In Reverence of Life -- China’s Suicide Prevention Centers

By LIU JUN & WEN CHIHUA

The Beijing Suicide Research & Prevention Center affiliated to the Huilongguan Hospital, a special institute for psychiatric health, was the first of its kind in China when it opened in Dec. 2002.

It is a gray Saturday morning on Nanjing Bridge. Dusty trucks and honking buses stream across as, 100 meters below, a lone dredger chugs along the Yangtze. On a nearby street corner stands a stout, thirty-something man with close-cropped hair. He looks intently at the stream of pedestrians that passes by, sifting through the bobbing mosaic of faces for a certain expression, observing closely each gait and body language trait that may betray what he defines as “a person without spirit.”

“You’ve got to act quickly,” says Chen Si, aged 37, “it takes only a second to jump.”

Chen’s regular weekend vigil over the past two years has prevented 82 suicides.

“I want to give desperate people some hope," says Chen, who works as a small shop vendor during the working week and acts as a one-man mercy mission at weekends. “Some have slipped past and thrown themselves into the river. I’m not always fast enough. One man simply isn’t enough to get the job done,” he says, bleakly.

There have been at least 1,000 “jumpers” from this landmark steel-and-concrete bridge in Jiangsu Province since it came into public use in 1968.

Not that anyone’s been counting. There are no official suicide statistics in China. Research into this taboo topic began just a few years ago, and many questions remain unanswered, says Dr. Michael Phillips, executive director of the Beijing Suicide Research and Prevention Center, the first of its kind in China.

Officially, there are 250,000 suicides a year, or 685 deaths a day. Dr. Phillips reckons that between 1995 and 1999 the annual figure was actually 287,000. He puts China’s suicide rate at around 23 per hundred thousand. Despite only one in eight attempts being successful, suicide is nevertheless the fifth highest cause of death in the country, after cancer, heart disease, cerebral hemorrhage and respiratory disease.

The tragic consequences of any one suicide are felt far beyond the immediate family: on average the mental health and work performance of at least 30 other friends and relatives are affected. These are the findings of Professor Zhai Shutao of the Nanjing Neurological Hospital, which in 1985 became the first hospital to establish a department specializing in suicide prevention.

More than 90 percent of potential suicides send out early indicators, says Zhai, who has 20 years of frontline experience. “A suicide attempt is generally preceded by behavioral and verbal expressions of desperation that stem from situational factors, such as economic distress or family problems.”

On August 20, Meng Yi, 26, a doctoral student at the Shanghai Institute of Organic Chemistry attached to the Chinese Academy of Sciences, jumped to his death from the seventh floor of his faculty building. The China Youth Daily reports that Meng left a suicide note in his dormitory that morning saying that he was “ …sick of life and depressed.” Upon finding and reading the note, a friend and Meng’s academic supervisor found, restrained and tried to dissuade him from suicide. They thought they had succeeded, but Meng suddenly broke free, ran down the corridor and plunged headlong through a window.

“If a person’s suicidal intent is detected early enough, professional psychological help can save their life,” says Professor Zhai, who launched China’s first suicide crisis center and hotline -- China’s equivalent to the Good Samaritans -- in 1991. Upon receiving a call, the hotline switchboard operator registers the number and tries to ascertain the caller’s name and address. This information makes it possible to trace and alert their family and friends. Since it was first established, the center has extended its functions to face-to-face and postal counseling. It helps people suffering from an ever-wider range of psychological problems any of which, if neglected, could lead to a suicide attempt.

In the past two decades, crisis intervention centers have been established across the country. “The existence of these centers does not necessarily indicate a rise in the number of suicides in China, rather an increasing awareness of mental health,” says Lin Xiongbiao, director of the Shenzhen crisis prevention center in south China’s Guangdong Province.

Lin says that roughly 8 out of every 100 callers to the center threaten suicide, but only one or two actually go through with it. The majority seeks advice and counseling.

Suicide is at last becoming recognized as a major public health concern in China, says Fu Sufen, director of the Hangzhou crisis prevention center in Zhejiang Province. She explains, “We get calls from people that have suffered trauma, such as the death of a family member or problems in a marriage or relationship -- taboo topics that are not normally shared. More and more people now acknowledge that mental and physical health are equally important, and that untreated mental illness is no less debilitating than SARS or AIDS.”

There has been no comprehensive national study on suicide, according to Professor Yu Xin, director of the Institute of Mental Health at Peking University. He elaborates, “Between 50 and 60 percent of suicide cases in China are linked with mental disorders, as compared with 90 percent of those in other countries. But there has been no detailed research explaining the causes of the remaining 40 percent of suicides.”

The little that has been documented on suicide in China throws up yet more questions. It is the main cause of death among Chinese people aged between 15 and 34. It is also known that the rate of suicide in rural communities is three times that in urban areas. But the most disturbing information to emerge is that a far higher proportion of women than men attempt suicide. This, Professor Yu states, sets China apart from most other countries.

Economic problems and chronic or incurable illnesses are the main reasons for suicides in rural areas. “Suicide is widely regarded as an acceptable means of freeing oneself from the misery of illness, emotional strife or financial burden,” Wang Jianping, a psychology professor at Beijing Normal University, explains.

Marital conflict is another cause. One female rural inhabitant, who prefers to remain anonymous, swallowed pesticide after her husband, in the midst of a heated argument, told her to “Go and die.” Her reaction is not surprising, bearing in mind that young rural women who leave their birth families to marry rely heavily on their husbands for psychological support. In these strained circumstances, even a minor disagreement can balloon into a vicious shouting match. Prof. Wang’s studies reveal that, for the most part, women declare having swallowed pesticide and immediately demand to be saved. As she observes, “In most cases, they don’t want to die. Women living in rural areas may fleetingly consider death as an escape from the problems that daily confront them, but their overriding sense of parental responsibility means that an attempted suicide is more a cry for help than a considered decision to die.”

Dr. Wang believes that social support is essential. In his opinion: “Timely psychological assistance would make all the difference.”

Raised standards of hospital emergency treatment in rural areas and reduced availability of pesticides are two imperative measures, says Dr. Phillips, going on: “Sixty-two percent of attempted suicides in rural areas, either by drinking pesticide or rat poison, succeed, despite medical treatment. Improvements to current levels of hospital treatment could save 50,000 lives a year.”

Experts agree that positive action to prevent suicides must commence with a shift in attitude on the part of the general public towards mental health. Professor Yu advocates mobilization of the police emergency 110 service and volunteers within local communities.

“Everyone is prey to psychological problems,” says Prof. Wang Jianping, “but no one should be allowed to reach the stage where suicide seems the only solution. It is crucial that people’s sense of self worth and capability of dealing with pressure be proved to them. This can be achieved by encouraging them to seek psychiatric help.”

To Chen Si, this is easier said than done. He points out that psychiatric help is way beyond the means of the average Chinese person, and has had no offers of financial aid in his self-appointed mission to prevent suicides. In his view, a solid financial base should be established on which to build a nationwide suicide prevention network.

As regards attitudes within society to mental health, Chen says there is still a long way to go. He cites a widely reported recent incident in another city, where a suicidal migrant worker standing on top of a high billboard was jeered, jibed at and challenged to jump by a crowd of onlookers.

Chen believes that: “In addition to providing psychological help, we must remind people that life is something to be treasured. Suicide prevention is everyone’s responsibility. Saving one life can spare scores of people misery.”