Centre for Suicide Research

and Prevention

The University of Hong Kong

香港大學香港賽馬會

防止自殺研究中心

Professor Paul Yip

April 8, 2016

Number of Suicides and Suicide rates in Hong Kong (1997-2014)

Registered death date up to 31 July 2015 (n=845)

Estimation of suicide death in 2014 (n=893) by adjustment with year 2013

Profile of youth suicide in HK

HK has a different pattern of youth suicide as compared to Western

countries (Yip et al., 2004; Ho, Lee, Tang, & Hung, 1998)

― Suicide rate in the 15-24-year age group is relatively lower than

other Western countries such as Australia, NZ, US etc.

― Lower gender ratio among teenagers

― Less depressive disturbance

― Less antisocial disturbance

― Less substance abuse or drug use

Risk factors in youth suicide in HK

• Academic pressure

• Mental illness

• Interpersonal relations

(peer, friends)

• Break up in a

relationship

• Conflict with family

members

T. P. Ho, S. F. Hung, C. C. Lee, K. F. Chung and S. Y. Chung (2000). Characteristics of youth suicide in Hong Kong . Social Psychiatry and Psychiatric Epidemiology Volume 30, Number 3, 107-112,

MENTAL HEALTH AND HELP SEEKING BEHAVIORS IN HK

BGCA (2009) About 4.2% P.1 – P.6 students at critical range for anxiety and

depression

Among 2,586 youth aged 15-24 (Yip et al., 2004), The prevalence rates of suicidal ideation and behavior: 17.8% considered 5.4% planning 8.4% attempt once or above 1.2% required medical care Among 2,220 respondents aged 15-29 (Cheung et al, 2004), Depressive symptoms: 9%(CES-D) (M:7.3% ; F:10.5%) Suicidal ideation: 6.2% Suicidal attempt: 2.0% (CSRP, 2005)

Mental health and suicidality in Hong Kong

Lifetime Prevalence of Risky Behaviours in HK Youth

CSRP research:

Telephone survey

was conducted in

2013, with a total

of 1010

respondents aged

12-29

0.30%

0.70%

1.20%

2.50%

2.70%

2.70%

6.10%

8.40%

9.50%

10.20%

10.4%

14.60%

20.50%

28.10%

28.10%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00%

STD

Abortion

Unintended pregnancy

Drug/ Substance abuse

Compensated dating

Legal offences

Debt problems

Unsafe sex

Bully others

>5 cigarettes per day

Injure self intentionally

Bullied by others

Consider suicide

Drink > 5 drinks in one occasion

Gambling

At-risk youths with

distress in past 4

weeks N=313

Did not seek help

N=89 (28%)

Seek informal help

(friends / family)

N=200 (64%)

Seek formal help

(social services)

N=24 (7%)

Help-seeking

behavior

Expressing distress

online

Yes

n=64 (72%)

Yes

n=165 (83%)

Yes

n=18 (75%)

Help-seeking behavior in youth

CSRP research: Telephone

survey was conducted in

2013, with a total of 1010

respondents aged 12-29

Contact group - substantial attention Non-contact group - ranged from 62% to 86% of suicide population (Vassilas and Morgan 1993, 1997; Pirkis and Burgess 1998; Appleby et al. 1999b; Andersen et al. 2000; Miller and Druss 2001; Manchester 2006; Ho, 2003; Hamdi et al, 2008; Law et al, 2010; Phillips, 2009 & 2010) )

The majority of the suicide population had made no contact with psychiatric service before they died (Law et al., 2010)

SUICIDE PREVENTION

With Public Health Approach 從公共健康著手

Suicide Prevention Strategies ~Public Health Approach~

Suicide prevention for high-risk groups would have only modest effect on population suicide rates, even if effective interventions were developed.

(Lewis, Hawton and Jones, 1997)

Reducing a small risk in a large population is more effective than for a high risk in a small population (Rose, 1992)

Lewis, G., Hawton, K., & Jones, P. (1997). Strategies for preventing suicide. British Journal of Psychiatry, 171, 351-354. Rose, G. (1992) The strategy of preventive medicine. Oxford, England: Oxford University Press.

