Suicide accounts for 6.1 % of all deaths in Korea and is the fifth most common cause of death after cancer, heart disease, cerebrovascular disease, and pneumonia.It is said that more people died from suicide than from diabetes, pneumonia, liver disease, and hypertensive diseases, and 2.3 times more people died from suicide than from traffic accidents.Nevertheless, compared to the cost invested in social structural approaches for traffic accident prevention or research on other disease treatments, our society's efforts to reduce the suicide rate, which is more than twice as high, are very insufficient. Systematic and scientific measures to reduce suicide, which is an important social problem and psychological and medical problem in Korea, are urgent. It will be too late to establish measures after a suicide occurs. Preemptive efforts and intervention are absolutely necessary for suicide prevention.
Suicide is said to be greatly influenced by the atmosphere and attitude of the society to which the individual belongs, the external environment, and personal characteristics.In other words, suicide increases more in an environment where individuals are isolated from society or social integration is lacking.Also, mental pain such as shame, inferiority, and despair, physical illness, mental disorder, and economic problems are also cited as major causes.It is said that suicide due to mental problems is common among the young, and suicide due to physical illness is common among the elderly.
Although the number of suicides is increasing in our society like this, efforts for suicide prevention are actually insufficient. Efforts for suicide prevention in the Korean church are also almost non-existent. Suicide prevention professionals, organizational systems, and budgets are still far too insufficient to solve Korea's suicide problem. Comparing only the suicide prevention budget between Japan and us reveals the difference.
The state cannot carry out all efforts such as prevention, education, and relief for the entire people. If churches and saints receive suicide prevention education and try to prevent it even partially, it can be resolved to a considerable extent.
1. 'Air Defense' for Suicide Prevention
We cannot prevent all suicides. However, knowing a few rules will be very helpful in coping. First of all, it is not easy to meet and talk with an individual in a crisis state who has suicidal thoughts. Also, few pastors or saints have received suicide prevention education or counseling course training. Therefore, meeting a person with suicidal thoughts among church members or family members is a once-in-a-lifetime event that becomes a great burden along with responsibility. There are 3 key elements that are important when interviewing an individual with suicide risk. Suicidal impulses are mostly difficult to eliminate in a short period of time, and it is said that it is not easy to prevent suicide with one or two interviews even for mental health experts. Therefore, recognizing the limits of help one can provide and remembering the following 4 key elements will be efficient crisis intervention. I once served as a chaplain in the Air Force in the past. The highest mission of the Air Force is the defense of the motherland's airspace, that is, air defense. Utilizing that experience, I summarized suicide prevention efforts into 4 concepts called 'Air Defense'.
1) Empathy
The first is 'Empathy'. One of the most important things when interviewing an individual considering suicide is to empathize with the fact that they are experiencing serious difficulties and pain enough to think about death. Empathy may not be easy to start a conversation because one feels ashamed of other people's feelings, thoughts, or attempts, but the attitude that I understand and empathize with your situation is very helpful in leading to a deeper conversation. In addition, since suicide risk can change frequently depending on the time, it must be evaluated while paying attention repeatedly, and even at this time, it is effective to pay attention and evaluate with an empathetic attitude rather than mechanical repetition. Empathetic communication is a necessary attitude when interviewing a suicide attempter. Therapeutic effects can begin when understanding and sharing the painful feelings and experiences of the subject thinking about suicide through empathy. Empathy starts from 'listening well' to the reason for wanting to die. Preaching unconditionally without fully understanding the reason for feeling suicidal impulses and the difficult situation, or giving clumsy comfort or encouragement is not very effective. Preaching about the value of life or arguing about the right and wrong of suicide to a person who says they want to die right away is also conveyed as a feeling of rejection of their thoughts and feelings, so it is not very effective in preventing suicide. When the heart that "It must be really painful because you seem to be in a difficult situation enough to think about death" is conveyed, the power of empathy is exerted and the comfort function works.
Of course, one must be careful not to convey the meaning that it is natural to think about suicide in that situation or that one agrees with the execution plan. The important point is the effort to actively express the painful emotions the individual is experiencing and to accept and understand them.
