11 August 2020
Unwarranted sentences meted out towards those who survive suicidal attempts have drawn public outcry and letters of protests from mental health organisations in the past two months when two such individuals were jailed and fined respectively. The unfortunate persons who commit these acts of suicide are unwell and deserve moderation in the approach taken by the authorities. Calls for decriminalisation of suicide over the years have largely gone unheeded and this path of action taken by those in jurisdiction can cause more stress, suffering and burden to those affected. Numerous other countries have taken that vital step, thus displaying their commitment to move forward and embrace mental health as an integral component in national well-being and productivity. The incidence of mental disorders is rising in our country, with the 2015 National Health and Morbidity survey reporting that 29.2% of adults suffered from a mental disorder even at that time. A wise man once said “A nation’s greatness is measured by how it treats its weakest members”; those who attempt suicide are not necessarily weak but instead suffer from an illness that makes them vulnerable, so does punishing one with a disease translate to a sign of greatness?
In our practice as mental health professionals, suicide and parasuicide are known complications of mental illness that often lie within a spectrum. The most common cause for suicidal thoughts and subsequently completed suicide is depression, a disease attributable to an imbalance of chemicals in the brain akin to other long-term physical illnesses like hypertension, diabetes and heart disease. An estimated 80-90% of depressed patients recover with a strategised bio-psycho-social approach to treatment and their suicidal thoughts resolve with no further attempts at taking their own life. Parasuicide, on the other hand, is a suicidal gesture in which the aim is not death. Sub-lethal drug overdose or wrist slashing are examples and are usually cries for help. Lastly, passive suicide shares the same spectrum and is often distinguished by a general wish not to live but without taking any active steps to ensure death by suicide. These persons, however, neglect their daily needs, medication and engage in risk-taking behaviours in the hope that something untoward happens. Do our decision-making peers know the intricate measures to differentiate between these three groups or are these sufferers merely going to be clumped together and served the same sentence?
Unfortunately, stigma and taboo surrounding mental disorders prevent people who truly deserve psychiatric care from seeking help. Hence, are we then justified by punishing those who could benefit from treatment but not had the means to while we merely moan and comment in social media about the self-centredness and irresponsibility of those who do not adhere to quarantine regulations during this pandemic and risk further spreading the virus? Why downplay such flouting and deviant attitudes but persecute the actions not under the control of someone in the pits of helplessness? Imposing Section 309 of the Penal Code, which basically states that “Whoever attempts to commit suicide, and does any act towards the commission of such offence, shall be punished with imprisonment for a term which may extend to one year or with fine, or with both” has not shown to decrease suicide rates, nor is there convincing evidence to prove that decriminalising suicide will lead to increased suicide attempts (Ng & Rao, 2019). Other provisions such as voluntary and involuntary admissions to mental health institutions under Sections 9-11 of the Mental Health Act 2001 and Section 36 of the Prisons Act 1995 could alternatively be exercised and which would guarantee help rather than punishment for this misjudged group.
Therefore, while policy makers work on making mental health services more accessible, we stand with the unified plea to lawmakers to decriminalise suicide by repealing or amending Section 309.
Psychiatry Chapter, College of Physicians, Academy of Medicine of Malaysia.