Suicide: Is the law doing more harm than good?

It was November 7, 2011 when John Wachira had an argument with his brothers at their home in Thirigitu village, Nyeri.

After the argument, Wachira felt like he had enough and he tried to commit suicide by hanging himself with a rope from a rafter in his house.

He failed, and the court would later punish him for it. Wachira was given a custodial sentence of three years for attempting suicide, according to a story captured in the Nation then.

Fast forward to October 8, 2013 when a 33-year-old man identified as Kelvin Wanjala decided to jump from a five-storey building after his neighbours in Nakuru County labelled him a thief.

Having felt like they had tarnished his name and after being shunned from the community, Wanjala had decided to take his own life by jumping from a building. All this was captured on camera.

He too did not die and was arrested and taken to court for attempted suicide. He was freed on a bond of Sh200,000.

These are just some of the few stories of men and women who have been sent to jail for attempted suicide. This is despite experts saying anybody who attempts suicide needs to be sent to a mental facility and not jail.

The number of people who attempt suicide and are sent to jail are on the rise. Some cases go unrecorded because they are sent to jail by their own families.

History of stigma

Others are lucky to have families who take them to see specialists for therapy. This is exactly what happened to Naomi (not her real name), who tried to commit suicide in early 2018. 

She was diagnosed as bipolar at the Mathari National Teaching and Referral Hospital, a hospital that caters to patients with mental health illnesses.

This particular facility’s past in and of itself has a history of stigma let alone the illnesses of the people who walk in there daily.

The history of the hospital dates back to the 19th Century when smallpox was prevalent in Kenya. Victims spotted in Nairobi area were collected together and tucked away in a bushy isolated place which was then known as the ‘Smallpox Isolation Centre’. The centre closed down in April 1910 and in July of the same year was re-opened as a lunatic’s asylum.

During the First World War, the asylum admitted patients from the various African troops fighting in the war who were considered insane.

In 1924, the asylum was renamed Mathari Mental Hospital and retained the name until 1964 when it was changed to Mathari Hospital.

It has since tried to clean up its image and is currently a teaching and referral centre.

This is where Naomi sought refuge and went through six sessions of a type of therapy that tried to stimulate or ease certain brain activity with electrical impulses known as electroconvulsive therapy (ECT).

“I saw a psychiatrist who recommended this form of treatment but I hated it because it caused some memory lapses. I, however, considered myself lucky because my doctor did not report me to the police,” she says.

According to the law, anyone who attempts suicide is considered to have engaged in an illegal act and instead of admitting them to a mental health facility they should be jailed.

Chapter 63, section 226 of the Penal Code stipulates that any person who attempts to kill himself or herself is guilty of a misdemeanour. The penalty is up to two years in prison or a fine or both. This is what Naomi was supposed to be condemned to had her doctor reported the matter to the police.

This law, like all Kenyan laws at the time, was adopted from the British colonisers. The irony, however, is that in 1961 England and Wales decriminalised suicide, so that those who failed in the attempt to kill themselves would no longer be prosecuted.

In fact, suicide is currently illegal in just 25 countries, and an additional 20 countries follow Islamic or Sharia law where suicide attempters may be punished with jail sentences. The vast majority of countries have laws making it illegal to abet, aid or encourage suicide, but the nature and punishment of the actions that are illegal varies.

Outdated law

The progress made by many countries around the world on mental health and especially suicide is the reason experts in the country are against this law. They believe that people who try to die by suicide need care and medical attention rather than be condemned to a life in prison.

Dr Boniface Chitayi, President of the Kenya Psychiatric Association, says no doctor can report their patients to the police because they understand there is no basis for having them jailed. He adds that this is an outdated law.

“The right to health is a fundamental human right guaranteed in the Constitution of Kenya. Article 43 of the Constitution provides that every person has the right to the highest attainable standard of health. So, no doctor would take their patient to the police instead of trying to treat them,” he tells HealthyNation.

Dr Chitayi says the law must be corrected to reflect the current scientific evidence, which shows that suicide comes from mental illness. He adds that even some sensitised police officers take people who have attempted suicide to hospital rather than the cells.

“If we were to report all attempted suicide cases then the cells would be full. We are bound by ethical practice and what is ethical for us to do is treat the patient because they belong in a hospital and not in jail,” he says.

Naomi only learnt of this at Mathari Hospital where some of the people admitted with her informed her of this law. “I was afraid of going to prison more than death itself,” she says.

This is why when the second time she felt suicidal, she immediately reported to the Mathari Hospital hoping to get some help for her illness. Unfortunately, at the time the facility was not taking in many patients and being unemployed, she could not seek treatment in a private facility.

“I was hosted at a rehab centre together with who were seeking treatment for addiction. While there, I had to go through a 12-step programme along with these people yet I did not have addiction. But, I did not mind as I learned a lot,” she says.

