National / Social Issues

Gatekeepers, listeners, tax money: How Akita, once the prefecture with highest rate, halved suicides

by Elaine Lies

Reuters

Taeko Watanabe awoke one cold March night and found a trail of blood in the hallway, a bloody cleaver on her son Yuki’s bed and no trace of him in the house. Then police discovered a suicide note in his bedroom.

“They found him in a canal by the temple and wrapped him in a blanket. After an autopsy, he came home in a coffin. I fell apart,” she recalled, eyes welling up as she sat by a photo of Yuki and a Buddhist altar laden with flowers and Fuji apples.

Yuki, who was 29 when he died in 2008, was one of many who took their own life that year in Akita Prefecture. For nearly two decades, Akita had the highest suicide rate in all of Japan, which itself has the highest rate among the Group of Seven nations.

But things have changed, Watanabe said. If her son faced the same situation now, “he would never have died. There are people who can prevent it.”

Watanabe, who contemplated suicide herself after Yuki’s death, now leads a suicide survivors’ group, part of national efforts that have brought Japan’s suicides down by nearly 40 percent in 15 years, exceeding the government target. Now, suicides in Akita are at their lowest in 40 years.

These efforts took off nationally in 2007 with a comprehensive suicide prevention plan, as academics and government agencies identified at-risk groups. In 2016, regions got more freedom to develop plans that fit local thinking.

Corporations, prompted by lawsuits from families of those who took their lives because of overwork, have made it easier to take leave; more offer psychological support; and a law caps overtime. The government mandates annual stress tests in companies with over 50 employees.

Suicide has a long history in Japan as a way to avoid shame or dishonor, and getting psychological help was stigmatized.

But when suicides hit a peak of 34,427 in 2003, it alarmed policymakers and drew foreign attention, often a catalyst for change in Japan.

“For a long time, thinking was that suicide was a personal problem and so the government didn’t really deal with it — not just Akita, but the whole country,” said Hiroki Koseki, an Akita civil servant in charge of suicide prevention.

Poor, elderly, alone

Suicides have multiple causes, but experts say Akita has so many because of its remoteness, lack of jobs, long winters, a large number of isolated and lonely elderly, and accumulating debt.

In 1999, Akita’s governor became the first in Japan to budget for suicide prevention. Amid positive media coverage, citizen and volunteer suicide prevention groups sprung up. The prefecture, with a population of just 981,000, now has one of the largest citizen help networks in Japan.

“Because it was a personal problem, even governments said tax money shouldn’t be used. That paradigm shift occurred in Akita; the rest of Japan followed,” said Yutaka Motohashi, director of the Japan Support Center for Suicide Countermeasures, who worked in Akita in the 1990s identifying at-risk groups. The prefecture began depression screening and public health workers checked in on at-risk people. There was also enthusiastic participation by volunteers such as Hisao Sato, who fought depression for years after his business failed in 2000.

“During that time one of my friends threw himself off a bridge and others had companies fail,” added Sato, 75, whose own father probably took his own life. “I was angry, I wanted them not to be forced to choose suicide.”

To help, in 2002 he created Kumonoito, or Spiderweb, a network of lawyers and financial experts offering practical help. About 60 percent of his funding comes from the Akita Prefectural Government; the rest is from donations.

The Diet is drawing up a law to create a national organization similar to Sato’s.

“A business failure isn’t just an economic problem, it’s also a human problem,” Sato said.

A network of gatekeepers

Akita also has an ever-growing network of “gatekeepers” — people trained to identify those contemplating suicide and, if needed, put them in touch with help. Anybody can undergo several hours of training from Akita public health personnel and take part.

“Basically, everybody is part of community suicide prevention. It’s everybody’s business,” Motohashi said.

Japan’s national barbers’ association has called on its members to get training, though few have volunteered to get involved so far. But 3,000 people in Akita have been trained since 2017 and the goal is 10,000, or one for every 100 people, by 2022.

Akita also has volunteer “listeners” — people like 79-year-old Ume Ito, who talks to at-risk people, many of whom are elderly, for hours at a time.

“About 70 to 80 percent of those we deal with say they want to die, but while they talk they stop thinking about suicide and eventually say, ‘I’m looking forward to seeing you,'” she said.

One of her clients is Sumiko, 73, bedridden after a fall. She spends her days alone until her son’s family returns at night.

