Sir,

Annually, suicides claim at least 100,000 lives in India.\[[@ref1]\] Suicide attempts are often under-reported as such an attempt is a punishable offence in India.\[[@ref2][@ref3]\] Though suicide attempts have been gradually decriminalized in other countries, it still remains a punishable offence under the Indian Penal Code.\[[@ref4]\] One of the reasons put forth for the continued existence of such a law is a deterrent effect afforded. Despite the law being in place, there is no concrete evidence about whether such a law acts as a deterrent. Gathering the perspectives of suicide attempters about legal aspects of suicide would be helpful in assessing their understanding whether the law serves as a deterrent. Hence, we conducted a study to find the knowledge and opinion on the legal status of suicide attempt in India among recent suicide attempters.

This pilot study was conducted at a government tertiary care hospital in southern India. Patients with a recent suicide attempt are evaluated at crisis intervention clinic run by the department of psychiatry of the hospital. Evaluation is done in a confidential manner among medically stable, oriented, cooperative subjects. Detailed assessments are conducted using structured questionnaires to evaluate suicide risk and to formulate a management plan. From January 2012 to July 2013, selected additional questions pertaining to suicide attempts were asked from patients. The first question related to whether they were aware of the current legal status of suicide attempt in India, that is, it is unlawful and punishable by imprisonment and/or fine. The answer was considered acceptable if the person could identify that suicide attempt was illegal. In the case the participant was not aware of this status, the current legal status was explained and further questions were asked. The further questions included whether awareness of legal status would have prevented their current attempt, is it likely to prevent their further attempts, and whether awareness in general is likely to prevent others from attempting. The responses to these questions were "yes," "no" or "don't know."

During the study period, 245 cases were registered in the clinic. Of them, 215 (87.8%) suicide attempters responded to questions related to legal status of suicide in India. Among the patients who had responded to the initial key question, 78 (36.3%) reported that they were aware of the legal status of suicide. Individuals with greater education (mean 10.1 years vs. 8.6 years, student *t* = 2.474, *P* = 0.014) were more likely to be aware of the legal status. Furthermore, those with a history of another previous suicidal attempt apart from the recent one were also more likely to be aware (25.6% vs. 11.1%, χ^2^= 7.601, *P* = 0.006). Age, gender, marital status, and residential background did not differ between those aware of and those not aware. Further questions were asked to patients who were not aware of the legal status (*n* = 137, 63.7%) \[[Figure 1](#F1){ref-type="fig"}\]. A large majority of these patients responded in the affirmative that awareness of the legal status would have prevented the current attempt (*n* = 90, 65.7%), and is likely to prevent their future attempts (*n* = 114, 83.2%), and others' future attempts (*n* = 98, 71.5%).

![Patient enrolment and responses](IJPsy-57-103-g001){#F1}

The finding that a majority of the suicide attempters were not aware of the legal status at the time of the attempt could be due to many reasons. First, it may reflect the general unawareness about the legal matters in the community. One may not know about the legal issues till one encounters such situation. Second, it may reflect the comparatively lower educational background of the suicide attempters in the particular catchment area. Third, it is possible some participants claimed ignorance despite knowing about the legal status, fearing entanglement into the legal matters.

The proposed mental health care bill in India is likely supersede the present legal provisions by decriminalizing suicide.\[[@ref4]\] Previous literature suggests that decriminalization of suicide attempts may increase the absolute number of attempts,\[[@ref5]\] but such an increase is less likely when coupled with intensive suicide prevention measures.\[[@ref6]\] Further research on suicides in India is both desirable and necessary. In this regards, this pilot study furthers the evidence of stakeholder perspectives on legalities of suicide attempts, at the same time emphasizing the need for further comprehensive research.

The authors would like to thank the participants.
