Singapore's Current Suicide Prevention Efforts
Public Viewpoint: An Uphill Struggle.
The Save.Me investigations indicate, among other crucial findings, a surprisingly low public perception of the efficacy of suicide prevention services. Younger respondents under the age of 21 have much lower ratings for the usefulness of support than older generations. The perception of support is significantly worse for individuals who know someone close who has attempted or died by suicide. This highlights a critical information gap in the public about how to aid persons in crises.
Hospitals' Key Gatekeepers: Risk Assessments
Hospitals and basic care physicians are frequently the first line of suicide prevention. Many Singaporean hospitals assess patients' suicide risk using tools such as the SAD PERSONS Scale (SPS) and the Columbia Suicide Severity Rating Scale (CSSRS). However, these instruments are not ideal. The white paper emphasises that, while these tests can identify people in danger, they should not be the exclusive method of assessment. Many of these tools overlook factors like as access to fatal methods or continuous despondency, which are critical in predicting and preventing suicide behaviour.
The Collaborative Assessment and Management of Suicidality (CAMS) is a more current instrument that was just launched in Singapore. CAMS—an evidence-based method—not only identifies suicide risk but also provides a comprehensive treatment plan. This includes public and community awareness, psychological treatments, and 24/7 assistance. CAMS, viewed as a more comprehensive approach, targets the root causes of suicidal thoughts and actions.
Taking a Multifaceted Approach Helps to Develop a Foundation
In response to the 2020 parliamentary request for a "Zero-Suicide Singapore," the Ministry of Health (MOH) created a Multi-Pronged Approach to Suicide Prevention and Intervention. This strategy focusses on four important areas:
Mental health programs are available for people of all ages. Senior citizen programs, corporations, and educational institutions offer seminars and resources to promote resilience and teach coping skills. The Samaritan of Singapore (SOS) also runs initiatives to help individuals detect suicide warning signs and know where to get help.
Schools train staff and instructors to recognise pupils in crisis, while peer support systems allow students to encourage one another to seek help. Programs such as the Community Health Assessment Team (CHAT) make mental health resources widely available to young people aged 16 to 30.
SOS and the Institute of Mental Health (IMH) operate 24-hour hotlines for people in trouble. In order to better understand and aid vulnerable young people, MOH established the Inter-Agency Research Workgroup on Youth Suicides in 2017.
IMH operates a Crisis Response Team in collaboration with the Singapore Police Force and assists those who have tried self-harm. Importantly, suicide attempts were decriminalised in 2020, demonstrating a shift in Singapore's attitude towards suicide—from a crime to a cry for help.
National Mental Health and Well-Being Strategy: Expanding the Framework
The National Mental Health and Well-Being Strategy, which was approved in October 2023, builds on the multifaceted approach that laid the framework. Its top priorities are:
Improving mental health service availability in communities and streamlining the help-seeking process would contribute to increased mental healthcare capacity. The strategy also includes 24-hour care for individuals in dire need.
By 2025, a National Mental Health Competency Training Framework aims to improve suicide risk assessment and intervention skills among frontline professionals.
Public education campaigns, mental health courses in schools, and resources for parents all contribute to increased mental health literacy through their various responsibilities.
Companies will be encouraged to prioritise mental health in the workplace through initiatives such as "Workplace Mental Well-being Champions" who will assist employees.
Strengths of Singapore's efforts in Suicide Prevention
All-inclusive and multi-faceted methodologies
Singapore's strategy is particularly strong due to its complete nature. The multifaceted approach ensures that suicide prevention is not limited to a single sector of society by targeting mental health across many age groups and social settings (schools, workplaces, and communities). The initiative is intended to reach a wide range of people, whether by training teachers to identify at-risk pupils or by establishing peer support networks inside communities.
Early Intervention Emphasises
Early detection and intervention training are also beneficial. Schools have programs that help instructors and students recognise early signs of stress. REACH and CHAT are readily available services designed to provide prompt support to young people who may be experiencing mental health issues.
Decriminalising Suicide Attempts
One significant advancement is the 2020 decriminalisation of suicide attempts. It shifts the emphasis from punishment to support, encouraging people to seek help free of legal implications.
Flaws and Gaps in Current Efforts
Obstacles remain regarding public perception and stigma of suicide ideation and prevention. Despite widespread efforts, the public has a negative perception of suicide prevention help. Many individuals are still unsure how to help someone in crisis, and suicide remains stigmatised. According to Save.Me research, many people are hesitant to provide help because they are unsure how to react or are afraid of making matters worse.
Insufficient Assessment of Suicidal Tendencies
Although many hospitals use techniques such as CSSRS and SPS, their ability to predict suicide behaviour is very limited. Many times, these exams overlook significant risk variables such as access to lethal weapons and pessimism. Support for persons with early signs of suicidal ideation is similarly limited, as many do not seek professional care until their illness worsens.
Insufficiently adapted interventions for high-risk groups.
Specific therapies for high-risk groups, such as LGBTQIA+ persons, those with chronic diseases, and those in great financial stress, remain neglected. These populations require targeted assistance activities suited to their specific circumstances.
Underperformance of Community Networks
Although community-based efforts such as Well-Being Circles and Caring for Life exist, their effectiveness is limited. Many people are still hesitant to seek treatment, often due to a lack of awareness or fear of stigma.
What Must Be Done?
Improve public education and reduce stigma
More has to be done to educate the public on how to identify signs of suicide risk and provide appropriate help. The primary goals of public awareness campaigns should be to reduce stigma and provide people with the tools they need to help someone in distress. People's apparent barriers to providing help will decrease as they gain confidence in their ability to do so.
Customise interventions for high-risk groups
It is critical to establish specific support networks for impoverished groups, such as LGBTQIA+ individuals and those suffering from chronic conditions. Addressing their specific needs can help close the gap in present suicide prevention measures.
Close the treatment gaps in mental health services
Making mental health services more accessible should be the primary focus of efforts, particularly for people who exhibit early signs of suicidal ideation. Closing the treatment gap necessitates improved access to affordable, timely mental health services.
Strengthen Community-Based Support Systems
Community projects should be expanded and enhanced in efficiency. Well-Being Circles and other peer support networks should be encouraged and integrated into local communities so that those suffering from mental illnesses have a more positive environment.
Track and improve strategies for assessing suicide risk
Although current suicide risk assessment tools are useful, they should be regularly examined and improved to ensure that they appropriately identify persons who are at risk. Including more comprehensive strategies, such as CAMS, could assist individuals gain a more accurate and full understanding of their suicide risk.
In Summary
Despite Singapore's comprehensive and progressive suicide prevention measures, more work remains to be done. Although the public's perception of suicide prevention is negative, shortages in mental health services and assistance for high-risk populations must be addressed. Expanding public education, improving access to care, and establishing community networks would assist Singapore continue its progress towards a "Zero-Suicide" culture.
Working together, we can foster a supportive environment in which everyone understands they are not alone in their struggle, stigma is lessened, and getting help is encouraged. This White Paper is immensely appreciated in our efforts to aid suicide prevention in Singapore.
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