Fight to decriminalise attempted suicide gains momentum as cases surge

In 2007, Emmanuel Brian Mbuthia, then a primary school student in Nyeri, experienced his first anxiety attack. Overwhelmed by a teacher's grating words about his poor performance, Emmanuel harmed himself and ran away from school.

This incident marked the beginning of a long, painful journey with mental health struggles and suicidal thoughts, which would shape his later life for years to come.

A life of loneliness, emotional torture, the feeling of wallowing in emptiness, worthlessness and dejection, without a steeple spire of hope in the horizon.

"I remember feeling that anxious feeling," Emmanuel recalls. "I was experiencing a lot of anxiety and uncertainty."

Emmanuel's story is not unique.

 Across Kenya, individuals like him grapple with mental health challenges in silence, their suffering exacerbated by Section 226 of Kenya's Penal Code.

This law, considered a relic of British colonial rule, states that any person who attempts to kill him/herself is guilty of a misdemeanor and liable to imprisonment for up to two years or a fine or both.

As the country faces a rising tide of mental health crises, a growing chorus of voices is calling for change, challenging the very foundations of how Kenya approaches mental health and suicide prevention.

The gravity of Kenya's mental health crisis is reflected in alarming statistics. According to the World Health Organization (WHO), approximately 1,408 people die by suicide in Kenya annually, with the rate standing at 3.2 per 100,000 population.

However, experts believe these numbers are likely underreported due to the stigma surrounding suicide and mental health issues.

Globally, the WHO reports that more than 700,000 people die by suicide every year, with 77 per cent of these deaths occurring in low- and middle-income countries. For every suicide, there are many more people who attempt suicide or experience suicidal ideation.

The Kenya National Commission on Human Rights (KNCHR) has highlighted the dire state of mental health care in the country.

According to their reports, Mathari National Teaching and Referral Hospital, the largest mental health facility in Kenya, struggles with overcrowding and inadequate resources. The hospital, designed to accommodate 1,500 patients, often houses over 2,000, with many forced to sleep on the floor due to lack of beds.

Furthermore, KNCHR estimates that over 75 per cent of Kenyans with mental health conditions go undiagnosed and untreated. This staggering figure underscores the urgent need for comprehensive mental health reform in the country.

Dr Lukoye Atwoli, a Professor of Psychiatry and who is also a leading Kenyan mental health advocate, explains the problematic nature of criminalising suicide attempts.

"The context in which it was written is very different from today's context. At that time, I do not think anybody thought about mental health as an important cause for suicide. And people thought about it the same way they thought about homicides and other things."

Today, however, the medical community recognises that mental illness is the single most important predictor of suicide attempts.

Dr Atwoli emphasises, "Usually either severe major depressive disorder or other mood disorders or some other severe mental disorder. Other than that, severe psychological distress as a result of things that are happening in the mind or around an individual can also be triggers for suicide."

The crisis extends beyond the general population, affecting even those tasked with caring for others.

The recent tragic death of 26-year-old Dr Desree Moraa Obwogi, a medical intern at Gatundu Level 5 Hospital, in what is suspected to be a case of suicide, has shaken the medical community, while encapsulating the magnitude of the situation.

The young lady, who had grappled with a tough life amid a cash crunch in the counties, brought to the fore the challenges associated with the medical profession. A situation that threatens to break the bright graduates who opt to be doctors.

In the wake of her death, some senior doctors admitted that young medical professionals work under hideous circumstances with harsh supervisors nettling the situation.  

In response to this urgent need for reform, Dr Atwoli has submitted a petition to the Parliament calling for the repeal of Section 226 of the Penal Code.

The petition argues that criminalising suicide attempts contradicts Kenya's constitutional guarantee of the highest attainable standard of healthcare, including mental healthcare.

"Taking a person to jail because they have psychological distress or they're feeling like life has lost meaning and they are in a difficult place, taking them to jail does not give them access to the highest attainable standard of mental healthcare," Dr Atwoli explains.

 "In fact, it deprives them of access to this highest attainable standard of healthcare," he adds.

For Emmanuel, now a mental health advocate, the criminalisation of suicide added another layer of fear and shame to his already overwhelming struggles. As he battled severe depression and anxiety throughout high school, the threat of legal consequences loomed over him, deterring him from seeking help.

