Considering Measures to Prevent Suicide in the Face of the Spike in Suicides among Young People during the Coronavirus Crisis
Visiting Researcher, Institute of Cultural Sciences, Chuo University
1. The current state of suicides among young people in Japan
Since the Basic Act on Suicide Prevention took effect in 2006, the number of suicides has decreased from the 30,000s to the 20,000s. Under this law, we can say that measures to prevent suicide have succeeded. On the other hand, there is a figure that is mostly unreported in the media: that the suicide rate among young people in fact reached an all-time high in 2019.
Japan's suicide prevention measures have been very effective for middle-aged and older people due to economic measures and action to combat depression among the elderly. However, suicide among young people remained at the same level until 2016, and measures to combat it have been completely ineffective. Because of this, in the revision made to the Basic Act on Suicide Prevention this year, suicide prevention among young people was made a priority, and schools were instructed to provide education on how to send out SOS messages.
Sadly, since this amendment was made, suicides among minors have been rising steadily every year. We must accept this trend as proof that these measures are not working in a way that is commensurate with the current situation surrounding young people and children, and that we must develop more effective ones.
Suicide prevention is divided into the primary, secondary, and tertiary stages. Primary prevention includes raising awareness, eliminating the causes of suicide, and creating physical environments designed to prevent suicide. Secondary prevention refers to interventions for those considering suicide, and tertiary prevention refers to support provided after suicide has occurred.
Education on how to send SOS messages, which is one of the primary prevention measures with regard to suicide among children, became a mandatory effort for every school in 2016. However, the government did not provide any specific means, such as who should communicate what and how, and the process was left entirely up to the schools. This has led to the current situation, in which very few schools are providing education on how to send out SOS messages--even after four years have passed.
With regard to secondary prevention, some consultation services are available, such as the Yorisoi Hotline, ChildLine, and Inochi-No-Denwa. However, these services are all on a volunteer basis, and rely on the dedication of counselors. Thus, Japan's consultation services are barely able to function through good intentions. The government has done nothing to assist these consultation services for distressed youth, and has been relying on volunteers since the Showa period.
Regarding tertiary prevention, the government has no support system in place for the estimated 10,000 children a year who lose a parent to suicide. In the United States, there are more than 500 facilities for supporting orphans whose parents have taken their own lives, whereas Japan has just 30--all of which are privately run--and 90 percent of which are operated by volunteers with no government support.
In short, Japan's efforts to prevent suicide among young people are weak and ineffective in all of the primary, secondary, and tertiary stages of prevention, so it is no wonder that suicide rates among young people continue to rise. Results show that in Japan, suicide is consistently the number one cause of death among young people, and year after year, figures indicate that among the G7 countries, Japan has the highest suicide rate among young people by far. These figures reveal the utter ineffectiveness of Japan's actions to prevent suicide.
2. Factors contributing to the spike in suicides during the coronavirus crisis
When I first saw the report showing that the overall number of suicides in August of this year was 1.2 times higher than in August of last year, and that it was 1.4 times higher for women, I was honestly lost for words. I anticipated that there would be an increase in suicides due to the coronavirus crisis, especially among middle-aged and older men due to economic reasons, but did not expect a spike in suicides among women. An analysis of the breakdown of suicides from data released by the Ministry of Health, Labour and Welfare indicated a sharp rise in the rate among women of all generations, from teenagers to those in their 70s, but especially in the rate among middle school-age girls; their rate was four times higher than last year. Furthermore, the rate among high school-age girls was 7.3 times higher than last year. This is a shocking statistic that cannot be written off as simply being due to the coronavirus crisis. Despite the urgency of this problem, the government has yet to even alert the schools about it, let alone show them the data.
I felt a strong sense of urgency about this problem, so I held an emergency Zoom conference in October to discuss the rapid spike in suicides among young people. The main takeaways from the data analysis were: (1) suicide rates are increasing in general, but the rate among female minors is rising especially rapidly; (2) there are differences among regions; (3) the number of sure methods of suicide among children, such as jumping from high places or jumping in front of a moving train, is increasing; and (4) the number of consultations related to abuse and domestic violence, as well as those that can be tied to gender, such as pregnancy, has been increasing during the coronavirus crisis. The government has yet to disclose detailed data related to the numbers of abortions, emergency room visits, and breakdowns of the rates of domestic violence and abuse, so it is not possible to develop specific suicide prevention measures. However, considering the higher rates of suicide among women, issues that are unique to women, such as pregnancy and sexual assault, should be taken into account in the context of life under partial lockdown, as well as the fact that women are no longer able to do the things they normally do to deal with stress, such as meeting with friends for meals, when discussing efforts to prevent suicide during the coronavirus crisis.
