The end of the year 2022 finally saw a great victory for mental health in Pakistan as the country's parliament adopted an amendment to the colonial-era criminal law to abolish the punishment for attempted suicide.
Section 325 of the Pakistan Penal Code (PPC) is a law from 1860 that originates from the British Common Law. It was used as a means to discourage suicide and allow the state to re-possess assets of those who committed suicide. In the United Kingdom, the law was repealed in 1961 because it discouraged those with mental illness to seek help, while in Pakistan it remained effective for almost half a century. Under the section, suicide or attempted suicide was an offence punishable by one year of imprisonment, fine or both.
The credit goes to Senator Shahadat Awan who took the lead and introduced the bill in the Senate to amend the PPC in September 2021. The Senate passed this amendment in May 2022. Member of National Assembly Qadir Khan Mandokhail further introduced this bill in the National Assembly of Pakistan in October 2022, and it subsequently passed the House. After being signed into law by President of Pakistan Dr Arif Alvi, Section 325 of the PPC has been successfully repealed in Pakistan.
The Express Tribune talked to Senator Awan about his motivation to work on this important issue. "Since there has been a lot of debate about decriminalisation of suicide in Pakistan's national media, I seriously thought about it and decided to take it up with the Senate. I involved the parliamentarians and discussed this topic in detail. After great deliberations, we reached the point that Islam tells us to save a life. A suicide is attempted by people suffering from mental disorders, and they need professional help and treatment, not punishment," he elaborated.
The Senator further said that in many instances earlier when a family member attempted suicide and suffered injuries or their condition deteriorated, they weren’t taken to a hospital as it is a criminal offence, and an FIR is registered. It is a fight for life, and a life can be saved if they are taken to the hospital on time instead of waiting for them to die. It meant that our earlier law was like taking action and punishing those who attempted suicide.
Senator Awan said that there is a need to understand that a mentally healthy person would not take such an extreme step, and rather they would look into ways to solve problems to make life easier and peaceful. "There are so many verses in the holy Quran about suicide but nothing about attempted suicide. Therefore, if someone tries to take their life, we should try our best to save their life and then help them seek professional help," he said. “Due to continuous financial and other stresses in life, depression and other mental health issues are affecting people, and thus there is a need to encourage people to seek proper treatment,” he added.
Mufti Faisal Japanwala in Karachi seconded that in the Quran there is nothing about punishing someone who commits suicide. “So, as per Islam, we must save a life,” he added.
Patients, not criminals
In September 2021, the Taskeen Health Initiative launched a nationwide campaign under the banner “Mujrim Nahin Mareez” (patients, not criminals) to repeal Section 325. September was declared the National Suicide Prevention Awareness month in 2008, and since then this month has been the time to acknowledge those affected by suicide, raising awareness, and connecting individuals with suicidal ideation to treatment services.
By the end of September 2021, Senator Awan had already introduced the bill in the Senate, but that was his independent initiative in light of a national debate. "We were not in touch with him before, but we played our part," said Dr Taha Sabri, Co-Founder of Taskeen, a non-profit that works for the promotion of wellbeing and prevention of mental illness in Pakistan. He added that the Pakistan Mental Health Coalition (PMHC), a group of organisations and individuals, is passionate about alleviating the psychological suffering of people. Some media outlets helped spread awareness about the issue. Taskeen also organised webinars.
Dr Sabri said, “The repeal of Section 325 will help to make suicide a medical and public health issue. It will also reduce the stigma associated with mental health and encourage families and loved ones of the individuals who attempt suicide or face mental health issues to get them help instead of focusing their energies on hiding a case from police. It will also be helpful for the accurate reporting of the number of suicides.” He added that this will prevent the unnecessary loss of life and help those individuals heal and progress towards a happier and more productive life.
In 2018, Senator Dr Karim Khawaja was the first one to work on decriminalising suicide. The Council of Islamic Ideology had approved the bill, and later it was sent to the National Assembly. But unfortunately, it lapsed following the change in government. "We learned the lesson that we have to start campaigning for this issue when a government still has two years in power," said Dr Sabri.
On December 2021, the Senate deferred the consideration of the bill after members exchanged arguments for and against the idea. Dr Sabri said that the main hurdle was from the Council of Islamic Ideology. Taskeen provided Senator Awan with material on suicide, fatwas, and videos to help him strengthen his case. "He was quite adept, but we supported him," Dr Sabri said, adding that there was a bit of a hurdle when the Senate sent the case to the Council of Islamic Ideology. "We also reached out to the members of the Council of Islamic Ideology and talked to them. They were on the same page that if someone who commits suicide has a mental health issue, the person should not be prosecuted. If it is not a mental illness, the person should be prosecuted. It was made conditional instead of removing it altogether. That was their stance."