"I remember we got to Form Two, that's when things started getting even worse," Emmanuel says. "At around Form Two, third term, that's when I started self-harming again. I was cutting (myself), and it became worse. That's when I attempted suicide for the first time."

Emmanuel's experiences highlight the cruel irony of the current law. Instead of providing support and care to individuals in crisis, some analysts say it pushes the victims further into the shadows, exacerbating their suffering and increasing the risk of future attempts.

"Criminalisation of suicide is actually a violation of human right to life, to autonomy," he says. "It's so stigmatising. It's such a stigmatising law."

According to Dr Atwoli this approach is barbaric, "A law that says that if you attempt to kill yourself, you should be taken before a judge and if convicted, be sentenced to two years in jail or a fine or both, that law is patently a stupid law because it punishes somebody who needs help."

Dr. Atwoli has submitted a petition to the Kenyan Parliament calling for the repeal of Section 226 of the Penal Code. The petition argues that criminalising suicide attempt contradicts Kenya's constitutional guarantee of the highest attainable standard of healthcare, including mental healthcare.

"Taking a person to jail because they have psychological distress or they're feeling like life has lost meaning and they are in a difficult place, taking them to jail does not give them access to the highest attainable standard of mental healthcare," Dr. Atwoli explains. "In fact, it deprives them of access to this highest attainable standard of healthcare."

The petition has garnered support from mental health professionals, advocates, and individuals with lived experience of mental health challenges. They argue that decriminalising suicide attempts is a crucial step towards destigmatising mental health issues and encouraging people to seek help without fear of legal repercussions.

Despite the growing momentum for change, the path to decriminalisation faces significant obstacles.

There are Cultural and religious beliefs that view suicide through a moral lens in many communities. Some fear that decriminalisation might be seen as condoning or encouraging suicide.

Additionally, the lack of political will to address mental health issues comprehensively has slowed progress.

"We are lacking that political good. This is something that has been finished a long time ago. But you find that, because you have some old guards still there, we have old traditional thinking,” Emmanuel notes.

The push to decriminalise suicide attempts is part of a larger effort to improve mental health care and suicide prevention in Kenya.

The country faces significant challenges in providing accessible, quality mental health services to its population.

"It is the responsibility of the government to ensure that every citizen has access to the highest attainable standard of mental health care. So they have to ensure that at every health facility there are mental health services that are available and accessible to the people,” says Dr Atwoli.

However, the reality on the ground often falls short of this ideal. Emmanuel's experiences as a mental health advocate have shown him the dire need for better resources and support systems.

"We have so many young men who are struggling with suicide," he says, adding, "Despite the number of suicides in Kenya, it's always hiking."

Experts agree that addressing the mental health crisis in Kenya requires a multi-faceted approach. The media has a crucial role to play in destigmatizing mental health issues and suicide.

Judah Wambui Njoroge, a mental health advocate, explains, "The media has a significant role in shaping public attitudes and perceptions towards mental health and suicide. To contribute to destigmatisation, media outlets should focus on storytelling from an empowerment perspective, valuing the lived experiences of individuals and families affected by mental health issues."

Equally important is the role of communities in creating supportive environments and fostering open discussions about mental health.

"Our greatest resource for improving mental health care in Kenya lies in community-level interventions," Njoroge says. "Our communities are the first point of contact for shaping attitudes, building resilience, and creating supportive environments."

Empowering communities to become active participants in mental health care, through education and support networks, will strengthen the collective ability to address mental health challenges early.

A rights-based approach that respects the dignity of service users is essential. Communities must be supported to understand mental health issues and engage in ways that reduce stigma and discrimination.

Dr. Atwoli envisions a future where Kenya's approach to suicide and mental health aligns with its constitutional values and modern medical understanding.

"I think it is time for us to make a statement as a country that we care about our people and their health and well-being," he says, "and that when they have distress, we would like them to have access to the highest attainable standard of mental healthcare rather than being sent into the criminal justice system where their circumstances will only worsen," he adds.

For those currently battling suicidal thoughts or supporting loved ones in crisis, Emmanuel offers words of hope.

 “I wouldn't let myself or people around me to ever succumb to suicide. I've actually been called to like two suicide cases," he shares.

"The best part about it is at least the people in the communities now know what it is. At least we can prevent it."