June 13, 2011

1. INTRODUCING THE DEPARTMENT AND MODULEDr. Paul Wong, D.Psyc. (Clinical), MAPS Dr. Saman Yousuf, FCPS (Psychiatry), Clinical Psychologist Honorary Fellow, June 13, 2011

2. About Us http://www.csrp.hku.hk Dedicated to; • generate and advance knowledge in suicide studies through vigorous scientific research • develop effective suicide preventive measures by public health approach • build evidence-based indigenous working models for suicide ideators, attempters, as well as survivors through practitioners-researchers collaboration • transfer skills and knowledge to front-line professionals through workshops, resource production as well as opportunity of practicum training • contribute to the formulation of social and health policies in combating the problem of suicide

3. Core Strategies

4. We do not… • Provide direct services such as medical treatments, counseling, therapy etc. • Function as a crisis centre • Run support groups

6. SSM Course Outline • WEEK 1 - Suicide & Suicidal Behavior: Definitions, global and local trends - Theories of suicide & deliberate self-harm - Risk and protective factors - Risk assessment - Management: Prevention and Intervention strategies

7. WEEK 2 - Management: Post-vention strategies - Suicide & Ethics - Euthanasia - Concept of health and well-being - Stigma and mental illness - Working with suicidal patients: Implications for doctors - Other necessary personal skills: problem-solving, stress management

8. Format • Lectures • Group discussions • Audio-visual clips related to the topics of discussion • Assignment 1-2 page summary of an original article published within the past 5 years about suicide or deliberate self harm • Exam • Pre/post evaluation of knowledge and attitudes related to suicide

9. PRE-COURSE EVALUATION ATTITUDES AND KNOWLEDGE ABOUT SUICIDE

10. SUICIDE & SUICIDAL BEHAVIOR: DEFINITIONS “What is in a name?”

11. Suicide • An act of deliberately killing oneself (WHO 2007) • Fatal self-inflicted destructive act with explicit or inferred intent to die (CDC 2007) FATAL --------- SELF INITIATED -------- INTENT TO DIE

12. Suicidal behavior – a continuum

13. Suicidal Ideation • Thoughts of harming or killing oneself (CDC 2007) • Other terms used (although less clear): suicidal pre-occupations, morbid ruminations, considering suicide, contemplating suicide

14. Suicidal planners • A degree higher than suicidal ideation; a person plans his suicide before actually carrying it out • Not always present

15. Suicidal behavior • Refers to the whole spectrum of suicide-related behaviors • O’Carroll et al. (1996) proposed a detailed list of terms related to suicide and these terms are commonly used by a lot of practitioners: • Suicide • Suicide attempt with injuries • Suicide attempt without injuries • Instrumental suicide-related behaviour • Suicide threat

17. Deliberate Self Harm • An act with a non-fatal outcome in which an individual deliberately initiates a non-habitual behavior that, without intervention from others, will cause self-harm or deliberately ingests a substance in excess of the prescribed or generally recognized therapeutic dosage and which is aimed at realizing changes which the subject desired via the actual or expected physical consequences. (WHO/EURO Multicentre Study on Parasuicide 1992) • Other terms: Non-suicidal self injury, self-inflicted violence, self-injurious behavior

18. GLOBAL TRENDS

19. One million people die of suicide every year across the world; MORE THAN THE NUMBER DYING BY HOMICIDE AND WAR COMBINED • Global mortality rate = 16 / 100 000 people • One death every 40 seconds • Over the last 4-5 decades: rates of suicide increased by 60% • 1.8% of the global burden of disease • For 15-44 year age groups: 3rd leading cause of death • For 10-24 years group: 2nd leading cause of death • For every suicide, there are 20-30 suicide attempts

22. “The Ungreying Of Suicides”

23. Highest in elderly population • 90% of suicides globally are due to mental illness or substance misuse • WHO Estimates that for the year 2020, 1.53 million people will die of suicide • 20 times this figure will attempt suicide • One death every 20 seconds and one attempt every 2 seconds! • Male:female ratio = 3.2:1 (1950) to 3.9:1 (2020) – except China where suicide more prevalent in females

24. World Health Organization, 2009 http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

25. Problems of data and reliability of data available • When comparison across regions is done; • Highest rates in Europe; particularly eastern Europe • Japan, Mauritius, Sri Lanka and Cuba follow next • Lowest figures from Eastern Mediterranean region (Muslim countries) and some central Asian republics

26. Hawton (2009) - Lancet

27. THE CONTEXT OF HONG KONG

28. Hong Kong • Total population (2010) = 7, 097, 600 • Male: Female ratio = 0.88:1 • Fertility rate is1.07 in 2010 (was >3 in 1961) • Average domestic household size = 2.9

29. Aging population

30. 10 Leading Causes of Death in Hong Kong (81-01) Yip, P.S.F. et. al. (2003)

31. Census and Statistics Department HKSAR in 2001, 2006 & 2009

32. Years of Life Lost – Leading causes of death Yip P.S.F et al (2003)

33. Years of Life Lost – Compared to all causes 3% 8% 47% 16%

34. Suicide Rates in Hong Kong – 1997 to 2010* up to April 30, 2011 26.5% reduction in suicide rate

35. Suicide Rate by age group (1997-2009)

38. Suicide Rate by Method Used (1981-2010)

39. Prevalence of Suicidal Ideation, Plans and Attempts • 2004 Community survey • 4,759,000 people aged 15-59 years interviewed for lifetime suicidal ideation, plans and attempts • 28.4% had lifetime suicidal ideation (1.5% men and 2.5% women had potentially serious ideation – based on ASIQ scale scores) • 6.5% had experienced it in the past 12 months • 1.7% made a suicide attempt in the past 12 months • 0.2% made an attempt that required medical care

40. Deliberate Self Harm in Hong Kong • From 2004 to 2008 - An increase of 24% of DSH rate (per 100,000 persons) from 49 to 60.5 • Based on the total of 4,171 DSH episodes in 2008, the estimation of the medical cost was about HKD 84.7 million, which was a 41.7% increase from that of the year in 2003