Prevention of suicide in Singapore.

Suicide prevention is an important public health issue. 1 In Singapore where the suicide rate has been relatively stable at 9.8 to13 per 100,000 over the last 5 decades, roughly 350 to 400 people kill themselves each year. 2 The impetus to suicide is infl uenced by a combination of factors including the individual's personality traits and coping mechanisms, concurrent life events and stressors, existing family and community support networks, availability of professional mental and physical healthcare, and the presence of government support and intervention programmes. 3 The common emotional key, however, is an overwhelming sense of psychological or physical suffering, hopelessness and an inability to fi nd a solution to their problems such that death becomes a viable alternative. 4 Studies have shown that the rates of suicide in Singapore are higher in older Chinese males, younger Indian males/ females, those who are widowed or divorced and the unemployed. 3 The reasons for suicide vary with age. Younger cases of suicide (<25 years) are more likely to be associated with poor family relationships (parental-child discontent/ sibling rivalry), boy-girl relationships and academic stress. 5,6 In adult cases (25 to 59 years), factors such as employment, debt, marital problems, legal problems and mental illness become more prevalent while in elderly cases (>60years), the primary reasons include physical illness, bereavement and fear of becoming a burden to their families. 7 The success of any suicide programme must thus be multifaceted with personal, familial, job, social, community, medical and mental-health components. In the acute stage, there needs to be an effective crisis intervention with longer term of follow-up and support to reduce future risk. There is also a need to have general mental wellness programmes to reduce the risk of overall suicide risk in the general population. The role of crisis intervention programmes is to provide help and support for persons-at-risk and their families when the suicide risk is greatest. In Singapore, this includes the 24-hour phone services such as those provided by the Samaritians of Singapore and by various drug and gambling helplines. Other front line workers include school counsellors/teachers, police/ civil defence staff, social workers, medical professionals (general practitioners and accident/emergency staff) and mental health professionals (psychologists, nurse consultants and psychiatrists). These people need to receive adequate training to recognise, assess and evaluate suicide risk, be able to defuse any imminent suicide threat, and be aware of the help and services …