Working Together Towards a Zero-Suicide Singapore

Parliamentary Speech, Adjournment Motion, 25 March 2020

THE REALITY OF SUICIDES IN SINGAPORE

Mr Deputy Speaker, please allow me to read the struggles of Lucy (not her real name) and her suicidal thoughts to this House (I quote verbatim): “I have been witness to a suicide, I have lost a friend to suicide, and I struggle with suicidal ideation on a near daily basis. It cost me my university education, landed me in tens of thousands of debt, and left me with little means to earn enough to pay back my study loan and survive on my own. I will likely never be able to earn more than $1000/month, and will likely take my life than die of other causes in the near future.” [1]

Other than Lucy, there were 46 more people who came forward to share with me about their experiences with suicide, among the 395 respondents of the public consultation on mental health conducted by my team. Like Lucy’s and the many near and far ones who have reached out to me, each and every one of their stories was heartbreaking to know, as they agonised over their struggles to live.

Suicide is a global public health concern. Close to 800,000 people lose their life to suicide every year, nearly one-third of which occur among young people.

Here in Singapore, teenage suicides peaked in 2018 — the highest since suicide tracking started in 1991. Sadly so did the number of elderly aged 60 and above who took their own lives. From 2017 to 2019, there were 1,204 attempted suicides yearly. Last year, the Immigration and Customs Authority reported that there were 8.36 suicides per 100,000 Singapore residents in 2018, up from 7.74 in 2017. Suicide has entrenched itself as the leading cause of death for those aged 10 to 29.

Sir, these worrying numbers could be higher, given issues of underreporting. According to the Attorney-General’s Chambers, a classification of ‘suicide’ only occurs when there is clear evidence of suicidal intent and self harm. From my interactions with suicide-bereaved parents, the cause of death is sometimes categorised as ‘fall from a high place’ or ‘unnatural death’ — also labelled as such on the requests of family. In addition, we must also not forget that for every suicide and attempted suicide we know, there are many more people struggling with self harm and suicide ideation that we have little data on. In fact, estimates from WHO show that for every suicide, there may have been more than 20 suicide attempts that go undetected.

So whilst some may argue that our numbers are not high by international standards, we are still not doing enough because the number of deaths by suicides in Singapore has remained relatively unchanged from 9.5 suicides per 100,000 residents in the 1980s to 8.3 suicides per 100,000 residents today.

How have we managed to develop from a third-world to first-world country and yet not be able to successfully tackle this issue of suicide? How is it that we still have the current number of suicide deaths we have today? One large reason might be the disappointing fact that Singapore was not listed as one of the few ‘high income’ countries with a national suicide prevention strategy even though we are a member state of WHO — because we don’t have one! National suicide prevention strategies are essential for working towards the ultimate goal of suicide reduction. According to WHO, such a strategy is important as it indicates a government’s clear commitment to prioritising and tackling suicide, while making resources available for necessary interventions.

Mr. Deputy Speaker, SMS Amy Khor’s assurance at Budget 2020 that a whole-of-government review of our mental health strategy will be undertaken to identify gaps and strengthen existing inter-agency efforts brought much hope to so many who are struggling. Building on this, I hope to use the rest of this speech to ask the Government to go further in developing a national response that aims for zero suicides under this review as part of a multi-ministry and multi-sectoral effort.

REFRAMING DISCOURSES ABOUT SUICIDE

But first, let me take this opportunity to address the discourses about suicide.

It is a common fear that talking about suicide could encourage suicidal behaviour, hence many friends and families who are concerned about their loved ones in distress often struggle with asking about suicidal ideation or intent. Similarly, Minister Ong Ye Kung shared his concerns in this House that talking about suicide numbers in schools “may heighten suicide risk in vulnerable youths”. While I appreciate the intention of these concerns, I would like to point out that youths today already consume a large volume of media online related to mental health and suicide. Youths have shared with me that schools often try to keep quiet about students who died due to suicide, but this backfires as students are often already in the know about their peers’ mental health and suicidal ideations. The expert consensus is that to have a chance at preventing suicide, we must talk about suicide responsibly.