3. The impact of suicide reporting and the state of news coverage
Amid the coronavirus crisis, in which people are experiencing anxiety over infections and uncertainty about the future, we have seen a series of suicides among well-known celebrities. The rise in suicide rates due to reporting on suicides is known as the Werther effect in suicidology, and previous research has shown that the greater the coverage of suicide, the greater the increase in suicides, that suicide rates tend to increase among communities where reporting on suicides is more readily available, and that the effect is greater among young people. Based on these facts, the WHO recommends the following "don'ts" in its suicide reporting guidelines.
- Don't place stories about suicide prominently and do not unduly repeat such stories
- Don't use language which sensationalizes or normalizes suicide, or presents it as a constructive solution to problems
- Don't explicitly describe the method used
- Don't provide details about the site/location
- Don't use sensational headlines
- Don't use photographs, video footage or social media links
How were these recent suicides among celebrities reported on during the coronavirus crisis? We saw how the media sensationalized them through emergency alerts, simplified the causes of suicide, and reported the methods of suicide in detail, failing to adhere to the WHO guidelines. As the WHO recommendations are not legally binding, they are not enforceable. However, as a society we must consider the wellbeing of those who are vulnerable to suicide reporting and take a more proactive stance in protecting lives. We should stop and ask ourselves if the news we are getting is acceptable, considering what we know about suicide reporting.
4. Suicide prevention measures that can respond to society-wide mental health crises
It is often said that suicides have increased because of the coronavirus crisis, but I believe that what the crisis has done was to expose the lack of effective ways to deal with the usual hardships of life. Suicide prevention measures are not isolated efforts; every component of society that supports the lives of people, such as policies related to child care, nursing care, unemployment, medical care and welfare, and education, can be considered as an effort to prevent suicide.
This society-wide mental health crisis is further damaging the parts of society that were already vulnerable before the coronavirus crisis.
Many people think that the cause or motivation for suicide among children in Japan is often due to bullying. However, statistics on the known causes of suicide revealed in suicide notes show that the leading cause is discipline and reprimand by family members among elementary school-age children, academic issues among junior high school-age children, and anxiety over the future path in life among high school-age children. We must consider how relationships between parents and children were impacted by the increased time at home due to the coronavirus crisis, and how anxiety over schoolwork and future prospects were affected due to the continued absence of school. It is difficult to ignore the distortions that have occurred in areas that we were previously unable to effectively cope with on a daily basis.
It is not a natural course of events that suicides have increased due to the rising unemployment rate amid the coronavirus crisis. The suicide rate has gone up because of our failure to address issues surrounding unemployment. It is unnatural that suicides have increased among young people because of celebrities committing suicide. Rather, it is society's failure to consider the wellbeing of people who are vulnerable to suicide reporting.
The basic principle of the Basic Act on Suicide Prevention is that suicide is a social problem, not an individual problem.
We must search for methods to prevent suicides during the coronavirus crisis in every possible way, and consider the lives of each and every member of society.
Visiting Researcher, Institute of Cultural Sciences, Chuo University
Satomi Takahashi obtained her doctorate from the Tohoku University School of Medicine. She holds a PhD in Medicine.
After working with nurses in psychiatry and psychosomatic medicine, she spent two years in Sweden conducting research on medical welfare and education systems. After returning to Japan, she has been involved in grief counseling for bereaved families and orphans of suicide, illnesses, and natural disasters, and has provided care for children who were orphaned by natural disasters. While conducting suicide prevention activities such as providing support for surviving family members, she has been providing suicide prevention education for elementary, middle, and high schools across the country since 2006, as well as teaching courses for teachers and parents on how to receive SOS messages. Her goal is to reduce the number of suicides among children to a quarter of today's numbers by the time the children of today reach the age of their parents.
She has taught mental health nursing science at Tsukuba International University since 2012.
She has worked as a professor at the National Defense Medical College's School of Medicine of since 2014, and as a visiting researcher at the Institute of Cultural Sciences, Chuo University since April 2020.
Recent publications include Kyoshi ni Dekiru Jisatsu Yobo (Suicide Prevention that Teachers Can Engage In) (Kyoikukaihatsu Kenkyusho)