In this three-part series on rising cases of suicide in Malawi, THOKOZANI CHENJEZI explores the true scale of the crisis, its damage on productive age groups, archaic laws on mental health treatment and whether criminalising suicide is the right response to the calamity
Despite wearing the Warm Heart of Africa brand, Malawi literally goes to bed a sad nation. The United Nations ranks the country the seventh saddest on earth in its 2019 Global Happiness Report.
From perennial hunger to high unemployment levels, corruption and high interest rates which entangle citizens in loan-sharks, Malawi’s problems are well-documented and summed up in it being among the poorest countries in the world.
The country’s socioeconomic challenges are compounding cases of stress, depression and substance abuse, among others.
And while some are able to stand the heat, others turn to suicide missions. Some who are lucky (or unlucky?) survive after trying to end their lives.
1,600 Malawians commit suicide every year
Apart from drug and substance abuse, suicide is one of the contemporary mental health problems the country is facing.
The surge of incidents of suicide has sent shivers among mental health experts and advocates to the extent that in 2018, the St John of God Hospitaller Services, a leading mental health service provider in Malawi, was moved to conduct research on the prevalence of suicide in Malawi. The results are alarming.
The research collected data of people who committed suicide in 2018 in police stations and health centres in Karonga and Nkhata Bay in the North, Nkhotakota and Mchinji in the Centre, sampled Balaka and Machinga in the South.
Director of Services at St John of God Hospitaller Services, Charles Masulani Mwale, said the research found that nine out every 100,000 people commit suicide every year in Malawi. This translates to about 1,600 suicide deaths per year from Malawi’s 18 million people.
Mwale said the figure is higher compared to findings in Zambia and South Africa. In Zambia, they found that five people per 100,000 people were committing suicide while in South Africa, they found the rate of 7.5 per 100,000 people.
Zambia and South Africa have populations of 17.8 million and 58.7 million respectively against Malawi’s 18.7 million.
“Nine people per 100,000 is quite high. And that nine could likely be an underestimation because…these are the only cases that were reported. So, roughly, our prevalence per 100,000 could be more than 10,” Mwale said.
Data sourced from the National Police Public Relations office shows that between September 2018 and June 2019, the police recorded 125 suicide and eight attempted suicide cases.
Malawi Police Services (MPS) spokesperson, James Kadadzera, refused to be drawn into a discussion as to what the suicide figures mean to the police’s efforts in preventing such deaths.
He said the duty of the police is just to enforce the law.
A World Health Organisation (WHO) report indicates that 669 Malawians killed themselves in 2016, comprising 520 males and 149 women. About 800,000 people commit suicide every year, making it among the top 20 leading causes of death globally, more than war, malaria, breast cancer and homicide.
Robbing Malawi of productive people
One striking observation in the data MPS provided is that suicide is claiming lives of young and energetic people who are in the prime of their productive age, hence robbing the country of fresh and innovative minds that can develop the nation.
Out of the 125 suicide deaths that were recorded by the police between September 2018 and June 2019, at least 100 victims were less than 45 years of age. And seven out of eight attempted suicide victims were also below 45.
In fact, two of the suicide victims were as young as nine years old.
This 80 percent suicide prevalence rate among young people in Malawi is much higher as compared to another one reflected in a WHO report titled Suicide in the World: Global Health Estimates, which states that over half of world suicide cases as occurring among people below the age of 45.
Mwale posits that suicide is prevalence among young people because most of them struggle with many challenges during their transition to adulthood.
“The reason suicide is common among young people is that there is transition from adolescence, young adulthood to adulthood. And basically, people struggle with many problems during this period that require them to think and that is what stresses their mind,” he said.
According to the mental health expert, romantic relationships breakdowns, unemployment, financial struggles, alcohol and substance abuse, among other social problems, often affect young people when they are not yet mature or experienced enough to handle them.
On gender, the data showed that at least 120 of the suicide victims were male and only five were female. All the attempted suicide victims were men.
Mwale said suicide is a big problem among men due to a perception that they will be deemed less resilient to social problems if they try to seek help from others.
“Women engage in attention-seeking behaviour whenever they want to commit suicide. They will come out and say ‘I will just take poison’. And while seeking attention, they get help. But men don’t disclose their problems; they will behave as if they are happy. Next thing you realise, they have killed themselves,” he says.
When laws punish attempters
Try to commit suicide in Malawi. Make it certain that you really die. Because if you dare survive, a jail term of up to three years will be waiting to swallow you alive.
Such is the legal stand of entertaining the emergent mental health problem of attempted suicide regardless of any unbearable psychological problems one has.
The Penal Code states that “any person who attempts to kill himself shall be guilty of a misdemeanour” which attracts a maximum jail sentence of three years.
It is even worse to help someone to commit suicide as the Penal Code also states that “any person who procures another to kill himself; counsels another to kill himself and thereby induces him to do so or aids another in killing himself, is guilty of a felony and shall be liable to imprisonment for life.”
For starters, according to a research paper titled “A Historical Perspective of 50 Years of Mental Health Services in Malawi”, mental health services in Malawi started in 1910 when the country, then Nyasaland and a British Protectorate, established the Zomba Lunatic Asylum which operated under Zomba Central Prison. It was used to separate prisoners who appeared mentally abnormal.
In the paper, health researchers Genesis Chorwe-Sungani, Anthony Peter Sefasi, Diana Jere, Lucy Kululanga and Chitsanzo Mafuta trace a comprehensive background of mental health in Malawi.
Prison warders were taking care of the mentally ill prisoners. By 1920, mentally ill patients were doing casual work and Christian worship as a form of therapy.
By 1930, people, especially Europeans working in the asylum, started recognising mental illness as any other medical condition requiring proper treatment by trained health professionals.
It was only in 1952, after the discovery of phenothiazine antipsychotics, (basic medication for mental disorders), that the Zomba Lunatic Asylum was handed over to the Director of Medical Services until 1953 when the present Zomba Mental Hospital was built.
The treatment of mental health was later in 1953 fully handed over to the Ministry Health and Population which recruited psychiatrists, nurses, medical orderlies and later medical assistants and clinical officers to work in the centre.
It was during this period and context, that the Mental Treatment Act was drafted and enacted in 1948. Unfortunately, this has been the same law that is being used to treat mental health up to this day, 71 years later.
It is the guidance that this Act provides that contextualises mental health in a way that motivated provisions in the Penal Code to criminalise attempted suicide.
Its gaps can no longer be ignored. Malawians are being jailed for years just because they were so depressed to the point of attempting suicide.
And now, the increase in suicide cases has brought the law under scrutiny as to whether attempting suicide should earn someone a jail term or to be considered a mental health problem requiring psychiatric and psychological solutions.