One is too many: the Hong Kong suicide expert battling to turn a tragic tide in student suicides
Originally published at the South China Morning Post on September 10, 2016.
Suicide prevention is not an easy task in Hong Kong, but one man has built a career on it.
With more than two decades of experience in suicide research, Paul Yip Siu-fai is now in his 14th year serving as the founding director of the Hong Kong Jockey Club Centre for Suicide Research and Prevention.
Recently appointed chairman of the government’s new Committee on Prevention of Student Suicides, Yip is also a professor of social work and administration at the University of Hong Kong and a recipient of the International Association for Suicide Prevention’s Stengel Award in 2011.
In Hong Kong, suicide prevention has become a hot button issue in recent months as a result of a spate of student suicides earlier this year. Last year there were 70 youth suicides and 23 cases of full-time student suicides.
The centre estimated the suicide rate in Hong Kong last year to be about 12.6 per 100,000. Although the rate has been decreasing for more than 10 years, the suicide rate among young people aged 15 to 24 spiked to an estimated 8.5 per 100,000 last year, up from the 6.2 per 100,000 in 2014.
With World Suicide Prevention Day on Saturday, Yip aims to raise awareness of the importance of suicide prevention and call on Hongkongers to work together to create a more caring and nurturing community.
In addition to reducing the stigma attached to mental illness in the city, Yip hopes to advocate for better support services for dysfunctional families and vulnerable groups such as young people and the elderly.
How did you get into this position and become interested in this work?
Suicide is like the tip of the iceberg. It really reflects the well-being of society. In 2002, there had been an increasingly high suicide rate due to the emergence of a new method of suicide by charcoal burning, and the University of Hong Kong formed a team to tackle the problem including psychiatrists, social workers, pathologists, statisticians and public health researchers.
When we meet the survivors, we do feel that a lot of pain has been inflicted on them and we believe that it can be avoided
At that time, suicide research in Hong Kong was quite fragmented. I was trained as a biostatistician so I always looked at the figures. I had done quite a bit of suicide related research since 1995, and I published a paper on suicide numbers in 1996 about the suicide rate between Beijing, Hong Kong and Taiwan in the British Journal of Psychiatry.
I was appointed as the founding director of this centre, and we were very fortunate. We had a group of people who thought: hey, we’re in the University of Hong Kong and we can do anything. There was a challenge. We believed that we needed a multidisciplinary approach to tackle the problem. In our early work, we did a lot of work providing support to survivors. When we meet the survivors, we do feel that a lot of pain has been inflicted on them and we believe that it can be avoided. That actually gave us the motivation.
We have a strong conviction – we care about the people and at the same time we would like to help them. I can see the changes, after we did the programme and set up a bereavement group. I’m very passionate towards society. It’s always very sad when any suicides occur.
Can you describe some of the factors that contributed to the recent spike of student suicides?
I went through the secondary school system in Hong Kong, and I still don’t think that it can bring the best out of people. I feel like at that time we had pressure, but not as much as kids do now. Our young people now have more mental well-being problems. Our data suggests that 94 per cent suffer from more than one problem.
Academic pressure is also not the only factor. We believe that up to now, based on data, [the spike] is because of a copycat effect. When there are two or three cases, it builds up an energy and becomes explosive. Then a lot of people who might not have taken suicide as a normal way to solve their problems, because of this extensive coverage, begin to see this abnormal behaviour become normal.
The news media has not been very conducive to suicide prevention. But in the past six months, I do think that they have become more forthcoming and sensitive when reporting on suicides.
You are also chairman of the government’s recently established Committee on Prevention of Student Suicides. What steps are the committee taking to tackle this issue?
We are talking about some short, medium and long-term ways of improving the well-being of students. For short-term, we are talking about how to empower school personnel like teachers and social workers. There’s the issue of early identification of pupils who have problems.
We would also like to improve the support system in schools. The Hospital Authority is working with us to send nurses to schools to talk to social workers and parents and students to improve treatment for people who are mentally unwell. We’re talking about how to provide training to school teachers, and infrastructure changes.
We would like to train students to be gatekeepers as well. The Quality Education Fund will provide funding of HK$150,000 for each school to come up with ways to help the well-being of schoolchildren. We are also talking about the systemic problem of exam-oriented curriculums that don’t give enough space for young people and teachers. Most importantly, we need to build up relationships between teachers, students and families.
As a community, what can we do to better prevent suicides?
