75 Prevention of suicide by jumping: Experiences from Taipei City (Taiwan), Hong Kong and Singapore

Nearly 80 per cent of the population of Hong Kong and Singapore live in high-rise buildings. High-rise buildings provide an opportunity for committing suicide by jumping, and elevated rates of suicide by this method are observed in the above-mentioned cities. An analysis of the suicides in Singapore, Hong Kong and Taipei can increase understanding and improve possibilities for prevention.

In Taiwan, jumping suicide rates vary greatly across different levels of urbanization; the more urbanized cities/counties, with greater density of high-rise buildings, were found to have as much as a fourfold increase in incidence rate compared to the less urbanized districts (Lin and Lu 2006). In Taipei City, the largest metropolitan area in Taiwan, with a population of 2,600,000 (Department of Budget Accounting and Statistics, 2004), there are about 35 per cent of households living on the sixth floor or higher. Taipei City is one of the cities in Taiwan with high rates for jumping suicide (Lu and Chen 2006). The overall suicide rate in Taipei City was 17.3 per 100,000 population in 2006, which was lower than the national average 19.3 per 1,000,000 population. However, the average proportion of suicide by jumping in Taipei City was about 20 per cent, which was much greater than in Taiwan as a whole (8 per cent), and was the largest among all the cities in Taiwan (Lu and Chen 2006).

In Hong Kong and Singapore, nearly 80 per cent of the population lives in high-rise buildings, which provide a very accessible method for people committing suicide by jumping. Suicide by jumping is the most common method of suicide in Hong Kong and Singapore, 50 per cent and 74 per cent in 2005 respectively. In Singapore, a very significant change of method of suicides was observed during the rapid transition to urbanization in Singapore. The proportion of jumping among suicide deaths in Singapore has increased from 18 per cent in 1960–1964 to 74 per cent in 2000–2004. It has replaced hanging as the leading method of suicide since the early 1980s. In Hong Kong, jumping has replaced hanging as the most common method of suicide since 1980s as more high-rise buildings were built. The easy accessibility to potential jumping sites was an important contributing factor to the increase in jumping suicide rates in Hong Kong, Singapore and Taipei City.

Data analysed by the Center for Suicide Research and Prevention in Hong Kong (2005) suggests that home residence is the most common place to jump: about 80 per cent of jumping suicides. However, suicide ‘hotspots’ in the community do exist. There have been about ten suicide deaths from jumping from the Tsing-Ma Bridge in Hong Kong since its opening in 1997.

A study conducted by Chen et al. (2008) analysed jumping suicides committed between 2002–2005 in Taipei, and had shown that private residential buildings comprised the highest proportion (67 per cent) of all jumping suicides, followed by business office buildings (13 per cent), hospitals (8 per cent) and shopping malls (5 per cent). However, hospitals and shopping malls were actually the two sites with the highest estimated risk. The number of jumping suicide per 1000 sites were 307 per 1000 hospitals, and 275 per 1000 shopping malls, compared to 0.7 per 1000 residential buildings (Chen and Lu 2008). The relative risks of jumping suicide in hospitals and shopping malls are much higher than other structures in Taipei, indicating that hotspots do exist in places where patterns of suicidal jumps mostly occur from high-rise residences. Restricting suicide from these two types of sites could prevent 13 per cent of suicide by jumping.

Studies examining jumping suicide from high-rise residences usually found that the rates were higher among elderly people (Copeland 1989; Abrams et al. 2005; Lu and Chen 2006) and younger adults. For the older age group, a jump from their own residence is accessible, and is comparatively easier to accomplish than hanging, especially for those living in high-rise buildings. For younger adults, some show very impulsive behaviour, particularly with a relationship break-up or other problems.

Several studies have indicated that the gender distribution of those who jumped from residential buildings resemble general suicide victims (Fischer et al. 1993; Yip 1997). In Taipei, however, jumping suicide rates were equal in men and women (Lu and Chen ; Chen and Lu 2008), which is different from the gender profiling of jumping suicide in other countries. This indicates that jumping suicide is a relatively preferred method of suicide among women in Taipei, as the male:female suicide gender ratio in Taipei is about 2:1 (Kuo et al. 2006; Lin and Lu 2008). Differences in method availability and cultural acceptability may drive higher jumping suicide rates among women in Taipei City.

Method availability relates to direct physical access to, familiarity with, and the technical skills and planning required to use the method. The factor of accessibility is a more dominant factor, especially among older adults with serious illness, since this restricts the use of other methods.

It is reasonable to expect that the unavailability of certain methods may reduce the number of people attempting suicide, or at least provide an opportunity to intervene as the person seeks another method. Although there is no formal report in Taipei, increasing the height of walls in the upper floor parking lots of a shopping

mall has decreased number of cases that jumped from the site (Figure 75.1). Similarly, Times Square, one of the busiest shopping centres in Hong Kong, contains a courtyard-style building, in which there were a few incidences of suicide by jumping from higher floors into the centre court during 2002–2003. As a result, the height of the transparent partitions the upper floors was raised. After the additional safety measures were implemented there were no more suicides by jumping, and the aesthetics of the mall were largely retained.

Sensational reporting of suicide from specific places can lead to a copycat effect, as seen in three cases of jumping from Times Square in Hong Kong, in which the victims were very similar in their profile: young adults with mental illness.

The suicides from the Tsing Ma bridge in Hong Kong were also different from the general suicide population. A careful reporting on suicides from suicide hotspots, for example, avoiding mention of the specific location, would reduce the copycat effect. It seems that this is not practical in news reporting. However, if we were aware of the possibility of excess risk in copycat suicides, it would certainly be an option worth exploring for the sake of protecting the vulnerable individuals in society. Media reporting of suicide from the parking lot of the shopping mall could create an impression that it is a good and potential place for jumping suicide.

The prevention of suicide by jumping can be achieved by building higher walls or fences at jump-sites, and decreasing media coverage of such suicides. These strategies may be especially effective for communities with a large number of high-rise buildings.