A win for mental health….Mekaiel Zia

ACCORDING to the World Health Organisation, last year approximately 20,000 Pakistanis died by suicide, with over 120,000 people attempting it. Suicide is a complication of mental illness which can only be prevented by offering mental health support to those affected. In October of this year, the National Assembly of Pakistan, through MNA Qadir Khan Mandokhail, passed a bill repealing Section 325 of the Pakistan Penal Code, which focused on punishing survivors of suicide attempts with legal action, preventing them from accessing the appropriate mental health support. The bill, introduced by Senator Shahadat Awan in September 2021, was passed in the Senate in May 2022 and has been signed by President Arif Alvi to be drafted into law last week.

This is a huge victory for mental health promotion in Pakistan and will help in developing a suicide prevention strategy to address the rising tide of these tragedies. It also demonstrates that when public and private institutions work together, they can work to collectively improve the human rights of all Pakistanis. Aside from the policymakers, the key drivers of this bill were the National Commission for Human Rights and the Ministry of National Health Services Regulation and Coordination from the public sector, and the Pakistan Mental Health Coalition from the private sector. A carefully crafted campaign was developed and implemented in collaboration with various media partners to increase the political will for the passage of the legislation. It is important to note that the key architects of the suicide decriminalisation campaign were those with lived experience of mental illness and survivors of suicide attempts.

Suicide in Pakistan was criminalised not by the country itself but by the British in 1870. At that time, it was thought that criminalising the act would dissuade any one from attempting it. However, this is not what results from criminalisation. Anyone attempting suicide is, technically, in violation of the Pakistan Penal Code. At presentation to a hospital, this requires the registration of a medico-legal case. Once at a care facility, families of those attempting suicide are often extorted by the medico-legal system to not register cases. Facing social and legal pressures, families will often try and hide the attempt. This invariably results in victims not receiving the mental healthcare they need.

With the decriminalisation of suicide, the focus returns to the individual attempting suicide. They can be offered care in any nearby facilities and the power of the system to extort families for money is vanquished. Victims will be able to receive the care that they need, and the medico-legal stigmatisation can also be mitigated. In addition to this, we will begin to have correct and factual reporting of suicide cases in Pakistan. At present, the number of cases is vastly underreported or misreported as accidents and the true burden of suicidal behaviour in Pakistan remains unknown.

Of course, repeal of the law will not automatically lead to better outcomes. Unless the law is duly implemented, the system will continue to abuse victims. Notifications to all hospitals, public campaigns on awareness and sensitisation to the issue are vital to ensuring that both the public and private healthcare practitioners realise the focus is to be on caring for victims rather than victimising them further. Additionally, police training and sensitisation must be a key area of focus to redirect the legal system to protect those in acute distress, rather than continuing existing practices.

One thing that must be kept in mind by policymakers is that research shows that after decriminalisation, suicide attempts go up due to more accurate reporting. Critics may try to link the increase in attempts to the decriminalisation itself, but that is not the case. In fact, research shows that while decriminalisation increases reporting of suicide attempts, it decreases the number of people dying by suicide since they can now receive the appropriate mental health services. Therefore, policymakers must be prepared to respond to this critique keeping these facts in mind.

The repeal of this draconian law is a momentous victory for the human rights of patients affected by mental illness and their families. As a nation, we must now build upon this success to develop and launch suicide prevention programmes, such as a national suicide prevention hotline, preparing ambulance services to deal with mental health emergencies, and training law enforcement to support these efforts.

Mekaiel Zia is a health policy and management professional. Taha Sabri is a public health practitioner focusing on mental health and COO, Taskeen Health Initiative.

Courtesy Dawn