Suicide, a self-destructive act, prowling on youths in Nigeria — Prof Taiwo Sheikh

Taiwo Sheikh, a professor of psychiatry at the Ahmadu Bello University and the convener of the Nigeria Suicide Prevention Advocacy Working Group, in this interview with SADE OGUNTOLA, says suicide, a deliberate act to die, is more common in youths in Africa, though these are preventable deaths.  Excerpts:

WHAT is tantamount to suicide in medical parlance?

In medical parlance, suicide is a condition where someone will inflict deliberate self-harm that will end with death; the individual is conscious that the action will lead to death. Let me give you a background. Suicide is surrounded by a lot of myths and misconceptions in our society. Talking about well-being, that’s our health; it is an active process of you making the correct choice of your style of living that will lead to a healthy and fulfilling life, and you know that choices have to do with your state of mind. If you are not of a stable mind, you are not likely to make correct choices; you may make wrong choices. So that brings us to suicide. Now, suicide, by definition in the medical books, like I said earlier, is a deliberate action or deliberate act that somebody does which results in death. It’s a conscious act. So you deliberately take an act that is self-destructive.

However, our understanding of suicide has gone beyond just deliberate acts. Suicide is a deliberate and compulsive urge to embark on an action that leads to an individual’s death. It is beyond their control. In my years of experience as a psychiatrist, interacting with so many people under the burden of suicidality, I have come to tinker a little bit with that general assumption that leads to that definition of a deliberate act of self-harm that leads to death.

Now, I see suicide as something that is beyond just a deliberate act of self-harm that leads to somebody’s death. It is now a “compulsive urge for someone to take his own life that leads to that deliberate act of self-harm that leads to death”. So suicide is not a normal thing. Suicide is an aberration. Everybody wants to live.

What are the reasons for suicide in Nigeria? What’s its trend like?

If you ask for reasons why we have suicide in Nigeria, that’s difficult to answer. The reasons are the same globally. Some of the factors that lead to suicide may vary from one community to the other, from one culture to the other, and from one country to the other. The human brain is wired the same, regardless of the race. So suicide is everywhere. However, there are things that are determinants of suicide. These could be biological, social or psychological factors that can trigger the thought of suicide or that are likely to perpetuate it.

The biological determinants have to do with your genetic makeup, your personality and the presence of mental or other physical illnesses that are chronic and most times not curable, like diabetes, hypertension, cancer and stroke. Social factors include things that have to do with our day-to-day life and our social interactions, like unemployment, toxic relationships, and failed examinations. While psychological factors that can serve as triggers include things like assault on a psyche made from trauma, banditry, rape and armed robbery.

 Are there factors that are peculiar to Nigeria regarding suicide?

In Nigeria, we have some peculiarities. There is a rising trend of suicide in Nigeria; everybody is aware of that. It is in the news and everywhere in the media. The statistics are there to show that cases of suicide are on the rise. About 90 per cent of completed suicides are due to mental health challenges, but we are handicapped. The gap between severe mental disorders and available treatment is high; in some communities it is up to 90 per cent. It means only about 1 out of 10 people with serious mental health conditions have access to mental health care. This is already putting us at a disadvantage. So untreated mental health conditions constitute a major determinant of suicide in Nigeria.

Now, when we consider the other 10 per cent that are due to other factors like social and psychological issues like lack of a job, poor housing, marital problems, power outages, banditry, and kidnapping, as well as poor purchasing power. Over time, all these take a toll on individuals. For instance, when one person is kidnapped, a minimum of 10 members of the family are affected by that kidnap. So these are some of the things that are responsible for the rising trend of suicide in Nigeria. A few years ago, we did not talk about such a magnitude of kidnapping or terrorism in Nigeria.

Back in 2019 to 2021, the incidence of suicide was about 6.9 per 100,000. Today, we are talking about maybe 5.2 (or there about) per 100,000 population. The statistic may appear to be improving, but the population is rising. So the quantum numbers of people who actually die of suicide are increasing.

Also, suicide has always been there. Some time ago, youth suicide in Africa was the third leading cause of death. Today, it is the second leading cause of death in Africa. So you may tell me the rate is this, but the number is actually increasing. That is where we are.

Awareness about suicide is increasing. In the past three years, we have had civil society organisations working on suicide prevention in Nigeria. I am also leading a coalition of civil society organizations that are working on suicide prevention in Nigeria. We are doing a lot of awareness campaigns and moving advocacy to policymakers.

