Warning: Suicide peak ahead for Singaporeans

Quote:

If the recession worsens, Singapore should brace itself for a rise in
suicides, said suicide expert Dr Chia Boon Hock. "S'pore is a great place to
live if you are young, intelligent, rich, successful, capable and healthy.
But the average person isn't all that," he said.

'In Singapore, no social security system exists. Losing one's job is
associated with a great loss of face and identity. Charity organisations
cater only to the very poor and very sick.

'The able-bodied unemployed may find it necessary to rely on their savings
or on the generosity of friends and family. The social stigma, coupled with
stress especially of an older person trying to find a job quickly, while
supporting a household, is enormous,' he says.

In fact, even in good times, money plays an inordinately large role in
suicides here, especially for men and the middle- aged. At least 27 per cent
of suicides here typically are financially motivated, he says.

About 26 per cent of Singaporean men and 14 per cent of women who committed
suicide from 2000 to 2004 did so because of financial problems, ranging from
debts, losses, gambling, unpaid credit card and medical bills and being
hounded by loan sharks.

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http://www.asiaone.com/Health/News/Story/A1Story20090423-137074.html

Warning: Suicide peak ahead

IF THE downturn deepens, Singapore should brace itself for a rise in
suicides. And it should do all it can to prevent the increase from starting
now, warns Dr Chia Boon Hock.

Singapore's resident suicidologist, who has spent 40 years collecting and
studying suicide data, says there have been four major suicide peaks here
over the past 100 years.

Notably, three of these happened just after major recessions, when financial
woes and unemployment took their toll. The other came in wartime.

The first was during the 1906 to 1910 Bankers' Panic financial crisis, which
saw the suicide rate surge 71 per cent to 11.3 per 100,000 people.

The second peak was in the aftermath of the Great Depression, from 1936 to
1940, when the toll swelled to 15.8 per 100,000 people.

The third, from 1941 to 1945, during the tumultuous Japanese Occupation, saw
a record 16 per 100,000 people kill themselves. The fourth saw 12.8 per
100,000 people ending it all from 1986 to 1990, just after the 1985
recession.

Apart from these peaks, Dr Chia says Singapore's suicide rate has been on a
downward trend and remained relatively stable at about 10 to 12 per 100,000
people per year. That translates to about 400 deaths a year, or one a day.

But if the recession worsens, the 73-year-old psychiatrist says that the
incidence of people taking their own lives may be headed for another crest.

Since it typically takes up to six months for a coroner's inquest to decree
a death a suicide and a further year to collate national data, the magnitude
of the problem will surface only in two years time. This being so, he says
it is important to sound the alarm bells early.

Throughout Asia, countries are already bracing themselves for a suicide
spike. In South Korea, commuter train operators are installing doors to
block access to railway tracks because there are more subway jumpers. In
Japan, suicide hotline numbers have been posted at suicide hot spot Mount
Fuji. Hong Kong has run special hotlines since October for crisis-related
depression.

The United States is also predicting a rise in suicide rates just like
during the Great Depression. Suicide rates rose from 14 to 17 for every
100,000 Americans from 1929 to 1933, as unemployment rates increased from
3.2 per cent to 24.9 per cent within the same period.

Similarly, there is a well-established link between unemployment and
suicides here. Citing data from 2000 to 2004, Dr Chia notes that suicide
rates for the jobless were about 20 times higher than those of the employed.

'In Singapore, no social security system exists. Losing one's job is
associated with a great loss of face and identity. Charity organisations
cater only to the very poor and very sick.

'The able-bodied unemployed may find it necessary to rely on their savings
or on the generosity of friends and family. The social stigma, coupled with
stress especially of an older person trying to find a job quickly, while
supporting a household, is enormous,' he says.

In fact, even in good times, money plays an inordinately large role in
suicides here, especially for men and the middle- aged. At least 27 per cent
of suicides here typically are financially motivated, he says.

About 26 per cent of Singaporean men and 14 per cent of women who committed
suicide from 2000 to 2004 did so because of financial problems, ranging from
debts, losses, gambling, unpaid credit card and medical bills and being
hounded by loan sharks.

But he is not particularly worried about the rash of 'honour' suicides among
the world's most financially powerful, such as London financier Kirk
Stephenson flinging himself in front of a train, French aristocrat
Rene-Thierry Magon de la Villehuchet swallowing pills and slitting his
wrists, and Chicago real estate mogul Steven Good shooting himself in his
Jaguar, after their fortunes soured in recent months.

'These are hard-driving Type A personalities who wanted it fast but lost it
all and found the shame too great to bear,' he says.

In reality, the incidence of rich people committing suicide here is rare
because 'they have too much to live for'. Those at the lower socio-economic
levels, who worry constantly about their jobs, are more vulnerable. Although
their identity is not attached to their wealth, it is attached to their
being providers for their families, he notes.

