Compulsory community service still punishment, medical, social rehabilitation necessary on attempted suicide, says SURPIN

The Suicide Research and Prevention Initiative (SURPIN) has faulted the Community Service Bill on attempted suicide proposed by the House of Representatives.

In this interview, Consultant Psychiatrist and National Coordinator, SURPIN, Dr. Raphael Ogbolu, is of the view that community service shouldn’t be made compulsory, but rather people should be allowed to voluntarily engage in it. He said there shouldn’t be any form of punishment for attempted suicide.

It was reported in the dailies recently that the House of Representatives propose ‘community service as punishment for attempted suicide’. What is SURPIN’s view about this?
While we commend the lawmakers for seeking to amend the Criminal Code Act CAP C38, 2004, which is long overdue, we are concerned that this amendment might be counterproductive. Recommending ‘compulsory counselling and community service for a period of not less than six months’ as punishment for suicide attempt, is like going from ‘from fire to frying pan’; a reverse of the common local parlance from frying pan to fire. We therefore, as an organisation made up of over 100 mental and public health professionals and experts across the country, and as the leading organisation in suicide prevention in Nigeria, are compelled to publicly respond to this mental health issue, as we have a responsibility to advocate for mental health and to educate the public.

What is SURPIN’s view on the proposed bill?
Firstly, suicide which is the act of killing oneself, remains a major public health concern and the lawmakers have rightly highlighted that there is strong evidence of a link between suicide and mental disorders, especially clinical depression. Based on this, addressing suicide prevention will only be meaningful if one fully understands such disorders as depression.

Depression is a medical and mental disorder which can be severely disabling, impacting on the persons mental and general well-being. Common symptoms include low mood, low energy and loss of interest in things that usually provide pleasure or happiness to the person. Left untreated, it can often culminate in feelings of helplessness and hopelessness, the latter of which is a strong predictor of suicide. Depression
is not deliberate and is not laziness.

Depression, like many mental disorders, cannot be prevented by vaccination and nobody is immune, however depression is treatable.

Unfortunately, many who are depressed cannot lift themselves up, to continue to be productive in their work/occupation, family life and other aspects of living that we take for granted. Such people need empathy and support to access effective medical treatment. There are other mental disorders that may contribute to people becoming suicidal and, just like depression, the approach should be to provide help and treatment for these individuals, many of whom are unable to fund the treatment themselves, and do not even know that they suffer from a disorder, largely due to Ignorance, lack of awareness and stigma associated with mental disorders.

From our experience having operated suicide prevention hotlines in Nigeria since 2017 we have come to realise that majority of people who feel suicidal have depressive features brought on by psychosocial issues, including financial problems and relationship issues.

As such in seeking to address the resulting suicidality, one needs to also provide guidance and direction on how to address the social circumstances. The World Health Organisation (WHO) in its executive summary – Preventing Suicide: A Global Imperative, encourages countries across the world to decriminalise suicide. Similarly, the National Institute for Health and Care Excellence (NICE) guidelines also does not prescribe punishment for suicide attempt.

Furthermore, the International Association for Suicide Progression (IASP) encourages countries to also decriminalise suicide and to enable the establishment of national strategies that target evidence-based approach in suicide prevention. As such there is abundant research evidence that recognises that punishment, in any guise or form, is not a solution.

It is such evidence base that informs SURPIN’s approach which includes reducing the availability and lethality of means, identifying those at risk of suicide and providing crisis interventions, promoting early treatment of mental disorders, improve reporting of suicidal behaviour in the media, and promoting mental well-being in the wider population through public education to address the issue of stigma.

How does SURPIN see the negative side of the proposed amendment?
Based on all the above, we therefore find that the good-intentioned amendment proposed by the distinguished members of the House of Representatives, has certain faults which need to be addressed urgently before amendment is made.

The first fault is that the amendment still implies the prescription of punishment in the form of community service as a solution. This should be completely expunged. There should be no punishment for someone who has attempted suicide. Community service in any form for someone struggling with depression or other mental disorders does not mitigate the attendant suffering from symptoms associated with the disorder, and does not promote recovery. Such an approach will be seen as punitive by the person who, having not died from suicide, has just been given another chance at life. For such a person to go into community service only tells them that next time they should make sure that they die from the attempt. This is important because if ‘compulsory’ here can imply detention or any deprivation of liberty, it would mean that it can violate article 5 of the Human Rights Act (Right to liberty and security of person), and while this may be necessary in many cases, it should be based on existing mental health laws and should not be a blanket prescription that will apply to all. Empowering the person starts from allowing them to voluntarily decide to engage in help that is offered.
The second fault is the ‘compulsory’ component of the amendment. This should not be absolute. People should be given the opportunity to voluntarily engage, and any compulsory approach should be the exception rather than the norm or expectation. This is because many who contemplate suicide do not really want to die but just don’t want to continue living the way they currently are and so if they are given an option of genuine care and support this can make them hopeful and encourage an informed decision to willingly engage.

The Lagos State Mental Health law has provided some direction on how suicide attempt should not be punished as it states in Chapter 60 (Section 9) under Part 6, that “A court may order a psychiatric assessment on a person who attempts to commit suicide”. In so doing, apart from the drawback that it uses the word ‘commit’ which we discourage, the law understands the link between suicide and mental disorders, and therefore provides an avenue for people to be helped along an appropriate care pathway through this assessment.

What is SURPIN’s advise on the way forward?
As an organisation we request that as a matter of urgency the lawmakers adjusts the intended amendment by expunging any connotation of punishment completely, and replacing ‘compulsory counselling and community service for a period of not less than six months’ with ‘medical and social rehabilitation and treatments funded by the State for up to an initial period of 6 months, either voluntarily or involuntarily, and renewable, in consonance with the applicable mental health law’. We believe that this more empathetic and more in keeping with international best practice, that will go a long way in providing succour to many people who suffer from depression and other mental disorders that drive suicidality.

By adjusting the good-intentioned amendment, the lawmakers will have done the public a great service and will ensure that our laws are pro-life. We at SURPIN will continue to advocate for this adjustment through our social media handles and in collaboration with partner organisations.