SINGAPORE - A coordinated, whole-of-society effort is needed to prevent more suicides, which disproportionately affect young people, said a group that has published a 160-page report outlining a national suicide prevention strategy for Singapore.

Among the White Paper’s recommendations are having a national office coordinate various anti-suicide efforts that function independently of mental health services, a surveillance system that produces more regular data, and a national public awareness campaign on suicide prevention.

The White Paper was launched in conjunction with World Suicide Prevention Day on Sept 10 by advocacy group SG Mental Health Matters, founded by former nominated MP Anthea Ong, and will be presented to the Government by the end of the month.

Called Project Hayat, which means “life” in Malay, the report laid out its own research findings and 23 recommendations for addressing the gaps in suicide prevention here.

Leading its recommendations is the establishment of a national office that is empowered and funded to coordinate the data, monitoring and interventions across multiple sectors in the Government and community.

It is the first study on suicide prevention in Singapore, and comes after the launch of Singapore’s National Mental Health and Well-Being Strategy in October 2023.

Ms Ong said the Government and community groups have made strides in suicide prevention, but the nation lacks a framework for coordinated action across the ecosystem that focuses on suicide specifically and not simply couched within a framework for mental health.

“We... have some mention of suicide prevention in the National Mental Health and Well-Being Strategy, but again, that is incomplete because not all suicides (can be) attributed to mental illness, and not all who have mental health conditions are suicidal,” she said.

“Without a national strategy and framework, we also would not be able to know which of the efforts contributed to the increase or reduction in suicide rates.”

Speaking to the crowd gathered at the National University of Singapore’s Saw Swee Hock School of Public Health for the launch, Ms Ong said: “Our suicide prevention efforts have also predominantly adopted a medical perspective with mental health services, often seen as the primary solution. But to effectively prevent suicide, underlying social, economic and cultural factors that contribute to societal behaviour also need to be addressed.”

Project Hayat is a community-led effort, guided by a working group that comprises policymakers, suicide experts, researchers, community workers and helping professionals, religious leaders, corporate leaders, representatives from the media, and people whose lives have been impacted by suicide.  

Dr Jared Ng, a psychiatrist and medical director at Connections MindHealth, one of the project’s three co-leads, told The Straits Times that having a surveillance system would provide not just more regular suicide data, but also information on how people took their own lives as well as the number who have tried to do so.

This would allow the Government to be more proactive in picking out the areas that need closer attention, he said.

Currently, suicide data is released yearly by suicide prevention charity Samaritans of Singapore. 

A total of 322 suicides were reported here in 2023, representing a 32.4 per cent drop from 2022 when there were 476 suicides, the highest number since the Samaritans began recording data in 2000.

And while deaths by suicide among those aged 10 to 29 fell in 2023, suicide was – for the fifth consecutive year – the leading cause of death among this group, making up 29.2 per cent of all deaths within this age group.

Project Hayat highlighted further improvements that could be made to current crisis response efforts.

For instance, infrared beam sensors may be installed to detect access to unsafe or unauthorised areas in high-rise buildings, neighbourhood watches could be instituted, and online safety interventions put in place that include preventing access to online material that glorifies suicide.

The paper also raised the value of strengthening family and community networks to mitigate suicide risks, and said more research is needed to identify priority groups at greater risk of mental health challenges, self-injury or suicide.

Furthermore, schools, religious organisations and workplaces were identified as groups that need to be effectively supported in carrying out their responsibility in suicide prevention across all ages.

Dr Ng, former chief of the emergency and crisis care department at the Institute of Mental Health, noted that research from the United States in 2018 showed that every suicide affects up to 135 people.

“I’ve seen families devastated by the effect of suicides, and, as a result, they are at higher risk, and there’s also the ripple effect in the community,” he said.

“As a society, we need to acknowledge the profound emotional impact of suicide and the distress that it can cause, and know how to support those who are affected.”

Sometimes, this may just mean simple acts of kindness, he said. If someone appears to be in distress, simply being there to listen to him could make a difference. Encouraging him to reach out to a trusted person, or seek professional help, can also be helpful, he added.

A year in the making, Project Hayat offers findings collected from people who have attempted suicide, those who have worked with people at risk, or witnessed heartbreaking losses first hand.

“Corroborating such personal experiences with published research as well as fresh data and international stakeholder interviews has validated some of the key recommendations of our work,” said Assistant Professor Rayner Tan from the Saw Swee Hock School of Public Health.

Dr Tan is the third co-lead, and led the research for the White Paper.

In a response issued on Sept 10, the Ministry of Health (MOH) said it acknowledges that suicide is a multifaceted and complex issue that requires a whole-of-society approach to deal with.

“Not everyone who presents suicidal behaviours has a mental health condition. There are often social stressors, such as relationship issues, academic stress or parental pressures. (Thus), our suicide prevention efforts need to go beyond a medical approach,” it said.

MOH said that many of Project Hayat’s recommendations are aligned with the Government’s plans to prevent self-harm and suicide, and to render help to those in need. 

These have been outlined in the National Mental Health and Well-Being Strategy, and many of the measures are already in place, while others are in the process of being implemented, it said.

“These measures range from upstream prevention such as public education campaigns, encouraging help-seeking and building mental resilience, to downstream interventions such as crisis support and treatment.

“The setting up of the National Mental Health Office will also enable us to coordinate partnership efforts more effectively, and to better synergise and maximise our efforts on the ground,” it said.

“We thank our stakeholders, such as SG Mental Health Matters, for their contributions. It is through these ground-up initiatives that we continue to update and evolve our strategies to meet the mental health needs of our population.”

More than 500 respondents, representative of Singapore’s age, gender and ethnicity, contributed more than 4,000 perspectives and suggestions in the first phase of Project Hayat’s public consultation on OPPi, a citizen engagement platform.

While Singaporeans acknowledged the Government’s efforts in suicide prevention, only half knew how to access help for support services, the project’s findings showed.

In addition to the Government, the White Paper will be presented to other stakeholders, including school boards and principals, employer groups, healthcare and religious institutions, and community leaders.

If and when it is adopted, Singapore could be the second Asean country to have a comprehensive suicide prevention strategy, behind Indonesia, which published one in August 2023.

The full 160-page report of the Project Hayat White Paper is available on www.sgmentalhealthmatters.com

It is a living document, which will be updated with the findings from the second phase of public consultation that is open on bit.ly/sgsuicideprevention till the end of September 2024.