Mental health

Japan turning a corner in suicide prevention

November 2015 - Japan has long battled one of the highest suicide rates in the industrialized world. In 2013, its national rate of suicide stood at 21.4 deaths per 100 000 people ̶ well above that of other high-income countries (12.7 deaths per 100 000 people). The statistics, however, mask significant gains in suicide prevention nationwide that have unfolded over the past decade.

WHO/P. Costa

Breaking the silence

In the late 1990s, suicide was a socially taboo topic in Japan, rarely discussed in the public sphere.

For families impacted by suicide, there was virtually nowhere to turn for counselling or support. “People thought that suicide was a selfish act,” says Mr Kazuhiro Yamaguchi, whose own father committed suicide. “I was afraid to talk about it.”

It was at summer camp that Mr Yamaguchi was finally able to share his story openly with other bereaved students. Together, they collaborated on the book “I could not say it was suicide”. The publication, released in the year 2000, attracted wide media attention and opened the door to a new era in national suicide prevention in Japan.

Stepping up suicide prevention

A major change took place around 2005 and 2006, when people began to look at suicide as a social problem. This triggered concrete action.

In May 2005, the nongovernmental organization, LIFELINK, collaborated with a member of the Japanese parliament to organize the first forum on suicide. At the forum, LIFELINK and other nongovernmental organizations submitted urgent proposals for comprehensive suicide prevention. From the viewpoint that suicide is preventable death, the Committee of Health, Labour and Welfare of the House of Councillors called for comprehensive measures of suicide prevention to be taken as a matter of urgency. The Minister of Health, Labour and Welfare, who attended the forum, vowed on behalf of the government to tackle the issue of suicide. This was widely reported in the media.

Subsequently, a bipartisan parliamentary group was formed in 2006 in support of the formation of a suicide prevention policy. The members of the House of Councillors from majority and minority parties decided to, together, promote suicide prevention as a national policy and to protect people’s lives. Buoyed by a petition with more than 100 000 signatories calling for suicide prevention legislation, Japan’s Basic Act for Suicide Prevention, the purpose of which is to promote suicide prevention and to help the relatives of people who die by suicide, was signed into law in June 2006. Implementation began in October of the same year. Through this Act, preventing suicide became an overarching government policy not limited to any single ministry.

“This holistic approach has been key to reducing suicide cases in Japan,” notes Mr Yamaguchi. “It has allowed us to talk about the multiple aspects of suicide ̶ medical, financial and other ̶ under the umbrella of suicide prevention.”

Following the global economic crisis in 2008, the Japanese government secured funding in 2009 through the “Regional comprehensive suicide prevention emergency strengthening fund”. The Fund was mainly used for reinforcing local suicide prevention activities, including intensive public awareness campaigns during the crucial month of March, when the rate of suicide was seen to increase. In 2010, the government designated March as National Suicide Prevention Month. It also introduced reforms for data collection, mandating the National Police Agency to release detailed municipal-level suicide statistics every month. This facilitated the promotion of suicide prevention measures aligned with local needs.

“I believe it is getting easier for the bereaved to talk about suicide,” notes Mr Yamaguchi. “Through the government’s efforts, suicide has become a frequent topic of discussion in public.” Mr Yamaguchi now runs a community association, “Re,” that provides opportunities for the bereaved in Nagasaki to share experiences with one another.

Gains in prevention, but key challenges remain

Investments in suicide prevention on a national scale appear to be paying off. By 2012, the number of suicides in Japan fell below 30 000 for the first time since 1998 ̶ a gradual trend that began in 2009.

“Initially we thought that this was just temporary, a blip,” says Dr Tadashi Takeshima, Director of Japan’s Centre for Suicide Prevention at the National Institute of Mental Health. “But in 2013 we saw a further decline in the numbers.”

Suicide rates among middle-aged men and the elderly are falling. The declines have been observed in many localities, including urban areas.

Despite progress, the rate of suicide among young people in Japan is still high, mirroring a trend seen in other countries around the world. Among young people aged 15 to 29, suicide is the second leading cause of death globally, according to a new report from WHO.

“We are behind in suicide prevention activities for the younger generation,” notes Dr Takeshima. “We need to strengthen support for youth by improving their educational and working environments.”

The global picture

According to the new WHO report, suicide accounted for more than 800 000 deaths worldwide in 2012 alone. But those figures could be higher. As suicide is a sensitive issue ̶ and even illegal in some countries ̶ many cases may go unreported.

The report, entitled “Preventing suicide: a global imperative,” turns a spotlight on the causes and consequences of suicide and aims to make suicide prevention a higher priority on the global public health agenda. Its release comes ahead of World Suicide Prevention Day ̶ observed each year on 10 September ̶ a global opportunity to raise awareness and promote joint action.