According to Dr Sabri, research shows that there is a history of mental illness in the ninety percent of the reported cases of attempted suicide. "Prosecuting ninety percent people for only ten percent of other cases is not a practical mechanism. Therefore, even though the Council of Islamic Ideology said to keep the code with amendments, the Senate voted to repeal it completely," he said.
Senator Awan played an important role in it by guiding senators that the recommendation of the Council of Islamic Ideology is not practical as it entails even more work as a medico-legal officer would have to investigate the case of attempted suicide. "We have some fatwas too that suggested to repeal Section 325 completely," said Dr Sabri, adding that this was the most challenging aspect of the entire process.
Dr Sabri said, “Taskeen played an important part in this entire process because we believed the time had come that suicide was decriminalised.” Th real credit goes to Senator Awan and later to MNA Qadir Khan Mandokhel. President Dr Arif Alvi were also very helpful. Aga Khan University, British Asian Trust, and Darul Aloom Deoband also helped in the entire process.
The bill was opposed by the Jamiat Ulema-i-Islami; Abdul Ghafoor Haidri said that attributing suicide to mental disorder was inappropriate because in today’s world, people facing poverty and joblessness were committing suicide under compelling circumstances. He added that suicide was prohibited in Islam.
Dr Ali Madeeh Hashmi, psychiatrist and Chairman of Department of Psychiatry at Lahore’s King Edward Medical University said, “What about Anthony Bourdain, a famous American celebrity chef, and Academy Award-winning actor Robin Williams? Were they poor or jobless? Mental illnesses and suicide happen in all social classes. We should make every effort to root out poverty and other social ills, but we need to pay attention to mental illnesses and their consequences like suicide. People who attribute a serious condition like suicide to simplistic explanations like being ‘impatient’ only betray their own ignorance and lack of sensitivity.”
It is true that poverty and its associated problems add to the burden of mental illness, and so do unemployment, divorce, medical illness, and disability.
Medicalising mental illness
“Since now suicide has been decriminalised, the ‘medical model’ will probably be most useful for our society's development,” said Dr Hashmi. While “medicalising” mental illness, including suicide, can be problematic in some ways, this is now likely the best way to de-stigmatise mental illness and suicide, to begin with. Encourage people to seek help from mental health professionals rather than going to faith healers.
Dr Hashmi said, “This was a rare piece of good news in Pakistan in 2022 when lawmakers from all sides united with the mental health community and the legal fraternity to roll back this draconian law.” He advised that a concerted public awareness and advocacy campaign should now be launched nationally to encourage people to come forward and seek help for depression and also report if they have suicidal ideas and behaviours in their family and loved ones. That was not possible before since every case of attempted suicide was automatically a criminal offence, which meant anyone attempting or reporting suicide was liable to being harassed by police or worse, arrested. Earlier, family members and loved ones misreported suicides as accidents or otherwise to avoid legal problems. "We can now begin to collect accurate data about mental illnesses, including suicide, which means we can finally start devising accurate and impactful policies on how to end this rising epidemic," suggested Dr Hashmi.
“It is important to keep highlighting this issue in media, that mental illnesses are not ‘sins’ or ‘character flaws’ but treatable conditions from which a person can fully recover. Attempted suicide is a symptom of a severe mental illness, and the person trying to take their life needs help and sympathy, not censure and abuse."
Importance of seeking help
According to the World Health Report, the suicide rate in Pakistan has alarmingly crossed eight percent, and one out of 200 people attempting suicide dies. Dr Hashmi suggests, “In order to create awareness, we need to keep talking on media and social media about the importance of seeking help for mental illness. Conversations must continue so people can come forward and get the help they need.”
At the same time, for those looking for help for mental health issues, Dr Hashmi advises that they go to the right person because due to lack of regulation and oversight in the practice of mental health, there are a lot of unqualified, poorly qualified, and unethical people defrauding unsuspecting people and causing them harm. Therefore, check experts' credentials carefully, ask around and get recommendations from others, ask lots of questions when you see a therapist, psychologist, or psychiatrist, and if you are not comfortable, walk away and find someone else.
“In the presence of Section 325, we couldn’t launch a suicide hotline because if someone commits suicide, constitutionally, you have to hand them over to the police. That means you cannot help them at all,” said Dr Sabri, adding that repealing of Section 325 basically helped expedite the whole process. "Taskeen already has a helpline, and our next goal is to launch a suicide hotline in the next few months. The hotline will work seven days a week."
“Another goal is to work with the Ministry of Health to send notifications to all hospitals, police departments, and medico-legal officers to sensitise them about the issue,” said Dr Sabri, adding that educating policymakers about the benefits of removing Section 325 is important so that nobody challenges the law, like it's happening in Egypt at present. "They are bringing laws to criminalise suicide due to unscientific and unfounded rhetoric. We have to reinforce and protect the law and to prevent it from being changed again."
Another plan is to train ambulance services on how to respond to mental health crises so that ambulances are also available nationwide for mental health patients, and then link it all to the national helpline and hotline.