Kapok: Suicide in Macao

Émile Durkheim was the first academic to dedicate a whole book to suicide. In his seminal work, the French sociologist was able to distinguish between egoistic, altruistic, anomic and fatalistic forms of suicide, along a double axis of social integration and moral regulation. The book was published in 1897, and although it has been criticised, especially for its exclusive reliance on aggregated statistics, it still constitutes a reference and has helped design public policies to address what represents a crucial indicator of the soundness of an entire society. The plight of a few can lead to the destruction of the whole.

No wonder that the hanging suicide of a 16-year-old girl on May 2 triggered wide coverage in the Macao press and later made Secretary for Social Affairs Alexis Tam express his genuine grief, instructing the relevant administrations to fully investigate the case and provide counselling to those in need. His overall message to youth, despite the clumsiness of the wording “not to act silly”, was to exhort young people to “cherish life”. Having acted both swiftly and comprehensively, to Mr Tam’s credit Macao’s suicide rate has dropped significantly in the past few years, standing at 8.2 per 100,000 individuals in 2015 if only residents are included and at 9.6 if the whole population is taken into account. The world average was 10.7 the same year according to the WHO.

Back in 2008, I had the privilege of inviting to Macao Paul Yip Siu Fai, the director of the Hong Kong Centre for Suicide Research and Prevention who had just edited a book on Suicide in Asia. At the time, Prof. Yip had emphasised that Macao’s suicide rate for 2007 stood at 16 per 100,000 (a figure I was never able to reconstruct), higher than the world average of 15 and clearly higher than Hong Kong’s 13. He emphasised that one of the shortcomings was the lack of detailed statistics and in-depth research about the situation in our SAR. Nevertheless, something must have been done right regarding awareness, portraying suicide in the media, reducing access to lethal methods of self-harm, identifying potential cases, educating the young, addressing the problems of the survivors and putting in place suicide prevention programs.

Yet, providing statistics, the very first task towards adequate surveillance and monitoring, remains problematic.

Firstly, statistics about suicide in Macao are only released once a year on "World Suicide Prevention Day" on September 10 and somewhat overexposed on World Mental Health Day on October 10. Not only can it be deemed prejudicial — is suicide solely a mental illness? — it is also clearly not enough, with insufficient detail — age, sex, education, etc., are important elements – and not accessible to the wider public.

Then, turning to the statistics from the Health Bureau — available since 1996 — one notes many discrepancies: there are no statistics for suicide before 2001 and the method of counting drastically changed in 2007 and led to a (downward!) revision of the total numbers for 2004 and 2005. From 2007, the gender breakdown is no longer provided (men used to be the majority) and the rate per 100,000 disappeared from 2007 to 2013, resurfacing only in 2014. But even then, a rate of 7.8 for 2015 is given, whereas the Health Bureau made its communication on September 10, 2016 [corrected], based on 8.2: which one is right? What about the peaks of 2004 and 2011: any explanations?

According to Paul Pun, the head of Caritas, some 305 and 222 suicide-related phone calls were made to Caritas’ Life Line in 2015 and 2016, including respectively 4 and 8 when the act was about to happen. Women are the most at risk (respectively 179 and 136 cases). Now the Blue Whale Game is also menacing Macao and a collective suicide attempt was indeed prevented just last month…

Please Mr Tam, provide us with more and better statistics. 

Published in Macau Daily Times, May 26, 2017.