Mental Health and Suicide Decriminalization: Connecting the Dots





Suicide is a current public health crisis as every year, more than 800,000 individuals die by suicide worldwide. According to World Health Organization (WHO) estimates, 77% of these deaths occur in low- and middle-income countries (LMICs). In context of mental illness only, the reported percentage of completed suicides varies from 60% to 98% of all suicides.2,3 Many of the remaining episodes have to do with interpersonal or financial issues, and the crises that follow. Nonetheless, prejudice, violence, and armed conflicts can be some of the other reasons.3 At the start of the twenty-first century, depression accounted for thirty percent of deaths worldwide from unnatural causes. Substance-use disorders came in second with eighteen percent, schizophrenia with fourteen percent, and personality disorders with thirteen percent.2
In June 2022, twenty nations had suicide attempts criminalized and subject to penalties.4 One prominent defense of criminalization of suicide was that it deters people from trying to die by suicide and thus may be a successful suicide prevention strategy but according to the literature, this idea is at best false and at worst deceptive. According to a recent study, there is no conclusive evidence that nations with criminalized suicide have lower suicide rates than the worldwide average.4.In fact, the suicide rates in five of the seven nations where it is illegal were higher than the global average.4 A recent ecological study of 171 countries has shown that suicide laws are linked to increased national suicide rates particularly among women in non-Muslim nations with low Human Development Index scores.5 Women may be more susceptible to suicidal thoughts due to the patriarchal culture's lack of support and the laws that criminalize suicide. This clearly shows that there is no positive benefit of criminalizing suicide while on the other hand research has shown that suicide rates are decreased by laws that restrict access to fatal suicide methods (pesticides, weapons, and so forth).6 While many countries do not prosecute people who attempt suicide rigorously ,7criminalization of suicide discourages people from seeking help, stigmatizes those who try suicide, and makes it difficult to accurately quantify suicide rates due to misclassification of the event because of law. The care process for people who attempt suicide is complicated by the criminalization of suicide attempts.8 Treatment can be considerably delayed by the criminal justice system.






Introduction
S uicide is a current public health crisis as every year, more than 800,000 individuals die by suicide worldwide.According to World Health Organization (WHO) estimates, 77% of these deaths occur in low-and middleincome countries (LMICs).In context of mental illness only, the reported percentage of completed suicides 2, 3 varies from 60% to 98% of all suicides.Many of the remaining episodes have to do with interpersonal or financial issues, and the crises that follow.Nonetheless, prejudice, violence, and armed conflicts can be some 3 of the other reasons.At the start of the twenty-first century, depression accounted for thirty percent of deaths worldwide from unnatural causes.Substance-use disorders came in second with eighteen percent, schizophrenia with fourteen percent, and personality disorders 2 with thirteen percent.
In June 2022, twenty nations had suicide attempts crimi-4 nalized and subject to penalties.One prominent defense of criminalization of suicide was that it deters people from trying to die by suicide and thus may be a successful suicide prevention strategy but according to the literature, this idea is at best false and at worst deceptive.According to a recent study, there is no conclusive evidence that nations with criminalized suicide have lower 4 suicide rates than the worldwide average.In fact, the suicide rates in five of the seven nations where it is illegal 4 were higher than the global average.A recent ecological study of 171 countries has shown that suicide laws are linked to increased national suicide rates particularly among women in non-Muslim nations 5 with low Human Development Index scores.Women may be more susceptible to suicidal thoughts due to the patriarchal culture's lack of support and the laws that criminalize suicide.This clearly shows that there is no positive benefit of criminalizing suicide while on the other hand research has shown that suicide rates are decreased by laws that restrict access to fatal 6 suicide methods (pesticides, weapons, and so forth).While many countries do not prosecute people who 7 attempt suicide rigorously, criminalization of suicide discourages people from seeking help, stigmatizes those who try suicide, and makes it difficult to accurately quantify suicide rates due to misclassification of the event because of law.The care process for people who attempt suicide is complicated by the criminalization 8 of suicide attempts.Treatment can be considerably delayed by the criminal justice system.

Pakistan and Recent decriminalization of Suicide:
The recent decriminalization of suicide in Pakistan has been a topic of significant discussion and advocacy.Numerous considerations, such as the necessity for mental health interventions and the removal of stigma and punishment connected with suicide attempts, fueled the movement towards decriminalization in the country.

Development of a comprehensive national suicide prevention strategy:
This includes several initiatives including postvention strategy; a series of guidelines designed to assist the community or organization in reacting to a suicide death in a caring and efficient manner.Supporting those impacted by the suicide death and lowering the risk to additional vulnerable people are the main priorities of the first responses.Long-term and intermediate supports for those who have lost a loved one to suicide should also be a part of prevention initiatives.

Training for gatekeepers by building and budgeting for a "post-decriminalization"/ "transition":
A training programme designed to raise awareness among first responders, such as law enforcement, emergency medical personnel, mental health specialists, peer supporters, and other pertinent indivi-duals who come into contact with persons at risk of suicide.

Depression identification and treatment:
It is an important part of suicide prevention strategy.One aspect is increasing budget for mental health specifically and health sector in general so functioning psychiatry and clinical psychology departments are available in all THQs and DHQs.To conclude, the decriminalization of Suicide in Pakistan marks a significant step towards a more compassionate and progressive approach to mental health and wellbeing.However, decriminalization alone is not enough.It needs to be accompanied by comprehensive attempt to understand and address local determinants and factors that increase mental distress and suicide risk.There is also a critical need to increase investment in suicide prevention initiatives and empower communities to identify, recognize, respond to and prevent suicidal behaviors.In post de-criminalization scenario, all stakeholders by working together, can contribute towards a compassionate society, where suicide is not met with punishment but with empathy, understanding and effective intervention.

" 2 Nazish
Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be Mental Health and Suicide Decriminalization: Connecting the Dots 1 Imran, Maryam Ayub January -March 2024 | Volume 30 | Issue 01 | Page 1 Consultant Psychiatrist, Connections Psychiatric Services.Lahore PakistanCorrespondence: nazishimrandr@gmail.com punished with simple imprisonment for a term which may extend to one year, or with a fine, or with both."Theabove line was Section 325 of Pakistan Penal Code, 1860 that dealt with penalizing suicide attempts.The criminalization of suicide law in Pakistan stood till 23rd December 2022 when it was finally announced that the President of Pakistan has approved the Criminal Laws (Amendment) Bill 2022, repealing the said section.It was the second attempt of revoking with first attempt being failed due to inactivity of lawmakers by national assembly in 2017 even though one parliamentary house Production Hosting by KEMU https://doi.org/10.21649/akemu.v30i1.56912024 The Author(s).Published by Annals of 2079-7192/© KEMU on behalf of King Edward Medical University Lahore, Pakistan.This is an open access article under the CC BY4.0 license http://creativecommons.org/licenses/by/4.0/ 2 10 al. 2022. .1. Developing and improving Suicide registry: This will allow for the systematic collection of data on suicides, identify local determinants of Suicidal behaviors, monitor trends, identify high risk groups, and evaluate suicide prevention strategies.