Preventing suicides in Malawi

Suicide

On Friday, August 13th, 2021 the media reported the death of Reverend William Mumba, indicating he had died of suicide. Following this reporting, social media was flooded with comments. Additional information on the death of Rev. Mumba followed including a copy of the suicide note.  People expressed feelings of grief, confusion, disappointment and more, which is normal following such news. However, this incident and the news sharing that followed also raise areas for concern.

Suicide itself is a major public health issue that needs a multi-stakeholder national response. In Malawi suicide remains criminalised under the penal code (sec. 228 & 229). The resulting stigma, guilt, and shame associated with suicide makes talking about it a challenging endeavor for those affected. In addition, the way the incident was reported including language used i.e., “committed suicide,” and the news further shared on social media calls for a conversation around safety, dignity, privacy and prevention of suicide contagion.

Media plays an important role in preventing suicide, but also, could be a catalyst for suicide contagion, stigma and shame affecting those left behind. We understand the difficult position journalists may find themselves in trying to balance developing a momentous story on suicide and avoiding those storylines that may contribute to an increase in the risk of imitative/ copycat suicide, particularly if the coverage is extensive, sensational, explicitly describes the method of suicide, and/or repeats widely-held myths about suicide.

As individuals dedicated to promoting mental health and wellness, and champion suicide prevention, helping save lives and bring hope to those affected by suicide, we are deeply saddened by the passing of Rev. Mumba, as we are with any loss of life to suicide. Our thoughts and prayers go to his family, friends, community, and the members of the Kapirimtende CCAP congregation. 

Suicide is a global public health problem. The World Health Organization (WHO) states that every 40 seconds someone, somewhere in the world dies by suicide. In Malawi suicide is increasingly becoming one of the leading causes of premature mortality. Police in 2020 reported that there was a 57 percent increase in suicide cases between January and August of 2020, in comparison with the same time in 2019. Recent figures between January and March 2021 indicate a 172 percent increase in comparison to the same period in 2020.

Additionally, the COVID-19 pandemic has proven that it is more than just a physical health crisis. It is also contributing to the significant mental health crisis that is having a substantial impact on the well-being of the general public. The COVID-19 pandemic has now created conditions that increase suicide risks, such as increased economic stress due to job losses or business closures, social and physical isolation, physical illness or loss of life leading to grief and/or anxiety, and reduced access to community and religious support as most of these have either been shut-down or have their time and/or capacity reduced.

We understand that every loss of life to suicide is tragic, and has far-reaching implications on individuals, family, friends, colleagues, and communities. The urgent need to respond to this growing public health problem cannot, thus, be overemphasised. As we approach World Suicide Day which is observed every 10th of September, we urge everyone to reflect upon the devastating toll that suicide has on individuals, families, communities, and the nation as a whole, and to explore ways to reduce this burden together.

While local research on suicide and mental health is limited. As a country, we can learn and adopt from research and resources from around the world including the World Health Organization (WHO) that informs more about suicide and how it can be prevented including best practices around suicide reporting and sharing. So, we have a basis to work from towards the prevention of suicide as well as the promotion of mental health and wellness, and we have NO excuse not to.

Suicide prevention efforts must engage all sectors, including public health and other healthcare services, mental health, social services, our police and military including veterans, the media, faith communities, our chiefs and other traditional leaders, education institutions, and businesses. These efforts must be informed and guided by data, inspired by the needs of the groups affected including voices of individuals and families with lived experiences to suicide ideation and/or losses.

Now what can we do?

The World Health Organization, states that there’s no health without mental health!

In 1996, the WHO, recognising the growing problem of suicide worldwide, urged member nations to address suicide. In their document, “Prevention of Suicide: Guidelines for the Formulation and Implementation of National Strategies,” they outlined recommendations and provided a framework for suicide prevention. The recommendations provided and their supporting conceptual framework are essential steps toward a comprehensive National Suicide Prevention Strategy. The nation needs to move forward with these important recommendations and support research efforts to improve the local evidence base for suicide prevention.

As a nation, we must address suicide as a significant public health issue. The government needs to take a leading role and provide a detailed roadmap that is coordinated and integrated including but not limited to a long-term commitment to the cause, national suicide prevention, and mental health strategy, adequate funding and support towards suicide prevention and mental health promotion efforts and a comprehensive Covid-19 recovery plan. It is sad to note that even during this time of the Covid-19 pandemic, the funding that has been directed towards the Non-Communicable Diseases (NCDs) and Mental Health Units is very insignificant to do anything meaningful. These two important units together have been allocated MK15million in 2020 and MK8million as their annual running budget. This is unacceptable.

It could be argued that the level of neglect by government in this case, is contributing to a state that undermines individuals and communities’ social and emotional wellbeing, thereby increasing their mental health vulnerabilities and risk of suicide.  We know that mental illness and substance use disorders (SUDs) are among the common factors related to suicide. Therefore, the goal could be investing in mental health and suicide prevention services and to help reduce the number of immediate life-threatening situations related to mental illness and SUDs through increased education, crisis intervention, support, and follow-up services including those provided virtually and over the phone. This funding can be channeled both through public institutions as well as community-based organizations and NGOs working in the area. A public-private partnership approach could also be explored.

Decriminalizing attempted suicide

We call upon the Ministry of Justice, the office of the Attorney General, Ministry of Health, the Malawi Human Rights Commission, the Malawi Parliament and all other relevant Stakeholders to work together, review and decriminalize attempted suicide in our laws. Suicide (attempted or completed) is a public health issue and not a criminal offense, and if we are to address the resulting stigma, guilt and shame associated with suicide and the barrier the law puts on people to open up and seek help. As a public health issue, suicide is a human rights issue and to prevent further suicide decriminalizing attempted suicide need to be considered and form part of the broader conversation and strategy.

The general public’s responsibility

Social media offers an opportunity for socialization. However, when it comes to discussing suicide, sharing suicide news, and any other personal health issues on social media, it’s important to exercise caution so that you don’t inadvertently send harmful messages that reinforce suicidal thoughts and feelings or other forms of self-harm. To ensure that you communicate your messages effectively and remain sensitive to those struggling with suicide and mental health issues, make an effort to learn more about mental health and some of the best practices around reporting and sharing suicide news.

Media responsibility

It is recommended that media reports about suicide should always include information about where to seek help, preferably from recognized suicide prevention services that are available.

As the public increasingly turns to social media to access news, it has never been more important for journalists and developers of online content to consider how they are portraying suicide. The increased capacity of social media users to share information rapidly to a broad audience means that getting a story right the first time, is essential.

At the minimum, we ask all members of the media to review the 2017 guidelines[1] provided by the World Health Organization. As an institution, we stand ready to work with the media and the general public on suicide prevention.

Someone said, “even the most well-considered plan accomplishes nothing if it is not implemented.” This is where commitment from all of us is essential.

About the author: Dennis Mwafulirwa is the CEO of Connect Plus Resource Institute (CPRI)