/ 10 October 2023

Mental health, patriarchy and the criminalisation of suicide

Morally bereft leadership raises questions of trust
(John McCann/M&G)

According to the WHO, for every suicide in Africa, there are about 20 attempts. While some countries have slowly moved towards repealing the criminal offence of attempted suicide, recognising it as a public health issue rather than a criminal one, others have retained the legislation and continue imprisoning people who attempt suicide. 

The 2023 World Population Review reports named Lesotho, eSwatini, South Africa, Botswana, Zimbabwe and Mozambique as the African countries with the highest number of reported suicides. Lesotho and eSwatini are in the top three globally. 

In Africa, and across the world, there is still a significant gap between male and female suicide rates. In Lesotho, the suicide rate is 72 per 100 000 people per year, but breaking it down between men and women it is 116 and 30, respectively. The same is true for eSwatini, where the average rate is 29 per 100 000, but the difference between men and women is 55 against 4.7.

These are essential statistics to ponder considering World Mental Health Day, celebrated on 10 October. The day offers those working on mental health issues a platform to discuss their work and what more must be done to make mental healthcare a reality for people worldwide.

Suicide is a global public health problem and men are more likely to die by suicide than women in every country. The review shows many reported suicides among men in almost all the countries where the studies were conducted. It notes, “When women show the strain of their stressful lives and are admitted to a hospital for psychiatric care, they are likely to be discharged much sooner than their male counterparts. They feel that they need to return to their jobs and families as quickly as possible, even if they are not ready.” 

Several other factors contribute to the high suicide rate among men, including patriarchy and the fear of vulnerability. Patriarchy is a system of social structures and practices that gives men power and privilege over women. This system can harm men’s mental health in several ways. For example, men might feel pressure to be successful, strong and self-sufficient. They may also be reluctant to seek help for mental health problems because they fear being seen as weak or inadequate.

The fear of vulnerability is probably a factor contributing to the high suicide rate among men, particularly in Africa. Men are often taught that showing emotions such as sadness, fear or weakness is unacceptable. This can lead them to bottle up their feelings and avoid seeking help when struggling. According to Faith Osasumwen Olanrewaju, “among African men, mental health challenges may arise because of underlying loneliness, depression, anxiety and stress which accumulate over time”.

This could result from internalised African traditions that see men as emotionally intelligent and deny them the opportunity to be vulnerable. J Goodey explains this concept in the British Journal on Criminology under the headline Boys Don’t Cry, focusing on the gendered stereotypes of the “fearless man and fearful woman”.

Psychiatrist Dr Natasha Bijlani says, “the idea that expressing emotions is a sign of weakness” contributes to the increasingly alarming statistics of suicide among men. These toxic stereotypes, or patriarchal systems, harm women and men, including men who identify or express less “masculinity” than society expects. 

For people who are gender non-conforming, suicide rates are even higher. A study conducted by Alex Müller showed that one in three transgender women (33%), one in six transgender men (16%) and three in five gender non-conforming people (60%) have attempted suicide in Lesotho. The same study showed that 42% of transgender participants have tried to commit suicide in eSwatini.

The impact of patriarchy and the fear of vulnerability on men’s mental health can be particularly pronounced in Africa. In many African cultures, men are expected to be strong, stoic and self-sufficient. This can make it difficult for them to seek help for mental health problems, even in a crisis.

Decriminalising attempted suicide

One crucial step that African states can take to address the high suicide rate among men and broadly address mental health is to decriminalise attempted suicide. While countries such as Lesotho, Ghana and Rwanda have recently decriminalised attempted suicide, it remains a crime in the Gambia, Kenya, Somalia, South Sudan, Sudan, Tanzania, Uganda, Malawi and Nigeria.

Another essential step African states must take is to invest in inclusive and comprehensive healthcare, prioritising people’s mental health and ensuring that mental health services are available and accessible to everyone, regardless of age, sex, gender identity, sexual orientation, or other status, or location. 

Training healthcare workers to identify and treat mental health problems is also vital. However, to ensure equal access to such services, states must repeal other offences which deter access to health services, such as offences which criminalise consensual same-sex sex.

By decriminalising attempted suicide and investing in inclusive and comprehensive healthcare, African states can take essential steps to reduce the high suicide rate among men and contribute towards addressing mental health issues. 

It is also vital to address the root causes of suicide, such as gender norms, poverty, unemployment and gender inequality. If we are to reduce the risk of suicide for all, we should create a just and equitable society.

Melusi Simelane is the consultant programme manager at Civic Rights Cluster.