MCLC: suicide prevention

[Denton, Kirk]

MCLC LIST
From: Jacqueline and Martin Winter <dujuan99 at gmail.com>.edu)
Subject: suicide prevention
*****************************************************************

Source: South China Morning Post (12/16/11):
http://www.scmp.com/portal/site/SCMP/menuitem.2af62ecb329d3d7733492d9253a0a
0a0/?vgnextoid=933bf4d6ce144310VgnVCM100000360a0a0aRCRD&ss=China&s=News

Lighting a candle for the living
Two million fewer people have killed themselves on the mainland over the
past 20 years, thanks in part to the work of Dr Michael Phillips and his
research into suicide
By Alice Yan  

Ten days after the death of Mao Zedong, in September 1976, Dr Michael
Phillips, a young Canadian, arrived at Beijing Language and Culture
University to study Putonghua. A month later he marched with other
students from the capital's Haidian district to Tiananmen Square.

"Down with the Gang of Four! Long live Hua Guofeng," the crowd chanted. He
could not speak a word of Chinese, but other foreign students who had been
studying it for longer explained what the chants meant.

Thirty-five years later, and now fluent in Putonghua, Phillips is one of
the mainland's top psychiatrists and has played a key role in suicide
prevention efforts that have helped save the lives of an estimated 2
million mainlanders.

Phillips, better known on the mainland as Fei Lipeng ,is based in
Shanghai, and executive director of the WHO Collaborating Centre for
Research and Training in Suicide Prevention at Beijing Huilongguan
Hospital. He is also treasurer and China representative at the
International Association for Suicide Prevention.

Nine years ago, Phillips and two mainland colleagues published an article
in the medical journal The Lancet that rocked the psychiatric world, at
home and abroad. Based on mortality data for 1995-99 provided by the
Ministry of Health, "Suicide rates in China, 1995-99" estimated that the
mean annual suicide rate was 23 per 100,000, with 287,000 suicides a year,
making the mainland's suicide rate one of the highest in the world.

The article said that the rate among women was 25 per cent higher than in
men, mainly because of the large number of suicides among young women in
rural areas. This was in sharp contrast to Western countries, where three
times more men kill themselves, compared to women. The mainland's suicide
rate in rural areas was three times higher than in urban centres, with
most taking their lives by drinking pesticide.

Sitting in his office at the Shanghai Mental Health Centre, Phillips, 62,
says the number of suicides has been dropping steadily for the past two
decades and now stands at fewer than 195,000 a year.

"There are about 100,000 suicide deaths less every year compared with 20
years ago, and in total two million people have been saved. It's hard to
determine my role in this, but I would say I definitely made a
contribution," he says.
"It's impossible to take part in such a huge project in other countries.
That's the attraction of my job."

Phillips earned his medical degree from McMaster University in Canada in
1974 and then worked in Auckland for two years. He was thinking of working
in Africa next, but by chance he was given the opportunity to study
Putonghua on the mainland as an exchange fellow in 1976.

After studying Putonghua for two years in Beijing and Nanjing, Phillips
discovered that he could "do things in China" and decided to focus on
public health and psychiatry.

"Mao Zedong's great contribution in medicine was that he advocated
developing the healthcare system in rural areas," Phillips says. "With
so-called barefoot doctors in villages, the public health level in China's
rural regions was better than other countries at a similar stage of
economic development.

"I wanted to learn about those public health measures and thought they
could be applied in other places in the future."

Phillips studied psychiatry, epidemiology and anthropology at the
University of Washington in the United States from 1980 to 1985, before
spending two years as a visiting scholar at Hunan Medical University in
Changsha, Hunan.

In 1987, again by chance, he was offered a job at the Mental Illness
Hospital in Shashi, a rural backwater in Hubei . He stayed there for seven
years, training psychiatrists from across the country and researching
schizophrenia. For two years he was in charge of 90 beds.

Phillips says the language barrier was a challenge, admitting that he is
not a naturally talented linguist. "I grew up in Montreal where there are
two languages. My French score was often 60 [out of 100]." He had to work
hard to understand what his patients and their relatives said, in various
dialects, instead of seeking help from interpreters.

But that problem largely vanished when Phillips moved to Beijing
Huilongguan Hospital in 1994, and he realised that he could understand
what everyone was talking about on the city's buses.

Last year, he resigned from the hospital, while retaining his position at
the WHO collaborating centre, and started to work at the Shanghai Mental
Health Centre.

Phillips says the reasons behind the dramatic drop in mainland suicides
are complex, involving multiple factors.
"Nobody can predict whether the suicide rate goes up or down, and there
are just many, many factors that work together to result in the suicide
rate," he says. "What are the major ones? My guess is economic improvement
... there are a lot fewer people living in poverty right now."

There are still some differences between China and Western countries.
Drinking pesticide remains the most common method of committing suicide on
the mainland, and the suicide rate is now equal for men and women, with
the rate in rural areas now double that in urban centres. In addition,
most Western doctors would not believe, Phillips says, that one third of
mainlanders who kill themselves and two thirds of those who attempt
suicide, do not have a diagnosable mental illness. In the West, 90 per
cent in both categories have active mental problems.

Phillips keeps in touch with developments in the West and spends some time
in the US each year as a visiting professor of psychiatry and behavioural
sciences at Emory University in Atlanta, and professor of clinical
psychiatry and epidemiology at Columbia University in New York.

For 10 years, he has been unsuccessfully trying to promote a national
suicide prevention plan to the central government.

It is designed to engage multiple institutions, including the education,
health, public security and agriculture authorities, and to be implemented
in several steps.

Phillips says one essential step is to carry out long-term "panel studies"
to make teenagers "more psychologically resilient". They would be divided
into small groups to interact and learn how to deal with stresses. Other
steps include removing the stigma from patients with mental problems,
providing a high-quality mental health service, assessing those who are
saved from suicide attempts, improving social networks, tightening up on
access to pesticides and establishing associations for the families of
those who have killed themselves.

Phillips says putting the plan into practice would require money and
high-level researchers, and it is difficult for him to get either on the
mainland.

He says he has never been granted funding from the central government and
that all the funding he has received for his projects over the years has
come from overseas.

"The authorities say the suicide rate has been reduced a lot and this
issue is not their priority," he says.

Phillips also plans to keep an eye on the implementation of the China
Mental Health Law once it is passed. The law has been stuck in the draft
stage for 26 years, but is now being considered by the National People's
Congress Standing Committee.

He says that after so many years on the mainland he finds himself unsuited
to life back in Canada, where daily talk about such things as what is on
TV sounds alien to him.

"Even my French pronunciation is tinged with a Chinese accent nowadays,"
Phillips says.
ting.yan at scmp.com