109 Suicide prevention in Japan

Suicide has been an emerging problem for many years in Japan, especially amongst males of working age, young people and the elderly. A dramatic jump in the year-over-year number of suicides occurred in 1998(32,863 victims compared to 24,391 in 1997). Since 1998, suicide numbers have exceeded 30,000 every year for ten consecutive years (MHLW 2008). According to the latest suicide rates, 37.7 per 100,000 males and 14.7 per 100,000 females completed suicide in Japan in 2007 (National Police Agency 2008). Seventy per cent of the victims are men and approximately a third are aged 60 years or over. Trigger factors for suicide are health and financial problems. The number of people who attempted or committed suicide in Japan due to work-related stress has doubled since 2003–2004. Due to cultural factors, Japanese men are not supposed to show weakness. The economic conditions of the elderly are worsening as the government restructures its budget and reduces the social security and pension budgets. There are not enough experts and psychiatrists available for consultations with people suicidal crisis.

Ministry of Health, Labour and Welfare (MHLW) called a special committee and released a report on national suicide prevention strategies in 2002 (MHLW 2002). The Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP) were launched to develop effective suicide-prevention methods supported by the MHLW in 2006. J-MISP consists of two projects: a community intervention trial (NOCOMIT-J) and a randomized controlled trial of post-suicide attempt case management (ACTION-J). The Diet approved the Basic Law on Suicide Countermeasures, which came into force in 2006. In 2007, the Cabinet agreed on the National Suicide Prevention Measure Outline, and the Cabinet Office coordinates the implementation. MHLW have supported community intervention projects in twenty selected regions. The time course of developing suicide-prevention measures is shown in Table 109.1

The government has a goal to cut suicides by 20 per cent by 2016. Several prevention measures within public health and health care systems are supported by the government. In 2008, MHLW introduced a new scheme for the payment of treatment fees from the medical insurance system to medical institutions. Remuneration is paid for psychiatric consultation for suicide attempters at emergency departments, and for psychiatric referrals by primary care doctors.

A new act on suicide prevention and supporting suicide survivors in Japan (Basic Law on Suicide Countermeasures, Law No 85 of 2006) was implemented on 28 October 2006. The intention of this legislation is that both national governmental and local authorities should be responsible for suicide prevention in the whole country. The fundamental concepts of suicide prevention in Japan are:

Two examples of suicide preventive projects are presented below.

Suicide has been recognized as a problem for children and adolescents in Japan, and health care measures and promoting health care education for adolescents and children have been prioritized. It is suggested that measures to improve anonymous telephone counselling should be undertaken, along with lectures in schools for children, teachers and parents regarding how to prevent suicide, and to improve recognition of students who have suicidal thoughts or plans as early as possible (MHLW 2008).

Psychological problems are recognized as important associated problems for psychiatric disorders, and the government is stimulating provision of improvements to the systems, providing psychiatric treatment for children and young people. This psychiatric treatment should be supported with a combination of different psychological and psychosocial treatments to strengthen suicide-preventative effects (Wasserman 2001).

The need to prevent suicide contagion and to protect children's mental states has led to a request to the media to take measures against publishing harmful information in an irresponsible way, although no specific guidelines are issued.

Some concrete suggestions for measures to prevent mental ill-health and suicide have been discussed by responsible authorities:

A community-based suicide prevention programme was under-taken in the Akita Prefecture of Japan (Motohashi et al. 2007) following a systematic review of recent strategies to prevent suicide (Mann et al. 2005). A health promotion approach was utilized including raising awareness and emphasizing empowerment of residents and civic participation. Welfare and community network measures were also taken. There was a significant drop in suicide rates in the area, from 70.8 per 100,000 inhabitants (1999) before the intervention to 34.1 per 100,000 after the intervention (2004). The study showed that empowering residents and increasing civic participation reduced the suicide rate in this rural area of Japan.