By Thokozani Chenjezi:
Continued from Monday
Just like colonialists recognised as early as 1950s that mental illness is just like any other medical condition, mental health experts and advocates are now questioning the law that sends suicide survivors to jail.
To mental health experts, suicide or attempted suicide is in fact “an emergency mental health case” requiring emergency mental treatment and not incarceration.
The experts argue that the law that sends suicide survivors to jail as punishment and deterrent to would-be offenders is in fact promoting suicide.
Among many arguments against criminalising suicide, the experts classify suicide or attempted suicide as “an extreme or emergency mental health case,” just like a road accident case, hence needs psychiatric treatment and not punishment or criminalisation.
Secondly, they argue that criminalising suicide makes it a taboo topic to discuss hence creates an environment in which Malawians are not equipped with information about mental health with–suicide/attempted suicide as an extreme case–how to recognise the symptoms; where to access mental health services and how to manage mental health problems.
The result is increased suicide thoughts and cases.
Mental health experts also argue that first responders to an attempted suicide case conceal the truth to emergency doctors that the friend or relative they have brought attempted to commit suicide for fear of imprisonment once the attempter survives.
In so doing, they mislead the doctors, risking giving untimely or wrong treatment in the process, which eventually leads to loss of life.
Furthermore, they argue that the concealment is somehow limiting the understanding of the depth of the problem, hence limiting the reach of mental health service provision, leading to increase in suicide cases in Malawi.
Mental Health Users and Carers Association (Mehuca) Executive Director Thandiwe Mkandawire argues that criminalising suicide creates an environment where Malawians cannot recognise symptoms; where to access mental health services and how to manage mental health problems.
“Mental illness is an invisible disability and it is very easy to underestimate the debilitating power of mental health problems and not recognise it as a problem,” says Mkandawire.
Another mental health expert, Charles Masulani Mwale, who is director of services at St John of God Hospitaller Services agrees with Mkandawire that it is wrong to react to a mental health problem with a criminal response.
Mwale says health-seeking behaviour in mental health is already low in Malawi because many people do not realise that they are suffering from a mental health problem requiring services of a psychologist.
He said many people are also in denial once they realise that they have a mental health problem and do not seek help. And when the problems reach breaking point, they attempt suicide.
“The government thinks criminalising it will be a deterrent to others and yet this complicates the issue as it leads to underreporting and adds to non-disclosures of intent to commit suicide.
“So, the consequence of this law is that it is promoting suicide because people can’t come out and get help and as a result, they are successfully committing suicide. To us, criminalisation of suicide is bad because it worsens the already poor health-seeking behaviour on mental health related issues,” says Mwale.
He adds: “If people are not allowed to express themselves, they will just keep it to themselves and commit suicide. The law is actually promoting suicide because it doesn’t promote people to come out to say they have suicide thoughts and need help.”
Psychologist Ndumanene Devlin Silungwe says it is even hard to measure the increase in suicide prevalence in Malawi right now since it is a secretive agenda owing to the criminality attached to it.
Silungwe argues that instead of penalising suicide and throwing the blame on suicide victims, Malawi should blame herself for her change in lifestyle which is now bent on profit and achievement, individualism, status, affluence, profession and disregard of religious values over too much emphasis on human rights and democracy.
He argues that this lifestyle is widening the gap between the rich and the poor hence bringing discontent and hopelessness among those who cannot afford it. The pressure is too high and many are turning to suicide.
“As a result, we have a lot of drug and substance abuse which reduces self-control and alters decision making hence suicide is becoming a result of unmanaged stress and anxiety,” Silungwe says.
Mental health experts have called for decriminalisation of suicide in Malawi, calling it draconian law that is out of touch with the current mental health environment.
Mkandawire says suicide ideation and attempts are almost always a result of mental illness and a symptom of a bigger problem that needs to be managed and not penalised.
“Incarcerating an individual with major depressive disorder, for instance, after a suicide attempt, only builds on feelings of worthlessness which further solidify suicidal ideation with a specific plan,” Mkandawire says.
Mwale agrees with Mkandawire, saying criminalising suicide must be abolished.
“It is wrong to criminalise suicide. Actually as mental health advocates, we have been negotiating and advocating for the repeal of the law that criminalises suicide.
“We have had meetings with Members of Parliament but it seems people don’t want to talk about suicide in this country, yet it is a huge problem,” he says.
However, lawyer George Kadzipatike disagrees with the mental health practitioners, saying it is important to criminalise attempted suicide to deter people from eliminating their own lives.
Kadzipatike argues that the life of every individual is important and that the State has interest in the life of every person, hence the need to protect it via legislation against suicide.
“I don’t think those who are stressed are prevented from seeking counselling on the basis of the law. They have other reasons for avoiding counselling. This is my opinion considering that the law does not criminalise mere oral suggestions that one wants to resolve their problems by committing suicide; the law criminalises an actual attempt to commit suicide,” Kadzipatike said.
On the position that criminalising suicide is promoting underreporting, concealment of truth and misleading of emergency doctors, Kadzipatike encourages relatives of suicide attempters to be good citizens and report such cases, saying there is no need to hide criminality.
“Looked at differently, the one who gets punished because of the concealment is the patient—the one who attempted suicide. In a way, the law serves its intended purpose of deterring would be offenders, albeit indirectly,” Kadzipatike says.
Mental Health experts have defined attempted suicide as “a non-fatal self-directed potentially injurious behaviour with intent to die.”
Research shows that attempted suicides are at least 20 times more common than the completed suicide.
It has also shown that of all those who engage in non-fatal suicidal behaviour, one-third repeat the behaviour within a year and nearly 10 percent eventually commit suicide.
The experts identify some mental health symptoms, of depression, for example, as including depressed mood, diminished interest or pleasure, significant weight loss or gain when not dieting, decrease or increase in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt and diminished ability to think or concentrate, as well as indecisiveness.
One huge symptom of depression, however, is the “recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.”
It is still not clear, however, whether having a law to prosecute suicide attempters indeed acts as a deterrent.
For example, in 1992, David Lester, an Emeritus Professor of Psychology at Stockton University compared suicide rates in Canada in a 10-year period before and after decriminalisation of suicide, and found no increase in the rate of suicide following decriminalisation.
Similarly, no change was observed in New Zealand during the decade before or after decriminalisation. Lester compared the suicide rates in seven countries (Canada, England and Wales, Finland, Hong Kong, Ireland, New Zealand and Sweden) five years prior and five years following decriminalisation, with an increase in the suicide rates after decriminalisation of suicide.
“This increase in suicide rates can be possibly explained due to better reporting of such attempts as earlier they could have been reported as accidents to prevent legal hassles,” observe some Indian researchers in quoting Lester’s research.
A psychologist Ndumanene Devlin Silungwe, adding his voice backed the abolishment of criminalisation of suicide, says suicide is a mental health problem, not a criminal problem.
“These are actually people who would have thought they have lived at the end of their alternatives around how they need to solve their problems. So they convince themselves that taking their life is a greater solution,” Silungwe says.
He further blames the diminishing role of faith and religion in the lives of people, saying religion gives values and moral compact and conscience on how people need to behave concerning their lives.
“So in the world where we are talking more of human rights and democracy, then we are talking the diminishing role of faith as a value that safeguards and works as a protective measure around suicide,” he says.