WHO: Decriminalisation Reduced Deaths By Suicide In Singapore

WHO’s new suicide policy brief highlights a Singapore case study, where deaths by suicide dropped 45% in the nine months post-decriminalisation in 2020. Singapore police play a vital role as first-line responders for suicidal ideation or suicide attempts.

KUALA LUMPUR, Sept 20 – Singapore’s move to decriminalise suicide resulted in a decline in deaths by suicide, according to the World Health Organization’s (WHO) latest policy brief on the health aspects of decriminalisation of suicide and suicide attempts.

The WHO’s case study on the island republic highlighted that Singapore witnessed a decrease in the number of deaths by suicide just nine months after decriminalisation. The Straits Times reported 166 suicide deaths from January to September 2020, a 45 per cent decline from 304 fatalities during the same period in 2019.

Suicide attempts were decriminalised in Singapore through the Criminal Law Reform Act in 2019, with changes taking effect at the beginning of 2020.

In 2015, out of 1,096 reported cases of attempted suicide in Singapore, 837 individuals were arrested. However, only 0.6 per cent of reported cases between 2013 and 2015 resulted in court proceedings, indicating that most arrests did not lead to charges.

During the period from January to September 2020, the Singapore police force provided support to 1,800 people dealing with suicidal ideation or suicide attempts, underscoring the vital role of the police as first-line responders, according to the WHO policy brief.

These first-line responders have access to a dedicated 24-hour hotline staffed by trained nurses and counsellors. The crisis response team, which manages approximately eight to 10 calls daily on the police hotline, allows for swift suicide risk assessments, safety planning, and access to mental health care.

Superintendent McIntyre Rosie Ann – part of the Crisis Negotiation Unit (CNU), a specialist unit of the Singapore Police Force – told Mothership in an interview in June 2021 that CNU, which primarily deals with suicide-related cases, works as a team with both negotiators and psychologists from the police psychological services department. The negotiators are police officers from various units holding secondary appointments.

“When I first joined CNU, I went through a one-week course in order to be trained in crisis negotiation. After that, we had to go through a lot of psychology assessment, scenario-based tests, exercises, and interviews before we are ready,” she was quoted saying.

In a statement last September 12, the WHO described suicide as a “major public health problem”, with over 700,000 people taking their own lives annually. It ranks as the fourth leading cause of death among 15 to 29-year-olds, and has profound and far-reaching impacts on families and communities.

Suicide can be linked to multiple, complex, and intersecting social, economic, cultural, and psychological factors and challenges, including the denial of basic human rights and access to resources as well as stressful life events such as loss of livelihood, work or academic pressures, relationship breakdowns and discrimination, among others.

Both the United Nations Sustainable Development Goals (SDGs) and the WHO Global Mental Health Action Plan aim to reduce the global suicide rate by one-third by 2030.

“Each death by suicide is a tragedy, and more must be done to strengthen suicide prevention. The resources launched by WHO today provide important guidance on two areas which are critical to suicide prevention efforts: decriminalisation of suicide and suicide attempts and responsible reporting of suicide by the media,” said Dévora Kestel, WHO director of mental health and substance use.

Suicide and suicide attempts are criminalised in the laws of at least 23 countries worldwide, with some actively punishing individuals who attempt suicide.

The WHO stated that the criminalisation of suicide perpetuates an environment that fosters blame towards people who attempt suicide and deters people from seeking timely help due to the fear of legal repercussions and stigma.

In light of the experiences of nations that have recently decriminalised suicide and suicide attempts, such as Guyana, Pakistan, and Singapore, the WHO’s policy brief on the health aspects of suicide decriminalisation provides recommendations for policymakers, legislators, and decision-makers considering reforms in this domain.

Key recommendations included developing national suicide prevention strategies; allocating budgets for post-decriminalisation training for first-line responders; establishing community-based mental health services that uphold individual rights; formulating new mental health-related laws and policies that promote quality care and the rights of persons with mental health conditions and psychosocial disabilities.

“Criminalising suicide only serves to exacerbate people’s distress. The decriminalisation of suicide and suicide attempts is a critical step that governments can take in their efforts to prevent suicide. WHO is committed to supporting efforts to decriminalise suicide” said WHO technical officer Nathalie Drew Bold.

The policy brief also outlines how decriminalisation contributes to saving lives by reducing the stigma and shame associated with suicide. It creates an environment where individuals feel comfortable seeking help, leading to improved data collection on suicide and suicide attempts, which in turn informs more effective interventions.

Meanwhile, the fourth edition of the WHO’s “Preventing suicide: a resource for media professionals” in a 2023 update, produced in collaboration with the International Association for Suicide Prevention, compiles current evidence on the impact of media reporting on suicide and provides practical guidance for media professionals on responsible suicide reporting.

“Responsible media coverage of suicide is an important tool in our collective suicide prevention efforts. By using this resource, media professionals can help minimise imitative behaviours through accurate, appropriate, and empathetic reporting on suicide, and encourage people to seek vital help,” said Dr Alexandra Fleischmann, a WHO scientist.

According to the WHO, studies show that vulnerable individuals, such as those with a history of suicide attempts or thoughts, or those exposed to suicide, face an increased risk of imitative behaviors following media reports of suicide. 

This risk is particularly elevated if the coverage is extensive, prominently displayed, sensationalised, explicitly describes the suicide method, normalises suicide, or perpetuates common misconceptions about it. 

The resource provides guidance on ensuring that reporting on suicide remains accurate, responsible, and appropriate.

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