Preventing suicide
In a significant stride towards mental health reform, Pakistan decriminalised attempted suicide (later challenged in the Federal Sharia Court) by repealing Section 325 of the Pakistan Penal Code, a change that stands out for its compassion and understanding.
The repeal is complemented by the Mental Health Act’s Section 49, which introduces mandatory psychiatric assessments to ensure that individuals experiencing mental distress receive the care they need. This reform became possible due to the steadfast advocacy of mental health experts, including those in the Pakistan Psychiatric Society, the efforts of legislators in 2022, and the support of religious and educational groups.
Suicide is a critical global public health concern, accounting for over 800,000 deaths worldwide. Globally, it is the third leading cause of death among 15- to 19-yearolds, and the second leading cause of death among 15- to 29-year-olds. Alarmingly, 90 per cent of adolescent suicides occur in low- and middle-income countries, with recent analyses reporting a pooled suicide rate of 3.77 per 100,000 in these regions.
In Pakistan, where 10.37pc of the population falls in the 15- to 19-year age group, there are no official national suicide statistics due to the absence of vital registration systems.
Nonetheless, estimates indicate 130,000 to 300,000 suicide attempts per year, and 13,000 to 15,000 deaths by suicide. It is concerning that the healthcare budget for 2023-24, totalling Rs24.21 billion, lacks designated allocation for mental health, highlighting a worrisome gap in mental health funding.
A series of tragic events has shone a harsh spotlight on Pakistan’s mental health crisis, marked by the untimely deaths of individuals grappling with severe psychological distress. In one instance, the 40-year-old son of a renowned religious cleric succumbed to a prolonged battle with severe depression. In July 2023, a life was lost to this crisis when a 63-year-old industrialist took his own life, leaving behind a note revealing his struggle with a chronic, undisclosed illness.
Such heart-wrenching incidents followed the shocking deaths by suicide of a 66-year-old psychiatrist from Multan, who ended both his own life and that of his daughter. In addition, there is the still-unresolved suicide of a celebrated actor who met a tragic end from a gunshot wound in 1986.
The concerning rise of ‘kala pathar poisoning’, caused by paraphenylenediamine, in districts like Rahim Yar Khan and Sahiwal is a significant public health issue, with a high mortality rate of 50.5pc among rural women.
These incidents, often linked to self-harm, emphasise the urgent need for an improved mental health infrastructure and strict regulations regarding dangerous substances. Investigations in Pakistan reveal the high prevalence of suicide attempts through pesticide ingestion and benzodiazepine overdose. The key risk factors among adolescents include mental health disorders, substance addiction, previous suicide attempts, a family history of suicide, and thoughts of suicide and homicide.
According to a 2023 study by Nazish Imran, et al, the ingestion of toxic substances was the suicide method for 50pc of the individuals in their sample (140 out of 279).
Hanging was the second most common method. These findings stress the need for prompt intervention and widespread preventive measures.
Recent circumstances have intensified the demand for improved mental health services in Pakistan, a country where psychological autopsies are rarely conducted. These autopsies are crucial as they can illuminate the psychological state prior to death, inform preventative actions, provide comfort to bereaved families, and influence policy reform.
Psychological autopsies involve a detailed postmortem examination of the deceased’s mental state through investigations into their life, emotions, and thoughts before death, typically by interviewing those close to them. Outcomes from these autopsies are instrumental in informing suicide prevention initiatives, enhancing mental health support, and deepening the understanding of suicide’s multifaceted nature.
Despite evidence that proactive measures can prevent suicide, the unique cultural and religious context of Muslim countries, such as Pakistan, hinders data-gathering, thus emphasising the need for customised research to create effective suicide prevention strategies.