SUICIDE AMONG THE ELDERLY

Ms Braema Mathiaparanam asked the Acting Minister for Community Development and Sports (a) how many elderly persons aged 65 and above committed suicide in 2000, 2001 and the first six months of this year; (b) what are the issues or problems faced by this group of vulnerable elderly; and (c) what measures his Ministry has taken and will undertake to help the elderly.

The Acting Minister for Community Development and Sports (Assoc. Prof. Dr Yaacob Ibrahim): Mr Speaker, Sir, there were 68 elderly suicides in year 2000, 74 cases in year 2001, and 16 cases for the first six months of this year.

According to a study carried out by MCDS on elderly suicides between 1995 and 2001, poor health and depression were the main reasons for elderly suicide. This is consistent with the findings of research conducted in other Asian countries. Elderly suicide is, however, a multi-faceted issue requiring a concerted effort among the various stakeholders, including health and social service providers, families and the police.

At present, the interventions for potential suicide cases are:

Firstly, counselling which is currently provided by Family Service Centres, SAGE Counselling Centre, the Samaritans of Singapore and hospitals;

Secondly, specialised treatment, including counselling for psychiatric cases, which is available at the Institute of Mental Health (IMH); and,

Thirdly, hospice care which provides for the management of patients, including the elderly, with serious illnesses where curative treatment is no longer appropriate. Some examples include the Dover Park Hospice and St Joseph's Home.

Other than these intervention services, I would like to share with Members the efforts of an inter-agency workgroup - the Golden Life Workgroup - which aims to raise public awareness about elderly suicide and the help available, and to equip professionals with better intervention measures to prevent such suicides. Formed in early 2000, this workgroup is chaired by the Singapore Action Group of Elders (SAGE), with representatives from various organisations, including MCDS, Ministry of Health, Institute of Mental Health, Samaritans of Singapore, National Council of Social Service, NTUC Eldercare, hospitals, hospices and family service centres.

Thus far, the workgroup has produced a training manual for professionals, such as social workers, nurses, doctors and the police, on the management of elderly suicide. The workgroup also conducts regular training workshops for professionals and caregivers to help them to identify suicidal tendencies among the elderly and render necessary assistance. To raise public awareness on elderly suicide, the workgroup launched a public education campaign in September last year.

My Ministry also funds Befriending Services, Day Care and Neighbourhood Link programmes which help relieve the social isolation that can contribute to depression. Such programmes serve to keep the elderly actively engaged. They also refer the elderly and their families to other appropriate services as necessary.

MCDS also plans to promote expertise in gero-counselling, a specialised form of counselling which is more sensitive to the physical and psycho-social needs of the elderly. For a start, we will sponsor suitable candidates for overseas training at the Masters level. MCDS will also work with interested agencies to develop local gero-counselling training programmes.

The Ministry of Health has various schemes to help the elderly have easy access to health care. In addition to the subsidies at polyclinics and specialist clinics, the Ministry of Health has put in place a range of schemes to provide affordable health care for the elderly, including Eldershield.

Finally, Sir, elderly suicide prevention is complex and the collaborative efforts of all stakeholders are necessary to prevent elderly suicide.

Dr Lily Neo: May I ask the Minister whether he agrees with me that many suicides are as a result of depression, and that depression is treatable and preventable? Therefore, will the Minister facilitate the early detection of depression by all those involved in the community through promoting their awareness and the early referral of depression by people such as community caregivers, family service providers and VWO providers in order to reduce the suicidal rate?

Assoc. Prof. Dr Yaacob Ibrahim: Sir, as I mentioned in my reply, two reasons were cited during the study. One of them was, of course, depression, and we have taken that into account. The Golden Life Workgroup has produced a training manual which will be used by all the caregivers to help them identify potential suicide cases. Once they have been identified, they can be referred, depending on their level, either to counselling or to various specialists at the Institute of Mental Health, to provide counselling and whatever curative care that is needed. So I would like to assure the Member that we have such a system in place at this point in time. A lot would depend on the cooperation of the various centres to use the manual that we have given to them, and also to use the skills that we have imparted to some of the counsellors who have been trained under this training programme.

Dr Lily Neo: May I ask the Minister whether it is correct to say that more men committed suicide compared to women, and that the ratio is 60:40? Has the Minister done any study to ascertain the reason for this fact, so that better preventive care can be implemented? If the answer is yes, could he share with this House the outcome of this study and the pro-active actions to be taken to improve the suicide rate? If the answer is no, could the Minister undertake such a study?

Assoc. Prof. Dr Yaacob Ibrahim: Sir, the Member is right. Just to give Members a feel of the figures, according to the data that we have obtained from the Subordinate Courts, more men than women actually committed suicide between 1995 and 2001 - roughly above 56%.

As to whether or not we have been successful in preventing it, this we will have to see over time, as we have already put the system in place. We are monitoring the figures very closely, and these figures have come from the Subordinate Courts. A lot would depend upon the training conducted by the Golden Life Workgroup, together with the various community service providers, in how they can successfully identify those potential cases and prevent them from taking place.

Our basic philosophy is that if we can continue to engage the elderly within the community, that would be one of the best steps forward, as that will bring them into contact with community service providers through the neighbourhood links, the activity centres, which can then help to identify potential cases and suicides can be prevented. I do not have a study to say that in the last five years this programme has been effective. We have just put in place some of these preventive programmes. We have to look over time how best the various community service providers will adopt some of these training measures that we have imparted to them.

Dr Lily Neo: Mr Speaker, Sir, I think the Minister did not get my question. I did not ask on the success of his programme. I asked whether any study had been done to ascertain why more men committed suicide compared to women, and whether anything can be done about it.

Assoc. Prof. Dr Yaacob Ibrahim: Sir, no study has been done to ascertain why there is a difference between men and women. Perhaps, given the data that we have, we can actually look back again. But, more often than not, we have to look into the case file, because this goes back to the Coroner, who would investigate the case. It is always very difficult because we have, in a sense, to do some inference looking at the background of the particular person - what may have happened - and make informed judgments. But a study can be conducted to understand some of those reasons.

Ms Braema Mathiaparanam: Sir, the Minister mentioned poor health and depression. To what extent do financial problems play a role? I ask this question because, for many of them, to depend on children is tough.

Assoc. Prof. Dr Yaacob Ibrahim: Sir, this is based on the data that we have collected between 1995-2001. Again, as I have said earlier, this is dependent upon the Coroner's findings with the police reports. On financial problems, about 30 suicides between 1995-2001 have been attributed to financial problems. Sir, it would appear that it is not one of the largest factors.

Dr Mohamed Maliki Bin Osman: Sir, can the Minister tell us what is the living arrangement of these elderly who have committed suicide? I am just wondering whether they were living with the family members and if they were, my understanding is, if we talk about poor health and depression, many of them do have foreign domestic helpers taking care of their physical needs. So, to what extent are these foreign domestic helpers being assisted or being prepared to help in identifying at-risk groups so that these suicides could be prevented?

Assoc. Prof. Dr Yaacob Ibrahim: Sir, based upon the 2001 data, out of the 74 elderly who committed suicide, 76% were married and 81% were living with at least one other family member. I do not have the information with respect to whether the maids have been trained. But at this point in time, there is no such programme.