Malaysian Journal Of Psychiatry, June 2019, Vol. 28, No. 1 MyCite, Google Scholar June 2019 Vol. 28, No. 1 CONTENTS Editorial A Cross-Sectional Study Exploring Perceived Depression, Anxiety and The Endgame of Section 309? An Stress among Chronic Pain Patients Appeal for Decriminalisation of in a Malaysian General Hospital 48-62 Suicide 1-6 Kurubaran Ganasegeran Ng Yin Ping Surajudeen Abiola Abdulrahman Ravivarma Rao Panirselvam Sami Abdo Radman Al-Dubai Tham Sin Wan Original Paper Sivashunmugam Sangaran Muralitharan Perumal Adaptation and Validation of the Malay Version of Daily Record of Severity of Stress and Temporomandibular Problems (DRSP) among under- Disorders Among Malaysian Armed graduate Students in a University Forces Paratroopers 63-72 in Malaysia 7-18 Siti Nordiana Dollah Siti Inarah Hasim Rosli Abd Majid Jamilah Hanum Abdul Khaiyom Mumtajnisah Abd Rahim Liana Ma Abdullah Validation of the Malay Version of Mohd Badli Mahmud Eating Disorder Examination- Ahmad Fahmi Bustaman Questionnaire 6.0 (EDE-Q 6.0) Shopia Ann Murray among Undergraduate Students: Shahirul Faizi Sapari A Study Protocol 19-28 Syarifah Azlin Juliana Syed Zainal Nasehah Mohd Taib Case Report Jamilah Hanum Abdul Khaiyom Bilateral Nipple Itching at the Age Islamic Integrated Cognitive Behavior of 4 Years: A Case of Conversion Therapy: A Shari’ah-Compliant Disorder 73-76 Intervention for Muslims with Depression 29-38 Redwana Hossain Wasima Rahman Zuraida Ahmad Sabki MMA Shalahuddin Qusar Malaysian Journal Of Psychiatry, June 2019, Vol. 28, No. 1 Che Zarrina Sa’ari Sanjida Tanjin Khan Sharifah Basirah Syed Muhsin S M Yasir Arafat Goh Lei Kheng Ahmad Hatim Sulaiman Anxiety and Cardiovascular Diseases: Harold G Koenig A Case Report 77-80 Socio-Demographic Analysis of Non- Wong Jing Yuan Compliance among Patients with Zurisha binti Zahari Schizophrenia: A Cross-Sectional Md Daniel bin Md Hassan Observation in a Tertiary Teaching Tang Song Ling Hospital of Bangladesh 39-47 Short Report Hasina Akter Bithika Mali Characteristics of Patients Referred S M Yasir Arafat for Consultation-liaison Psychiatry in a Regional Referral Hospital in Malaysia 81-86 Luke Sy-Cherng Woon Noor Izuana Redzuan Malaysian Journal Of Psychiatry, June 2019, Vol. 28, No. 1 EDITORIAL BY INVITATION The Endgame of Section 309? An Appeal for Decriminalisation of Suicide Ng Yin Ping1,2, Ravivarma Rao Panirselvam1,3 1Suicide Prevention Research Malaysia (SUPREMA), Malaysia 2Hospital Pantai Penang, Malaysia 3Hospital Bintulu, Sarawak, Malaysia According to the World Health Organisation In Malaysia, a suicide attempt is currently (WHO), nearly 800 000 people lose their seen as a crime which is punishable by jail lives each year to suicide (1]. This translates term or fine or both. to one loss of life every 40 seconds. For each loss of life, approximately 20 others Section 309 of the Malaysian Penal Code attempt suicide [1]. states that ‘Whoever attempts to commit suicide, and does any act towards the The prevalence of suicide in Malaysia is commission of such offence; shall be reported to be 6 to 8 per 100,000 population punished with imprisonment for a term in a systematic review conducted by which may extend to one year or with fine or Armitage and team (2015) [2] while the with both’ [7]. Ministry of Health’s National Suicide Registry Malaysia (NSRM) [3] reported a In March 2017, a 24-year old lady was much lower, likely under-reported figure of charged in court a few days after she 1.18 per 100 000 population. Although the attempted to end her life. She was sentenced NRSM is currently inactive after 2010 due to a fine of RM2000 or 3 months jail [8]. to funding issues, the prevalence of suicide- Later in the same year, a Rohingya teenager related symptoms as reflected in the was arrested and sentenced to 3 months of National Health Morbidity Survey (NHMS) jail under the same charge when he tried to reports are concerning. In 2011, the NHMS harm himself during a protest at the reported that there were 1.7% who had Myanmar Embassy in Kuala Lumpur [9]. suicidal ideation, 0.9% with suicide plans and 0.5% who had attempted suicide [4]. In In the recent years, there have been calls by the more recent 2017 NHMS report, nearly 7% policymakers and mental health of Malaysian adolescents were found to professionals alike for suicidal attempts to have attempted suicide [5]. be decriminalized. Last year, the Malaysian Psychiatric Association together with Laman Suicide is defined as a voluntary and Minda released a statement calling for intentional act to end one’s own life. It is ‘unified policy action by Parliament and for legally defined as ‘a wilful and voluntary act the ‘archaic’ law criminalizing suicide to be of a person who understands the physical repealed’ [10]. The current views posit that a nature of the act, and intends by it to suicide attempt is a cry for help by a person accomplish the result of self-destruction’ [6]. experiencing severe psychological