I think in Hong Kong we need to think about how we can cultivate a more conducive family relationship. It’s essential. Among the 34 suicides cases we have looked through, they all suffered from relationship problems. They did not feel that their family was close enough. They felt disconnected and alone.
Among the cases, half of them were from complicated families, for example with parents who are divorced, remarried or single. These people do not have sufficient support. If are facing an increasing number of dysfunctional families in Hong Kong now, how can we make families be functional again?
Or, how can we use the community to make up for this deficiency?
Every time a student commits suicide, people talk about having more social workers. But when we ask students who they want to talk to when they have a problem, social workers are at the bottom of the list. They want to talk to their friends, their classmates.
We need to build up a more caring environment, whether at home or at school, and try to remove barriers like academic pressure. When we look at suicides among school children, both parents usually have to work. They just don’t have time to talk to them.
We hear parents say that even if they did have time, their children would not talk to them. But that’s not true. When we look at death notes left by young students who committed suicide, they ask for the forgiveness of their parents. Reading them, I nearly cried. That is really tragic. The older generation has to be more empathetic and adaptive.
In Hong Kong, people also spend more than half of their time in the workplace. So, we need to ask: how can we make our workplace more friendly? People are depressed because of work. Everybody has a responsibility [to make things better].
Aside from students, what other groups in Hong Kong are vulnerable to suicide? Also, how does the city’s suicide rate compare to other places?
The elderly, above 65, have a suicide rate of I think double the general population. They also suffer from this disconnectedness. They feel that either they do not have sufficient help, or they are a burden to their families. That is also very sad. The shortcomings of our present [health care] system include long waiting queues, elderly care centres that are understaffed and age homes with inhuman situations.
I just got back from Australia and I met my relative there who is 85 and lives in an elderly home. She’s very happy because they have a garden there, she has her own room. But in Hong Kong, to have a home and a garden you need to pay HK$20-30,000 a month. For her, it’s all paid for by the government. Can’t we do something about this? Hong Kong is not short of money. We do have the money, but we just haven’t put it to the right use.
For our suicide rate, we are slightly below the world average. But if you compare us to Korea, Japan and Taiwan we are the lowest at about 12.6 per 100,000. Each year we have about 800 or 900 people kill themselves. But that means that every day we have about two or three people committing suicide – that’s not a small number. We always say that one is too many.
Can you talk about the stigma against mental illness?
In Hong Kong, politically we are so polarised, there is income poverty, we have so many vulnerable and disadvantaged people. It’s simply not right. I always say to people that if they are mentally unwell, it’s OK and it’s not uncommon. It’s not something that should be stigmatised. But in Hong Kong we still have a stigma.
If you have cancer, people are sympathetic to you. If you tell people you are mentally unwell, everyone will stay away from you. So we have to raise money for our centre, which is self-funded. When you talk about depression or mental illness or suicide prevention, people have this attitude of ambivalence and they think that there’s not much we can do. Actually, there’s a lot of people who are very ambivalent when they are about to commit suicide. If you can step in, provide support, they can be helped.
I hope that this stigma of mental illness can be further eliminated in our society, and that we can build up a more caring society.
What advice do you have for people looking to enter social work, particularly suicide prevention?
Try to be more empathetic and compassionate. You also need to remember to be optimistic. We have a team of very committed people and we do debriefing all the time. If you take the burden of suicides on yourself, that is not good. So, first of all, don’t kill yourself. Second, be a gatekeeper for other people.
At this moment, we’re working with Facebook as a research collaborator in promoting the mental well-being of users. Nowadays young people don’t call, they would rather type something on Facebook and share it online. You need to give [gatekeepers] some training on how seriously they should take these warnings. I believe that everyone can be a gatekeeper to others. If everyone can do this, we can create a safety net so that no one can fall through the cracks.
What are some of the most important lessons you’ve learned?
I’ve become more appreciative of what I have. Sometimes we feel like somebody owes us something. Everybody thinks that they deserve something more. As a matter of fact, when we look at suicide notes by these unfortunate people, when you see what they’ve gone through, I think I’m very grateful for what I have.
If you do not have this heart of gratefulness, you’ll always have a sense of bitterness and apprehension about everything. If everyone is always complaining about something, we will not be happy. For me, I’ve tried harder to understand other people’s needs and make sure that no one kills themselves. For those who are more fortunate, please help others. What I really hope is that the whole community can raise awareness and start caring more about other people.
The centre launched a webpage providing recommendations on suicide prevention: http://wecare.csrp.hku.hk/