A diagnostic system for ICD-11 is proposed which commences with broad reorganization and simplification of the current categories and the use of clinically relevant specifiers. Such changes have implications for the positioning of diagnostic groups and lead to a range of possibilities for improving terminology and the juxtaposition of individual conditions. The development of ICD-11 provides the fi rst opportunity in almost two decades to improve the validity and reliability of the international classification system. Widespread change in broad categories and criteria cannot be justified by research that has emerged since the last revision. It would also be disruptive to clinical practice and might devalue past research work. However, the case for reorganization of the categories is stronger and has recently been made by an eminent international group of researchers (Andrews et al., 2009). A simpler, interlinked diagnostic system is proposed here which is likely to have fewer categories than its predecessor. There are major advantages of such a system for clinical practice and research and it could also produce much needed simplification for primary care (Gask et al., 2008) and the developing world (Wig, 1990; Kohn et al., 2004).

IntroductionPakistan is an Islamic country where religion is considered an important protective factor against suicide. Recent research and media reports identify that suicide and self harm behaviours are increasing in different parts of Pakistan.ObjectivesTo inform public policy debate and suicide awareness education interventions.AimsTo study socio-cultural, political, interpersonal and religious factors that can influence suicide and suicide awareness.MethodsSystematic search of Medline, Embase, PsychInfo, CINAHL, Pakmedinet, TRIP, and electronic searches of Pakistani Medical Journals, using terms Suicide, Self harm, Deliberate Self Harm, Self Poisoning, Non-Accidental Deaths, Undetermined Deaths. Focus Group Discussion, Aga Khan Medical University, Pakistan Consultation with experts in the field.Resultsa.Epidemiological evidence confirms an increase in suicide rates with variable figures reported from different parts of Pakistan. Higher rates of suicide rates are reported for men with an association with unemployment and mental health problems. Marital Discord and domestic violence identified as risk factors in female suicides.b.Religion is continued to be identified as an important protective factor against suicide.However, Pakistan's legal system that criminalizes suicide and self harm is criticized for exercising negative influence through preventing early identification of high risk individuals. A variable pattern of suicide reported from different parts of Pakistan identifies the need for deep cultural understanding and examination of protective and risk factors that operate with in family structures and sub-cultures in Pakistan.ConclusionsAn increase in suicide rates in Pakistan has raised mental health and public policy awareness.

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