What are the things that make Nigerians particularly vulnerable, and who are those that are vulnerable to suicide in Nigeria?

Lack of access to mental health care is one factor that makes Nigerians highly vulnerable. A lot of conditions that will lead to suicide are within the sphere of mental health, and it can be nipped in the bud if the service is available. Where such services are not available, then prevention is very difficult. Today, suicide is preventable worldwide. If we don’t take the steps that will lead to prevention of suicide, if we don’t provide mental health services that will prevent suicide, then it makes us highly vulnerable.

As it is, we are the headquarters of social and psychological determinants of suicide in the world. The social challenges in this country are many and are making many Nigerians vulnerable. Look at it now; individuals find it difficult paying their children’s school fees; they don’t have decent housing, no water, poor environmental hygiene, no seamless transportation, no power and no job. There is hunger in the land. Everybody has become a beggar. Just go on to the street and see what is happening.

But when you look at those who are more vulnerable to suicide, then it will dawn on you why suicide should not be handled with a kids’ club in Nigeria. Suicide is majorly a youth problem. Nigeria is in the belt of the world where youth suicide is the highest. Seventy-seven per cent of youth suicide, that is, suicide between the ages of 15 and 29 in the world, is taking place in low- and medium-income countries.

Nigeria is one of the most populated countries; we have a high population of young people in Nigeria. The youth (under 30) population of Nigeria is over 60%. So, suicide is a threat for the survival of our young people. Another thing is, the African continent has the highest male suicide rates in the world. Male suicide in Nigeria is almost three times the female suicide rate in Nigeria. The female suicide rate in Nigeria is averaging 5 per 100,000 population. The male suicide rate in Nigeria is higher; it’s about 12 per 100,000 population. The youth suicide rate in Nigeria is about 15 per 100,000 population, which is about the African average as well.

Suicide is something that is threatening young people; it is a threat to men within our society; it is a threat to our workforce in terms of productivity. It is a threat to our future because this group of young people represents our future. So, Nigeria cannot treat suicide with kid gloves. We must put our hands on deck for suicide prevention in Nigeria.

 Is failure in examination enough reason for somebody, even a medical student, to commit suicide?

First, we are campaigning against criminalizing suicide. So, we don’t like using the word ‘commit’ anymore. The word has already criminalized it. You only commit an offence. People can take their own lives. People can die of suicide. Can failure in an examination be a reason for suicide? This is the problem; people look at suicide as something that is caused by only one situation. But this ends up trivializing suicide. There are other factors that are related to that failure of the exam. Other things that people don’t see that are silently there. For instance, the struggles of this person before he died and before the examination are not considered. That student may have been struggling with mental health challenges before that time or even suffered from psychological trauma or been struggling with social challenges. Suicide occurs as a result of complex, intertwining factors. So, one factor will pull the trigger, but there are other factors that have been pushing the person to the wall.

If you ask in that medical school, was he the only one who failed his exams? Certainly he might not be the only one. So, why didn’t others also die of suicide? That is the question. So it is not appropriate for us to trivialize suicide and make it look like a one-event or one-factor issue. Every time suicide occurs, we must all look beyond the immediate problem. We should try to find out what has been happening. You will hear someone will say, ‘Ah, he’s been struggling with some mental health challenges for some weeks,’ and things like that. Or you will hear that his father died a few weeks ago, the mother is hospitalised and things like that.

So, is treatment and prevention of suicide mainly for psychiatrists alone?

Clearly this role is not for psychiatrists alone. Suicide prevention is everybody’s responsibility. And this is one of the things we are talking about, because the theme for this year’s Suicide Prevention Day is changing the narratives of suicide. It’s a whole society’s responsibility to prevent suicide. However, there are certain aspects of the prevention that are technical, which will need some experts to lead.

Suicide is an end of life. Once somebody takes his own life, there is nothing to treat. That’s the end of the journey. So suicide can only be prevented. Personally, I always say that suicide is a preventable tragedy. All over the world today, suicide is preventable. Our approach to suicide prevention is whole-society, community-based and person-centred. And everybody has a role to play within these three layers.

Does it mean that even families and people around have a role to play in all of these?

