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Content Warning: violence, sexual abuse and suicide
Two weeks before his 21st birthday, Sam* sat alone atop a bridge in Brunei’s capital, Bandar Seri Begawan, seemingly ready to end his life.
Having suffered at the hands of his abusive mother, Sam had been thrown out of his family’s home after a confrontation over her beating of his younger siblings. Forced to sleep in his car, living with HIV and having turned to drugs to help him cope with a life that had been full of mental and physical abuse, Sam was at breaking point. But, before taking his life, Sam felt that he needed to tell his story.
He called Brunei’s Mental Health Hotline.
Sam’s story had a positive ending because he is still alive today. He is just one of a number of young Bruneians who came forward wanting to share their stories with me in the hope of raising awareness about the often interconnected issues of mental health and suicide. But for every story told, there are countless others that are never heard.
In an article published in May, Dr. Hilda Ho, head of psychiatric services at Brunei’s Ministry of Health, noted that people with mental health issues are often reluctant to speak out for fear of stigma and discrimination, while many in this predominantly Muslim country view suicide and attempted suicide as sinful. Islam teaches that those who commit suicide will face punishment from Allah, while two verses of the Quran expressly forbid suicide:
And do not kill the soul which Allah has forbidden [to be killed], except by [legal] right. (Quran 6:151)
And do not kill yourselves. Indeed, Allah is to you ever merciful. (Quran 4:29).
A Civil and Religious Crime
The stigma surrounding suicide is further compounded by Brunei’s criminalisation of attempted suicide. Under both civil and sharia law, attempted suicide is punishable by imprisonment of up to one year, a fine of up to 4,000 Brunei dollars (about US$2,900) or both. In the region, Malaysia also still criminalises suicide, while Singapore decriminalised attempted suicide at the start of 2020.
Suicide receives very little coverage by Brunei’s local media, other than the occasional report of a suicide death. In these rare instances, such reports will normally be accompanied by a statement from the police reminding the public that attempting suicide is a criminal offence. Yet, despite the Brunei government’s insistence on using criminalisation as a deterrent, it rarely factors into the thinking of those attempting or considering suicide.
Ramizah* didn’t even realise that attempting suicide is illegal in Brunei. Aged 22, she has been battling a severe depressive disorder and suicidal ideation for several years. When told about the laws criminalising attempted suicide, Ramizah replied, “If I’m not alive, it won’t matter if I’m a criminal or not” and adds that such laws are “society’s way of judging my family and dehumanising me.” Meanwhile, Ezzah*, a young woman in her early 20s who is currently being treated for mental health issues that stem from having been sexually abused, believes that criminalisation only adds to the stigma surrounding suicide and will deter people from seeking the treatment they need.
This is a view shared by mental health and suicide prevention experts such as Kenny Lim, executive director of Befrienders Kuala Lumpur, a Malaysian nonprofit organisation that provides free counselling services to both Malaysians and Bruneians. Befrienders has been lobbying the Malaysian government to remove suicide from Malaysia’s Penal Code and Lim argues that criminalising suicide only increases the stigma because when a person who attempts suicide is prosecuted or investigated, they become a criminal in the eyes of the public. Furthermore, Lim says that the fear of being persecuted and stigmatised by society will not only deter people from reaching out for help but may even make them more suicidal. In a piece co-written by Singaporeans Corinna Lim of AWARE and Porsche Poh of Silver Ribbon Singapore, they argue:
Criminalisation focuses on censure and the assignation of fault, rather than helping attempters deal with the causes of distress, such as illness, bereavement or financial difficulties. Criminalisation may even motivate those attempting suicide to ensure that they die, rather than survive and face punishment.
The stigma attached to suicide, fuelled by its criminalisation and religious beliefs that suicide is sinful, means that Bruneians are reluctant to talk about suicide and mental illness. Yet Leow Yangfa, executive director of Oogachaga, a community-based nonprofit organisation in Singapore that provides counselling and information to the lesbian, gay, bisexual, transgender and questioning (LGBTQ+) communities in Singapore and Brunei, says that openly talking about suicide and mental illness is necessary to enable those at risk to release oppressive feelings and reach out for help, support and intervention.
Lim of Befrienders agrees, noting that “encouraging public discussions on mental health and suicide helps reduce stigma [and] having people with lived experience sharing about their struggles helps to show that mental illness is real.” Leow adds that in the longer term, this has “the positive effect of normalising such behaviour, [further] reducing the stigma as more people get the help that they need.”
While Bruneians may be reluctant to talk about suicide and mental illness, the country’s increasing rate of suicide suggests that they are issues that can no longer be ignored. Data from the Royal Brunei Police Force indicates that Brunei’s suicide rate has been steadily increasing since 2015, rising from 1.9 deaths per 100,000 people that year to 2.6 deaths per 100,000 people in 2018. Between 2016 and 2017 it was reported that the number of suicides in Brunei increased by 62 percent.
Despite the Brunei government’s insistence on using criminalisation as a deterrent, it rarely factors into the thinking of those attempting or considering suicide.
Although the overall number of suicide deaths in Brunei remains relatively low, with a total of 46 suicide deaths and 43 attempted suicides reported between 2014 and August 2018, this needs to be considered in the context of Brunei’s total population, which numbers less than 500,000 people. Further, the figure used by Brunei’s local media when reporting suicide deaths, and attributed to the Royal Brunei Police Force, is at odds with data collected by the World Bank, which put the number of suicide deaths in Brunei at 4.6 per 100,000 people in 2016. This is compared to a suicide mortality rate of 3.2 per 100,000 people in the Philippines and 3.4 per 100,000 people in Indonesia, the countries with the two lowest suicide mortality rates in Southeast Asia, and 14.4 per 100,000 people in Thailand, which had the region’s highest suicide mortality rate. Malaysia recorded a suicide mortality rate of 5.5 per 100,000 people, while Singapore, which still criminalised suicide in 2016, had a suicide mortality rate of 9.9 per 100,000 people.
