Criminalization of suicide attempts is an archaic barrier to suicide prevention. Globally, clinical profiles of prosecuted suicide attempters are an under-researched area. This retrospective study aims to describe the clinical profiles of individuals who were charged for attempted suicide and subsequently sent for criminal responsibility and fitness to plead evaluation in a forensic psychiatric unit in Malaysia from January 1, 2008, to December 31, 2019. We identified 22 cases who were mostly adult males (90.9%). Seventy-three percent have a psychiatric disorder. Mood disorders were more prevalent (32%) followed by psychotic disorders and substance use disorders. For most of these individuals, this was the first contact with any form of mental health services and 41% defaulted their treatment before arrest. This sample illustrates a vulnerable group who has been disengaged with mental healthcare. Future research is warranted to further investigate mechanisms that are effective in addressing unmet needs of persons in suicidal crisis as opposed to utilizing the criminal justice pathway.

Introduction and Study Objectives: Criminalization of suicide attempts is an archaic barrier to suicide prevention. Malaysia remains one of the few upper middle-income countries that still criminalizes suicide attempts. Globally, clinical profiles of prosecuted suicide attempters are an under-researched area. Recognizing the prosecuted would aid in understanding the survival and help in the narrative for the need for decriminalization of suicide attempts. Method and Materials: This retrospective study of clinical notes aims to describe the clinical profiles of individuals who were charged for attempted suicide and subsequently sent for criminal responsibility and fitness to plead evaluation in a forensic psychiatric unit in Malaysia from January 1, 2008, to December 31, 2019. Results: We identified 22 cases who were mostly adult males (90.9%) and half of the individuals were hospitalized post-attempt due to lethality of method. Seventy-three percent have a psychiatric disorder. Mood disorders were more prevalent (32%) followed by psychotic disorders and substance use disorders. For most of these individuals, this was the first contact with any form of mental health services and 41% defaulted their treatment before arrest. Notably, a large portion of the sample (72.7%) had no additional criminal charge. Conclusion: Criminalization of suicide attempts complicates the care pathway for individuals who attempt suicide in Malaysia. The criminal justice pathway can significantly delay treatment. Legal processes and assessments that persons prosecuted for suicide attempt have to undergo may take precedence over mental health care. The clinical outcome post-discharge is largely unknown to a group that is at increased risk of suicide. Therefore, this sample illustrates a vulnerable group who has been and will be disengaged with mental healthcare. Future research is warranted to further investigate mechanisms that are effective in addressing unmet needs of persons in suicidal crisis as opposed to utilizing the criminal justice pathway include the need for decriminalization of suicide attempts.