By Maryam Ayub, King Edward Medical University and Sadiq Naveed, Eastern Connecticut Health Network
LAHORE, April 25 – Last year, a female student from Lahore jumped from the third floor of her university college, in an attempted suicide.
She had been married 15 days before the event, and her mother said she had some issues with her marriage and was mentally disturbed. She was taken to hospital in a safe but critical condition.
Research shows most suicides in Pakistan are completed by people under the age of 30, with more men than women dying by suicide.
Like other low- and middle-income countries, it bears a heavier burden of suicide than high-income countries. Nearly 2,300 suicides were reported by Pakistani newspapers in 2019 and 2020 but the real figure is likely to be much higher due to significant under-reporting.
Data also suggests being married could be a suicide risk factor for Pakistani women, which is in contrast to Western countries, where marriage has been shown to be a protective factor against suicide.
Due to a recent change in the law, individuals with suicidal behaviours would now be unlikely to face criminal penalties with the repeal of the section of the Pakistan Penal Code criminalising suicide attempts in December 2022.
But decriminalisation on its own may not be enough to tackle Pakistan’s suicide crisis.
It can lead to pathways for comprehensive healthcare programs that target suicide reduction, specifically focusing on reducing the stigma attached to suicides. This will enable people to seek the help they need.
Previously, suicidal behaviour may have been concealed due to a lack of reporting or misclassification of the event due to the law.
The dread of intimidation and humiliation by police and social stigma prevented people from visiting public hospitals.
Cases were brought to private hospitals, where they were neither investigated nor reported to the authorities because of the difficulties with police reporting.
All mainstream religions including Islam, condemn those who complete suicide. There are no clearly indicated legal and societal punishments in the Quran for those who survive suicide attempts.
Religions can govern morality and dictate a code of conduct, but religious principles must be used carefully if used in the formulation of criminal laws.
Using religion as a basis for devising legislation is a delicate issue and needs careful consideration.
Moreover, the lack of a liaison between mental healthcare providers and legal systems, and primary healthcare workers’ inability to recognise suicidal signs and conduct risk assessments for high-risk patients also contributed to the suicide crisis.
Thus, the previous rates of completed and attempted suicide in Islamic countries such as Pakistan may be misleading.
Decriminalisation may allow better quality data around suicidal behaviour in Pakistan to be collected, so the phenomenon can be better understood and diagnosed.
Other proven suicide prevention strategies that can now be applied more widely are restricting the means to attempt suicide — for example, pesticides and firearms, improving mental health literacy and access to psychosocial support and responsible media coverage of suicide.
For example, according to 2020 data from the World Health Organization, the Pakistani population has very poor access to psychiatric treatment facilities.
For a population of over 200 million people, there are only 0.14 registered psychiatrists, 0.05 psychologists, and 0.28 social workers per 100,000 people in Pakistan.
The majority of the population lives in rural areas, but most psychiatric services are available in urban settings.
There are also thought to be other health issues at play.
For women in Pakistan, studies have consistently reported that the effects of men’s patriarchal dominance over women, lower socio-economic status of women and girls in the family and society, lower female educational attainments, forced and/or early marriage, divorce or threat to divorce, forced childbearing, infertility, conflicts with in-laws and different forms of abuse and oppression are strongly associated with suicidal behaviours among women and girls.
The rates of depression are high in population-based studies from Pakistan due to the higher prevalence of socioeconomic challenges.
Depression and other mental health problems are often undiagnosed and untreated in Pakistan, which likely contributes to the suicide rates in the country.
Responsible reporting about deaths by suicide can be used to raise awareness of mental health issues and notify readers about helpful resources they can access, like helplines.
Maryam Ayub is a resident physician at the Academic Department of Psychiatry and Behavioural Sciences, King Edward Medical University, Lahore, Pakistan. Sadiq Naveed is the Psychiatry Program Director, Eastern Connecticut Health Network, Connecticut.
Article courtesy of 360info.