Earlier this month, SMS Edwin Tong indicated that allowing for treatment for self-inflicted injuries in Medisave/Medishield Life could encourage suicidal behaviour, although exceptions could be made for those with existing mental health conditions. In this House, a few colleagues expressed their concerns last year that decriminalisation could send the wrong signal in incentivising suicide. These views perpetuate the stigma by shrouding suicide in exclusion. Experts indicate that incentives for help-seeking are helpful in combating stigma, allowing those who are struggling to feel more comfortable in seeking support.

Mr. Deputy Speaker, apart from poor mental health that SMS Edwin Tong gave concession to, we must also recognise that there are social and environmental factors embedded within our society and structures that also contribute to an individual’s intention to self harm or suicide. Intense feelings of hopelessness can also arise from sudden and adverse life events including unemployment, trauma and the loss of loved ones. Not every suicide is a result of mental illness, nor is someone with mental illness always suicidal.

Lastly, we must take the lead in recognising that suicide is far from a selfish choice, and cannot be blamed on the individual. My cousin, who has attempted suicides several times, often shares that he feels that he’s a burden to his family, including me, even as he acknowledged that he knows how much we love him. Studies have shown that people who attempt to take or took their own lives commonly feel that their lives hamper others, viewing their decisions as relieving their loved ones. The following excerpt of a suicide letter from an elderly victim broke my heart: (I quote) Father is reluctant to leave all of you. I have failed so badly that I have no choice.” This is the reality of suicides, and those who succumb can hardly be labelled as selfish.

THE ROLE OF PUBLIC POLICY IN SUICIDE PREVENTION

Mr Deputy Speaker, as recommended by the WHO, it is fundamental for the Government to lead and coordinate efforts in suicide prevention, starting from the establishment of a national strategy, to show this Government’s priority in tackling suicides. This should first start from identifying currently available resources and commiting further resources and funding to improve suicide prevention and efforts to support individuals struggling with suicide. One example could be to expand funding for organisations like SOS, not just to operate our de-facto national suicide helpline, but to ensure timely follow-ups with callers who need further support. We should also consider increasing resources and funding for mental healthcare services to address wait time and patient load issues.

I am deeply alarmed that our public hospitals do not track whether an admission is due to attempted suicide. Yet, studies show that 83% of people who die by suicide visit some kind of doctor a year before their death. Hence, healthcare facilities, especially emergency departments, are a logical place to prevent suicides. By getting our hospitals to track suicide attempts, our national strategy is better placed to coordinate the continuity of care for these suicide attempters. In the mould of the Zero Suicide Initiative, we must ensure that on the individual level that we acknowledge each person’s pain, empower them to make safe decisions, and on the systems level build hope for recovery with a continuity of care approach across agencies.

We should also note that since the decriminalisation of suicides, data of suicide attempts is no longer required by the criminal code. Without data surveillance of attempted suicides, our ability in developing informed strategies is limited.

Through a national strategy of data surveillance coordinated across government agencies and community partners, the transparency and awareness of the support available can be improved, allowing various stakeholders better position their role and plan their work in tackling suicides. A robust framework of monitoring and evaluation is also required, thereby instilling a sense of accountability among those in charge of interventions.

We have a crisis on our hands with the spike in teenage suicides. I would like to lend a voice to the suicide-bereaved mothers of the Please Stay Movement. They believe there needs to be clear and strong suicide prevention and post-suicide intervention guidelines in schools. Despite their inconsolable grief, they came forward to share what they believe could be done to prevent more teen suicides so that other parents do not have to go through the same pain. Families and friends, especially other students in the school, will inevitably suffer from grief and trauma to varying degrees and urgently need this post suicide intervention support.

Many education systems such as the State Government of Victoria in Australiaestablish step-by-step guidelines on what to do in the event of a suicide attempt and/or suicide, making them publicly available as part of a whole-of-society effort. Notwithstanding the peer support networks that Minister Indranee cited in response to my question in COS on MOE’s suicide prevention strategy, I am sure we all agree that laying out clearly MOE’s suicide protocols to parents and students can only help confront increasing suicides amongst teens.

