Suicide in India: from criminalisation to compassion

The Indian Government has announced that it will overturn Section 309, a controversial law criminalising suicide. The announcement follows a 2008 report from the Indian Law Commission that recommended repeal of the “anachronistic” statute, mandating that people attempting suicide would be presumed to be suffering from mental illness and thus not liable for punishment.

Precise figures are difficult to obtain, but suicide represents a huge public health problem in India.

In 2012, Vikram Patel and colleagues calculated that 187?000 suicides occurred in 2010—ranking second among causes of mortality in people aged 15–29 years—whereas this year WHO estimatedthat 258?000 Indians died by suicide in 2012, a third of all suicides worldwide.

Despite a huge unmet need of psychiatric morbidity, few resources are available for suicide prevention. India spends just 0•06% of its health budget on mental health, compared with 10•8% spent by England.

The 2013 draft Mental Health Care Bill (establishing rights to mental health care, currently in parliament), together with the launch of India’s first National Mental Health Policy, and now clarification of the legal status of people who attempt suicide, are all welcome and desperately needed measures.

However, WHO suggests that mental disorders might be present in only about 60% of people who die by suicide in India, compared with up to 90% of those in high-income countries.

Thus, beyond improvement of mental health services, other factors contributing to suicide—the widespread availability of lethal organophosphates, and social determinants such as gender-based violence and acute indebtedness—must be addressed.

The Law Commission specifically cited the dehumanising effects of Section 309, perhaps signifying a shift from legal and philosophical arguments about the existence of a right to die to recognition of suicide as a health issue.

Overturning Section 309 represents more than the end of a law. It demonstrates the Indian Government’s potential to contribute to a global cultural shift towards a pragmatic and compassionate approach to suicide.

Lancet-Editorial Dec 2014.

G Mohan.