Suicides in Singapore and why we should help

By Walter Jayandran
Note: This article is not meant to offer medial advice. If you know of anyone who might be contemplating suicide and need assistance, please use the helplines listed below.
Two weeks ago a mother was killed by her daughter who then took her own life in a horrible suicide with her mangled body lying on the concrete pavement below the block of flats in Ang Mo Kio.
According to the latest statistics, there were 467 suicides in 2012 – nearly 30 per cent more than in the previous year – raising the national suicide rate from 8.13 per 100,000 resident population in 2011 to 10.3 in 2012. We do not have 2013 statistics, but we can assume it will be no better than that of 2012. The 2012 figure is the highest in 21 years, with the most significant increase coming from three age groups – the young, the middle aged, and the early senior aged.  What a sad waste of lives. Could we have done something to at least save some of them?

Table showing 2012 breakdown of suicides by age group (adapted from Samaritans of Singapore)
Every day, about four or five people in Singapore try to kill themselves, and at least one succeeds. According to police records, the number of reported attempted suicides increased from 1,009 in 2011 to 1,090 in 2012.  The number of death arising from suicide rose from 8.1 per 100,000 population in 2011 to 10.3 per 100,000 in 2012. In 2012, the Samaritans of Singapore (SOS) handled more than 44,000 hotline calls, indicating the number of people contemplating suicide even if not attempting it. Other help organizations like Care Counselling Centre (Mandarin speaking call centre) and Singapore Association for Mental Health have also been receiving more than 2,000 calls for help during the same period.
Singapore ranks 48^th out of 110 countries in terms of suicide rates as of 2012. A simple comparison with India with a population of 1.3 billion is ranked 46^th with a suicide rate of 10.5 per 100,000, can make us wonder why we have a high suicide rate when our population is only 5 million and our  GDP is 15 times more than that of India.
Worrying trends
What is worrying is doctors and social workers say people attempting suicide appear to be getting younger and younger.  If we look at the statistics for 2012 (above table), of the 298 male suicides, 22% were below 30 years of age. Among the 169 female suicides, 21.7% were below 30 years of age.  Within this category, about one-fifth of the suicides were committed by teens.
According to various media and academic reports citing professionals in the field, the reasons for suicide vary among age groups. Teens usually take their lives over issues like friction with parents and breaking up with a boyfriend or girlfriend. People in their 20s are exploring their identity, discovering new responsibilities and building their career and their family, and some of them cannot cope with the stress. People in their 30s and 40s are largely driven to suicide by issues such as failed relationships and debts. Suicide among the elderly, while getting fewer over the years, is usually caused byloneliness, suffering from chronic illness, or a belief that they do not have purpose in life.
The 2011 Institute of Mental Health study on the state of mental health in Singapore identified three major mental illnesses affect a large number of Singaporeans. One in 17 people in Singapore have suffered from Major Depressive Disorder at some time in their lifetime, while Alcohol Abuse and Anxiety Disorder affected one in 32 and one in 33 people, respectively. The study also found out that the majority of the mental illnesses occurred by the age of 29 years, and most of the people with mental illness were not seeking help. This can explain why the age ranges of 30 -49 and 50 – 69 show a significant number of suicides.
The IMH study also indicated that major depressive disorder (MDD) was the most common mental illness in Singapore. 5.8% of the adult population in Singapore suffer from MDD at some time in their lifetime. Depression was also associated with chronic physical illnesses. About half of people with MDD had at least one chronic physical illness. About 3.1% and 3.6% of the population suffer from alcohol abuse and Anxiety Disorder respectively at some time in their life.
Broader issues
Looking at these figures, in our tiny city state, we have more than half a million people (young and old) suffering from depression, anxiety disorder and alcohol abuse amongst us, and they could be driven to suicide at any time, if they do not seek help.
In our little Red Dot, suicides account for about 2.5% of total deaths every year officially.In 2006, suicide was one of the top ten causes of death in Singapore. The coroner decides if a death is natural, unnatural or a suicide. It is possible that some suicides may be classified as unnatural deaths, especially if there is no clear evidence like a suicide note.
This may not sound significant, but in our city state, every life counts especially when our total fertility rate is falling by the year, and human resources are our key strength for economic success. Beyond economic concerns, there is also a moral imperative to reduce suicide rates, as an indicator of our national health and quality of life.
Clearly, there is much cause for concern. Looking at the statistics revealed in the IMH study, one can see the potential danger of increased suicides unless mental illness is managed more effectively.
Intuitional support
The Ministry of Health states that hospitals do provide crisis intervention for patients who have attempted suicide. Some of the actions taken include “elimination of acute suicide danger (eg: hospitalization, sedation, crisis-intervention), adequate treatment, follow-up care for those with high suicide risk and counselling and support groups for patients both within the hospital and community settings”. MOH also mentions that access to mental health services has improved.
The Health Promotion Board (HPB) has been conducting various mental health promotion and education programmes “to promote mental well-being among children, adults and seniors”.  In 2011, more than 40 initiatives and activities were organised in schools, workplaces and community settings, reaching out to some 170,000 students and members of the public.
IMH’s community mental health teams (CMHTs) provides rehabilitation for stable patients. CMHT also operates a Mobile Crisis Team which comprises a 24-hour hotline giving information and advice, and a Home Visit Team that helps to de-escalate stressful situations that patients face in their homes.
The GP Partnership Programme helps GPs better manage persons with mental illness in the community. Other programmes include the Community Health Assessment Team (CHAT), launched in 2010 and led by the Institute of Mental Health. CHAT includes efforts to reach out to distressed youth from post-secondary education institutions such as polytechnics and the Institute of Technical Education.
Perhaps what is lacking is awareness. These preventive and proactive programmes need to be publicised and promoted more often to inform the layman.
Can we help?
Non-governmental organisations like SOS, Care Counselling Centre, Singapore Association for Mental Health and others are also doing their part, but they can only help if a suicidal person reaches them. As stakeholders in our nation, we need to play our part to support proactive solutions to complement what the government and NGOs are doing.
Most of us are generous with our donations, but very few are really keen to help suicidal people. A common reason cited is that we are not sure who are at risk, or if our help would be deemed interfering in others’ personal lives or that we do not know when or how to help. There is also a fear that we may get into issues of relationship and dependency once we offer help.
However, what should be more important is understanding that we can actually save a life in our encounter with a suicidal person, and nothing should prevent us from doing it. The fact that there are many “walking wounded” amongst us at work, on the trains, on the buses, and on the walkways, should spur us to act, to do something, especially if we know them personally.
There are numerous guides to recognise suicidal persons and simple key steps to saving them. The Montana Suicide Prevention Lifeline, USA, provides a handy, easy to understand guide for identifying suicidal tendencies. SOS and The Health Promotion Board also offers some tips on identifying depression.
Identifying persons at risk of suicide is an important first step that all of us can do, so that adequate help can be offered to the person, and for us to save one more life.
 
Helplines
Samaritans of Singapore (SOS): 1800 221 4444
Family Service Centre: 1800 838 0100
Singapore Association for Mental Health: 1800 283 7019
Seniors Helpline (for the elderly): 1800 555 5555
Care Corner Mandarin Counselling Centre (for Mandarin speakers): 1800 353 5800
Touchline (Touch Youth Service): 1800 377 2252
Tinkle Friend (for children): 1800 274 4788 on weekdays
 
Image – screen capture from The Straits Times Online