Providing treatment and care to individuals with suicidal ideation, rather than criminal proceedings, seems very humane and appropriate. However, in more than 20 countries, suicide and suicide attempts are still considered punishable offences, with imprisonment and fines for suicide attempts, and financial penalties for family members of those who die by suicide. The continued legal opposition to suicide and suicide attempts is based in part on two controversial views that need to be interrogated.
The first view is that the law is a deterrent. But it's hard to imagine that mentally tortured individuals would care about the specific provisions of the law. It is difficult to obtain clear evidence that the law is a deterrent. Suicide deaths and suicide attempts are often underreported or misclassified, and differences in the implementation of punitive laws make the evidence base on which decisions are based more confusing. As a result, many studies present mixed results. In some countries, suicide rates have increased after decriminalization of suicide attempts; Evidence suggests that suicide rates in countries that continue to criminalize suicide attempts are below the global average. However, a study published last year showed that criminalizing suicide was associated with a slight increase in the national suicide rate, especially among women.
The second misconception holds that the decriminalization of suicide and suicide attempts is condoning suicide. But decriminalization does not mean giving anyone the right to end or attempt to end life. Decriminalizing suicide does not represent support for suicide, but rather drives change: it is no longer seen as a problem of the criminal justice system, but as a problem that requires a proactive response from the rest of society, especially the health community.
What is clear is that criminalization discourages people from seeking support when they need it most. Punitive legal provisions can lead to a dire situation where patients who have attempted suicide who gradually recover in hospitals face prosecution once discharged, that is, they are punished for not killing themselves. Such legal provisions promote stigmatized attitudes about mental health issues and mental illness at the individual level and at the wider societal level, and contribute to the persistence of such attitudes.
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Changes may need to be made by considering a combination of public opinion, religious beliefs, the ethical values of health care professionals, and often controversial political views. The intricacies of this can be illustrated by the fact that different countries have begun to implement enlightened strategies to treat individuals with suicidal ideation and mental illness at different times: Sweden decriminalized suicide in 1864, Finland in 1910, Australia in 1958, England and Wales in 1966, Ireland in 1993, and Pakistan in 2022. At the behest of military leaders, Jordan's parliament recently criminalized suicides and attempted suicides in public places. In countries where unemployment and poverty rates remain high and unemployment and poverty are particularly pronounced among young people (46.1% of those under 25), such policy regressions do not help address the severe shortage of public mental health services.
Globally, an estimated 703 000 people die by suicide each year, and for every one suicide death, 20 people may attempt to end their lives. In many countries and regions, the situation is becoming increasingly serious. In the United States, for example, the number of teenage women reporting severe grief and suicide increased by 57% between 2011 and 2021.
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Most people who die or attempt suicide have a diagnosable psychiatric disorder, mainly including depression, schizophrenia, and alcohol-related disorders. Providing effective treatment to patients when accessing health services should be the primary goal of health professionals. In addition, prevention programs need to be implemented and financed, including controlling toxic substances and drugs, treating harmful substances emitted from household gas and vehicle exhaust, restricting access to firearms, erecting barriers that prevent jumping from heights, and ensuring responsible media coverage. The latter requires limiting or controlling social media platforms, as many believe that social media platforms are associated with an increase in teen suicide and self-injury.
Treatment for people in crisis who report suicidal ideation is far from optimal, even in countries that have repealed laws prohibiting suicide and suicide attempts. Patients suffering from mental illness are often continuously deprived of their liberty within the constraints of risk-based laws and regulations initially imposed by law enforcement; These legal measures have done little to alleviate their pain and suffering. Methods that are more in line with the spirit of humanity should be universalized. END
Resources
For more on the evidence around criminalisation as a deterrant see BMC Psychiatry 2022; 22: 424; Psychol Rep 2002; 91: 898; and BMJ Open 2022; 12: e049425
For more on sadness in US teenagers see
https://www.cdc.gov/media/releases/2023/p0213-yrbs.html#:~:text=Youth%20mental%20health%20has%20continued,60%25%20from%20a%20decade%20ago
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Chinese translations are for reference only, and all contents are based on the original English language.
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