There is no single cause of suicide and it often happens when stressors exceeds a person’s capacity to cope, and the person feels helpless and hopeless about the future.

THE STIGMA

Some Consider it as Sinful and Shameful

SUICIDE IS SECOND LEADING CAUSE OF DEATH IN THE WORLD.

About 1 in 3 individuals who commit suicide expressed their suicide intentions verbally or through writing.

Malaysia has struggled to collect reliable data on attempted and completed suicides in Malaysia (Maniam, 1995). The National Suicide Registry Malaysia (NSRM) published their last report in 2009 which shows a rate of 1.3 per 100,000. Experts agree that this figure underestimates the actual rate due to underreporting by police and family members.

One of the main reasons for the lack of accurate and reliable data is that there is an omission of notification to the Registry. Although the law mandates that all cases of “sudden death” must be fully investigated, the discretion lies with the attending police officer. Medical officers may also fail to notify due to their unfamiliarity with the ICD reporting system. In addition, there is a stigma associated with suicide, as some consider it as sinful and shameful. It is also considered a crime to commit suicide or to abet another to commit suicide under the Penal Code (Act 574). These factors have led to the systematic under-reporting of both completed and attempted suicides.

A recent study placed the figure at 6 - 8 % per 100,000 individuals per year, and the Ministry of Health has estimated that the rate could be as high as 10-13% per 100,000 individuals. The number of suicide attempts are at least 15 times more than the number of completed suicides. The most popular methods in Malaysia of suicide is by hanging, poisoning (by pesticides), jumping off a tall building and poisoning by car exhaust gas.

This means 10 per 100 000 people commit suicide everyday.

Ethnic Indians, men and individuals under age 40 are at high risk of completed suicide. Other risk factors (things that make it more likely that someone would take their life) include experiencing a significant negative life event, physical and/or mental illness, past suicide attempts, and family history of suicide and mental illness.

About 1 in 3 individuals who commit suicide expressed their suicide intentions verbally or through writing. This means that at least 30% of completed suicides gave some sort of warning of their plans and could have been helped prior to the suicide.

Suicide ideation is when a person has thoughts about suicide and is considered a risk factor for attempting suicide. The National Health and Comorbidity Study conducted in 2011 showed that suicidal ideation is highest among individuals aged 16 to 24 years. This age group is also most likely to have a suicide plan and to attempt suicide. Other risk factors for attempting suicide include living in an urban area, being female, and being an ethnic Malay.

The prevalence rate of attempted suicide in Malaysia is 6.3 per 100 000 people or 250 people a day.

WARNING SIGNS

Something to look out for when concerned that a person may be suicidal is a change in behavior or the presence of entirely new behaviors. This is of sharpest concern if the new or changed behavior is related to a painful event, loss, or change. Most people who take their lives exhibit one or more warning signs, either through what they say or what they do.

TALK

If a person talks about:

  • Being a burden to others
  • Feeling trapped
  • Experiencing unbearable pain
  • Having no reason to live
  • Killing themselves

BEHAVIOUR

Specific things to look out for include:

  • Increased use of alcohol or drugs
  • Looking for a way to kill themselves, such as searching online for materials or means
  • Acting recklessly
  • Withdrawing from activities
  • Isolating from family and friends
  • Sleeping too much or too little
  • Visiting or calling people to say goodbye
  • Giving away prized possessions
  • Aggression

MOOD

People who are considering suicide often display one or more of the following moods:

  • Depression
  • Loss of interest
  • Rage
  • Irritability
  • Humiliation
  • Anxiety

SUICIDE PREVENTION

If you are concerned that someone you know is thinking about suicide or planning to attempt suicide, here are some steps that you can take.

1. Share The Love.

Let your friend know that you care for them and that you would like to help them.
Be direct and open about suicide.
Listen and accept their feelings.
Don’t correct or judge their thoughts and feelings.
Don’t promise not to tell anyone. This prevents you and your loved one from seeking support.

