Will suicide be forever a taboo subject in Singapore?

This is dangerous territory. Are you sane? It’s too hard. What? Don’t you know talking about it actually makes it worse? Best not to say anything. Leave this alone.

These were words I heard on repeat from different well-meaning friends when I shared about my then-forthcoming new project about suicide, with the Samaritans of Singapore (SOS), between 2020 and 2021.

I am one of the innumerable who have lost family or friends to suicide.

I also teach statistics to university students. During and after training, we work together as one to serve society with statistics in one common mission. For these first five months of 2022, it has been about suicide.

With my students, we sought to understand Singaporeans’ perceptions and awareness of suicide through a nationwide study, codenamed “Project Save.Me”.

DOES AWARENESS OF SUICIDE HELP TO PREDICT AND PREVENT IT? 

The findings on suicide that we uncovered come from citizens across Singapore, through face-to-face, digital, telephone interviews in January and February.

We stuck doggedly, as far as was possible, to the demographical scales by gender, race and age.

We also dug into the respondents' knowledge and beliefs about suicide, their preferred platforms for reaching out for help, the level of support available to people in crisis, and the efficacy of such support channels.

Last year, I ran a separate study end-of-life survey on preparations for death and emerged with what were arguably the most hostile of reactions to date from survey respondents. 

But this year, Project Save.Me. has given me a hefty correction on that, with the degree to which many potential respondents clammed up and shunned all further conversation at the word “suicide”.

But the 2,960 ultimate respondents who so generously gave their time and invested their effort in this difficult survey with their full thoughts and feelings on the subject, soon showed us why a few months later when we ran the analysis.

The most significant myth believed here is that talking about suicide may give someone the idea, with 70 per cent of those with immediate family connected to suicide forming the highest proportion holding that belief. We now see the why of the tight lip and cold shoulder.

More than eight in 10 believe that stigma is associated with suicide. 

More alarmingly, those with no connection to suicide, who form the majority of society, have a significantly more negative outlook towards suicide than those with immediate family who attempted suicide or took their lives and those with friends who did the same.

For everyone who would avoid someone suicidal or a person in a crisis, an excess of 70 per cent cite their fear of making the affected person worse, their lack of ability to do anything, and their low knowledge levels, which more than three in four peg at below average, citing “No outreach or education” as the top reason.

I have always believed education holds one of the keys to self-preservation and suicide prevention. The numbers show that with more years of education comes a greater percentage who believe suicide can be predicted and prevented.

Knowledge, as with almost everything else, serves as a double-edged sword. 

It can kill, like looking up ways to die by suicide, but if we are one and all vaccinated from young with the knowledge that allows us to identify signs of distress in people around us to save and rescue lives, this will lessen the effects of stigma and fear cited by so many here in Singapore, young and old alike.

According to experts and published data on the Singapore Ministry of Health’s website, vaccination against Covid-19 may not prevent the disease, but could lessen its severity. 

Likewise, so will open and upfront conversations about suicide.

CAN SUICIDE BE PREVENTED? 

The Project Save.Me survey found that 92 per cent of respondents believe that suicide can be prevented.

The younger they are, the more disposed they are to believing in the preventability of suicides: Gen Z (93.3 per cent) to millennials (93 per cent) to Gen X (90 per cent) to baby boomers (84 per cent).

Then why was suicide the 2020 leading cause of death for those aged 10 to 29, five times more than that from transport accidents that same year, and up from the corresponding figures in 2019?

Do our efforts in suicide prevention at the very basic level of education, meet this rising tide of oft-silent cries for help?

If they do, why do fewer than one in 10 of the Save.Me survey respondents think highly of the effectiveness of support in Singapore for a person facing a crisis and thinking about or affected by suicide?

Why have the citizens rated the overall effectiveness of such support in Singapore as below average?

If we do have suicide management or prevention protocols in schools or workplaces, are they made known?  Do we have continuity of care for those who attempt to do away with themselves? Or does a cloak of silence descend upon them?

DEAFENING SILENCE

With our millennials and Gen Z so fluidly conversant with digital information, we owe it to them to impart knowledge for suicide prevention.

In the course of Project Save.Me., I was introduced to Caring For Life founder, Dr Sally Thio, who told me about the need to educate our young to recognise signs of suicide in people around them.

She added that suicide prevention efforts have to involve the entire community, especially loved ones and close friends of the people at risk of self-harm.

Likewise, Samaritans of Singapore, my partner in Project Save.Me, has been championing support for people in crises since 1969.

In the course of writing this, I read the Ministry of Education’s parliamentary reply dated February 2020, to then-Nominated member of Parliament Anthea Ong who had requested detailed data on suicides in schools. Mr Ong Ye Kung, who was then Minister for Education, said in reply that “tabulating and publicising such data can have other implications, such as heightening suicide risk in vulnerable youths”.

Suicide contagion was also my initial and biggest fear before before carrying out Project Save.Me.

That drove me to seek answers from mental health professionals both here and overseas, asking them this same question point-blank. One and all yielded the same answer — a clear and firm “No”.

SOS and experts all point to the preventability of suicide through the channel of open conversations. 

Medical intervention aside, the heart of this throbs with the absolute necessity of educating ourselves on the facts which allow us to make a difference to someone in crisis. 

Do we agree that we, as a first-world nation, have arrived at the doorstep of creating a national suicide prevention strategy oiled by data to help us plan our services better?

As Ms Ong said in a commentary in August 2021: “Not talking about suicide also means not talking about their prevention.”

The thick blanket of silence can asphyxiate and kill. If we allow fear or stigma as our excuse, then we will never succeed in stemming the tide of suicides.

What we don’t measure, we can’t manage.

One lesser-known fact about the famous architect of the modern hospital, Florence Nightingale, is that in 1858, she became the first female member of the Royal Statistical Society, for her trailblazing statistical work, made all the more remarkable for a girl of her time who had never had any formal schooling. 

At the barracks military hospital where she served, Nightingale painstakingly collected death and survival figures, charting and creating original statistical plots. 

Her work revealed and confirmed her suspicions, that the primary cause of deaths of soldiers was infection causing a death rate far higher than that attributed to being killed in the Crimean war itself. 

Her pioneering data visualisation work swiftly led to a Royal Commission to enquire into the health of the army and subsequent military hospital reform.

She said: “I attribute my success to this — I never gave or took any excuse.”

If no one will speak to break the stigma, thus allowing the consequent silence surrounding suicide to continue, the numbers will.

 

ABOUT THE AUTHOR:

Rosie Ching is Principal Lecturer of Statistics at the Singapore Management University.