The Ladies Cue

Suicide Prevention Awareness Month provides a dedicated time to come together with a collective passion and strength around a difficult topic.

On 10 September, WHO, in collaboration with global partners, the World Federation for Mental Health, the International Association for Suicide Prevention and United for Global Mental Health, is launching the 40 seconds of action campaign. The culmination of the campaign will be on World Mental Health Day, 10 October, the focus of which is also suicide prevention this year.

Statics and Key Facts extracted from World Health Organization

Close to 800 000 people die due to suicide every year.
For every suicide there are many more people who attempt suicide every year. A prior suicide attempt is the single most important risk factor for suicide in the general population.
Suicide is the third leading cause of death in 15-19-year-olds.
79% of global suicides occur in low- and middle-income countries.
Ingestion of pesticide, hanging, firearms and jumping off from high-rise building are among the most common methods of suicide globally.

Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind.

The Situation in Singapore Data from Samaritans of Singapore (SOS)

Suicide is the leading cause of death for those aged 10-29
There are 3 times more deaths from suicide than transport accidents in 2019
400 lives were lost to suicide in 2019
Males account for more than 66% of all suicides in 2019
For every suicide, at least 6 suicide survivors are left behind

Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multi-sectoral suicide prevention strategy is needed.

Suicide rate highest in high-income countries; second leading cause of death among young people

The global age-standardized suicide rate [1] for 2016 [2] was 10.5 per 100 000. Rates varied widely, however, between countries, from 5 suicide deaths per 100 000, to more than 30 per 100 000. While 79% of the world’s suicides occurred in low- and middle-income countries, high-income countries had the highest rate, at 11.5 per 100 000. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low- and middle-income countries, where the rate is more equal.

Suicide was the second leading cause of death among young people aged 15-29 years, after road injury. Among teenagers aged 15-19 years, suicide was the second leading cause of death among girls (after maternal conditions) and the third leading cause of death in boys (after road injury and interpersonal violence).

The most common methods of suicide are hanging, pesticide self-poisoning, jumping down from high floors and instances of transport accidents. Key interventions that have shown success in reducing suicides are restricting access to means; educating the media on responsible reporting of suicide; implementing programmes among young people to build life skills that enable them to cope with life stresses; and early identification, management and follow-up of people at risk of suicide.

Who Is At Risk?

While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.

In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. By far the strongest risk factor for suicide is a previous suicide attempt.

Prevention, Symptoms and Stigma

Suicides are preventable and there are signs and symptoms. Most importantly, “It’s Okay to Talk About Suicide”!

There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. These include:

reducing access to the means of suicide (e.g. pesticides, jumping off a high rise building, certain medications and instances of transport accidents);
reporting by media in a responsible way;
school-based interventions;
introducing alcohol policies to reduce the harmful use of alcohol;
early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute emotional distress;
training of non-specialized health workers in the assessment and management of suicidal behaviour;
follow-up care for people who attempted suicide and provision of community support.

Suicide is a complex issue and therefore suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defense, politics, and the media. These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide.

Warning Signs & What We Can Do

Let us be kind and concerned the people who you know appeared to have these symptoms:

Talking about killing themselves and mentioned such as “My family will be better off without me”, “There’s no point to my life anymore”
Suicide threats: “If you don’t love me anymore, I will kill myself”
Extreme emotional outbursts (anger, sadness, irritability, recklessness)
Being a burden to others
Giving away prized possessions/ Writing suicide notes (including emails/diaries/blogs)
Sleeping too much or too little
Withdrawing from activities and/or loss of interest

Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need. The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it. To date, only a few countries have included suicide prevention among their health priorities and only 38 countries report having a national suicide prevention strategy.

Raising community awareness and breaking down the taboo is important to promote healing and remember to:

Be kind and caring
Keep them safe
Be a skilful empathetic listener
Help them stay connected
Follow up

The COVID-19 pandemic has not only worsened the mental health of some people, but also caused increased stress in others who do not have existing mental health issues.