Suicide attempts in India have reduced by 4.1% in the last five years, but the number is steadily rising since the last three years. While psychiatrists believe that imposing jail terms for attempting suicide will worsen suicide rate, there exists a conflict between IPC Section 309 which criminalises attempt to suicide and the Mental Healthcare Act, 2017 which bars prosecution.

According to Section 309 of the Indian Penal Code, "Whoever attempts to commit suicide and does any act towards the commission of such offence, shall he punished with simple imprisonment for a term which may extend to one year 1[or with fine, or with both]."

Whereas, the MHCA 2017 says, "Any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said Code. The appropriate Government shall have a duty to provide care, treatment and rehabilitation to a person, having severe stress and who attempted to commit suicide, to reduce the risk of recurrence of attempt to commit suicide."

So, can a person be prosecuted for attempting to die by suicide? No. While the IPC law remains a punishable offence, the Mental Healthcare Act, 2017, has created an exception within Section 309.

"We can say that attempt to suicide has been decriminalised for all practical purposes. Section 309 exists because it will require an amendment to the Indian Penal Code (IPC) to remove it from the statute books," Dr Soumitra Pathare, Director of Centre for Mental Health Law and Policy, told FactChecker.

"Mental Healthcare Act has effectively taken away the sting of Section 309. It will be good when the IPC is amended and Section 309 removed. Until then, Mental Healthcare Act will ensure that people who attempt suicide can be provided with services they need and also protected from harassment from police authorities," he added.

The Kerala High Court, in May 2022, quashed a criminal case registered against a village officer for attempting suicide. The court observed that punishing one for suicidal behaviours will "constitute an affront to human dignity".

"Mental Healthcare Act creates a rebuttable presumption that anyone who attempts suicide is presumed to have a mental illness and so should not be liable for prosecution or punishment," said Dr Pathare. If the police proves that the person did not attempt suicide due to any mental illness – for example, a political act of self-immolation — the case would not fall under the Mental Healthcare Act. Moreover, since the Act only provides relief from prosecution and punishment, the police will still have to investigate the matter under Section 309.

Suicide Attempts Rise

While the country has seen an overall decline in cases of attempt to commit suicide between 2017 and 2021, there has been a 10.5% rise in these cases in the last two years —from 1,685 cases in 2020 to 1,863 cases in 2021, shows data from National Crime Records Bureau.

In the last five years, with over 2,000 cases, 2018 saw the highest number of suicide attempts. This was the same year when the Mental Healthcare Act, 2017 was implemented.

More than 85% of attempt to suicide cases in 2021 were concentrated in five states and one Union territory. With 587 cases, Jammu and Kashmir accounts for the highest number of such cases followed by Andhra Pradesh (322), Maharashtra (278), Tamil Nadu (178), Telangana (119) and Karnataka (111). Among these six regions, Jammu & Kashmir and Andhra Pradesh account for nearly half of the share. These regions have consistently contributed to the rise in suicide attempts in India in the last five years.

How Do Hospitals Deal with Attempt to Suicide Cases?

All doctors FactChecker spoke to said they deal with 2-3 patients with suicidal ideations on a daily basis. "I deal with more than five patients in a week. However, currently I see more of pre-teen and teenage patients with suicidal thoughts," Dr Harish Shetty, consultant psychiatrist at Dr LH Hiranandani Hospital, Mumbai told FactChecker.

There has been a significant rise in suicide-related consultations since the pandemic started, most doctors said. "Depression stemming from unemployment, isolation, stress, academic failures and hopelessness are the main reasons for suicidal thoughts among patients," he added.

FactChecker recently spoke to 10 suicide prevention helplines to understand their struggles and how they train the volunteers. Most of them said the most common reasons for people calling suicide prevention helplines were examination-related stress, romantic relationship and family issues, and debt. "Uncertainty is the main trigger for suicidal thoughts in the patients," said Dr Sagar Mundada, consultant psychiatrist at Healthspring Healthcare in Mumbai.

The doctors also said most emergency rooms receive cases of impulsive suicide attempters. "Most of these cases are either related to self-inflicting injuries or substance abuse and those who are brought in are mainly in the 15-30 age group," said Dr Rajesh Sagar, professor at Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi.

All three doctors said follow a standard protocol for attempt to suicide cases which is in accordance with the MHCA 2017. They follow a step-by-step procedure while attending a person who has attempted suicide:

Step 1: Stabilising the patient medically and emotionally and triaging in the emergency ward. According to Dr Sagar, AIIMS deploys 2-3 primary care physicians and psychiatrists 24X7 in emergency wards to attend crisis cases. "As soon as we receive someone who has attempted suicide, we immediately stabilise the patient and ensure their safety," said Dr Sagar. Once the patient is stabilised, the physician looks at underlying physical problems that may have contributed to the suicide attempt such as untreated medical conditions, side effects or presence of drugs, etc. The physician further notifies the psychiatric team for evaluation and diagnosis of the patient.

During the evaluation, a thorough mental health assessment is conducted focusing on four areas: 1) If there are any psychiatric or medical conditions present, 2) If there were any recent personal, social or financial stressors that led to behavioural change, 3) The method used to harm themselves and if there have been previous attempts, and 4) If there are immediate support systems.

Step 2: Mandatory medico-legal case registration regardless of how major or minor the self-injury incident is. It must be done right after stabilising the person. "If we suspect domestic abuse or other non-stress related reasons for the suicide attempt, we immediately inform police authorities since it becomes a medico-legal case," said Dr Mundada.

Step 3: Compulsory mental health referral for required assessment and diagnosis and treatment. To understand the severity of stress and suicidal behaviour, doctors may administer the perceived stress scale and the suicide intent scale. An hourly or two hourly check must be done of high-risk patients.

Step 4: Informing the patient regarding Section 115 of MHCA 2017. According to the Section 115 of Mental Healthcare Act (MHCA), 2017, people attempting suicide are presumed to have severe stress, not to be punished and the government should have duty to provide care, treatment, and rehabilitation to reduce the risk of recurrence.

Step 5: Inquiry by the police regarding Sections 108, 109, and 116 IPC

Step 6: Once the evaluation and medico-legal procedures are completed, doctors keep patients under observation for some time. If the risk for non-fatal suicide attempt behaviour is low, discharge and follow-up care are planned.

According to the recommendations of MHCA 2017, a 24-hour contact number for support has to be included apart from the regular follow-up care. The patient can also be provided rehabilitation that could include medical, surgical, and brief psychological interventions.