Given the media reports of increased suicide in Malaysia, there have been calls for better suicide prevention strategies. Before developing these strategies, we first need to have adequate research evidence to inform us about the development of resources, facilities and policies that could contribute to the prevention of suicide.
What sort of evidence or information do we need before the development of strategic policies and initiatives? Factors that contribute to suicide.
Do we have such information in Malaysia? I believe we do but in bits and pieces. We used to have a National Suicide Registry of Malaysia (NSRM) before 2009. Unfortunately, the Registry is no longer in existence after a three-year run. Since then, we no longer have a standardised record system for suicides and attempted suicides. Given this lack of data, how would the nation be informed about suicide patterns, methods used, demographics of those attempting and completing suicides, and so on?
Why would these data be important to formulate suicide prevention strategies? It is because when we have information about risk factors, the efficacy of existing prevention methods for prevention, intervention, investigations, stakeholder coordination, and such would improve.
Surveillance data can help relevant stakeholders devise appropriate intervention approaches according to various socio-demographic factors such as age, sex, religion, ethnicity, socioeconomic status, education level, history of suicide attempts, family background, medical status, suicide ideation, and correlation to substance abuse.
There would also be better insights into the next steps required to align our national strategies to the existing global gold standards in suicide prevention. The World Health Organization has published various policy papers on suicide prevention and surveillance methods. These are evidence-based practices that are being continuously updated.
From global research, the top factors that contribute to suicide are relationship problems, financial struggles and chronic physical illnesses. Apart from triggers, many other risk factors contribute to suicide. These include systemic factors such as poor access to the health system and information, increased access to means of suicide, inappropriate reporting of suicide in the media and the general stigma and taboo surrounding suicide.
Nevertheless, without updated information within the Malaysian setting, it is very difficult to design any form of strategy to address suicide. While there has been research conducted on suicide in general as well as suicide intervention such as the gatekeeper method for improving suicide literacy, there is still a need for concerted efforts to study the fundamentals of suicide in Malaysia.
The former NSRM was a very good effort to collect data that would inform prevention and intervention strategies. It comprised comprehensive information that helped in identifying risk factors, the evaluation of critical responses to suicide attempts as well as the dynamics of addressing suicide by stakeholders involved. Problems regarding existing data that were identified included the lack of medical certification of death, lack of response from private medical centres on suicide records, classification of suicides hampered by the stigma associated with criminal status, shame, taboo, religious beliefs, and insurance claims, as well as the insufficient time for postmortem investigations to determine the cause of death in instances where funeral arrangements must happen within 24 hours of death.
One way to effectively act on addressing suicide in Malaysia would be to reinstate the NSRM. We need as much evidence as possible to better understand suicides in the country. Accuracy of information would also be facilitated by the decriminalisation of suicide, as it is currently under-reported because it is a crime.
Another barrier to gathering accurate information on suicide is that the topic of suicide itself is a difficult one. It is steeped in stigma, prejudice and perversion. Stigma, because suicide is a taboo subject that some people feel is to be avoided in case it triggers people to contemplate ending their life. Prejudice, because victims or survivors of suicide are often misattributed as having a mental illness. Perversion, because certain quarters of society gawk at suicide scenes and then share them on social media, without understanding the negative impact of their actions.
Suicide would remain a difficult topic as long as we allow it to remain stigmatised, prejudiced against, and a subject of human perversion. To help individuals and to address suicidality, we need to be able to openly talk about and keep having conversations about suicide. Understanding factors surrounding suicide can help address the misconceptions about it and destigmatise it.
But what are the factors contributing to suicide? Do we readily know them? Do we know how to differentiate suicide myths from facts? How much we know reflects our suicide literacy. I believe our collective suicide literacy is low in Malaysia. So, part of suicide prevention would also involve improving the literacy about suicide in the country.
It a commonly believed that talking about suicide leads to suicide ideation, especially amongst the mentally ill. Research has found that this belief is far from truthful. Talking about suicide helps better educate people about it and to normalize any suicidal ideation, which is usually more common than most people think. Normalisation leads to acceptance, validation and a sense of belonging – three of the most useful experiences that help reduce suicidality.
To support efforts in understanding suicide in Malaysia, and towards better strategies for suicide intervention, organisations must first invest in continued research on the subject matter. Updated knowledge can be shared with the relevant stakeholders as well as the public to improve overall suicide literacy, and to bust the common myths about suicide. Research would provide scientific evidence that informs policy and practice for more efficient suicide prevention and intervention.
Attempted and completed suicides come at an excessive cost to economic and psychological well-being. Trauma to family members, friends, work colleagues and the community affects their productivity and well-being. The cost and other implications for human resources and other resources surrounding suicide also add up very significantly. Therefore, I implore relevant government and non-governmental agencies to collaborate with universities in researching suicide, for it is a national economic threat.
By Professor Alvin Ng Lai Oon, Professorial Teaching Fellow and Associate Dean (International) – School of Medical and Life Sciences, Sunway University