A Lack of Transparency
Questions over the accuracy of locally reported figures on suicide deaths and attempted suicides have also been raised within Brunei’s Ministry of Health.
Speaking on condition of anonymity, a former senior Health Ministry official confirmed that the number of recorded suicide deaths in Brunei is likely under-reported. He says that during his time at the ministry, concerns were raised about the accuracy of the number of suicide deaths being reported and he is aware of instances in which suicide deaths were instead recorded as accidental deaths at the insistence of the deceased’s family, who would often refuse to acknowledge the death as a suicide.
“Encouraging public discussions on mental health and suicide helps reduce stigma [and] having people with lived experience sharing about their struggles helps to show that mental illness is real.”
Changing public attitudes towards mental illness and suicide, and getting people to openly discuss these issues, is not easy when even the close family members of those suffering mental health issues fail to understand those issues and take them seriously. When Ramizah first told her mother about her mental health issues while she was studying abroad, her mother threatened to pull Ramizah out of school, labelled her as “crazy” and blamed her problems on Western influences. Her mother then told the rest of Ramizah’s family and, when Ramizah returned from overseas, she was constantly mocked by them. Even saying something like she was tired or not hungry was met with jokes about her being depressed. This has left Ramizah feeling uncertain about who she can confide in and was a factor in her not continuing her psychiatric treatment when she returned to Brunei.
To its credit, the Brunei government responded to the country’s increasing suicide rate by establishing a long overdue mental health hotline in February 2019. However, the hotline operators have faced challenges in a society that fails to take the issue of mental health seriously. In its first six months of operation, it was reported that the hotline received nearly 300 nuisance calls. This included prank calls asking for pizza delivery and threats to the operators. The hotline also does not provide a 24-hour service, meaning that some crisis calls go unanswered.
This was the experience that 25-year-old Fatini* had when she repeatedly tried calling the hotline late one night in 2019. Desperate to talk to someone but not knowing who else she could turn to, Fatini ended up self-harming and subsequently had to go to hospital the next day for treatment for her physical injuries.
Before trying to call the mental health hotline, Fatini had attempted to speak with her mother to share her anguish and express her feelings about wanting to end her life, but her mother just questioned the strength of Fatini’s religious faith. In Brunei, where Islam permeates almost every aspect of life, the strength of one’s faith is often portrayed as the solution to all woes. This is even evident within Brunei’s public health system, where mental health practitioners take a religion-oriented approach to therapy, as 23-year-old Ben found when he sought treatment for depression and anxiety. After first appearing neutral in their approach, Ben says the therapist implied that he just lacked faith and that he would not be depressed if he was closer to God. Ben left the session feeling worse than before his treatment and says that he has now lost trust in local therapists.
Ezzah also feels let down by her experience with public mental health practitioners, who she felt lacked empathy and often seemed judgmental of her. At her initial assessment to determine if she was eligible to meet with a psychologist, Ezzah recalls that she was made to feel as though she was to blame for the sexual abuse she had suffered, with the female assessor interviewing Ezzah saying, “Don’t tell any more people [about the sexual abuse]. Who knows what people would say about you if they knew what happened. They could mock you.”
The danger is when a person believes that they can get rid of mental illness just by praying or turning to religion—and when people start blaming someone with mental health issues for a lack of religious fervour or insufficient prayer.
Although Ezzah was subsequently assigned a male psychologist for her treatment, it was the religious orientation of her sessions with him that bothered Ezzah more than having to talk to a man about the sexual abuse she had endured. Throughout her sessions with the psychologist, Ezzah says that she became very conscious of the fact that she was alone in a room with a Muslim man and was talking about a taboo subject. As a survivor of sexual abuse, Ezzah says that the religious orientation of the counselling sessions leaves survivors like herself feeling as though they are immoral.
While the religious approaches adopted by the practitioners who treated Ezzah and Ben were ineffective and only seemed to exacerbate the mental health issues they were experiencing, counselling experts Lim and Leow believe that the inclusion of religion as part of a multifaceted approach to treatment can, in some instances, be beneficial to the patient’s healing. Leow points to his work with LGBTQ+ Muslims and Christians who see their faith in God as a resource to help cope with their pain of being rejected by family and community. However, he stresses that such treatment should adopt an “inclusive approach that incorporates a multicultural perspective, acknowledging religion as one aspect of [the patient’s life] and not to the exclusion of other aspects and identities.”
The danger, Lim notes, is when a person believes that they can get rid of mental illness just by praying or turning to religion—and when people start blaming someone with mental health issues for a lack of religious fervour or insufficient prayer.
While religion can, in some cases, play a role in the treatment of mental health patients, Lim and Leow say that the criminalisation of attempted suicide has no proven value as a suicide deterrent. Furthermore, criminalisation increases the already entrenched stigma associated with suicide, which is counterproductive to other suicide prevention measures, and deters those at risk of suicide from reaching out for help, while potentially encouraging those attempting suicide to try even harder to ensure that their attempt is successful so they will not face punishment.
The greatest ongoing challenge to suicide prevention in Brunei remains destigmatising suicide and changing public perceptions about mental illness so that those at risk feel comfortable asking for help. Ramizah believes that a lot of Bruneians view depression as an excuse that others use to validate their problems, while suicide is considered to be something people use to get attention. This, Ramizah says, is extremely degrading. “The conversation surrounding mental health should be drastically changed because the way it’s being conceived now creates a lot of misconception,” she says. “It really doesn’t hurt society to be a little more understanding or empathetic.”
*Some names have been changed to protect the privacy of those interviewed.