“I thought I’d be stuck in bed the rest of my life. Is this it for me? I thought I’d lose my mind,” said Sumiko, who declined to give her surname.

“If she wasn’t coming it’d be so depressing. I can’t tell my family everything in my heart and darkness remains,” she added, smiling at Ito. “I tell my son: Being listened to saved me.”

Akita’s suicide rate has fallen from a high of 44.6 per 100,000 in 2003 to 20.7 in 2018, according to preliminary data — a drastic improvement, but still the sixth-highest nationally.

Japan’s suicides have fallen from the 2003 peak to 20,840, while the rate dropped from 27 per 100,000 to 16.5, according to figures from the National Police Agency. The government aims to hit 13 per 100,000 by 2027. By contrast, the suicide rate in the U.S., which has a population twice that of Japan, was 14 per 100,000 in 2017.

Focusing on youths

But 543 Japanese age 19 and younger killed themselves in 2018, a 30-year high.

Youth suicides were given unprecedented importance in a 2017 prevention plan, with counselors now at many schools, often starting in primary grades, said Ryusuke Hagiwara, who works on suicide prevention at the health ministry.

Japanese youths often drop out of community activities and focus on school affairs by junior high, limiting possible confidants.

“Just at the time when stress increases for them, their world narrows,” said Yoshiaki Takahashi, a suicide researcher with the Nakasone Peace Institute. “We need to open things out.”

Education ministry pamphlets aimed at primary school children allow them, through cheery manga, to assess how they’re feeling, teaching stress-reduction measures such as deep breathing and encouraging them to seek help.

“If we teach children it’s OK to get help, and how, they’ll be more open to it later too,” Akita’s Koseki said. “Raising adults like this may help reduce future suicides.”


In reserved Japan, talking is key to reducing suicides

Every phone at a suicide hotline center started ringing at 8 p.m. on a Friday night, seconds after it opened, and the narrow room off a Tokyo back street was filled with the voices of those trying to help.

“Is it trouble at work, or something at home?” asked Machiko Nakayama, a hotline volunteer in her 60s, speaking softly into her headset. “You feel like you want to die?”

In Japan, a place known for personal reserve, experts and volunteers say allowing people to express their innermost feelings has helped reduce suicides by nearly 40 percent from their 2003 peak.

“The fact that I couldn’t talk about my feelings at all became oppressive,” said author and suicide activist Akita Suei, whose mother killed herself in 1955, when he was a child. “So once I finally was able to talk … all of a sudden my mood became much lighter.”

Operating every day, almost always from 8 p.m. to 5:30 a.m., the phones at Befrienders Worldwide Tokyo are rarely silent, staffed by about 40 volunteers working four at a time in three-hour shifts.

“If the phones stop ringing for a few minutes, we worry they’re broken,” said Nakayama, who volunteered for 20 years and now is the director.

Befrienders is one of scores of organizations operating hotlines around Japan. They advertise with messages like “Are you down? There are people to help lift you up” in Tokyo’s vast network of subways, the site of many suicide attempts.

“There are still very closed-off aspects to society here; it’s really hard to talk about personal things — especially for men, who since the old days have scorned ‘letting things out,’ ” said Yoshie Otsuhata, sub-director of the help line.

Most callers are in their 30s and 40s, with 56 percent of them women and 43 percent men in 2018.

Largely rural Akita Prefecture, which for decades had the highest suicide rate in Japan, also emphasizes outreach. Alongside hotlines there is a network of trained “listeners” who connect with the area’s lonely and isolated elderly.

Sumiko, a formerly active 73-year-old woman who is largely bedridden after a fall, thought there was no meaning to life until Ume Ito, a “listener,” started visiting two years ago.

“Everyone left for the day. People would call, but they’d just say ‘keep fighting’ and hang up really soon,” recalled Sumiko, wearing a pink bathrobe as she sat in a hospital bed in a windowless inner room of her son’s home, two mobile phones propped on a nearby dresser.

Ito said most of the people she visits insist at first that they want to die. But over weeks and months, their mood brightens.

“Our work is to give them enough space in their hearts to think,” she said.

Sumiko, whose health is gradually improving, says Ito’s visits have given her a new goal.

“I want to get stronger as fast as possible and become a listener,” she said. “If I could help even just one or two people, that’d be great.”