Table 2 Documentation procedures, policies, and practices as reported by stakeholders
From: Suicide surveillance and health systems in Nepal: a qualitative and social network analysis
Stakeholder group | Roles with group | Legal requirements related to suicide | Policy providing guidelines | Definition of suicide | Reported experience |
|---|---|---|---|---|---|
Nepal Police (Ministry of Home Affairs) | Local police intake individual report and relay to the district police office District police investigate, document, request a post mortem, and send case files to the central headquarters. The court system confirms suicidal deaths after two years | Investigative reporting, documenting witnesses, submitting case file and evidence to the court system | Section 187: Draft Penal Code (abatement of suicide) Country Code (Muluki Ain): Procedural Investigation for homicides and unclear suicides No written laws exist criminalizing an individual for dying or attempting suicide in Nepal | No explicit definition in the Penal Code nor the Muluki Ain | Individuals do not report suicides to police Homicides are misreported as suicides Officers are bribed to not record death Paper-based documentation causes human error and data loss Reports are not properly completed Police occasionally have to pay for health and post-mortem related fees Officers are not trained in suicide first aid or how to best interact with the family during investigations |
Health system (Ministry of Health and Population) | DEATHS: Conduct post-mortem procedure and immediate cause of death Appear in court as a medical expert ATTEMPTS: Nurses must maintain the records documenting the patient’s diagnosis according to the physician Physician: treat and stabilize attempt case Psychiatrist: See all ‘accident cases’; talk to family and patient, perscribe medication, determine severity of intent, give psychiatric diagnosis, and document changes in suicidal thoughts and behaviors FCHV: monitor births and deaths and submit monthly report ot the health post Health post: aggregate monthly reports from FCHV and health post services. Send data to district health office (DHO) DHO: aggregate data from health posts and send to the national level ministry | DEATHS: Conduct post mortem report and confirm death with an EEG ATTEMPTS: No legal requirements | Standardized reporting forms designed by MoHP Only government institutions can perform post mortems. Physicians must appear to court if called Inexperienced doctors are encouraged to not speculate on underlying cause of death | lCD codes (X60, X68, X70, X78) Post mortem report requires immediate cause of death but no underlying cause | Suicides do not present to the health sector Suicides are misreported as accidents or homicides as suicides Suicide attempts are included as an indicator in HMIS forms and thus never recorded Emergency room data are not included in MoHP reports nor the medical record office Dead on arrival cases are not reported in hospital data The quality of health post data is low and reports are often not submitted FCHVs do not actively report deaths |
VDC or Municipality (Ministry of Federal Affairs and local Development) | Issue death certificates. If death is reported as suicide, the office requires a police investigation and doctor's report | All unnatural deaths must have supporting police and medical reports. Send aggregated data to the District Development Office | Civil Registration Act of 1976 | Police and medical documentation related to the cause of death | Individuals never report a death to VDC as suicide Deaths are typically only registered if a certificate is needed for property transfer or other government services |
Other government institutions | Central Bureau of Statistics is charged with collecting and reporting data from the police, MoHP, and other ministries Department of Home Affairs: aggregates police reports Ministry of Federal Affairs and local development: conducting and reporting births and deaths |  |  |  |  |