PREVENTING SUICIDES TOGETHER WITH THE COMMUNITY

Mr. Deputy Speaker, as much as the Government must take the lead in suicide prevention, the complex and multi-faceted nature of suicide means that all of us are a part of this national response towards zero suicides.

Studies show that 50 to 60 percent of all persons who died by suicide gave some warning of their intentions to a friend or family member. One mother from the Please Stay Movement shared she was not aware that her 11 year old son was suicidal until it was too late. Young people have often asked me what the warning signs are and how they can help their friends.

We need more public education programmes in schools, workplaces and communities on suicide prevention 101, including learning these warning signs from unusual and sustained changes in actions (withdrawal, loss of interest), words (verbal statements such as “everybody will be better off without me” and “what’s the point of living”), feelings (guilt, hopelessness); and biological/physical aspects (poor sleep, loss of appetite). Key ‘gatekeepers’ like the police, teachers, grassroots leaders and more must also be trained in suicide first-responder training so that they can intervene appropriately for suicide attempts.

Community support groups with the SOS as the first community responder, Please Stay and new groups like Caring for Life are key stakeholders in this whole-of-society effort to reduce and prevent suicides. However, without a national strategy for these efforts to align to, we risk having a fragmented and sub-optimal approach to supporting survivors and bereaved families.

IF ONE SUICIDE IS TRULY ONE TOO MANY, WE NEED FIRM ACTIONS NOW

Mr Deputy Speaker, I would like to conclude by imploring the Government to take action now to arrest the rising suicide numbers by initiating a National Suicide Prevention Strategy with a vision towards a Zero-Suicide Singapore, together with community partners and citizens. We must stand firm in the belief that suicides are preventable and commit to the efforts in making that possible.

Why zero suicides? Because unlike any other targets of 2020 for gender equality, 30 by 30 for food security that we have made in this House, when it comes to loss of lives — human lives, nothing short of zero has ever been good enough for us. A Zero-Suicide Singapore as a goal joins the Vision Zero aspiration of our workplace safety and health policies and the Zero Accident movement in our public transportation policies too.

And we won’t be alone. United States aspires towards a nation free of the tragedy of suicide in its national prevention strategy. Japan envisions a society where no one is driven to take their own life. South Korea wants to create safe and healthy communities free from suicide. And last but not least, Sweden’s Vision Zero Policy which was ratified by its Parliament in 2008 aims to build a nation where no one should be in a situation of such vulnerability that suicide is seen as the only way out.

Mr Deputy Speaker, as they say, if we fail to plan, we plan to fail. And we most certainly must not fail our people like Lucy. We must work together towards a zero-suicide society that cares because every life matters.

To Lucy and those of you struggling with suicidal thoughts, please know this. No, you are not a burden., nor are you alone. Yes, the world is a better place because of you in it. Please stay.

Thank you.

[1] SG Mental Health Matters Public Consultation — Respondent #111

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Anthea Ong is a Nominated Member of Parliament. (A Nominated Member of Parliament (NMP) is a Member of the Parliament of Singapore who is appointed by the President. They are not affiliated to any political party and do not represent any constituency. There are currently nine NMPs in Parliament.)

The multi-sector perspective that comes from her ground immersion of 12 years in different capacities helps her translate single-sector issues and ideas across boundaries without alienating any particular community/group. As an entrepreneur and with many years in business leadership, it is innate in her to discuss social issues with the intent of finding solutions, or at least of exploring possibilities. She champions mental health, diversity and inclusion — and climate change in Parliament.

She is also an impact entrepreneur/investor and a passionate mental health advocate, especially in workplace wellbeing. She started WorkWell Leaders Workgroup in May 2018 to bring together top leaders (CXOs, Heads of HR/CSR/D&I) of top employers in Singapore (both public and private) to share, discuss and co-create inclusive practices to promote workplace wellbeing. Anthea is also the founder of Hush TeaBar, Singapore’s 1st silent teabar and a social movement that aims to bring silence, self care and social inclusion into every workplace, every community — with a cup of tea. The Hush Experience is completely led by lovingly-trained Deaf facilitators, supported by a team of Persons with Mental Health Issues (PMHIs).

Follow Anthea Ong on her public page at www.facebook.com/antheaonglaytheng

A full-time human, and part-time everything else.

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