Originally published January 2019 on https://www.vice.com/en_asia/article/ev3jjz/singapore-suicide-elderly-senior-citizens
In Singapore, a Shocking Rise in Suicides from an Unexpected Age Group
Why some Singaporeans are deciding to cut their lives short – and how the Asian city-state and individuals are trying to curb the problem
“Employees of funeral companies work shifts. The moment the police call, which can be at any hour of the day, the staff on duty head over to collect the corpse. The police cordon off the scene, which is usually quite graphic, and the undertaking staff transport the remains to embalmers who try their best to hide the physical damage."
Johari, not his real name, works in the undertaking industry and told VICE Asia that he comes across several jumping cases each week.
He said that most of these victims are given closed-casket funerals, as their faces have been disfigured beyond repair. The suicides themselves are surprising, as is the frequency.
But perhaps what's most shocking is this: many are senior citizens.
Although persons aged 60 and above account for just a tenth of Singapore's population according to government numbers, the number of persons from this demographic who committed suicide in 2017 was 129 out of the 361 cases across all age groups. That number was a record high in that age group since the government started tracking suicides in 1991.
Still, Johari believes that many cases are unaccounted for.
At his job, he says he comes across elderly jumpers much more than 2.5 times per week –which is 2017's total of 129 suicides averaged across 52 weeks in a year.
But why exactly are these Singaporean seniors cutting their lives short?
Having spoken to many victims’ families, Johari shares that accumulated debt from habitual gambling, medical fees or living expenses are prevalent push factors. Brandishing a constantly changing skyline peppered with skyscrapers of banks and the iconic Marina Bay Sands casino and hotel, “the Switzerland of Asia” is also known to be one of the most expensive and most stressful cities in the world.
“You might not be able to afford to live here, but you can afford to die,” is a well-known running joke among locals. Here, a low-end car costs around SGD65,000 or $48,000. As for government housing, resale one- and two-room flats start from SGD200,000 or $147,000.
“Suicide is an inherently complex behavior. It is difficult to explain exactly how people facing a crisis perceive and interpret their daily lives,” the Samaritans of Singapore (SOS), told VICE via email. SOS is a non-profit suicide prevention organization.
SOS said reasons include "a deep sense of despair, helplessness, hopelessness, a sense of being overwhelmed and meaninglessness."
"This can lead to a sort of tunnel vision, where they are no longer able to see outside of their desperate situation, unable to see other options, unable to believe that anything but ending their lives will help,” SOS added in the email. “They feel trapped, unable to control or change their circumstances, and so take action on the only thing they still have control of – their lives.”
A regional medical hub, Singapore’s consultations, pharmaceuticals and treatments are relatively expensive. Medical expenses, despite subsidies, are a heavy cross to bear for retirees who are less well off, which then fall upon their children.
A rapidly greying society with a low birth rate, Singapore’s ratio of working adults to dependents is on a rapid decline. Today, its population of 5.5 million comprises 440,000 persons above age 65, who were born during the post-WWII baby boom. The population above 65 will increase to 900,000 by 2030. Just 3 years ago, Singapore’s ratio of working age (20 to 64) adults to adults above 65 was 4.7 to 1. By 2030, this ratio is estimated to become 2.3 to 1.
Turning 70 this year, Jeffrey Jonathan, who is retired, cares for his wife who has dementia. Every day, he drops her off in a daycare center that charges SGD240 or $177 each month. Each visit to the doctor’s sets him back about SGD100 or $73, while her medication costs an average of SGD75 or $55 per month. The couple are assisted by their helper, whose salary is SGD570 or $420 and levy is SGD60 or $44.
Besides food and utilities, his additional expenses include her diapers, which add up to about SGD90 or $66 per month, and additional medical fees when she falls sick. Treatment and consultation are expensive in Singapore, he said, and the same dementia drugs that he purchases for his wife are available at cheaper prices in nearby Malaysia and Australia. In total, he spends about SGD1,135 or $835 a month just to care for his wife – quite a hefty sum for someone who is living off of their retirement savings.
In such scenarios, those in need are not just the patients, but the caregivers too.
A psychotherapist and founder of her own practice Heart-To-Heart Psychotherapy, Dr. Jasmine Siang emphasized that the chronic mental or physical illnesses of the elderly do not have timelines, which makes their reliance on family members and domestic helpers a heavy and indefinite burden.
“We need to help society gain a better understanding of mental health and supply our community with the right information about self-care, and at the same time, raise public awareness of available sources of support,” she said.
This heavy reliance on their loved ones is not lost among the elderly. SOS highlighted that patients are conscious and concerned about their dependence on caregivers.
“Some common struggles cited by elderly callers at our 24-hour hotline are social disconnection, the fear of becoming a burden to family and friends, and impairments to daily functioning due to physical challenges and deteriorating physical and mental health,” SOS said.
“Being dependent on others, like their family members or caregivers, may lead to feelings of worthlessness. The lack of a close social circle may exacerbate the feelings of helplessness and worthlessness.”
According to SOS, suicide is preventable.
“Most importantly, suicidal people do not want to die. They want to live so desperately, but they can’t seem to find a way to,” SOS said. “They feel like they have exhausted all their options and the pain they are experiencing is well beyond them.”
The good news is there are efforts to help.
Several local government agencies are dedicated to dignified ageing and work in tandem to care for seniors in all living situations. These organizations hold group activities for the elderly, assign volunteers to befriend elders living in homes for the aged, cluster homes and private homes, and also keep an eye on isolated and at-risk elders. These statutory boards also encourage charity and philanthropy through various activities and campaigns, and explore different ways of supporting caregivers.
There are individuals too who are lending a hand. Virtual reality (VR) developer Eugene Soh – knowing that many Singaporean-Chinese men and women will not be able to fully enjoy and celebrate the upcoming Chinese New Year because of physical disabilities or the absence of children – is working hard to bring the celebrations to them instead.
Instead of spending the holidays alone in their nursing homes or one-room apartments, they will don Eugene’s VR headsets to enjoy a traditional Lion Dance or visit China together.
One of the few developers in the world granted access to Facebook’s cutting-edge proprietary technology, Eugene has worked on other projects involving the elderly too, which include using VR to bring dementia patients to their old homes and help them remember their loved ones. Eugene told VICE that the trial run of his Chinese New Year VR sequence yielded generally positive reactions: many of the seniors were in good spirits afterward and seen chatting excitedly about the experience.
"Most long-stay nursing home residents don't get to go home even during Chinese New Year. They hardly leave the premises because of various reasons," he said.
Eugene will also be bringing seniors on VR safari tours soon, allowing them to lead and control the entire virtual experience in a safe and comfortable environment.
"Staying in the same place over long periods of time takes a toll on their mental health and, in turn, their physical health, so that's where (my project) Mind Palace come in to bring them around the world in virtual reality. Bringing new scenery to their eyes."
Persons who notice their elderly giving away treasured possessions and saying goodbye, researching suicide methods, writing suicide notes including emails, diaries and blogs, withdrawing from interpersonal relations, and giving up familiar interests and activities, can call the SOS 24-hour hotline at 1800-221 4444 or write in to the SOS befriending service at email@example.com.