Decriminalizing suicide: the 2017 Mental Healthcare Act and suicide mortality in India, 2001-2020

We examine whether decriminalization of suicide in India following the 2017 Mental Health Act corresponds with changes in suicide mortality overall and by level of state development. Our study utilizes counts of suicides from the National Crime Records Bureau (NCRB) across 35 Indian states from 2001 to 2020. The exposure variable is a binary indicator for the decriminalization of suicide following 2018. We use fixed-effect Poisson regression models that include population offsets and adjust for time trends, literacy, gross state domestic product and infant mortality. We find no relation between decriminalization of suicides and overall suicide mortality (Incidence Rate Ratio (IRR): 1.037; 95% CI (0.510-2.107)). Stratification by level of state development shows that less developed states saw an increase in suicide mortality by 1.9 times following decriminalization, compared to prior years (IRR: 1.859; 95% CI (1.028-3.364)). Our findings thus indicate that decriminalization did not coincide with a decline in suicide mortality in the country, thereby highlighting the need for improved mental health infrastructure and support in India, especially in less developed states.