Public Health Approach

Mercy and Rosenberg 2000, Powell, and Kachur 1995, Potter, Rosenberg, and Hammond 1998, US

Department of Health and Human Services 2001

Towards Evidence-based Suicide Prevention Programmes, WHO 2010

Evaluation 評價

What works?

Prevention/ Intervention 預防／介入

How do we do it?

Risk (Protective) Factor Identification

風險因素識別

What’s the cause?

Surveillance 監測

What’s the problem?

Problem 問題 Response 應對

Public Health Approach: Interventions

Source: WHO. (2010)

Tip of the

iceberg Indicated

The entire population • Community-based suicide

prevention programs

• School-based mental

health enhancement

programs

• Limiting charcoal

access

• Suicide reporting

recommendations

Subgroups with risk factors • Care for suicide survivor project

• Gatekeeper training program

• Consulting for NGOs

High-risk individuals • Volunteer mentorship: help young

adults with DSH behaviour

Projects

Universal

Selective

Bo

ttom

s u

p a

pp

roach

UNIVERSAL

Intervention in Public Health Approach

Universal Approach

Awareness and Education

― Improve recognition of suicide risk and understanding of suicidal behavior

and mental illness

― Promote help seeking behavior

― Reduce stigma of mental illness and suicide

― Enhance mental well-being through school-based programs

• Little Prince is Depressed, Professor Gooley & The Flame of Mind, The

Adventures of DoReMiFa

www.depression.edu.hk

www.mindmap.hk

Conceptual framework of the

school-based program

Cognitive-behavioral approach

Positive psychology intervention

Content of the program

Emotional competence

CBT Model & ABC Theory

Problem-solving skills

Social & communication skills

Empathy

Gratitude

Hope

Self-esteem & strengths

Goal setting

Universal Approach

Social Media Engagement

Centre for Suicide Research and Prevention website - #WeCare

http://csrp.hku.hk/wecare/

此專頁旨在為關注學生自殺的各界人士提供幫助。我們整理了青少年自殺風險因素、預警訊號、社區可以提供幫助的資源、如何與青少年傾談的技巧等，亦針對不同的人士（例如傳媒、網民、家長、學生、校長、老師等）提供具體的跟進建議。

Centre for Suicide Research and Prevention - Facebook https://www.facebook.com/hkucsrp

SELECTIVE

Intervention in Public Health Approach

Action plan in response to current situation

Short-term: break or slow down the infection chain

CSRP:

A hub website to guide different users to relevant resources

and information (#WeCare)

Through psychological autopsy studies to identify potential

risk factors in youth and suicide cluster

Social media:

Stop sharing or reposting sensational suicide news. The

message can be delivered by a hashtag campaign

Facebook users: if they see anyone possibly at suicide risk,

they can @ those NGOs with online services

EDB:

Contact the deceased's family and close friends to remind them NOT

to set up online memorial for the deceased for now.

Provide professional training for teachers on early identification and

crisis management

Teachers or school social workers should directly ask or spot students

with potential suicidal risk or affected by the recent suicide news

Active monitoring on Facebook secrets pages and try to contact those

showing suicide risk

Revise the Guideline on Student Suicide and provide training on

utilization of the guideline

Short-term: break or slow down the infection chain

CSRP Facebook

Promotion strategy: • Re-package webpage information into bite-

sized pieces, multi-media illustration.

• Share through social networks

• @ mass media and online media’s FB accounts

• # hashtag campaigns for different initiatives

• Collect feedback for webpage updates

http://csrp.hku.hk/wecare

Main page: • general information of youth suicide problems

(e.g. risk factors, protective factors, warning

signs, statistics, intervention suggestions, etc.)

• Interaction with readers via email and phone call

• Entrance to categorized pages

Mass media, online

media, public: 1. Media reporting and

online information

dissemination

guidelines

2. Contact information

of experts in

relevant fields

3. Contact information

of social services,

including online

services

4. Training

opportunities

5. Research evidence

6. Examples of good

and poor practices

7. News articles/video

clips relating to this

topic

8. Reader’s sharing

Survivors:

1. Self-help

manual

2. Contact

information

of NGOs that

provide

services for

survivors

3. News

articles/video

clips relating

to this topic

4. Reader’s

sharing

School principals and

teachers:

1. Crisis management

guidelines

2. Training

opportunities

3. Tips for mental

health promotion

4. Educational

psychology

resources

5. Contact information

of NGOs that provide

services for school

issues.

