcomes me into her tidy house and shows me pictures of her large family. I’m here to talk about one of her children – her eldest, Tlohang.

At 38, he has joined a grim statistic in Lesotho, the Kingdom in the Sky, which has the highest suicide rate in the world.

“Troyhan is a good son. He has spoken to me about his mental health issues,” Ms Molloy said.

“Even on the day he committed suicide, he came to me and said ‘Mom, one day you’re going to hear about me committing suicide’.

“I am so sad about his death. I really wish he would explain in more detail what was bothering him. He was afraid that if he told others, they would think he was a weak person who couldn’t solve his own problems.”

According to the World Health Organization, Lesotho has an annual suicide rate of 87.5 people per 100,000 population.

By comparison, that number is more than double that of the next country on the list – Guyana in South America – which has just over 40.

It is also nearly 10 times the global average of 9 suicides per 100,000 people.

Some NGOs, such as HelpLesotho, are determined to change this by equipping young people with the skills to manage their mental health.

In the town of Hlotse, about two hours’ drive from the capital, Maseru, I attended one of the regular group therapy sessions for young women organized by social worker Lineo Raphoka.

“People think it’s against our African principles, our cultural experience, against our spirit as Africans and as a community as a whole,” Parsings, 24, told the group.

“But we also shy away from the fact that this is happening. I’m speaking from the perspective of suicide, having lost three friends and having attempted suicide myself.”

Everyone here has had suicidal thoughts or knows someone who has died by suicide.

Thirty-five-year-old Nzoki became emotional as she told the group her story of being raped in hospital.

“The doctor said I was too attractive. He then pulled out a gun and told me he wanted to have fun with me and if I didn’t he would kill me.

“Every time I thought about suicide, I thought it was the only solution. But I couldn’t do it, I didn’t have the strength. The only thing that kept me going or alive was the faces of my brothers. They believed I was strong, but I was weak.”

Everyone comforted her and reassured her that she had the courage to share her feelings.

By the end of the session, all the women were chatting, smiling, and saying that sharing their stories made them feel better.

The reasons why people commit suicide are often complex and it is difficult to identify a single cause.

Still, Ms. Lafuka said she had discovered something that could explain Lesotho’s high suicide rate.

“Most of them have experienced rape, job loss, death, etc. They abuse drugs and alcohol.”

According to the 2022 World Population Review, 86% of women in Lesotho have experienced gender-based violence.

Meanwhile, the World Bank says two in five young people are not employed or in education.

“They don’t get enough support from their family, friends or any connections,” Ms. LaFouca continued.

This is something I hear often in Lesotho. Time and again, people say they don’t feel comfortable talking about their mental health issues because others might judge them.

One evening, I was sitting in a bar in Helotes, where male patrons were chatting about politics over local beer and a football match was on TV, and I turned the conversation to mental health.

“We did talk about it, and we said let’s have this discussion in the open,” Kosi Mpiti told me.

Some people worry that if they reveal too much, they might be gossiped about. Still, he said the situation is getting better.

“As a group of friends, we are very supportive. If I have a problem, I tell everyone and we support each other.”

But when people seek help, they face difficulties in the public health system.

Last year, the country’s only psychiatric department was criticized by the Ombudsman, an official tasked with safeguarding the public interest, for not having a psychiatrist since 2017.

She also highlighted widespread human rights violations, including “violating living conditions”.

Previously, the country had no national mental health policy to deal with the crisis, although the government elected in October 2022 said it was drafting one.

“Mental health issues have become an epidemic,” acknowledged MP Mokhothu Maharanyane, who leads the parliamentary committee dealing with health issues.

He told the BBC: “We are making sure we step up our outreach from primary schools to secondary schools and then to places where young people gather, like football tournaments.”

“The policy will also have specific provisions on treatment and allow those affected to undergo rehabilitation treatment.”

He also said Lesotho could learn lessons from its fight against HIV/AIDS.

In 2016, the country became the first to introduce a “test and treat” strategy, meaning people can start treatment as soon as they are diagnosed. Infection rates have been falling.

“Our experience is that having an open conversation, rather than blaming or criticising people for their situation, helps turn things around.”

Back on the hill, Ms. Molloy took a short walk to tend to Trohan’s grave.

His final resting place is a scenic plot of land dotted with streams, green spaces and small houses.

Ms Moloi is one of many people in Lesotho who have suffered the grief of suicide.

As we admired the view, she said she wanted to say something to those who felt the same way as her son.

“I want to tell people that suicide is never the answer. What you have to do is talk to the people around you so they can help you.”

If you are affected by the issues in this story and are experiencing distress or despair and need support, you can talk to a health professional or an organisation that offers support.

In the UK, you can get help from: BBC Action LineFor more information on help available in many countries, visit Global Friends Association.