Commentary: Concerns over giving people ideas undermine needed conversations on suicide

SINGAPORE: We are poorly equipped as a society to help those in crisis.

We were reminded of that this week when a Singapore Armed Forces regular was found dead at a multi-storey carpark at Gombak Base on Monday (Aug 23) and just last month after revelations that a River Valley High School student charged with the murder of his schoolmate had attempted suicide.

But the warning bells were sounded earlier when the Samaritans of Singapore (SOS) reported the highest number of reported suicides last year since 2012 and highlighted the psychological distress arising from social isolation and financial worries exacerbated by the pandemic.

Worryingly, the suicide incidence rate among those aged 10 to 19 had also risen from 4.0 per 100,000 in 2019 to 5.5 per 100,000 in 2020.

People too tend not to ask for help, suggesting the numbers of those contemplating suicide may be much larger. Despite elderly suicides spiking, SOS had received much fewer calls from this group between April 2019 to March 2020. 

What’s clear is that we need to have a national conversation so those who need help can find it. But how can we do so in a sensitive manner for such a delicate issue?

WARINESS OVER TALKING ABOUT SUICIDE

We still struggle to talk about suicide as a society because the topic has remained taboo.

Even a factual request I made for statistics on suicide attempts and self-harm among students in our schools filed in Parliament last February saw the Ministry of Education highlight a general skittishness towards doing so for fear that releasing such information could increase the risk of suicide incidences.

Indeed, experts have warned of the Werther effect – where copycat suicides arise following media reports of high-profile deaths.

A study found that in the month following famed actor Robin Williams’ 2014 death, the incidence of suicide in the United States increased by 10 per cent. Researchers point to news covering controversial reactions like the Academy of Motion Picture Arts and Sciences’ tweet of an image showing Disney’s Aladdin hugging the genie voiced by Williams in the film with the caption, “Genie, you’re free.”

Such messaging suggesting suicide is a viable option providing release to those in painful situations must be stemmed. Experts too advise against sensational portrayals of suicide that provide graphic descriptions of methods employed or glamourise the act.

Here in Singapore, SOS guidelines echoing global best practices from World Health Organization (WHO) also encourage the media to avoid explicit details, exercise caution in the use of wording and choice of images, show consideration for the bereaved, and provide information on resources and encourage help-seeking.

The National Council of Social Services’ Beyond The Label Media Guide published in 2021 also reiterates these.

But part of best practice must also include providing accurate information about suicide facts, suicide prevention efforts, and reporting of suicide as a public health problem, the National Institutes of Mental Health in the United States has pointed out.

THE URGENT NEED FOR A NATIONAL SUICIDE PREVENTION STRATEGY

Responses from the #AreWeOkay poll conducted by SG Mental Health Matters from March to April among 561 participants on their perceptions of mental health policies in Singapore and suicide prevention are revealing. 

When it comes to suicide prevention in Singapore, 79.1 per cent of participants thought not enough was done. 

“There is only one (suicide) hotline, demand is too high and supply too low. The Institute of Mental Health is FULL, patients wait up to 8 hours and I was sent to the general ward because there were no beds. There are limited conversations and support groups and services for suicidal patients and suicide survivors”, said a poll participant. 

People in mental health circles point out too that the waiting time at IMH is now four to six months, with only those who can afford it turning to private clinics instead.

The over 45,000 calls received by the National Care Hotline since it was established in April 2020 clearly demonstrates this increased demand for psychiatric care and psychological support
 

We desperately need a multi-prong national approach to suicide prevention that critically assesses risk factors and targets support. 

While groups such as the PleaseStay youth suicide prevention movement, Caring for Life, and SOS have been essential care and intervention agencies, we must also provide support to healthcare institutions, families, schools and even workplaces more comprehensively.

This is why I urged the Government to establish a national suicide prevention strategy in an adjournment motion last year - one that prioritises interventions including establishing a robust continuity of care framework for those who have attempted suicide.