6. News articles/video

clips relating to this

topic

7. Reader’s sharing

Parents:

1. Suggestions on

communication

skills

2. Training

opportunities

3. Tips for mental

health promotion

4. Contact

information of

NGOs that provide

services for

parental issues,

family issues, etc.

5. News

articles/video

clips relating to

this topic

6. Reader’s sharing

Students:

1. Guidelines for

student-initiated

programs

2. Suggestions on

peer support skills

3. Tips for mental

health promotion

4. Training

opportunities on

peer support

5. Contact information

of NGOs or school

services that

provide mental

health support.

6. News articles/video

clips relating to this

topic

7. Reader’s sharing

Figure 1. Architecture of #WeCare Project

Mid-term: vaccine and better care

Request all of the schools to include mental health programs into

regular curriculum

More mental health training for teachers and parents

Provide training to all teachers and school staff on suicide

prevention

More mental health awareness training for the public

Increase the capacity of school psychologists and social workers

Support NGOs to develop services that meet youth's needs

Facilitate those self-initiated helping programs or mental health

campaigns

Long-term: change the context/culture

Reform education system to ensure students' well-being

Change family dynamics to more open and supportive

communications between family members

Legislate to protect youth's mental health, including that the media

should not report any personal information of under-aged person,

even if the person is dead.

Change help-seeking culture to "it's ok to seek help.“

Through psychological autopsy studies and other related research

studies, to identify effective strategies for suicide prevention

What else can we do to

prevent student suicide?

Preparing students for new transition

The purpose of preparation class is to lessen students’ burden

But does teaching English, Chinese or maths really help lessen their

stress or burden?

Or how shall we prepare them?

Preparatory classes introduce concepts taught in P1, build

basic skills and clear misconceptions

(Sources: The Straits Times, 28 Dec 2015)

…

Over the last six months, XX, who will start at XXX Primary

School next month, attended weekly preparatory lessons in

Primary 1 subjects – English, Chinese and maths – on top of her

regular kindergarten classes.

…

Preparing students for new transition

Goal: to reduce students’ anxiety and build social network

Orientation program for primary school students

― Ice breaking games

― Group activities (teachers are welcomed to join)

― Introduction of one’s character strengths (positive psychology)

― School tour

• Buddy system (pair up new students with older students)

• Introduction of the school environment and facilities

• Introduction of teachers and other staff

• Be familiar with the new schedule

• Activities for enhancing mental health awareness

Preparing students for new transition

Goal: to enhance one’s problem-solving skills and build social network

Orientation program for secondary school students

― Ice breaking games

― Welcoming lunch

― School tour

• Introduction of the teachers, social workers and other staff

• Introduction of the activities/clubs that are available for students

• Be familiar with the new schedule

― Former students to share their school lives, such as:

• How to build one’s own social network

• How to ask and seek help

• How to deal with academic stress

• How to establish good habits

• Open discussion about the changes student will experience

Activities for enhancing mental health awareness

Community plays Important Roles in

Suicide Prevention Work

If we don’t win their hearts today,

they will break our hearts tomorrow.

Photo by Centre for Suicide Research and Prevention

RESOURCES AVAILABLE

Suicide Prevention Services

Suicide Prevention Services (24-hour) 2382 0000

The Samaritan Befrienders Hong Kong (24-hour) 2389 2222

The Samaritans (24-hour Multi-lingual suicide

prevention services)

2896 0000

Social & Legal Services Information and Telephone

Caritas Family Crisis Support Centre (24-hr) 18288

Social Welfare Department Hotline Service

Monday to Saturday (9am – 10pm)

2343 2255

Legal Aid Department (24-hr) 2537 7677

Domestic Violence Hotline for women 2375 5322

Victim of abused women – Harmony Family

Services (24-hr)

2522 0434

Harmony Family Services (for men) 2295 1386