Absolutely. For every suicide that has occurred, there are 20 other people that are attempting but fail. For every suicide that has occurred, a minimum of six members of the family are at risk of taking their own life as well. This means that people within the family also need support, which we can call psychological first aid. These things matter. So you can see that everybody has a role. The priest, the imam, and traditional leaders, all within the extended family, can come to provide some support. So, everybody has a role to play. Suicide is not contagious, but if it can affect someone that is very close, many things can push them towards suicide.

How far has your association working on ensuring suicide prevention in Nigeria gone with ensuring that attempted suicide is no longer a criminal offence in Nigeria?

A: Our coalition of civil society organizations in Nigeria called the “Nigeria Suicide Prevention Advocacy Working Group”, which I am the convener of, is made up of civil society organizations within the sphere of mental health and suicide prevention, as well as individuals across different professional and civic groups that are interested in suicide prevention in Nigeria, like serving and retired judges, engineers, senators, members of the House of Reps within that group, students, market people and the whole society.

The large group launched last year has been running workshops and online webinars and equipping our members on how to go ahead with advocacy and awareness campaigns. We are providing them with data and reports to be able to challenge what is going on and change the narrative of suicide in Nigeria. We call it evidence-based advocacy. It is that group that developed this multi-layer approach to suicide prevention in Nigeria. We define this multi-layer approach; we say whole society, community-based, and person-centred.

So when you look at the whole society, we try to address policies, strategic plans, and laws that have to do with suicide and access to care for mental health in Nigeria. We supported the Federal Ministry of Health when the ministry was developing the National Strategic Framework for Suicide Prevention in Nigeria. We were part of it.

We went ahead to develop a concept bill for comprehensive suicide prevention in Nigeria, which has now transformed into a legislative bill in the National Assembly. So we have a bill in the National Assembly that is sponsored by Senator Asuquo Ekpenyong, the Chairman of the Senate Committee for NDDC. The bill has gone through the first reading. It is a bill that comprehensively addresses suicide and seeks to prevent suicide and also repeal the laws that criminalize attempted suicide in Nigeria.

Every year, we try to increase our advocacy and awareness during either Mental Health Day or Suicide Prevention Day. At the community level, we run workshops for people. We have religious leaders within our group: Christian, Muslim, and traditional religious leaders. We listen to their concepts of suicide and approach to suicide prevention. And we work in the same line, and we see that what we are doing is not challenging the norms of our society.

We create avenues for them to make public presentations. We create platforms for Christian priests, Muslim Malams and the traditional leaders to make public presentations on their understanding of suicide and its prevention and then cross-fertilise their ideas to ensure that everybody is carried along and everybody’s religion and culture are respected. In that way we are trying to disarm the myths and misconceptions about suicide. Today we have come to realize that there is no religion in this country that has punishment for attempted suicide. All religions abhor suicide; they take suicide as a sin. According to religions, the punishment for that sin is in heaven. However, the consensus is that if you can protect someone from committing that sin, you also have a blessing because you have saved a life. And that is what suicide prevention is all about. It is to prevent people from going foul of the religion and dying of sin. You pull him out, and you save him. Let us not play God; punishment for suicide is in heaven, not on earth!

In the community, we educate people and create awareness. We empower people with better knowledge to be able to disseminate suicide prevention messages. We also let people know the relationship between mental health and suicide, the relationship between our social norms and suicide, and the relationship between psychological assault and suicide, as well as where services are available. That is what we mean by community-based.

Then, we go to practitioners taking care of individuals who have mental health challenges and those providing psychosocial help for social problems to create awareness, educate them, and carry out advocacy for them so that they will know how to manage individuals who are under the burden of suicidality. And that is what we mean by a person-centred approach. So they will know how to take care of the person who has a problem. If they need medication, social support or rehabilitation, they will be able to help.

We do know that substance use disorder is also one of the predispositions to suicide. How they can manage people with substance use disorder. How they can manage young people, adolescents, who have mental health issues that can be suicidal. And so on and so forth. So this is what we mean by person-centred approach. Also, you see our messages on suicide prevention and the need to decriminalize suicide attempts on Facebook, LinkedIn and other social media platforms, including in the newspapers.

We hosted an international conference on suicide prevention and decriminalization of attempted suicide in Nigeria in October 2024 in Abuja, where we had all the stakeholders, including representatives of the Federal Ministry of Justice, the Federal Ministry of Health, the Federal Ministry of Youth, foreign embassies, high commissions, and the Minister for Youth was physically present. At that conference, we passed some key messages regarding the present non-compassionate law criminalizing attempted suicide.

