'Ask directly: Do you have suicidal thoughts?'

By Lee Kyung-min

Directly asking if a person feels suicidal helps reduce the chances of someone killing themselves, a notion that seems counterintuitive to many who fear that the mentioning the word may trigger the tragedy, according to a government official. The Korea Suicide Prevention Center, supervised by the Ministry of Health and Welfare, held a “gatekeeper training” course that teaches ways to better “see, hear and speak” when encountering those who show signs of suicide.

“Many people find it very difficult to even broach the issue. Understandably so. But by asking the question, we need to carefully listen to how much a person is distraught and in pain. This lending of an empathetic ear should be followed by showing support that their hardship is understood. We then need to emphasize they do have reasons to be hopeful about life by reminding them of important ties such as family, friends or other communities,” an instructor at the center said.

Listening helps people get involved, the instructor said. Listening carefully and sincerely, and putting oneself in the speaker's shoes and not passing judgment. “People easily say suicide is bad, blaming or undermining the pain a person experiences. Others get angry and try to berate the person for even thinking about it. They give what they claim is advice not to make such a “stupid” choice. These are all examples of listening that do not help.”

Those who have suicidal thoughts do not directly express their state of mind including whether they are thinking about giving up on life, she added. “They want help and we sometimes do not notice that they do. That is why we need to pay greater attention to the warning signals they send.”

Asking about previous suicide attempts, mental illness treatment records and alcohol abuse should precede referrals made to regional branches of the National Center for Mental Health. “Asking whether they have friends to talk to and whether they planned the suicide in detail are also important.”

Korea's suicide rate is the highest among OECD countries

The campaign launched in 2013 is part of the government's ongoing efforts to reduce the suicide rate. The initiative was one of President Moon Jae-in's major campaign pledges, with the objective of reducing the rate to 20 for every 100,000 people, from the current 25.6. According to Statistics Korea, 13,092 people committed suicide in 2016, about 35.8 people per day. Korea's suicide rate is over twice the average among OECD nations which stood at 12.1.

The effort also comes amid high numbers of possible “preventable deaths.” Ministry data unveiled on psychological autopsies of 289 cases between 2015 and last year showed one out 10 people showed verbal or behavioral indicators of possible suicide. Over 92 percent of them frequently mentioned words “suicide,” “murder” and “death” and said they had physical discomfort without any clear medical diagnosis.

Many of them expressed self-demeaning thoughts and asked about ways to commit suicide. Insomnia, a difficulty falling and/or staying asleep, as well as hypersomnia, excessive sleepiness were experienced by the group. Extreme mood swings were observed as well as aggressive, hypersensitive and introspective behavior, and a lack of interest in general. In other cases, they behaved in an anguished or restless way, claiming to be at a “dead end” or feeling “unbearable” pain. Some of them either ate too much or refused to eat at all and stopped caring about their appearance. They gave objects that they valued most to close friends as presents.

However, only 21.4 percent of their family members noticed such “different and unusual” changes and less than a third of them asked whether they had had suicidal thoughts or consulted relevant mental healthcare organizations. When multiple answers were allowed, nearly 40 percent said they became worried but did not think their loved ones would actually commit suicide. About a third said they tried to help, but to no avail, and 20 percent said they did not take the situation seriously. Of the total, 80 percent of the bereaved said they suffered from depression, 27 percent of whom were feared to be in serious condition in need of immediate help.

The government plans to expand analyses of psychological autopsies, a research process that attempts to determine the complex mental conditions preceding suicides, in continued efforts to shed the negative image associated with the country.