Editor’s note: The following story contains references to suicide and may be triggering for some audiences. If you or someone you know is having ideations of suicide or self-harm, please reach out to mental health care providers or organizations.
Since COVID-19 was first reported in late 2019, the virus has spread far and fast; over a year later and more than a million have succumbed to the disease, while many more have been infected. Left with not much choice, countries often had to impose strict lockdowns in a bid to cut viral transmission. Before long, psychology experts raised warnings about a second, more silent, and in many ways more worrying impending pandemic: that of mental health problems.
Today, reports from all over the world paint a grim picture. The media is awash with stories of people taking their own lives and even the medical literature, typically slow to pick up sudden spikes in trends, is seeing a steady stream of data regarding suicide rates. Because the world lacks a singular, independent, and well-vetted mechanism to document suicides across different countries, an exact and rigorous conclusion about the impact of the pandemic on mental health remains far off. But does it matter? Every suicide is a life lost and a family devastated. No statistic of it is acceptable.
In the following feature, writer Kritsada Subpawanthanakun details how this growing rates of suicide are ravaging Thailand’s urban poor, and how we as a society can approach such a complex problem.
On May 30, 2021, another one of Thailand’s taxi drivers took his own life.
Left behind on the streets of the Rama VII bridge, before he decided to surrender everything to the Chao Phraya River below, were the pair of slippers he had on and his taxi, his partner in livelihood, its hood and trunk left wide open, screaming into the evening traffic.
Bystanders say that his final words were dripping with exhaustion: “I can’t take this life anymore.”
In over a year since the COVID-19 pandemic, suicide rates in the Southeast Asian country have spiked. Experts say that much of the problem lies in how the government handled the crisis.
To stem the tide of the virus, Thailand imposed a series of strict lockdowns. Its caseload, while not the best in the world, reflect a respectable degree of viral control. But as in other countries that have closed their cities down, the Thai economy took a hard blow, and businesses suddenly had to close up shop.
In turn, thousands upon thousands of workers, daily wage earners who make just enough to get by, quickly descended into hunger and desperation. During the early days of the pandemic in 2020, a research team funded by the Thailand Science Research and Innovation (TSRI) published a statement pointing out that between April 1 and 21, 2020, there had been at least 38 suicide attempts. At the time, this equaled the number of COVID-19 deaths.
The figures only reflected instances shown in media and had likely missed suicides that went unreported.
The statement was met with mixed responses. Though many were sympathetic to hardships the urban poor faced amid the lockdown, others, particularly those in educated circles or held posts in the government, bemoaned the lack of scientific rigor.
Dr Kiatiphum Wongrajit, then the Director-General of the Department of Mental Health, argued that focusing on media reports was not a proper representation of the suicide situation in Thailand. He said that because they failed to compare the rates in April 2020 with that of previous months, attributing the deaths to the pandemic was premature. Worse, Wongrajit said, it could only cause public misunderstanding.
But even as its officials contest the researchers’ assertions, data from the Department itself show that over the past year, suicide rates in Thailand have indeed been rising.
On May 30, 2021, a Thai taxi driver took his life, saying “I can’t take this life anymore” before dying by suicide. He was just one among the growing number of cases of suicide in the country, which many people attribute to the COVID-19 lockdowns that have pushed thousands into poverty.
The COVID-19 pandemic and suicide
In 1999, two years after the financial crisis of 1997 (also known as the Tom Yum Kung crisis), Thailand saw its highest suicide rate, peaking at 8.59 per 100,000 people. The floating of the Thai baht had triggered a crippling economic recession in the country, driving more and more people into poverty and despair.
As the economy eased, so did the suicide rates. In the years following the crisis, suicide rates dipped to below 7 per 100,000. In 2020, the suicide rate rose once more, reaching 7.37 per 100,000.
Dr Nattakorn Jampathong, Director of the National Suicide Prevention Center and of Khon Kaen Rajana Garindra Psychiatric Hospital, said that the usual suicide rate in Thailand is around 6.0-6.5 per 100,000 people, or 4,000-4,500 cases per year. He added that the suicide rate did not suddenly rise during the crisis, but increased gradually over 1-2 years.
He explained that one of the reasons for the rise in the suicide rate was that some people were able to recover, while others were not. Since the 2020 rate was quite high, Jampathong said he would keep an eye on 2021 to see whether the country has another Tom Yum Kung crisis on its hands or not.
Jampathong also said that the number of suicides as seen from death certificates during the first three months of this year does not seem very high when compared with the first three months of 2020. Of course, data from just three months may not be significant, but they are encouraging. Data for the succeeding months, which has not yet arrived, will be more informative.
“Generally, the suicide rate will not immediately reflect the situation in society, but it will around 1-2 months later,” he explains. “At this time, I cannot say anything definite because the data has not yet come in.”
Dr Nattakorn Jampathong, pictured above, is the Director of the National Suicide Prevention Center of Thailand. He explains that while economic pressures under the COVID-19 pandemic have been strong, and have no doubt contributed to the rising cases of suicide in the country, it’s far too simplistic to name it as the singular reason behind the worrying statistics.
Harder economic hits in 2020
In talking about suicide, the question of cause is crucial. Normally, the main causes of suicide are, in order: problems in relationships, especially between family members or intimate partners; chronic physical and mental disease; alcohol abuse; economic factors; and substance abuse, according to Jampathong.
The reasons that drive a person to commit suicide may be too complicated to isolate a single major cause. And even when the potential causes are known, it is still typically impossible to identify the main cause.
While it’s true than in 2020, economic pressures were stronger than other factors like, say, alcohol abuse, many details still need to be looked in to.
Source: Dr. Nattakorn Jampathong, Director of the National Suicide Prevention Centre and Khon Kaen Rajanagarindra Psychiatric Hospital in Thailand.
“In 2020, what happened? It has to be accepted that economic factors overtook alcohol,” Jampathong says. “I did not mean that the economy became a more serious factor, because for one thing, the alcohol problem was reduced in 2020. There were measures and other things in society which made people drink less, especially during the period when there were measures by the Communicable Disease Committees in several provinces to control alcohol consumption and distribution.”
“These had a great effect, so the alcohol factor decreased. The economic factor became more serious at one level, and it must be accepted that the result was that the economic factor was pretty much neck and neck with chronic disease,” he adds.
“For each month they were neck and neck like that. In some months it must be accepted that economic factors took second place and chronic disease was third, but in some months chronic disease was second.”
Complex issue, complex solution
Thai suicides are a complex social problem, Jampathong says, and are not only a health problem, but also have social and economic components. Therefore, the solution has to cover every aspect of the problem.
“If we know that in 2020, the economic factor will be serious and, in some areas, we have information that groups of workers have a serious problem, in some areas groups with no income have a serious problem, while in other areas farmers have no serious problem and traders have no serious problem, we will be able to focus properly,” he explains.
“If there are areas where workers have a serious problem, can we coordinate with the workers? In areas where the elderly have a serious problem, can we coordinate with agencies that care for the elderly?”
“It is a perspective of integrating many sectors, and not looking at the problem of suicides as a health problem, but as a social and economic problem that has a complex relationship with personal factors,” Jampathong emphasizes.
We have to wait and see whether the government can manage the economy, vaccine procurement, and recovery for affected people and how it can prioritize budgets. ●
This article was first published by Prachatai on June 25, 2021, and is being republished here by the Asia Democracy Chronicles with their permission.