distress 1 Malaysian Journal Of Psychiatry, June 2019, Vol. 28, No. 1 [11]. Instead of litigation and punishment, deterrent effect to others who might be the focus should be to facilitate access to contemplating suicidal behaviour [16]. appropriate care in a professional and sensitive manner. Does punishing suicidal attempts help to reduce suicide? According to the World Health Organisation, at least 59 countries have decriminalized Most authorities think not and neither does suicide [12]. Attempted suicide is the evidence support it. Mishara and decriminalized in North America, all of Weisstub (2016) reviewed the suicide rates Europe, most of South America and some of 23 out of 25 countries which criminalized parts of Asia. Even United Kingdom, of suicides or punished attempted suicides; and which the British Common Law formed the concluded that the suicide rates were not basis of our Penal Code, decriminalized higher or lower when compared to other suicide in 1961 [13] while India, which countries, nor did the change in suicide rates shares a similar penal code to Malaysia, differ from the rest of the world [16]. This recently decriminalized suicide in 2014 [14]. shows that the punishing those who have Steps to decriminalize suicide attempts have attempted suicides did not help reduce also begun in Singapore early this year as suicides. part of its Penal Code reforms [15]. On the other hand, there are 25 independent In addition, it is important to understand the countries (including Malaysia) that still hold factors influencing suicidal behaviour. specific laws and punishments for attempted Suicidal behaviour is not caused by a single suicide [16]. factor, but rather, a complex interaction of many underlying risk factors. These include Should Malaysia decriminalize suicide a previous suicide attempt, the presence of attempts? any mental health condition(s), harmful use of substances, hopelessness and In order to answer this, it is important to psychosocial stressors [1]. Among those understand why suicide was considered to who have lost their lives to suicide or have be a criminal offence in the first place. attempted suicide, at least 90% were found to have at least one mental health condition Section 309 of Malaysia’s Penal Code, [18, 19]. Having said that, it does not mean which is in pari materia with the Indian that all of those who have attempted or died Penal Code , was enacted in 1936 based on by suicide have a diagnosable mental the British Common Law approach [7]. The disorder [20]. What we do know is that the British Common Law was in turn heavily majority of those who do attempt suicide or influenced by religious beliefs which held engage in self-harm are in distress and often that suicide is sinful or wrong as it is an ambivalent about dying [11]. These offence against God – after all, life is given individuals who attempt suicide often see it and determined by God and the taking one’s as an endpoint to their suffering as they are own life is against the will of God [17]. This not able to see any other way out, rather than view is not dissimilar from most religious intentionally going against religious precepts teachings practiced in Malaysia. In addition, or cultural values. criminalizing and punishing one for attempting suicide was intended as a Punishing those who have attempted suicide with legal action may worsen the suffering 2 Malaysian Journal Of Psychiatry, June 2019, Vol. 28, No. 1 of people who are already in crisis [16]. found no increase in suicide rates after Such punishment which is aimed at bringing suicide was decriminalized. Osman and behavior change via aversion, is served on team (2017) reported similar findings in that people who obtain no joy but only suffering there was no significant rise in suicide from the very act that they are being deaths after decriminalization of suicide in punished from. For in most parts, it may Ireland in 1993. Instead, they found that the increase the stigma surrounding mental rates of ‘undetermined death verdict’ fell health and suicide even further and deter significantly following the decriminalization people from seeking the help that they truly [24]. need. For example, individuals who are undergoing litigation may be discouraged We can see from the evidence above that from disclosing their suicidal thoughts, decriminalizing suicide attempts generally which may for a greater part be an organic do not worsen suicide rates. However, this response to an illness or crisis. Indeed, this alone is not sufficient to reduce or prevent has been recognised as one of the key suicides. At present, there are some barriers to suicide prevention efforts [1]. In provisions within the current Mental Health addition, Mishara and Weisstub noted that Act that facilitate access to mental health there is currently no empirical evidence to services for those who are in crisis [25] even support the notion that the threat of without any need for Section 309.