SINGAPORE: When Madam Tan (not her real name), a widow in her 90s, suddenly lost her son to a heart attack, she thought all hope was lost.
After all, he was the only close family member she had left. Furthermore Mdm Tan, a fall risk living in a rental flat, had lost all independence due to her limited mobility and weak legs.
"Our care management team knew of her suicidal thoughts," senior social worker at Tsao Foundation's Hua Mei Mobile Clinic Jasmine Wong told Channel NewsAsia.
So, staff from the organisation's counselling and coaching team provided her with psycho-emotional counselling and therapy, and worked with neighbours and community partners to support her daily living.
With Mdm Tan refusing to go to a nursing home, the staff made frequent visits to "reassure her that life has more to offer". They continued to care for her for another year or so, until she died from cancer.
But there are others who fall through the cracks.
The number of elderly aged 60 and above who took their own lives peaked at 129 last year, the highest since suicide tracking started in 1991, the Samaritans of Singapore (SOS) said in a release on Monday (Jul 30).
This is six cases more than 2016, when 123 elderly suicides were reported. The proportion of elderly suicides has also gone up: Seniors made up 36 per cent of 361 suicides reported in 2017, compared to 29 per cent of 429 suicides the year before.
“It is very worrying that many elderly are turning to suicide as the only choice to end their pain and struggles, when they should be enjoying the lustre of their golden years,” SOS executive director Christine Wong said.
According to National University of Singapore sociologist Tan Ern Ser, the typical profile of a senior who is more likely to commit suicide is probably someone aged 75 or above, living alone or with a spouse, and has only up to primary school education.
FEAR OF BEING A BURDEN, SOCIAL DISCONNECTION AMONG REASONS
These seniors might feel that life is "empty and meaningless", Dr Tan told Channel NewsAsia, stating the absence of social support or a chronic or terminal illness as some common reasons for suicide.
Other common struggles include social disconnection, the fear of burdening family and friends, and daily difficulties due to physical challenges and deteriorating mental health, SOS said, citing callers to their 24-hour hotline.
"These concerns predisposes socially isolated elderly to depression and suicidal thoughts when struggles go undetected and unaddressed," it added.
READ: High prevalence of suicide in older adults aged 50 and above: SOS
However, SOS said fewer seniors are calling in. Last year, 5,652 calls were made by the elderly, an 18 per cent drop from the 6,904 calls in 2016.
This is particularly worrying given the current trend, SOS said, especially as the hotline is "favoured by the older demographic group". Of those who disclosed their age, 23 per cent of calls made to the SOS last year were by seniors aged 60 and above.
Dr Tan explained that some might choose not to call in as they are not used to the idea of sharing their "innermost thoughts with others or seeking help through a hotline to speak to a stranger".
"They are also thinking that no one could understand them and their situation, let alone help them," he said.
What's worse is some of them might not even be aware of other forms of help.
"They are probably living in isolation, have few or no friends, know only people who are just as ignorant about other forms of help, or do not see non-kin as a possible source of help," Dr Tan added.
And when this happens, SOS said the elderly might feel a "strong sense of helplessness which may exacerbate social isolation".
Nevertheless, Dr Tan said alternative assistance can come in the form of family members who are "caring, supportive and attentive".
Volunteers who meet the elderly regularly, are seen as friends, and can link them up with trained counsellors who can provide professional help are also beneficial, he added.
To that end, SOS stressed the "imminent need for stronger support networks as the number of elderly Singapore residents living alone continues to increase", pointing out that this will bring about challenges to current social support services.
THE RED FLAGS
Mr Simon-Peter Lum, deputy head of COMNET Senior Services under AMKFSC Community Services, said staff are trained to look out for suicidal tendencies by attending courses conducted by SOS and the Institute of Mental Health (IMH), and through case conferences and case sharing sessions.
Symptoms of suicidal tendencies include making preparations for death, like writing a will or giving away cherished belongings, enquiring about a sudden change in environment, and a sudden withdrawal from social interactions.
Tsao Foundation's Ms Wong said red flags include physical complaints like "wa long cong tia", Hokkien for "I'm feeling pain everywhere", and self-neglect in terms of low personal hygiene and a dirty living environment.
Staff should also pay extra attention to elderly who are struggling with a recent life crisis, like the death of a loved one or excessive medical bills.
In one real-life case, a senior who had experienced hallucinations approached a COMNET worker and requested depression screening. "The senior was found to be at high risk of suicide and staff members accompanied him to IMH with his consent," Mr Lum said.
After the senior was treated and discharged, social workers, Senior Activity Centre (SAC) staff and those with the Community Resource, Engagement and Support Team continued to monitor him through home visits and his participation at the SAC.
For low-risk cases, staff provide counselling and emotional support, help them look at the positives in life, and recognise their stressors and how to manage them.
"We also develop a safety plan with them and continue to monitor and follow-up until they stabilise," Mr Lum added. "We will also refer the cases to social workers where appropriate."
WHAT YOU CAN DO
Mr Lum encouraged family members, caregivers and volunteers to communicate with their seniors and take note of character changes and suicide symptoms for early detection.
"Convey concern and allow them to express what is troubling them, empathise and support them and let them know they are not alone," he said. "Helping them to identify stressors provides a sense of relief, sharing their burden increases their ability and confidence to cope."
Besides that, he added, keeping them engaged in meaningful activities will help give them purpose.
"Sometimes, expressions of suicidal thoughts can be signs of the elders crying for help," Tsao Foundation's Ms Wong said. "It’s not advisable to brush the elders aside for having ‘silly, idle thoughts’ – which may well be red flags for suicide risk."
Taking a senior to see a good and trusted general practitioner (GP) over the years can also help identify signs of depression, social isolation and calls for help, she said.
"Indirect clues that a GP will have opportunity to identify would include repeat visits by an elder for loss of appetite and weight loss, inability to sleep and refusal to take medicine," she added. "GPs can also help to refer relevant cases to counsellors and other community partners."
OVERALL SUICIDES LOWEST SINCE 2012
Meanwhile, the overall number of suicides reported last year – at 361 – was the lowest since 2012.
This means that the average suicide rate dropped to 7.74 deaths by suicide per 100,000 residents, compared to 9.14 deaths from 2012 to 2016.
“For the past years, our community outreach education and engagements targeted mainly youths and adults who are technologically savvy as these efforts were concentrated on various social media platforms,” SOS' Ms Wong said.
“The drop in deaths by suicide in these age groups may be attributed to the concerted efforts of all social service partners and many others in the community, even members of the public who are aware of SOS suicide prevention work.”
READ: New mum’s suicide casts light on struggles of working mums, coroner says
READ: Facing depression – working adults battle not just demons, but also stigma
Despite that, Ms Wong said the community and an individual's social support groups should continue to step up efforts and not let go "thinking that a slight decrease makes a difference on suicide prevention and awareness among the youths".
SOS said: "Beyond just being a reporting figure, the annual suicide statistics also reveal the reality of struggles faced by ordinary Singaporeans."
Where to get help: Samaritans of Singapore operates a 24-hour hotline at 1800 221 4444, or you can email firstname.lastname@example.org. You can also find a list of international helplines here. If someone you know is at immediate risk, call 24-hour emergency medical services.