WHILE a registry of those who harm themselves is a crucial tool to prevent repeated suicide attempts, a mental health advocate has urged the government to first decriminalise suicide attempts and compile data on those who have died due to suicide.
University of Nottingham Malaysia Assistant Professor of business law Chan Wen Li said a surveillance system to monitor self-harm cases could be meaningfully implemented only when suicide attempts were decriminalised.
The recently proposed National Self-Harm Registry, she said, was a nationwide system to capture data from the medical records of people who were brought to hospitals as a result of self-harm (with or without suicidal intentions).
"The establishment of such a registry would allow for timely monitoring of trends in occurrences of self-harm to better gauge service capacity for treatment and help identify high-risk groups for early intervention.
"This would also contribute to policy development on suicide prevention strategies.
"However, as long as suicide attempts are considered criminal acts, suicide attempts and self-harm will remain underreported for fear of legal repercussions, which would defeat the registry's purpose.
"Setting up the registry would also involve multiple stakeholders, ranging from government agencies to experts in areas such as public health, psychiatry, emergency medicine, suicide prevention, health information systems and statistics.
"As the registry would be a long-term commitment, it is important to ensure that budget, capacity-building and human resource considerations are sustainable for the long run," she told the New Sunday Times.
On Wednesday, Minister in the Prime Minister's Department (Parliament and Law) Datuk Seri Dr Wan Junaidi Tuanku Jaafar told the Dewan Rakyat that the government planned to set up a National Self-Harm Registry to prevent suicide re-attempts.
His announcement came after Deputy Health Minister II Datuk Aaron Ago Dagang, on Oct 7, said the Home Ministry and Attorney-General's Chambers had agreed to abolish Section 309 of the Penal Code, which criminalises suicide attempts.
Under this law, anyone who tries to commit suicide can be jailed for up to a year or fined, or both.
Chan said Ireland established the world's first National Self-Harm Registry in 2015, and the Irish registry had been the template in the World Health Organisation's guidelines to set up and maintain such surveillance systems.
However, she advised the government to instead create a National Suicide and Fatal Injury Registry first to compile data on deaths by suicide in the country.
"This registry should include data on suicide rates, demographic and geographic information, trends, as well as indications of populations that may be at high risk of suicide.
"This is important for healthcare providers to identify areas that deserve focus and priority.
"In comparison, the National Self-Harm Registry captures data on occurrences of non-fatal suicidal behaviour.
"Incidences of self-harm can have different levels of suicidal intent (or no suicidal intent) as well as different underlying motives. Nevertheless, all self-injuring behaviour should be taken seriously.
"Attention should be paid to ethical and data protection requirements surrounding the access of data on self-harm and associated characteristics of patients.
"Confidentiality and anonymity should be ensured at all times," she said.
Malaysian Mental Health Association president professor Datuk Dr Andrew Mohanraj said the self-harm registry should cover hospital-treated cases as well as non-hospital treated cases, including those in private care.
Lauding the government's plans to establish the registry, Dr Andrew said the information on methods and lethality of self-harm, age, gender and psychiatric admissions could help monitor trends and craft appropriate mental health support for vulnerable individuals.
The reporting system in government hospitals, he said, also needed to be improved to reflect true statistics.
Befrienders KL patron Tan Sri Lee Lam Thye said a self-harm registry could help healthcare workers identify potential causes of suicide and allow them to take better prevention measures.
"Those found to have attempted suicide should be sent for follow-up sessions and clinical intervention should be recommended for them.
"It is also important to provide appropriate support to survivors of suicide loss as they endure life without their loved ones," he added.