Time to focus on mental health

DEATH by suicide is rising globally with almost 800,000 people taking their own lives every year – or one person every 40 seconds.

Despite this, suicide has not been given the level of attention compared with other global public health issues, such as Covid-19, HIV/AIDS and cancer.

Suicide is more common than murder across most countries in the world, and studies show that twice as many people die from suicide than from homicide.

Sadly, Malaysia is no exception to the rising phenomenon.

On World Suicide Prevention Day on Sept 10, Health Minister Khairy Jamaluddin said 1,142 suicides were recorded in 2021, a staggering spike of 81% over the 631 cases in 2020.

The Covid-19 pandemic may have been a contributing cause for the rise as people were isolated under lockdowns, facing uncertainties over jobs, business incomes and other worries.

Khairy highlighted the ministry’s commitment towards educating Malaysians on mental health issues and other factors contributing towards suicidal tendencies. He also reiterated the involvement of all segments of society – families, communities, policymakers, politicians, government agencies, the private sector and non-governmental organisations – in dealing with suicidal behaviour.

But the government’s plan to decriminalise suicide attempts appears to have hit a snag. Despite the initial optimism, the process to amend Section 309 of the Penal Code, under which suicide survivors can be fined and jailed for a year, has been stalled.

It has been close to a year since Deputy Health Minister II Datuk Aaron Ago Dagang announced the move in the Dewan Rakyat. In June, Khairy said the proposal was still being studied by the Attorney General’s Chambers (AGC).

The road ahead does not appear to be smooth because existing provisions under the Mental Health Act, 2001 and the Mental Health Regulations, 2010, which allow for the psychiatric assessment of suicidal attempts and the submission of medical reports before court decisions, have to be taken in consideration.

Although the move to decriminalise suicides might not deter suicides, it can help prevent the further alienation of vulnerable people with suicidal tendencies.

On the plus side, the National Suicide and Fatal Injury Registry Malaysia is expected to be operational from next year. The registry will provide detailed and accurate statistics on suicides for better focused prevention programmes.

The Health Ministry is also working with the Education Ministry to address problems of students suffering from depression for early intervention and treatments.

The reasons why people attempt suicide are varied and complex, but they usually involve severe and unbearable emotional or physical pain.

While depression, a much-misunderstood form of mental illness, is the common cause of suicides, there is a diverse and complex range of reasons, including psychological issues, bullying, discrimination, loss of income or employment and alcohol or drug abuse.

Research shows that a person contemplating suicide may display warning signs, such as grief, deep sense of shame, utter worthlessness, intense guilt, rage or desire to seek revenge, a feeling that they are a burden to others or that life is not worth living.

According to the World Health Organisation, suicide is the fourth leading cause of death among 15- to 19-year-olds and 77% of suicides occur in low and middle-income countries.

Suicide rates for countries are measured by the number of suicides per 100,000 people.

Based on figures from 2019, the 10 countries with the highest suicide rates are: Lesotho (72.4) Guyana (40.3), Eswatini, formerly known as Swaziland (29.4), South Korea (28.6), Kiribati (28.3), Federated States of Micronesia (28.2), Lithuania (26.1), Suriname (25.4), Russia (25.1) and South Africa (23.5).

The reported suicide rate in Malaysia is 6.3 per 100,000 – 4.8 times higher than the average of 1.3 recorded a decade ago.

In reality, the situation is more dire, according to Malaysian Mental Health Association president Professor Datuk Dr Andrew Mohanraj.

“Based on published information and the deficiency in suicide reporting, the more realistic figure is likely to be between 11 and 13 per 100,000 population.

“Psychological reasons from the consequences of the Covid-19 pandemic, such as financial insecurity, isolation and effects of long Covid, are likely to maintain this upward trend,” he said.

He said that in the majority of cases, suicide is contemplated when stressful events exceed a person’s capacity to cope with life, adding that the pain of continuing to live must be so overwhelming that the person decides that the only way to escape is to die.

On the ethnicity of victims, statistics show that Indian men were at a higher risk of suicides in Malaysia while the overall significant risks included being male, having a mental illness, family history of mental illness and alcohol or substance abuse.

But since the Covid-19 pandemic, there was also an increase in cases of attempted and completed suicides among younger Malay females, said Dr Mohanraj.

In 30% of the cases, warning signs had been given either verbally or in writing, including on social media.

“The conclusion from this data is, one out of three of them could have been saved if only they had the support and treatment which eluded them.

“This means we need to increase our efforts in suicide prevention activities and devise new strategies to mitigate the situation. We cannot let another precious life be lost because help was not available on time.”

Dr Mohanraj said the activation of the suicide registry would minimise the under-reporting of suicides in the country.

“There is optimism that there will be greater accuracy in the reported cases. Veritable data on suicide methods, socio-economic status of victims and stress factors can help in crafting appropriate prevention strategies.”

Those suffering from problems can reach out to Mental Health Psychosocial Support Service (03-2935 9935 or 014-322 3392); Talian Kasih (15999 or WhatsApp [phone]); Jakim’s Family, Social and Community care centre (WhatsApp [phone]); and Befrienders Kuala Lumpur (03-7627 2929 or www.befrienders.org.my/centre-in-malaysia a full list of numbers and operating hours).

Media consultant M. Veera Pandiyan likes this quote by Ralph Waldo Emerson: “When it is darkest, you can see the stars.” The views expressed here are the writer’s own.