Saturday 10th September was world suicide day, set apart to give attention the issue of suicide “reduce stigma and raise awareness among organizations, government, and the public. The message is, suicide can be prevented.
According to the World Health Organisation, suicide is a public health concern that requires urgent attention. The WHO says “an estimated 703,000 people a year take their life around the world. For every suicide, there are likely 20 other people making a suicide attempt and many more have serious thoughts of suicide. Millions of people suffer intense grief or are otherwise profoundly impacted by suicidal behaviours”.
Suicide itself is not a mental disorder but mental disorders are the most important causes of suicide. Mental health issues such as depression, substance use, Bi polar disorders among others are associated with an increased risk of suicide.
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How prepared is Nigeria to tackle this public health problem?
Nigeria’s 106-year-old mental health law dates back to 1916 and was tagged “the lunacy ordinance” which was later amended in 1958 to grant medical practitioners and magistrates the right to detain people with mental health problems. With terms like “lunacy” and “idiot” in the language of the law as well as wide-sweeping rights for magistrates to remand mentally ill people or those who attempt suicide, the law, in effect, criminalizes mental health issues.
It is no surprise then that Nigeria does not have a national suicide prevention strategy, which guides the reduction and prevention of suicidal deaths, and the elimination of the stigmatisation of survivors and relatives of suicidal victims; as direction for issues of mental health is based on a law that criminalizes the act.
Under section 327 of the criminal code, the law states, “Any person who attempts to kill himself is guilty of a misdemeanour and is liable to imprisonment for one year”. This means that a person who survives a suicide attempt would be arrested and imprisoned for a one-year period. According to experts, this law has neither reduced nor controlled the rate of suicide in Nigeria but would rather worsen the suicide rate.
One clear implication of the punitive law on suicide is the underreporting of suicide in Nigeria and also the lack of data on suicide.
There appears to be a reduction in suicide rates in Nigeria according to WHO data on suicide in Nigeria from 2015, however, it is entirely plausible that there is underreporting of suicidal deaths in Nigeria due to the provisions of the law as well as the stigmatisation associated with suicides.
Suicidal deaths are subject to a number of causes and research shows that financial strain is a significant driver of suicide. In Nigeria, suicidal deaths have also been attributed to financial frustrations especially as more Nigerians are pushed below the poverty line. According to a fact sheet on suicide by the world bank, suicides are more prevalent in low-income and middle-income countries.
Other reasons for suicide in Nigeria includes physical, mental and spiritual reasons. Suicide is often masked, especially by close family, as accidents or deaths of natural causes. This is due to the stigmatisation surrounding suicides in Nigeria and how suicide is regarded as taboo in some parts of the country.
Another significant driver of suicide is the strain on the social relationships of suicidal victims, strainor difficulty in the parent-child relationship, man-woman relationship and relationships among peers or age groups could lead a person to suicide.
Even if people wanted to access mental health care, the care is not available. Currently, 80% of Nigerians with mental health issues do not have access to a care facility, and Nigeria has only 300 psychiatrists to its estimated 200 million population, with a doctor-to-patient ratio of 1 doctor to 700,000 people.
Despite the outdated law and lack of a national strategy on suicide, a number of organisations work to provide support to and prevent suicidal deaths in Nigeria.
Several reports have asked for a reform of the mental health law in Nigeria as well as a national suicide strategy especially as mental health takes on more significance as a public health crisis across the world, it can only be hoped that it does not take another century for reforms to happen.
As we celebrate World Suicide Prevention day, If you or someone you know is suicidal, depressed or anxious these are helplines to reach out to; 08062106493, 08092106493, 09080217555, 09034400009, 08111909909, 07013811143 via the Health Emergency initiative.