One, that law is not indigenous to Nigeria. We inherited that law from our colonial masters. We are still holding on to that law. Our colonial masters, when they saw our approach to suicide prevention and to those who attempt suicide, went back to their countries, and they changed the law. They have seen that if a Nigerian wants to jump into the river to die, we will not push the individual; we will rather try to help solve his problem. That is our attitude. They realized that we provide support; we don’t punish. So they went back to their countries and, learning from us, changed the laws.

Two, we realized that the law tries to prevent the act, but it does not address the thoughts that lead to the attempt at that time. The act starts with thoughts; you have to start thinking of killing yourself before you act. And the law also does not address the social determinants and psychological determinants of suicide. For instance, the law does not provide employment, provide food, or provide electricity; it does not make mental health services available. It just picks people and sends them to jail. It doesn’t provide light, it doesn’t provide fast food, and it doesn’t provide job opportunities for young people.

Three, we used to have lunacy law in Nigeria before we had the National Mental Health Law. The lunacy law says that anybody who is classified as a lunatic should be dropped in the asylum. It doesn’t provide treatment. Fortunately for us, on December 28, 2022, late President Buhari signed a new mental law into force which is more compassionate. It took us over 25 years to be able to change this. It’s the same narrative to push out the lunacy law because it is an old, archaic, inhumane and uncompassionate law. When the lunacy law came, the colonial masters who brought it didn’t have strategies for mental health prevention or treatment, so they came with a custodial law that sends people to asylums. So also with the suicide law that they brought, they thought that sending people to jail is the only way to prevent them from killing themselves. Today we have various types of suicide prevention interventions in Nigeria; we do not need to send people to jail.

Four, this suicide law is a barrier to service uptake. People are afraid to come out. In fact, this law will make you ensure that you do everything possible to take your life because if you fail and you are caught, you go to jail. In a way, this law is a driver for people to complete suicide. Aside from that, it is also a barrier for people to talk and to seek help. The law says that if you are aware that somebody is attempting to take his own life (even if you are rendering help) and you don’t report it, you are liable to go to jail for one month. If you are a doctor and they bring somebody to you who has attempted to kill himself and you resuscitate that person, you treat him, and you don’t report to the police, you are likely to go to jail for one month. So if you come to me, I’ll tell you, ‘Please don’t come; I cannot help you.’ It’s a barrier to service seeking and service uptake.

And then the crux of that law is that when you drive people underground, you don’t have data. So you cannot plan. The data we have are WHO projections; they are underestimations of the actual situation. So, you realize that we don’t need this law anymore. We need to change the law to that which will create service, ensure data generation, create funding and help the relations of those who died by suicide so that they too will not take their own life, as well as create training for everybody to be able to handle suicide attempts in Nigeria. That is the law we need, and that is the law that is in the National Assembly today.

Finally, there are countries like Singapore, Pakistan, Ghana and others that have decriminalized attempted suicide, and this has led to a reduction in suicide attempts and completed suicide in those countries.

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So how soon can this become a law assented to by President Bola Tinubu?

We need people to help us to actualize it. Last week we had a meeting with Senator Ekpeyong, when we paid him an advocacy call to push for the second reading of that law. Moreover, we are pushing and having advocacies with partners and influencers regarding the law. The journalist constituency is a powerful community, and we need to ensure that this law is passed. We want the media to prioritize this law? This is for Nigerians. This is to save our youth. This is for our generation, yet unborn. Imagine us carrying along this archaic law that people who built the law had gone on to change.

Imagine the moment they say suicide is a sin. People now assume that attempted suicide must be punished, whereas there is no religion that has punishment for attempted suicide. No section in the Bible or the Quran says so. In the Quran, there is a verse that was specifically brought down because of people who have the compulsive urge for suicide. There is a verse that was revealed to the prophet Mohammed; may the peace of God be upon him. He had a situation where he was thinking of taking his life, and Allah revealed a verse to him. If you are faced with this kind of situation, you keep reciting that verse in the Quran. So is this a punishment? No, it’s not a punishment. So punishment is after death. Do we want to play God? Do we want to start punishing when God has not asked us to punish? No.