Emergency medical facilities are one of the key points for suicide prevention

Up until 1997, the number of deaths from suicide in Japan hovered around 25,000, but in 1998, it surged to 32,863.

The number subsequently fell below 30,000 in 2012 and then to 20,840 in 2018. However, this still represents about six times the number of road accident fatalities (based on statistics from the Ministry of Health, Labour and Welfare).

Moreover, on a country-by-country comparison, Japan has the highest suicide rate among seven major developed nations (France, United States, United Kingdom, Germany, Italy, Canada and Japan).

The government took this situation to heart, and in order to promote suicide prevention measures, the Basic Act on Suicide Prevention came into force in 2006, and based on this act, the General Principles of Suicide Prevention Policy was approved by Cabinet in 2007. Currently, local governments and relevant agencies are implementing suicide prevention measures based on these general principles.

The General Principles of Suicide Prevention Policy list nine priority policies. One of these is “preventing repeat suicide attempts”. The basis for this policy is that a previous suicide attempt is thought to be the most influential risk factor in subsequent attempts, and in suicide deaths. This has been clearly identified in studies not just in Japan, but also in various countries around the world.

For this reason, any emergency medical facilities where people who have attempted suicide are brought to are regarded as important centers for preventing repeated suicide attempts.

In general, emergency medical facilities tend to be thought of as places where only the physical condition of transferred patients is treated. However, in addition to surgical treatment, it is important that patients who have attempted suicide also receive psychiatric evaluation and treatment as well as mental support, that reliable, trustworthy counselors be secured for after the patient’s discharge from the medical facility, and that adjustments to the patient’s environment be made.

About 90% of people who attempt suicide may have suffered from some kind of mental illness

It has been reported that about 90 percent of people who die by suicide may have suffered from some kind of mental illness prior to their death. Our research has also shown that a prevalence of psychiatric disorders among patients admitted to an emergency medical facility following a suicide attempt is high.

However, it is purported that most people who die by suicide did not receive appropriate psychiatric evaluations and psychosocial support while they were alive. For this reason, WHO advocates that improving mental health is the key to preventing suicide.

In reality, people at high risk of suicide often have symptoms of depression, such as a loss of interest or joy or lack of hope, and often lack the strength to seek support themselves or have become socially isolated due to a narrowing psychological horizon.

For example, depression can result in the narrowing of a person’s emotional horizon or in a reduction in their intrinsic cognitive ability, judgment or flexibility of thought. If someone is in high spirits, they realize that they have family and friends, but if depression strikes, they can easily lose sight of that.

In addition to psychiatric treatment, psychosocial support that is closely attuned to an individual’s life background and values is very important for suicide prevention.

Assertive case management provided by mental health professionals is effective

The aforementioned General Principles of Suicide Prevention Policy were revised in 2017. The new general principles still listed “preventing repeat suicide attempts” as the priority policy and pointed to the need for improvements in the emergency care system for patients who have attempted suicide, so that they can be diagnosed by psychiatrists and receive care from mental health professionals.

The causes and motives of suicide are truly diverse and complex. They include work issues, workplace relationships, family relationships, financial problems and health problems. Moreover, rather than a single issue in isolation, they often involve a number of overlapping issues.

Therefore, it is important to provide patients who have attempted suicide with highly individualized support that is attuned to the difficulties faced by each individual.

Specifically, then, what kind of support should be provided in order to prevent repeated suicide attempts? A recent collaborative study by several large-scale facilities revealed that “assertive case management” conducted by mental health professionals (social workers, clinical psychologists, nurses, etc.) is effective for patients who have been brought to an emergency medical facility after surviving an attempted suicide.

It has been demonstrated that suicide attempts can be deterred by providing highly individualized, complex, ongoing assertive case management based on crisis intervention, psychiatric evaluation, psychoeducation and multidisciplinary cooperation.

In response to the efficacy of “assertive case management” having been demonstrated by way of high-quality research methods, this support program was to be included in Japan’s medical fee system from fiscal 2016.

Furthermore, by providing assertive case management to patients transferred to an emergency medical facility after attempting suicide, medical care facilities were now able to calculate medical fee.

This made it easier for hospitals to consider the recruitment and assignment of social workers, clinical psychologists and other specialists as mental health professionals conducting assertive case management.

Coinciding with these developments, a training program was also developed to train mental health professionals capable of conducting assertive case management faithfully. Furthermore, taking this training program became a mandatory requirement for calculating medical fee for assertive case management.

In this way, foundations for conducting the prevention of repeated suicide attempts based on scientific evidence have been established.

Currently, this training program is held regularly in Tokyo, Kansai and Kyushu, among other places. Efforts are also being made to promote assertive case management, as well as to maintain the quality of support and to strengthen the circle of support.

“Working Together to Prevent Suicide”

In the past, the different theme was had every year, but in the 3 years from 2018, we will continue to uphold “Working Together to Prevent Suicide”. Reference :Website “International Association for Suicide Prevention (IASP)”

In order to reduce suicide, besides support for people at high risk of suicide, the social environment must also be changed.

Power harassment and bullying, for instance, are one of the potential causes of suicide. Their prevention, though, requires everyone to work together.

Stigma and pressure that regard people driven to suicide as being weak or unusual are also hindrances to providing support to people at high risk of suicide and to their families.

It is important to communicate on a daily basis with family members, friends, work colleagues and others around you so as not to become isolated or to isolate others. And if you notice something unusual in someone’s manner, ask them what the matter is and listen to what they have to say.

Such an initial greeting like “What’s up? Are you OK?” or “Has something happened?” is very important.

One of the activities of the International Association for Suicide Prevention (IASP) is “Working Together to Prevent Suicide.” It advocates everyone working in partnership to prevent suicide.

Suicide prevention is not something that can be done by experts alone. It is important that everyone cooperates with each other.

To do so, I believe we must change our indifference to others and our evasiveness to becoming acquainted.

* The information contained herein is current as of January 2020.
* The contents of articles on Meiji.net are based on the personal ideas and opinions of the author and do not indicate the official opinion of Meiji University.
* I work to achieve SDGs related to the educational and research themes that I am currently engaged in.

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