Naomi says she got support from her family. Her father who was a religious leader found support from the PCEA church even though he was not a member of that denomination. He was comfortable talking about his daughter’s illness with people who were ready to listen so that he would make them more aware of mental health and he was a great source of support for Naomi.

“One day, however, he mentioned that his daughter was admitted at Mathari Hospital to a group of friends and he was ostracised,” she recalls.

Hard topic

Experts warn that sending those who attempt suicide to jail makes mental health a hard topic to speak about.

Dr Linnet Ongeri-Kioi, a research psychiatrist at Kenya Medical Research Institute Centre for Clinical Research, says some of the reasons people die by suicide are mental illnesses such as depression, substance abuse and psychotic disorders.

Other reasons include interpersonal conflict brought on by breakups and affairs, financial reasons linked to land disputes, job loss and debt and chronic illnesses such as HIV and cancer especially when associated with pain.

Dr Ongeri-Kioi, who was speaking during a recent Aga Khan University webinar, led the mental health talk on decriminalisation of suicide in Kenya.

She said a research she and her team conducted had shown that some people attributed suicide to supernatural forces such as witchcraft, inherited curses or spiritual possession. This, in addition to the criminal status of suicidal behaviour in Kenya, contributes to the current stigma.

The impact of suicide stigma is seen in the discriminatory burial practices of suicide victims, the stigmatising treatment of bereaved family members as well as in delayed care seeking behaviour.

A 40-year-old male magistrate she interviewed in the study said: “Once you have reached that stage of committing suicide, I do not think there is much the law can do. If you want to commit suicide because of one aspect or the other and I take you to prison, won’t you look for a belt and hang yourself?”

There are mixed reactions when it comes to suicide and what people should do when a person they know tries to end their life. In fact, in some communities the body of a person found to have hung themselves is supposed to be lashed and the person who discovered this body is supposed to go through some sort of cleansing “to get rid of the bad omen”.

The beliefs and stigma that surround suicide are never ending and for many years the law has treated those who do harshly.

This is why Dr Ongeri-Kioi and other experts believe that the time has come to increase awareness on suicide and its risk factors. They believe that the stigma around mental health can only be reduced by decriminalising this act.

However, this outdated law is about to change soon if a mental health task force that has recommended mental illness be declared a national emergency is successful in repealing it.

The Dr Frank Njenga-led team, whose formation was ordered by the President, says it has begun the process to make sure this law is rescinded so that people who attempt suicide can seek treatment without fear of being jailed.

The task force estimates that one in every 10 people suffers from a common mental disorder. The number increases to one in every four people among patients attending routine outpatient services, which is why they want the National Assembly to move fast to decriminalise suicide attempts in order to reduce stigma and discrimination.

Feel suicidal

They hope that this will encourage help-seeking behaviour among the people who feel suicidal.

It also recommends restricting access to firearms, educating the media on responsible reporting of suicide and implementing programmes among young people to build life skills that enable them to cope with life stresses.

Dr Njenga says that top on their agenda is the proposal to have section 226 of the penal code that criminalises attempted suicide amended or repealed by Parliament.

“This is one of the specific recommendations that we want to deal with immediately. The section that criminalises attempted suicide is one that should be repealed. We have already started engagement with the appropriate parliamentary committee on the matter,” he adds.

The task force, which handed over a mental health and wellbeing report to Health Cabinet Secretary Mutahi Kagwe last year, revealed that the common mental illnesses in Kenya are depression and suicide, substance use disorder, bipolar disorder, schizophrenia and other psychoses.

Psychiatrists in the country are not in support of this law with many saying it is hard to choose between helping a patient and informing the police, which eventually leads to arrest.

This is not the first time mental health issues will be brought to the floor of Parliament since Nominated Senator Sylvia Kasanga sponsored a Mental Health Amendment Bill 2018 that seeks to, among other issues, promote mental well-being. 

The senator says the bill seeks to help reduce the impact of mental illnesses including the effects of stigma on individuals, families and the communities while promoting recovery.

The bill proposes that a person in charge of, or any person employed at a mental health facility or unit who strikes, treats badly, abuses or wilfully neglects any patient commits an offence.

The issues surrounding mental and suicide are now becoming more acceptable. The country has also started making small steps in understanding mental health with the Health ministry launching the Kenya Mental Health Action Plan (2021-2025) to promote mental wellbeing among citizens.

The action plan provides a framework for the national, county governments and other key stakeholders to implement policies that promote the mental and psychological well-being of citizens.

Dr Mercy Mwangangi, chief administrative secretary in the Health ministry who launched the plan says: “Through the plan, mental health and psychosocial support will be integrated into the emergency and humanitarian response especially in the response to the Covid-19 pandemic as well as the long-term recovery strategy.”