Part of this framework must include our public hospitals tracking whether an admission is due to attempted suicide so healthcare agencies can coordinate care beyond the provision of medication.

A friend whose young cousin was discharged from Institute of Mental Health (IMH) soon after admission asked me for information on step-down care facilities because his cousin was not ready to be taken care of at home given the risks. Unfortunately we do not yet have these in Singapore.

Not unlike our community hospitals and nursing homes, step-down facilities for psychiatric care could include inpatient rehabilitation wards, clubhouse rehabilitation centres and even psychiatrically-themed nursing homes.

A continuity of care approach will necessarily see greater investment in public institutions such as IMH to expand acute and step-down care capacity as well as involve community mental health agencies to provide ongoing support for individuals and their families.  

WHAT CAN WE DO?

Suicide is preventable. Countless studies show that 50 to 60 per cent of all who died by suicide gave some warning of their intentions to a loved one.

Leaving aside national infrastructure, we know what each of us do can make a world of difference to someone in crisis.

We can pay attention to unusual and sustained changes in actions (like withdrawal or loss of interest), words (including verbal statements like “everybody will be better off without me” and “what’s the point of living”), feelings (guilt, hopelessness), and physical changes (especially poor sleep or loss of appetite).

In this, we should discard outdated stereotypes and simplistic thinking of suicidal individuals as only those with pre-existing mental illnesses. Signs to look out for include stress triggers, traumatic events or developments which invoke feelings of loss and worthlessness.

And we must take the stigma out of suicide so more can share and find solace in the connections formed. People in trouble find it hard to translate their woes into cries for help but we see this changing.

Maybe this is why in my new Shades of Love podcast series where we discuss pressing issues of our times with a guest each week, suicide comes up in various conversations. 

In one episode with Rayner Tan, a visiting research fellow with Saw Swee Hock School of Public Health and lead author of the SG Mental Health Matters’ #AreWeOkay public consultation report, we discussed his experience with imposter syndrome, the challenges he faced regarding his sexual orientation, as well as living with Tourette’s; both of which led to bullying in school and the use of substances.

In another episode with Linda Collins, author of the international best-seller Loss Adjustment, we touched on living with grief and talking about youth mental health as a parent. Linda’s daughter, Victoria, killed herself when she was 17.

FOCUS ON SUICIDE PREVENTION NOT JUST MENTAL HEALTH SUPPORT

The Ministry of Health and the Ministry of Social and Family Development have established an Interagency Taskforce on Mental Health and Well-being that will prioritise developing a national mental health and well-being strategy, a consolidated mental health resources webpage to help individuals access useful and accurate information, and a national mental health competency training framework.

These three priorities are necessary and welcomed, but more can be done to officially entrench suicide prevention within these priorities so that we don't leave the urgent objective of reducing suicides to chance.  

As French sociologist and pioneering thinker Emile Durkheim asserted, suicide show up the deep crisis in our society; it is symptomatic of the breakdown of the collective conscience. It is not a personal failing.  

We urgently need a national conversation about suicide and to treat it as a public health issue by understanding the social determinants in order to provide a supportive climate in schools, workplaces and communities for those in crisis to seek help.  

When we avoid talking about suicide, we also avoid talking about their prevention.

Where to get help:

National Care Hotline: 1800 202 6868

National Anti-Violence Helpline: 1800 777 0000

Samaritans of Singapore Hotline: 1800 221 4444

Institute of Mental Health’s Helpline: 6389 2222

Singapore Association of Mental Health Helpline: 1800 283 7019

AIC Hotline (for aged and community care support): 1800 650 6060 

You can also find a list of international helplines here. If someone you know is at immediate risk, call 24-hour emergency medical services.

Anthea Ong is a former Nominated Member of Parliament, a professional certified coach, a social entrepreneur (SG Mental Health Matters, A Good Space, WorkWell Leaders Workgroup, Hush TeaBar) and the author of 50 Shades of Love.