Dear Editor
THE International Association for Suicide Prevention (IASP) earlier this year made a call for the global decriminalisation of suicide. The IASP, “recommends the decriminalisation of attempted suicide on the grounds that this will:
? reduce social stigma,
? help remove barriers to obtaining adequate mental health care,
? increase access to emergency medical services, foster suicide-prevention activities,
? improve the well-being of people who are vulnerable to engaging in suicidal behaviours,
? contribute to more accurate monitoring of suicidal behaviours.
On the other hand, “The criminalisation of attempted suicide undermines national and international suicide-prevention efforts and impedes access among vulnerable individuals and groups to suicide-prevention and mental-health services”. Also, “the criminalisation of attempted suicide impedes the prevention of suicidal behavior.” Thus, the IASP “encourages countries where suicide attempts are currently illegal or punishable to develop and implement legislation that decriminalises suicide attempts.”
As well, the IASP recommends “firm advocacy on the part of professionals, volunteers, and also by those who are afflicted with suicidal impulses” to promote implementation of effective approaches to suicide prevention. “This may involve advocacy at the legislative level, for example in decriminalising suicidal behaviour in those countries where this has not yet been achieved.”

The IASP’s policy position statement asserts that while suicide has been decriminalised in many countries, attempting suicide still represents a punishable offence in 45 countries, where legal penalties range from a small fine or a short period of imprisonment to life imprisonment, resulting in significant, added distress and upheaval for vulnerable individuals who have engaged in a suicide attempt and often have serious mental health problems, which need treatment.
Furthermore, “the deleterious effects of the criminalisation of suicide attempts go beyond the persecution of the individual, by undermining the provision of appropriate care following an attempt, and exacerbating the social stigma associated with suicidal behaviour, which impedes help-seeking.” It also, “hinders the surveillance of suicidal behaviours, resulting in an underestimation of their true prevalence and thus creates obstacles to the planning and implementation of appropriate suicide-prevention interventions”.
On the other hand, decriminalisation recognises that:
? people who attempt suicide often have a reduced capacity to make an informed decision as a result of mental illness, substance abuse and/or an extreme crisis situation;
? suicidal behaviour is unlikely to be deterred by the criminal status of suicide attempts and the threat of legal sanction;
? imprisonment exacerbates suicide risk, leaving those incarcerated for attempting suicide with a lack of, or inadequate, requisite psychological and psychiatric support;
? should lead to increased recognition and treatment of suicidal behaviour as a public health and social-justice concern;
? reduce stigma and increase help-seeking among vulnerable individuals; “Encourage tolerant and compassionate attitudes in healthcare and welfare agencies towards those who attempt suicide;
? is highly unlikely to lead to an increase in actual suicidal behaviour, although it might result in a greater willingness to report suicidal behaviour.
Decriminalisation is most effective when supplemented by:
? A national suicide-prevention strategy and action plan (WHO, 2014).
? A comprehensive surveillance system to monitor the characteristics of, and trends in,suicidal behaviour (WHO, 2016).
? Education and training for law enforcement, healthcare and social services staff responsible for the provision of care to those who engage, or are likely to engage, in suicidal behaviour.
? Improvements in the quality and accessibility of community and hospital-based care for suicidal individuals and persons experiencing mental health difficulties.
? The implementation of measures to reduce the social stigma associated with mental ill-health and suicidal behaviour.
Within this context the IASP resolves to:
? Advocate for the decriminalisation of attempted suicide in countries where this behaviour remains illegal or punishable.
? Support the implementation of legislation that decriminalises attempted suicide, through the provision of letters, research data and endorsements to support those promoting decriminalisation within their country.
? Support representatives in countries where attempted suicide is currently punishable and illegal to advance the decriminalisation of attempted suicide in their country.
Over the past two centuries, there has been a worldwide shift in attitudes and responses to suicidal behaviour, from fear, condemnation and punishment to compassion, understanding, treatment and support. However, the continuing criminalisation of attempted suicide perpetuates individual suffering, exacerbates the stigmatisation of suicidal behaviour and inhibits help-seeking. The decriminalisation of attempted suicide, where it is illegal or punishable, is vital to ensure that persons who engage in a suicide attempt obtain the help they need, and are supported by national policies, which value the lives and contributions of all the members of society.
With suicide rising exponentially during this pandemic, an April 10 article in the Journal of the American Medical Association suggests that we may be at the beginning of something far worse. Titled “Suicide Mortality and Coronavirus Disease 2019: A Perfect Storm?” the article suggests that the unprecedented public health actions needed to contain the new pandemic, along with social-distancing requirements, stay-at-home orders, and stress due to job loss, may well result in far more suicides in the years to come. Written by a team of mental health professionals led by Mark Regger of the University of Washington, the article outlines many of the economic, psychosocial, and health-associated risk factors that can be expected to increase suicide risk.
Dare we hope that a new government will move quickly to decriminalise as a first step to providing more resources and greater focus on suicide prevention to tackle the upcoming storm?

Sincerely
The Caribbean Voice