Another group at risk are the underemployed, such as those recently laid
off, now struggling to support themselves in the service sector and cope
with diminished circumstances. Between 2000 and 2004, he notes, a total of
45 self-employed people killed themselves, along with 42 in sales positions,
40 labourers, 24 taxi drivers and 19 cleaners.

Equally vulnerable are retirees who have lost their life savings in the
market upheaval. He is currently seeing a few depressed patients in this
predicament.

'Overnight, their nest eggs have been wiped out. There is no chance of
recovery. If they are struck by a major illness, it will tip them over the
edge.

'What aggravates the problem is that the reason why most elderly
Singaporeans kill themselves, besides prolonged pain and suffering, is
dwindling finances and the feeling that they are a burden to their family.
It's an Asian thing. Even if their kids have money and want to give it to
them, they feel shy to take it.'

This is why he is apprehensive about the news that pro-euthanasia group Exit
International has been allowed to hold a workshop here in May, where
information on how to end life painlessly will be dispensed. He fears the
momentum towards legalising euthanasia here may lead to more elderly folk
feeling obligated to make an early exit.

'There is potential for abuse, especially by third parties. It can be
misused by relatives with mixed motives. It needs to be studied very
carefully and approved only selectively on a case-by-case basis,' he
cautions.

Over the years, he notes the Government has done a laudable job in bringing
down elderly suicides, from a high of 51.7 per 100,000 in 1972 to a low of
23.2 per 100,000 in 2004. Among 62 countries worldwide, Singapore's suicide
rate for those aged above 65 now ranks a more acceptable 24th for men and
28th for women.

In recent years, he notes economic upheaval has, at most, had a minor effect
on the suicide rate here, thanks to government measures to arrest
unemployment and mitigate hardship. No surges were noted after the 1997
Asian Financial Crisis, 2001 recession and 2003 Sars epidemic. Suicide rates
then were a moderate 9.1, 8.6 and 8.3 per 100,000 respectively.

This compares favourably to South Korea, where suicide rates nearly doubled
during the Asian Financial Crisis to 19.9 in 1998.

In fact, he says Singapore's tumbling suicide rate now compares favourably
with many other nations. Out of 62 countries and territories worldwide,
Singapore's suicide rate now ranks 37th for males and 27th for females
overall. It trails far behind South Korea (24 per 100,000), Japan (23.1 per
100,000), rural China (22.2 per 100,000) and Hong Kong (18.6 per 100,000).

But there is no room for complacency. While he lauds the Government's recent
decision to inject $35 million over the next three years to shore up
emotional resilience here, he says that beyond state efforts, people should
do more to look out for each other on an everyday basis.

'Suicide is not only a desperate final act for those who find life hopeless
and bleak because of their inability to cope, general social stresses,
mental and physical illnesses. It is also, indirectly, a sad reflection of a
society's failure to help them as needed,' he says.

Because attempting suicide is a crime, it is carried out in secret. Out of
1,717 suicides from 2000 to 2004, he notes that only two contacted suicide
hotlines prior to the deed.

'Although hotlines are good for building awareness, providing support for
the bereaved and counselling the distressed, whether they prevent suicide,
I've my doubts. If people make up their minds to kill themselves, they don't
need to consult anyone. It is up to people around them to detect their plan.
Even if you ask them tactfully and directly, some may evade the issue.'

But he notes that Singaporeans, being pragmatic, can be relied on to seek
medical help to alleviate symptoms of stress and anxiety, which could be a
prelude to suicide.

'If they can't sleep, they see a doctor for sleeping pills. Likewise if they
have chest pains, cannot sleep and eat. This is why they might broach
suicide if doctors ask them diplomatically.'

This is where, he says, general practitioners, nurses, school counsellors,
social workers and religious leaders, who are trained to be alert to early
signs of suicide, can come in. This can help make up for the shortfall in
psychiatrists in Singapore - currently about one for every 38,461 people -
as life here becomes more stressful.

He notes that 27 per cent of those who took their own lives from 2000 to
2004 suffered from a major mental disorder. Almost all of them - 97 per
cent - had sought psychiatric help prior to the deed.

Yet their blood levels at death showed that most were not taking their
prescribed medicines, not being treated adequately, or not responding to the
treatment given.

'This suggests that what failed them was not a lack of services, but that
follow-up care was not good enough. There was probably no continuity of care
and no ownership of their treatment, without a single case manager
responsible for their care.'

He says that if there is a concerted effort at all levels to beef up care
and training for all to be alert to early suicidal signs, it could cut
suicides by 20 or more yearly. 'Cutting down Singapore's suicide rate by up
to 10 per cent is probably the best-case scenario in these circumstances,'
he says.

Because in the suicide stakes, he says, Singapore should do all it can to
remain an underperformer - and be proud of it.


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