Suicide Worldwide in 2019 Report: WHO

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A new WHO report stated that the world is not on track to reduce suicide mortality rate by 2030.

Key Findings of Report 

• Crisis before COVID-19: While COVID-19 has increased mental stress globally, the report shows a crisis was already in place in 2019. It shows that some 703,000 people or one in a 100, died by suicide in 2019. 
• Young People: More than half of global suicides (58 per cent) occurred before the age of 50 years. Suicide was the fourth-leading cause of death among young people aged 15-29 globally in 2019, according to the report.
• Prevalence in Low-income Nations: Some 77 percent of global suicides in 2019 occurred in low- and middle-income countries. On an average, 9 out of every 100,000 people ended their lives in the world.
• Higher in Africa, Europe: The three WHO regions – Africa, Europe and South-East Asia – recorded suicide rates higher than the global average. This number was highest in the WHO Africa region (11.2) followed by Europe (10.5) and South-East Asia (10.2).
• Overall Decline in Suicides: The report noted that in 20 years (2000-2019), the global suicide rate had decreased by 36 per cent. The decrease ranged from 17 per cent in the Eastern Mediterranean Region to 47 per cent in the European Region and 49 per cent in the Western Pacific Region. The Region of the Americas recorded a substantial 17 per cent increase in the suicide rate during the same period and has been an exception.
• Falling short of SDGs: Despite this overall decline, the world will not be able to achieve the SDGs concerning mental health. The SDGs call on countries to reduce premature mortality from non-communicable diseases by a third, by 2030 through prevention and treatment and to promote mental health and well-being (target 3.4, indicator 3.4.2).
• Lack of Prevention Stategy: Although some countries have placed suicide prevention high on their agendas, too many countries remain uncommitted, the report said. Currently, only 38 countries are known to have a national suicide prevention strategy.

Section 309

• The law, brought in by the British in the 19th century, reflected the thinking of the time, when killing or attempting to kill oneself was considered a crime against the state, as well as against religion.
• Anyone who survives an attempted suicide can be booked under Section 309 IPC, which deals with “Attempt to commit suicide”. 
• The section reads: “Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year (or with fine, or with both)”.

Status of Section 309

• Unlike people’s perception, the section continues to remain in the IPC and is more misused.
• However, the Mental Healthcare Act (MHCA), 2017, which came into force in July 2018, has significantly reduced the scope for the use of Section 309 IPC and made the attempt to commit suicide punishable only as an exception.
• The restrictions put on the use of this section under the provisions of the MHCA, as opposed to it being removed from the statute all together, do not seem to be enough simply because of continued reports of its use by police forces across the country.

Efforts Taken to Repeal this Law:

• 1971: The Law Commission in its 42nd Report recommended the repeal of Section 309 IPC. 
• 1978: The IPC (Amendment) Bill, 1978, was even passed by Rajya Sabha, but before it could be passed by Lok Sabha, Parliament was dissolved, and the Bill lapsed.
• 1996: In ‘Gian Kaur vs State of Punjab’, a Constitution Bench of the Supreme Court upheld the constitutional validity of Section 309. 
• 2008: The Law Commission in its 210th Report said that an attempt to suicide needed medical and psychiatric care, and not punishment. 
• 2011: The Supreme Court recommended to Parliament that it should consider the feasibility of deleting the section.
• The Delhi High Court stated that if Section 309 is restricted in its application to attempts to commit suicide which are cowardly and which are unworthy, then only this section would be in consonance with Article 21. 

Section 309: Challenges

• Use of this Section can potentially deprive a victim of treatment in the golden hour, as hospitals wait for a go-ahead from police in what would be seen as a “medico-legal case”.
• Unscrupulous hospital authorities may misuse this situation and charge extra to “hush up” the case by not informing the police. Similar extortion is possible on the part of corrupt police personnel as well.
• The stigma around mental illness isn’t just social, it is built into our very systems of politics and healthcare.
• In the Mental Healthcare Act, 2017, the exact procedure to execute an “advanced directive”, for example, which laid out details about how and when individuals with mental illness could dictate the terms of their treatment, are missing. 

(Image Courtesy : TOI)

Decriminalization of Suicide: Ethical Arguements

• Moral right to die on account of terminal illness:
  • Suicide is one of the ways in which people can exercise a right to die. 
  • Burn victims having severe injuries resort to and claim that they have a right to die of which any prevention of their intention to die is seen as a breach of their right to die because it seems impossible to recover from their suffering.
• Liberty:
  • To those who see man as a free agent, suicide is morally right. 
  • Man’s life belongs to him, hence he is at liberty to take it without denial; and no other person has the right to force their own ideals that life must be lived. 
  • Rather, only the individual involved can make such a decision and whatever decision he or she does make, should be respected.
• Losses and shameful acts: 
  • Suicide is morally right in the instance of losses or shameful acts like loss of limb or of physical beauty and the person is not in a position to give any meaning to his life, i.e., he is under a high level of depression, as no relief can be procured.
• To save the life of more people: 
  • When a person refuses to give information to an enemy camp in order not to endanger the lives of other; killing himself is morally right.

LIVE LIFE Guidelines

• The WHO had published new LIVE LIFE guidelines to help countries reduce the global suicide mortality rate by a third by 2030. These are:
  • Limiting access to the means of suicide, such as highly hazardous pesticides and firearms.
  • Educating the media on responsible reporting of suicide.
  • Fostering socio-emotional life skills in adolescents.
  • Early identification, assessment, management and follow-up of anyone affected by suicidal thoughts and behaviour.

Indian Initiatives 

• National Mental Health Programme (NMHP) in 1982
  • To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population.
• Mental Healthcare Act, 2017
  • It was passed in 2017, came into effect in May 2018 and replaced the Mental Health Act of 1987. 
  • To the joy of most Indian medical practitioners and advocates of mental health, the act decriminalised suicide attempts in India. 
  • It also included WHO guidelines in the categorisation of mental illnesses. 
  • The most significant provision in the act was “advanced directives”, which allowed individuals with mental illnesses to decide the course of their treatment and also appoint someone to be their representative. 
  • It also restricted the use of electro-convulsive therapy (ECT), and banned its use on minors, finally introducing measures to tackle stigma in Indian society.
• Rights of Persons with Disabilities Act, 2017
  • The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide effective mechanism for ensuring their empowerment and inclusion in the society
• Manodarpan Initiative
  • An initiative under Atmanirbhar Bharat Abhiyan, aims to provide psycho-social support to students for their mental health and well-being.

Way Forward

• The Section 309 IPC can be redefined in such a manner where it can still be leveraged in law and order situations, and not be used against those who are suffering from genuine mental health issues.
• Until we push for a change in every sphere and at every level, there’s still work to do in tackling the epidemic of suicide in India.

Sources: DTE