When Ghana’s parliament voted to decriminalise suicide and attempted suicide in March, Prof Joseph Osafo felt a weight lift from his shoulders. Osafo, head of psychology at the University of Ghana, had been engaged in a near 20-year battle to abolish the law – brought in by the British – which stated that anyone who attempts suicide should face imprisonment or a fine. “It was a very good feeling. I felt like a certain burden had been removed. I was extremely elated,” he remembers. “Then the next morning, I realised we had a lot of work to do.” Ghana is one of four countries to have decriminalised suicide in the past year – Malaysia, Guyana and Pakistan are the others. More could soon follow, which campaigners say is a sign of greater awareness and understanding of mental health. Kenya and Uganda have filed petitions to overturn laws and members of the UN group of Small Island Developing States have committed to decriminalise. Discussions are also being held in Nigeria and Bangladesh. “There seems to be a domino effect taking place,” says Muhammad Ali Hasnain, a barrister from United for Global Mental Health, a group calling for decriminalisation. “As one country decriminalises suicide, others start to follow suit.” “It is quite unusual,” adds Sarah Kline, the organisation’s chief executive. “It’s a huge sign of progress and an important step forward for the populations most at risk, as well as the countries as a whole.” More than 700,000 people globally die by suicide every year, about three-quarters (77%) in low- and middle-income countries. It is the fourth leading cause of death among 15 to 29-year-olds. A large number of laws were introduced by the British during colonial rule. Suicide was decriminalised in England, Wales and Northern Ireland in the 1960s – it was never criminalised in Scotland. At least 17 countries still have laws labelling suicide a criminal offence. Just last year, Jordan criminalised attempting suicide in a public place, and sentenced a man to a month’s imprisonment. In Nigeria, children as young as seven can be arrested, tried and prosecuted for attempted suicide. In the Bahamas, Bangladesh and Kenya, the will of someone judged to have killed themselves may be discounted. In other countries, people who attempt suicide can face time in prison and/or a fine. The results of these punishments can be “devastating” and present “a huge barrier” to addressing the problem, says Natalie Drew, a technical officer with the mental health policy and service development team at the World Health Organization. Health experts and advocates argue that suicide should be treated as a public health issue rather than a crime. Criminalising suicide denies people the right to access health services and discriminates against them because of something they’re experiencing, Drew adds. Research shows that in countries where suicide has been decriminalised, people can seek help for mental health and rates tend to then decline. In September, the WHO is due to release a guide on decriminalising suicide for policymakers, with explanations of how countries have managed it. In Ghana, Osafo is tasked with making sure the logistics, facilities and resources are in place for people needing support. The government is thinking of initiating a national suicide prevention policy and expanding a mental health helpline, he says. The Ghana Association for Suicide Prevention is devising programmes, information is being disseminated to teachers in schools, and there are plans to hire more psychologists. Osafo hopes Ghana’s decision to decriminalise will encourage other countries in the region to look at their statute books. “[Ghana’s decision] should have an impact on the work ongoing in other countries, especially in the Africa region,” says Osafo. Within the past couple of months, he has set up a mental health working group with representatives from about 20 African countries, and one of the biggest issues on the agenda is decriminalisation of suicide, he says. “Nigeria is active, Cameroon is active … Kenya has joined and is doing fantastic work. We have Uganda. People have been asking us how we did it.” Derrick Kizza, executive director of Mental Health Uganda (MHU), a network of people with lived experience of mental health issues, hopes to replicate Ghana’s success in his country. “We think Ghana gives [our case] some more mileage because it’s in the African context,” he says. In April, MHU, along with Raymond Felix Odokonyero, a psychiatrist, Sarah Tushemereirwe, a woman who has attempted suicide and John Mary Kimuraheebwa, an advocate of the high court, filed a petition with the constitutional court of Uganda arguing that the Penal Code Act, which labels suicide “a misdemeanour” carrying a prison term of up to two years, is at odds with the Ugandan constitution and international human rights law. In neighbouring Kenya, which like Uganda and Ghana, inherited suicide laws from the British, the Kenya National Human Rights Commission has also filed a petition for the decriminalisation of suicide. Last month, at the Small Island Developing States ministerial conference on noncommunicable diseases and mental health, members adopted the Bridgetown Declaration, which commits them to decriminalise suicide. Meanwhile, Abdullah Al Harun, a project manager at ADD International Bangladesh, a UK-based international NGO, is involved in a grassroots movement looking at how to decriminalise suicide in the country. Bangladesh inherited the Indian Penal Code of 1860 and according to section 309, suicide and suicide attempts are considered criminal offences. The government of Bangladesh lists mental illnesses as one of the top 10 priority health concerns in the country. There has been some recent policy changes but nothing relating to suicide decriminalisation. The Lunacy Act 1912, another remnant of British colonial law, was repealed and replaced by the Mental Health Act in 2018. It was introduced to protect the dignity, property rights, rehabilitation and overall welfare of people living with mental health problems, which was missing in the previous act, says Abudullah. He has been closely watching events in Pakistan and Malaysia, which share cultural similarities and where, as in Bangladesh, Islam, which labels suicide a sin, is the predominant religion. Since suicide was decriminalised in Malaysia last month, Anita Abu Bakar, founder and president of the Mental Illness Awareness and Support Association (Miasa), has already seen things change. Crisis response teams and helplines are expanding, and money from the mental health budget is being given to organisations who work in the community. “This is the shift we’re so happy to see,” she says. “It was such an archaic law.” She adds: “I’m a person with lived experience. What does decriminalisation mean to people like me? We feel supported, we feel this conversation can go to a different level. Obviously decriminalisation is not the only way to prevent suicide, but it’s a big one. I’m happy for this progressive move – better late than never. I’m excited to see what happens next, not just for Malaysia but for the rest of us.” In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counselor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org