2. Ask About Their Plan.

Contrary to popular opinion, asking someone about their suicide intentions or plans does not increase the chances of suicide happening. Rather, bringing it up can help the person feel safe enough to talk about their feelings and thoughts and get help.
How much have they been thinking about suicide?
Do they have a specific plan on how to commit suicide?
Do they intend to carry out the plan?
The more frequent and intense the suicide ideation, and the more specific the plan is, the higher the risk the individual is going to commit suicide.

3. Take Action.

Explore other options other than suicide.
Talk about their reasons to live vs. to die. Highlight what there is to live for.
If possible, remove their means of committing suicide (e.g. pesticides).
Sign a no-suicide contract.
Don’t assume that they will get better without help or that they will seek help on their own.

4. Get Help.

Make an appointment with a medical health professional (GP, Psychiatrist, Psychologist or Counsellor) and offer to go along.
If the risk is imminent, go to the Emergency Room (UM or HUKM). Private hospitals in Malaysia do not handle suicide emergency cases.

5. Self-Care

It is emotionally draining to provide care for someone who is suffering from mental health problems, and/or suicidal.
You can only give as much care as you are cared for. Find someone to talk things over with.

Strength is not in bearing the burden alone, but in bearing the burden together. For yourself and for your loved one.

I NEED HELP NOW!

Talk to someone, anytime, anywhere. imalive is the first online crisis centre. All their volunteers have been trained in crisis intervention and are available 24/7 to provide you a safe place to talk through your intense emotional pain and unrelenting dark thoughts.

You can also call Befrienders Malaysia at +603-795 68145 or email them at sam@befrienders.org.my . Their phone lines are manned 24/7 by trained volunteers who are ready to listen to your story and to support you in your darker moments.

References
American Foundation for Suicide Prevention. Risk factors and warning signs. Retrieved 26 September 2016, from https://afsp.org/about-suicide/risk-factors-and-warning-signs/
Aishvarya, Maiam, Oei & Subramaniam. (2014). Suicide attempts in Malaysia from the Year 1969 to 2011. The Scientific World Journal, 2014, 1-13. http://dx.doi.org/10.1155/2014/718367
Armitage, C.J., Panagioti, M., Abdul Rahim, W., Rowe, R. & O’Connor, R.C. (2015). Completed suicides and self-harm in Malaysia: A systematic review. General Hospital Psychiatry, 27, 153 - 165.
Institute of Public Health, Ministry of Health. (2011). National Health Morbidity Survey 2011 — non-communicable diseases-- Volume 2. Retrieved from http://www.iku.gov.my/images/IKU/Document/REPORT/NHMS2011-VolumeII.pdf.
Maniam, T. (1995). Suicide and undetermined violent deaths in Malaysia, 1966-1990: Evidence for the misclassification of suicide statistics. Asia-Pacific journal of public health, 8(3), 181-185.
Maniam, T. H. B. A., Chinna, K., Lim, C. H., Kadir, A. B., Nurashikin, I., Salina, A. A., & Mariapun, J. (2013). Suicide prevention program for at-risk groups: pointers from an epidemiological study. Preventive medicine, 57, S45-S46.
Maniam, T., Marhani, M., Firdaus, M., Kadir, A. B., Mazni, M. J., Azizul, A., ... & Jasvindar, K. (2014). Risk factors for suicidal ideation, plans and attempts in Malaysia—Results of an epidemiological survey. Comprehensive psychiatry, 55, S121-S125.
Ministry of Health. (2005). Malaysia’s Health. Retrieved from http://www.moh.gov.my/images/gallery/publications/mh/MalaysiaHealth2005.pdf
National Suicide Registry Malaysia. (2010). National Suicide Registry Malaysia Annual Report for 2009. Retrieved from http://www.crc.gov.my/wp-content/uploads/documents/report/NSRM_report_2009.pdf.
Sane. How to help when someone is suicidal. Retrieved 26 September 2016, from https://www.sane.org/mental-health-and-illness/facts-and-guides/sane-steps-how-to-help-when-someone-is-suicidal