Suicide cases in Q1 jumps 300% y-o-y, association calls for ‘stepped care’ model

Macau has recorded an alarming number of suicide cases in the first quarter of this year, which could be interpreted as hitting a crisis level.

The Times has observed that the Judiciary Police (PJ) has sent more suicide alerts and death notices due to ‘falls’ this year, compared to last year.

In a response to the Times, the PJ stated that between January to March 2022, there have been 28 cases of suicide, while the number of deaths due to ‘falls’ was 11.

These figures are much higher than those recorded last year.

In 2021, covering the same period, authorities recorded a total of eight cases of suicide, along with three cases of deaths due to falling, reaching an alarming increase of over 300%.

As of April 19, authorities have already reported eight suicide cases, including cases of deaths due to falling. The most recent case included a 12-year-old resident who ‘fell’ from her bedroom window onto the residential building’s podium on the third floor. She was pronounced dead following efforts to revive her at the hospital. Although no suicide note was found, the PJ have classified the case as suicide.

In 2020, the education bureau urged parents and teachers to pay attention to students’ needs, following the death of a 16-year-old male secondary student who jumped off a building.

That same year, suicide cases totaled 76, including 65 residents (41 men and 24 women), equating to a suicide rate of 11.1 per 100,000 inhabitants, an increase of 13.3% compared to 2019.

Data shows that Macau recorded a total of 60 suicides cases 2021, a decrease of 21.1% compared to the previous year. The figure represents a suicide incident once per week.

Despite ‘decreases’ being recorded during quarters, a single case of suicide is too many. 

Back in 2020, the Times reported that the Macau SAR has not yet overcome the stigma of mental illness: a stigma which leads people with mental health problems to ‘save face’ and refrain from seeking help.

Two years later, the problem remains: only now, it represents a more significant challenge. Besides the issue of the stigma of mental illness, mental health experts are now seeing an increase in the severity of cases (though not an increase in case numbers).

Henry Lao, chairman of the Macau Society of Registered Psychotherapists (MSRP), told the Times that 36% of all clients seeking help are teenagers and adolescents, double the former figure of 15%.

“The severity of clients’ [cases has] increased. Prior the pandemic, 15 to 16% of the clients had suicidal ideation or self-harm. But now, around 44% are having suicidal ideation,” Lao said.

On the question of the stigma around mental health, Lao said that Macau residents tend to be more reticent about seeking professional help, while those from the mainland are more open about it.

The chairman, who works for an NGO and teaches at a university, remarked that people in Macau, compared to other countries, or the mainland, have a totally different sense of mental health. “I spoke with some staff and colleagues in university settings and 80% of their clients are from the mainland. It’s a local university, but clients who come to the counseling center [are mostly from the mainland],” he explained.

Lack of resources 

and professionals 

Seeking help and having the available resources to help are two different aspects of the problem.

Findings within the UN health agency’s new report suggest that the greatest deterioration in mental health took place in the areas worst-hit by the pandemic, where infections were high and social interaction was restricted.

According to the UN, the report is a wake-up call for all countries to pay more attention to the matter and do a better job of supporting their populations’ mental health.

The Chief Executive (CE) Ho Iat Seng said last week that at the end of 2021 there were 84 psychotherapists in Macau, which is 1.2 psychotherapists per 10,000 people.

However, Lao explained that, despite the disclosed figure, “We don’t have that many people who are really working and [full-time] providing psychotherapy services in the field.”

This has led to a persistent problem: resources and professionals have not been increasing, resources are insufficient, and people are not aware of those resources, according to the psychotherapist. 

Absence of intervention among youngsters

In Hong Kong, the government has a “stepped care” model for supporting youth mental health, as do many developed countries. It mainly comprises a hierarchy of detection and intervention of varying intensity to match the level of patient needs. The least resource-intensive treatment is delivered first, with the option to “step up” to intensive or specialist services after the severity of symptoms is assessed.

Lao hopes that such a model could be adopted in Macau. He lamented, “we don’t even have [a] registered educational psychologist” to boost mental health awareness for young people.

The CE has also previously announced that UM will consider reopening the Master’s program in clinical psychology.

In developed countries, in order to practice what is referred to in Macau as psychotherapy, an individual must possess at least a Master’s degree in clinical psychology, the discipline which focuses on supporting people in a clinical setting.

Pursuant to Executive Regulation No. 23/2021, registrants in psychotherapy in Macau must possess a Master’s degree in clinical psychology. However, no Master’s program is currently offered in the region.

Late last year, a mobile application to monitor users’ mental health was launched to provide reliable and effective guidance for users trying self-help.

Aimed at university students, the ‘Step by Step’ app was jointly developed by the University of Macau (UM) and New York University Shanghai (NYU Shanghai), and is currently being trialed.

Meanwhile, the statistics and analysis on mental health topics that Macau currently possesses is not sufficient to forecast future needs.

According to the MSRP, the city’s resources are currently highly under strain, therefore providing the same quality of therapy sessions and services is not feasible.

In Hong Kong, the average time limit of each session is between one hour and two, a “much longer” practice compared to Macau.

“We really need to improve and see whether we have a sufficient ratio of psychotherapists. We’re not just looking at the number of ratio of [psychotherapists] and citizens. We need to rank the average rating time, time line for each session, the quality of each service,” said Lao.

However, these kinds of statistics are not available in Macau.