2) Intervention
If it is important to predict and evaluate the risk of suicide, that is, the possibility of executing suicide, with an empathetic attitude, now we must enter the stage of intervention. Perhaps the treatment strategy will vary greatly depending on the suicide risk. Evaluating suicide risk quickly in an urgent situation before entering a hospital or meeting medical staff is a priority decision for pastors or saints. Most suicide attempters do not want to go to the hospital on their own just because family members or church pastors advise them. Perhaps they will deny it unconditionally at first. Do not turn away with relief just because they deny it, but if risk factors are visible, attempt to intervene through a simple evaluation.
When trying to find out the degree of considering suicide, it is good to generalize (normalize) thoughts about suicide to reduce the burden or rejection of talking about suicide so that they can express suicide more comfortably. For example, you can start a question like this: "When life is hard or you have pessimistic thoughts, you may think that you don't want to live or want to die. Have you ever had such thoughts?" You start the question like this, but eventually, you must use the term 'suicide' directly to check how concrete and active the thoughts about suicide are. In other words, checking each of the following: how often they think about suicide, whether they have thought about and attempted suicide methods, how strong their intention to attempt suicide is, whether they have made a concrete plan for suicide, whether they have prepared suicide tools, whether they can control suicidal impulses, etc.
Depending on the identified suicide risk and cause, you should proceed to the next stage. If you think there is a suicide risk, you should immediately request evaluation and therapeutic intervention from a psychiatrist. Suicide risk can be sufficiently reduced by therapeutic intervention, but it decreases gradually rather than being resolved immediately, and there are many statistics that suicide is often unavoidable even if accompanied closely for 24 hours in a high suicide risk state. Therefore, if the suicide risk is considered high, it is necessary to be hospitalized in a psychiatric closed ward to prevent suicide attempts and manage intensively while passing the crisis period. And from there, attempts should be made to reduce changeable suicide risk factors.
3) Defense
To reduce suicide risk factors, it is important to identify defense factors that suppress suicidal impulses and strengthen them. Generally, the most powerful suicide defense factor is known to be family. Married people with families have a lower suicide rate than those who are bereaved or divorced. The national divorce rate and suicide rate tend to be proportional. Not only spouses but also children or parents act as important defense factors for suicide. It is common to say, "I want to die, but I can't commit suicide because of my children." When confronting a suicide attempter in a place like a high building or bridge, if family members are called to persuade them, most of them give up the suicide attempt and come down. That much, family is important as a defense factor.
Conversely, if the family, which is a defense factor for suicide, loses its function and acts as a risk factor, the risk of suicide will become very high. For example, the suicide risk of the elderly who think "I think I am a burden to my children, so dying is the way for my children" becomes very high. In this case, intervention and mediation are needed so that the family can act as a defense factor for suicide. Religion often acts as a defense factor for suicide. Reports on the difference in suicide rates according to the presence or absence of religion tend to be inconsistent. However, strong religiosity is reported to be related to a decrease in suicide attempts or suicidal thoughts. In particular, it is reported that religion is related to a decrease in suicide attempts in patients with depression or bipolar disorder. It is thought that religion suppresses suicidal impulses through moral and religious opposition to suicide, responsibility for family, and reduction of despair. In Korea, the difference in suicide rates according to religion is not reported, but there are not a few religious people who say, "I feel like dying, but I won't commit suicide because suicide is a sin," and in this case, religious and moral values can act as a defense factor for suicide. Recognizing that the role of the church is very important in suicide prevention in this part, the church needs prior faith education so that saints in crisis do not make extreme choices.
4) Harmony
As shown in the figure below, the causes of suicide in Korean society are diverse. First of all, in the case of past suicide attempters, a much larger number commit suicide than the general public. So the first target to pay attention to is suicide attempters. Also, looking at the causes and characteristics of suicide attempts, psychiatric symptoms were the most common. Next, there were many people who committed suicide due to interpersonal problems. To solve interpersonal problems, one must harmonize. The church especially has characteristics that are good for harmonizing than any other institution.