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Thursday, June 18, 2009
The safety nets for would-be suicides
Suicide-prevention experts Yukio Saito and Yasuyuki Shimizu believe there is a solution
By TOMOKO OTAKE
Every time the National Police Agency comes out with new suicide statistics, media reports tend to focus on the fact that the annual suicide count has reached a new high or has topped the psychologically significant 30,000 threshold for yet another year. (The latest figure available was 32,249 in 2008.)
But each of the 30,000-plus who commit suicides in Japan every year has a face. They also have life stories and a complex set of reasons that drove them into killing themselves. The announcements reveal very little about the backgrounds of these people — except from their age, occupation and the known "reason" for the suicide, provided only as "health" or "economic and financial problems."
But what is actually going on? Do people really kill themselves because they are ill or simply because the economy is bad? Yasuyuki Shimizu has asked himself this question, and investigated further.
The director of a Tokyo-based nonprofit group Lifelink, 37-year-old Shimizu first got involved with such issues nine years ago while working for public broadcaster NHK and directing a series of programs on children whose fathers had committed suicide.
"There was no public consensus on what should be done, and most people regarded the issue as a personal one, not society's," Shimizu says. "I talked to these children, and learned how much they blamed themselves for their fathers' suicides and how isolated they felt, unable to share their experiences with anyone."
The shows received enormous feedback from viewers, but, frustrated with the lack of progress on the issue, he quit NHK and set up Lifelink in 2004.
Over the years Shimizu has come to play a pivotal role in Japan's campaign against suicide. A major achievement has been persuading lawmakers to draft and pass a landmark bill that for the first time spelled out the responsibility of national and municipal governments in preventing people from committing suicide. The Basic Suicide Prevention Law, implemented in 2006, urges all parties involved — including government agencies, hospitals, employers and schools — to build a better network among themselves so more people at risk can be identified and rescued before too late. Based on the law, the government has mapped out the nation's overall strategy on suicide prevention.
Such moves are good news for longtime antisuicide advocates such as Yukio Saito, director of nonprofit telephone counseling service Inochi no Denwa (Lifeline), which was set up in the late 1970s (IND's 7,000 volunteers take 700,000 calls a year across the nation). Saito welcomes the fact that the government has finally become proactive and declared that suicides should be prevented by the whole community, unlike in the past, when doctors and nurses responsible for government health checkups were tasked with recognizing those on the brink of killing themselves.
But Saito has also said that many local governments are still clueless as to what specific steps to take, and that in some cases leave prevention measures in the hands of grassroots groups like IND.
"Some government agencies, including the Cabinet Office (tasked with suicide prevention measures) seem to think that they have done their job just by throwing out a lot of money to local governments," Saito says. "And quite a few prefectures seem to be at a loss what to do."
One reason the prefectural governments are at a loss might be because they don't have the hard data behind their areas' suicides.
"Approaches to suicide prevention should vary from municipality to municipality depending on that suicide characteristics particular to the area, but for long, no such local data were available," Shimizu says.
Last year his group published Jisatsu Jittai Hakusho (A White Paper on Suicide Facts), providing a breakdown of suicide trends in every one of the nation's 1,206 police jurisdictions, where individual suicide reports are compiled. The statistics — albeit still sketchy — show micro-level suicide trends, by showing affected age groups, sexes, occupations and a known cause, in the order of frequency. Thanks to the report, various regional tendencies have come to light.
For example, among the 24,208 "company workers" — as opposed to the self-employed and the jobless — who took their lives between 2004 and 2006, Toyota City in Aichi Prefecture, stood out as the worst municipality, with 93 people killing themselves there. Toyota is of course the home to Toyota Motors Corp., the world's biggest automaker and the myriad of contractors and subcontractors whose fortunes depend on business they get from the automaker.
"The data have shown clearly that antisuicide measures should involve, in a place like Toyota, the cooperation of businesses," Shimizu said.
But can suicides really be prevented by intervention from the outside? Aren't they down to more personal issues, including upbringing and character traits? And what about the culture that some say is permissive toward people committing suicide in Japan?
Shimizu concedes that cultural factors do exist. "In Japan, unlike in the West, suicides are maybe considered a shame but not a sin or a betrayal of your contract with God," he said.
And yet, suicide has closer links to the social and economic climate, Shimizu argues. He cites the sudden upturn in the number of suicides logged in 1998, a year when the annual toll, which had hovered somewhere in the mid-20,000s, topped 30,000 for the first time since 1899 (no data is available for 1944-46). Suicide figures rose sharply in March 1998 — the end of the financial year — when the impacts of the November 1997 collapse of brokerage giant Yamaichi Securities Co. trickled down to the real economy.
Shimizu also points to another surge in October 2008, a month after the U.S. brokerage Lehman Brothers went under. During the business year that began in April 2008 and ended March 2009, October had the most suicides, at 3,092, which Shimizu suspects was linked to the Lehman shock, since in no other year in the previous 10 had October reported such a surge in suicide figures.
Saito of IND also says that, while the Japanese culture of shame and self-reproach has "played a part," such aspects are often exaggerated and sensationalized by the media. The western media's stereotypical view of Japan, which often links modern-day suicides to seppuku rituals from the Edo Period (1603-1867), is biased and flawed, he says, noting that seppuku was a penalty, not suicide.
Cultural differences aside, what can be done to stop people from turning to suicides as their way out? Shimizu says the biggest problem is the breakdown in communication among various agencies offering "safety-net" programs that range from legal advice for people with debts to loan sharks to counseling for people with depression. Lifelink has conducted in-depth interviews with bereaved families, revealing the paths that led 350 people to believe that suicide was their only option. The group found that, behind each suicide is an average of "four crisis factors," with early signs such as stress from work developing into bigger problems as they become exacerbated by family discord, physical illnesses and economic hardship.
Shimizu advocates the public sector to intervene early before these factors add up and get out of hand. Also, given that people with numerous problems are too exhausted to seek out sources of solutions for each themselves, government officials should learn what kind of services are offered by other agencies outside their jurisdictions, he maintains.
"I really think suicide problems in Japan have to do with how agencies expand their 'safety nets,' rather than people's individual views on life and death," Shimizu says.
Saito, on the other hand, says it is ultimately the duty of every one of us in society to stop people from crossing that fatal line, and to send out the message that help is out there.